Strange that this article should appear today. Sydney Zion, whose daughter Libby died at the age of 17 of serotonin syndrome, died yesterday and his obituary is in the NY Times. He is famous for the book and the lawsuit. There were two drugs involved in Libby Zion's death - an antidepressant and demerol, I believe.

There are actually quite a few cases of serotonin syndrome and people need to be on the watch for it.

Here is an article from SSRI Stories:

http://www.ssristories.com/show.php?item=1624

Paragraph 4 reads: "In their review in The New England Journal of Medicine, Dr. Boyer and Dr. Shannon cited a report based on calls to poison control centers around the country in 2002 showing 7,349 cases of serotonin toxicity and 93 deaths. (In 2005, the last year for which statistics are available, 118 deaths were reported.)"

Paragraph 3 reads: "Now, with the enormous rise in the use of serotonin-enhancing antidepressants, often taken in combination with other drugs that also raise serotonin levels, emergency medicine specialists are trying to educate doctors and patients about this not-so-rare and potentially life-threatening disorder. In March 2005, two such specialists, Dr. Edward W. Boyer and Dr. Michael Shannon of Children’s Hospital Boston, noted that more than 85 percent of doctors were 'unaware of the serotonin syndrome as a clinical diagnosis.' ”

http://www.nytimes.com/2007/02/27/health/27brody.html?em&ex=1172638800&en=9287fb6bfa45cbc6&ei=5087%0A

A Mix of Medicines That Can Be Lethal
By JANE E. BRODY
Published: February 27, 2007

But it's all anecdotal.
I never thought I would be an anecdotal evidence and that people who commit suicide or homicide would be considered... anecdotal evidence.
Others who suffer severe harm are also... anecdotal evidence.

My husband died from Serotonin Syndrome in January 09. ER docs knew nothing of the syndrome--and even though I told them what I thought it was and why--they gave more meds to my husband that made the syndrome fatal. This is a very real reaction--that while 'rare' may not really be all that rare...and rare doesn't matter if it is you or your loved one that suffered from it.

I took Cymbalta 90mg daily for a number of years. In June of 2008 I was hospitalized for 15 days from what I believe could have been Serotonin Syndrome. How can I get a definite diagnosis???

L Heitman,
Now, that is a good question. I've searched the internet daily for information regarding the effects of these drugs and I'd also like to know where you could go to get permanent damage caused to the body and brain assessed and called what it is. No luck online or with the endocrinologist, neurologist, internal medicine specialist or holistic MD.
I know longer mention the past medication use to doc's because of the stupid blank stare.

There is no way to get a 'definite diagnosis' because there is no test for Serotonin Syndrome. I myself have Serotonin Syndrome and have had it for a year now. It is a very atypical case (I have the symptoms for weeks instead of hours even with treatment with Cyproheptadine) and I've had three separate episodes in the past year.

From what I understand of the chemical basis of Serotonin syndrome is this: the medications that you are taking all act on serotonin in different ways-they may make your brain make more serotonin, they may keep the serotonin in your brain longer so that a smaller amount can have a larger effect, it can change other brain chemicals so that your serotonin changes, it can create more receptors, and/or it could do some or all of this. Serotonin syndrome occurs when there is too much serotonin in your brain. The different symptoms are all related to what serotonin does in your body: it (partially) controls your temperature (hence the hyperthermia), it controls your smooth muscle movement (hence the myoclonic jerks), it controls your heart and breathing, and obviously it effects your mood (hence the mood changes seen with SS). The treatment that is used most often is an antihistamine called Cyproheptadine which actually blocks the serotonin receptors on the post-synaptic cleft (the part receiving the signals) so that the serotonin cannot bind and send signals through your brain. As time goes on your body flushes out the serotonin from your system leaving you "normal" again. There is also a possible genetic contribution in that there is a cytochrome (Cytochrome p450) that is an enzyme (I think) in your stomach that helps metabolize things-if you're cytochrome is sort of messed up (which is more common than you'd think) than you aren't metabolizing things (like your medications) like you should be which allows more to be in your system which could give you a "predisposition" to a toxic level of medication (serotonin syndrome is also known as serotonin toxicity).

I hope that helped...I'm trying to share what I know with as many people as possible so that more people will understand what's going on.