5-羟色胺毒性的最温和形式可能比较常见,但往往没有报道。[2]Buckley NA, Dawson AH, Isbister GK. Serotonin syndrome. BMJ. 2014;348:g1626http://www.ncbi.nlm.nih.gov/pubmed/24554467?tool=bestpractice.com[3]Isbister GK, Buckley NA. The pathophysiology of serotonin toxicity in animals and humans: implications for diagnosis and treatment. Clin Neuropharmacol. 2005;28:205-214.http://www.ncbi.nlm.nih.gov/pubmed/16239759?tool=bestpractice.com[8]Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 2004;22:335-404.http://www.ncbi.nlm.nih.gov/pubmed/15490384?tool=bestpractice.com[9]Bronstein AC, Spyker DA, Cantilena LR Jr, et al. 2010 annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 28th annual report. Clin Toxicol (Phila). 2011;49:910-941.http://www.ncbi.nlm.nih.gov/pubmed/22165864?tool=bestpractice.com此外,模糊的 Sternbach 标准(一种多年来用于定义 5-羟色胺中毒的标准)[10]Isbister GK, Hackett LP, Dawson AH, et al. Moclobemide poisoning: toxicokinetics and occurrence of serotonin toxicity. Br J Clin Pharm. 2003;56:441-450.http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2125.2003.01895.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/12968990?tool=bestpractice.com可能会导致许多其他疾病被误诊为 5-羟色胺中毒,尽管该标准的第二部分要求排除其他病因。[3]Isbister GK, Buckley NA. The pathophysiology of serotonin toxicity in animals and humans: implications for diagnosis and treatment. Clin Neuropharmacol. 2005;28:205-214.http://www.ncbi.nlm.nih.gov/pubmed/16239759?tool=bestpractice.com[11]Sternbach H. The serotonin syndrome. Am J Psychiatry. 1991;148:705-713.http://www.ncbi.nlm.nih.gov/pubmed/2035713?tool=bestpractice.com
目前,5-羟色胺中毒发生率的数据非常有限。2002 年毒物暴露监控系统 (TESS) 数据显示,在医疗中心接受治疗的患者中,约有 30,000 名使用选择性 5-羟色胺再摄取抑制剂 (SSRI),其中 28% 出现毒性反应,死亡率为 0.3%。[8]Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 2004;22:335-404.http://www.ncbi.nlm.nih.gov/pubmed/15490384?tool=bestpractice.com2007 年同一来源的数据显示,约 9000 例患者使用,毒性反应占 13%,无死亡报道。[9]Bronstein AC, Spyker DA, Cantilena LR Jr, et al. 2010 annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 28th annual report. Clin Toxicol (Phila). 2011;49:910-941.http://www.ncbi.nlm.nih.gov/pubmed/22165864?tool=bestpractice.com目前尚不完全清楚为什么数据和不良反应频率会下降。前者可能与普遍使用新的非 SSRI 抗抑郁药(如米氮平)有关;后者可能与预防意识提高和单胺氧化酶抑制剂 (MAOI) 使用量减少有关。因此,发生 MAOI/SSRI 药物间相互作用的可能性减少,而这在过去常导致最严重的不良反应。[10]Isbister GK, Hackett LP, Dawson AH, et al. Moclobemide poisoning: toxicokinetics and occurrence of serotonin toxicity. Br J Clin Pharm. 2003;56:441-450.http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2125.2003.01895.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/12968990?tool=bestpractice.com
澳大利亚对故意服毒的研究发现,SSRI 过量不良反应发生频率约为 15%,重度 5-羟色胺中毒的发生数量在减少。[4]Dunkley EJ, Isbister GK, Sibbritt D, et al. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM. 2003;96:635-642.http://qjmed.oxfordjournals.org/content/96/9/635.fullhttp://www.ncbi.nlm.nih.gov/pubmed/12925718?tool=bestpractice.com[10]Isbister GK, Hackett LP, Dawson AH, et al. Moclobemide poisoning: toxicokinetics and occurrence of serotonin toxicity. Br J Clin Pharm. 2003;56:441-450.http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2125.2003.01895.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/12968990?tool=bestpractice.com[12]Isbister GK, Bowe SJ, Dawson A, et al. Relative toxicity of selective serotonin reuptake inhibitors (SSRIs) in overdose. J Toxicol Clin Toxicol. 2004;42:277-285.http://www.ncbi.nlm.nih.gov/pubmed/15362595?tool=bestpractice.com