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Table 4 Usual suspects? Top 10 causes of serotonin syndrome

From: Conundrums in neurology: diagnosing serotonin syndrome – a meta-analysis of cases

Cause All cases (n = 299) Accounting for ICU cases (n = 114)
  % %
Combination antidepressant - opiate 16.1 10.5
Overdose 15.4 26.3
Combination antidepressant with another potentially serotonergic agenta 13.0 7.9
Combination of different antidepressants 7.7 5.3
Combination antidepressant - linezolid 7.0 9.6
Swap antidepressants 6.4 4.4
Combination antidepressant – methylene blue 5.4 11.4
Start of antidepressants 4.7 -
Substance misuse 4.3 8.8
Start/ discontinuation of second generation antipsychotics in the presence of another pro-serotonergic agenta 3.3 2.6
  1. aIncluding agents such as dextromethorphan, SNRI used for other purposes (milnacipran, sibutramine), triptanes, antiemetics (metoclopramide, setrones); other agents affecting the metabolism of antidepressants