Epidemiology

In its mildest form, serotonin toxicity is probably relatively common but is often unreported.[2][3] In addition, the ambiguous nature of the Sternbach criteria, a set of criteria that has been used to define serotonin toxicity for many years, means that many other medical conditions were often misdiagnosed as serotonin toxicity, despite the Sternbach criteria requiring the absence of other causes.[3][8][9]

There are limited data on the current incidence of serotonin toxicity. Unintentional and intentional exposures to serotonergic drugs are a significant cause of morbidity and mortality in the US. The US National Poison Data System reported over 130,000 exposures to antidepressants in 2020, representing 5.4% of reported cases.[10] Selective serotonin-reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) were in the top 25 categories associated with the largest number of fatalities.[10]

A number of Australian studies on deliberate self-poisoning found the frequency of adverse effects in SSRI overdoses to be about 15% and the number of severe serotonin toxicity cases to be decreasing.[4][8][11]

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