You can't make the diagnosis if you don't know it exists. I saw a patient in the hospital on multiple antidepressants complaining of palpitations with an abnormaly fast heart rate, a supraventricular tachycardia. I didn't know about serotonin sydrome at the time, but I could check with the pharmacy and find that a number of her meds can cause tachycardia. I called her shrink who insisted that the patient had to remain on her meds even though she was symptomatic.
A Mix of Medicines That Can Be Lethal my thread
A Mix of Medicines That Can Be Lethal the NY Times printer friendly version
The Serotonin Syndrome pdf link to the NEJM article
The incidence of the serotonin syndrome is thought to mirror the increasing number of proserotonergic agents being used in clinical practice. 7 In 2002, the Toxic Exposure Surveillance System, which receives case descriptions from office-based practices, inpatient settings, and emergency departments, reported 26,733 incidences of exposure to selective serotonin-reuptake inhibitors (SSRIs) that caused significant toxic effects in 7349 persons and resulted in 93 deaths. 8,9 The assessment of the serotonin syndrome in therapeutic drug dosing has relied on post-marketing surveillance studies, one of which identified an incidence of 0.4 case per 1000 patient-months for patients who were taking nefazodone. 10 Performing a rigorous epidemiologic assessment of the serotonin syndrome, however, is difficult, since more than 85 percent of physicians are unaware of the serotonin syndrome as a clinical diagnosis. 10 The syndrome occurs in approximately 14 to 16 percent of persons who overdose on SSRIs. 8
True. But it's the doctor's responsibility to know that this is a possible diagnosis. In the interests of full disclosure, I am a rep. Though I've never sold SSRIs I have come across serotonin sydrome in the literature as I was reading up on my own medication (CNS, but not antidepressant). So it's not Lilly's fault that the 85% of doctors (staggering figure) are unaware of serotonin sydrome as a diagnosis. We could debate the responsibility of a drug manufacturer to educate the doctor on AEs, but the final responsibility does not lie with the pharma company. The syndrome has been around for some time and it's appearance in NEJM and NYT would make me as a doctor want to do some additional research (maybe that's just me).
The article in NEJM certainly does not lay the responsibility at the feet of the drugs. Nor does the Times article. It appears most of the cases are from drug interactions, not the result of administration of SSRIs on their own (at the proper dosage). Secondly, the rate in the footnotes of 14-16% who OD on SSRIs developing serotonin sydrome would seem to be some sort of large percentage (at least on the face) of the serious adverse events. If a large portion of the AEs is improper administration of the drug or avoidable drug interactions, then Big Pharma isn't quite the bogeyman that some people would wish to make in this scenario.
As far as psychs, they are a strange lot. They seem to have no established logarithms for treatment and prefer what I call "alchemy." Thus the reluctance of the psych to switch the patient with obvious AEs off their meds.