Serotonin Syndrome in Children and Adolescents Exposed to Selective Serotonin Reuptake Inhibitors - A Review of Literature.

Objective: The use of selective serotonin reuptake inhibitors (SSRIs) in children and adolescents is increasing in Canada and internationally. While SSRIs are known for their generally well tolerated side effect profile, serotonin syndrome can arise as a severe complication. The objective of this study is to review literature on SSRI-related serotonin syndrome in the pediatric population.

Methods: An extensive review of literature on "serotonin syndrome" is conducted using PubMed from inception to March 2019, focusing on subjects zero to 18 years of age. Descriptive statistics are used for data analysis.

Results: The search yielded N=337 references and N=18 studies are included, all of which are case reports. The cases encompass ethnically diverse subjects ranging from 4 to 18 years of age, diagnosed with serotonin syndrome after exposure to SSRI agents. Most common presenting symptoms are confusion, agitation, tachycardia, hypertension, hyperreflexia, rigidity, and tremor. Serotonin syndrome manifested from SSRI monotherapy (7/18; 3 after first dose), when SSRI was combined with another serotonergic agent (6/18), or after an overdose (5/18). Risk factors include high starting doses and co-prescription. Changing multiple medications at the same time adds to diagnostic challenges.

Conclusions: Serotonin syndrome is a severe adverse drug reaction associated with SSRI, and can be associated with diverse presentations in the pediatrics population and diagnostic challenges. Clinicians are recommended to be vigilant in the monitoring and recognition of serotonin syndrome.