Death by “Ecstasy”: The Serotonin Syndrome?☆,☆☆,★
Section snippets
INTRODUCTION
Serotonin syndrome, a condition in which there is central serotonin receptor hyperstimulation, has been described since the 1950s. Classic findings of severe serotonin syndrome include hyperthermia, mental status changes, autonomic instability, and altered muscle tone or rigidity. 1 A number of medications have been implicated in the induction of serotonin syndrome, including those that reduce metabolism (ie, monoamine oxidase inhibitors [MAOIs]), increase production (ie, l -tryptophan), or
CASE REPORT
A 20-year-old woman was brought to the emergency department by paramedics unresponsive and cyanotic with agonal respirations. She had ingested 2 tablets of MDMA for recreational purposes within the previous 4 hours according to her boyfriend. She had a negative past medical history, was taking no medications, and had not been previously treated with any antidepressant or other prescription medications. History of previous use of MDMA or other illicit drugs was not available.
Vital signs were as
DISCUSSION
Diagnostic criteria for serotonin syndrome recommended by Sternbach and commonly recognized include the recent addition or increase in dosage of an agent that increases central serotonin neurotransmission, with at least 3 of the following signs or symptoms: mental status or behavioral changes (confusion, agitation, hypomania, coma), alteration in muscle tone or neuromuscular activity (incoordination, shivering, tremor, hyperreflexia, myoclonus, rigidity), autonomic instability (diaphoresis,
References (15)
- et al.
Toxicity and deaths from 3,4-methylenedioxymethamphetamine (“ecstasy”)
Lancet
(1992) - et al.
1995 annual report of the American Association of Poison Control Centers toxic exposure surveillance system
Am J Emerg Med
(1996) The serotonin syndrome
Am J Psychiatry
(1991)- et al.
Serotonin syndrome
Neurology
(1995) The serotonin syndrome—implicated drugs, pathophysiology and management
Drug Safety
(1995)- et al.
Neurochemistry and neurotoxicity of 3,4-methylenedioxymethamphetamine (MDMA, “Ecstasy”)
J Neurochem
(1990) - et al.
The molecular mechanism of “ecstasy” [3,4-methylenedioxymethamphetamine (MDMA)]: serotonin transporters are targets for MDMA-induced serotonin release
Proc Natl Acad Sci USA
(1992)
Cited by (79)
Mephedrone and MDMA: A comparative review
2020, Brain ResearchBody temperature regulation and drugs of abuse
2018, Handbook of Clinical NeurologyPerioperative considerations in patients consumers of illicit drugs frequently used
2016, Revista Chilena de CirugiaAnimal models of the serotonin syndrome: A systematic review
2013, Behavioural Brain ResearchCitation Excerpt :Recently, opioids such as tramadol and pethidine (meperidine), which in addition to effects on the opioid receptors have serotonergic actions [39,40], have also been implicated in the SS [for a review: [11]]. Several illicit drugs which block reuptake and/or increase release of 5-HT have been implicated in the SS, for example 3,4-methylenedioxy-N-methamphetamine (MDMA; “ecstasy”) and cocaine [41–44]. Factors that have been shown to increase the risk of the SS associated with illicit drug ingestion, include high doses, repeated use, and ingestion in combination with another illicit compound or with a MAOI [14,45].
Life-Threatening 3,4-Methylenedioxyamphetamine (MDMA) Usage
2022, Handbook of Substance Misuse and Addictions: From Biology to Public Health
- ☆
From the University of Florida, Gainesville,* and the Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL.‡
- ☆☆
Reprint no. 47/1/92278
- ★
Address for reprints: Paula D Mueller, MD Department of Emergency Medicine Orlando Regional Medical Center 1414 S Orange Avenue Orlando, FL 32806 407-841-5111, ext 6329