Editing Serotonin (section)

===Serotonin syndrome===
{{Main|Serotonin syndrome}}

Extremely high levels of serotonin or activation of certain serotonin receptors can cause a condition known as [[serotonin syndrome]], with toxic and potentially fatal effects. In practice, such toxic levels are essentially impossible to reach through an [[overdose]] of a single antidepressant drug, but require a combination of serotonergic agents, such as an [[SSRI]] with a [[MAOI]], which may occur in therapeutic doses.<ref name="New 285–293">{{cite journal | vauthors = New AM, Nelson S, Leung JG | title = Psychiatric Emergencies in the Intensive Care Unit | journal = AACN Advanced Critical Care | volume = 26 | issue = 4 | pages = 285–293; quiz 294–295 | date = 2015-10-01 | pmid = 26484986 | doi = 10.4037/NCI.0000000000000104 | veditors = Alexander E, Susla GM }}</ref><ref>{{cite journal | vauthors = Isbister GK, Bowe SJ, Dawson A, Whyte IM | title = Relative toxicity of selective serotonin reuptake inhibitors (SSRIs) in overdose | journal = Journal of Toxicology. Clinical Toxicology | volume = 42 | issue = 3 | pages = 277–285 | year = 2004 | pmid = 15362595 | doi = 10.1081/CLT-120037428 | s2cid = 43121327 }}</ref> However, serotonin syndrome can occur with overdose of certain serotonin receptor agonists, like the [[25-NB|NBOMe]] series of serotonergic psychedelics.<ref name="ScottonHillWilliams2019">{{cite journal | vauthors = Scotton WJ, Hill LJ, Williams AC, Barnes NM | title = Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions | journal = Int J Tryptophan Res | volume = 12 | issue = | pages = 1178646919873925 | date = 2019 | pmid = 31523132 | pmc = 6734608 | doi = 10.1177/1178646919873925 | url = }}</ref><ref name="OrdakZmysłowskaBielski2021">{{cite journal | vauthors = Ordak M, Zmysłowska A, Bielski M, Rybak D, Tomaszewska M, Wyszomierska K, Kmiec A, Garlicka N, Zalewska M, Zalewski M, Nasierowski T, Muszynska E, Bujalska-Zadrozny M | title = Pharmacotherapy of Patients Taking New Psychoactive Substances: A Systematic Review and Analysis of Case Reports | journal = Front Psychiatry | volume = 12 | issue = | pages = 669921 | date = 2021 | pmid = 33967865 | pmc = 8102790 | doi = 10.3389/fpsyt.2021.669921 | doi-access = free | url = }}</ref><ref name="JacbosAkersVohra2020">{{cite journal | vauthors = Jacobs ET, Akers KG, Vohra V, King AM | title=Cyproheptadine for Serotonin Toxicity: an Updated Systematic Review and Grading of Evidence | journal=Current Emergency and Hospital Medicine Reports | publisher=Springer Science and Business Media LLC | volume=8 | issue=4 | date=10 October 2020 | issn=2167-4884 | doi=10.1007/s40138-020-00222-5 | pages=151–159}}</ref>

The intensity of the symptoms of serotonin syndrome vary over a wide spectrum, and the milder forms are seen even at nontoxic levels.<ref name="pmid12925718">{{cite journal | vauthors = Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM | title = The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity | journal = QJM | volume = 96 | issue = 9 | pages = 635–642 | date = September 2003 | pmid = 12925718 | doi = 10.1093/qjmed/hcg109 | doi-access = free }}</ref> It is estimated that 14% of patients experiencing serotonin syndrome overdose on SSRIs; meanwhile the fatality rate is between 2% and 12%.<ref name="New 285–293"/><ref name="pmid18625822">{{cite journal | vauthors = Frank C | title = Recognition and treatment of serotonin syndrome | journal = Canadian Family Physician | volume = 54 | issue = 7 | pages = 988–992 | date = July 2008 | pmid = 18625822 | pmc = 2464814 | doi =  }}</ref><ref name="pmid15784664">{{cite journal | vauthors = Boyer EW, Shannon M | title = The serotonin syndrome | journal = The New England Journal of Medicine | volume = 352 | issue = 11 | pages = 1112–1120 | date = March 2005 | pmid = 15784664 | doi = 10.1056/NEJMra041867 }}</ref>