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The quality of SS diagnoses was assessed using the Hunter Serotonin Toxicity and the Sternbach Criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 764 cases were included; 653 (85.6%) and 496 (65.0%) met the Sternbach and the Hunter Criteria, respectively. Patients with SS following suicide attempts were more frequently admitted to intensive care units with higher mortality rates than patients with SS related to regular prescriptions (79.4% vs 35.6% and 18.0% vs 5.1%, respectively, both\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Of 645 regular prescription cases, 92.9% were drug combinations (\u2265\u20092 agents). Monotherapy cases were milder and often occurred after initiation of a new antidepressant in younger patients. Drug combinations involved non-antidepressants in 90.7%. Network analysis identified trazodone as the most connected antidepressant, and fentanyl and tramadol as the most connected non-antidepressant nodes. We identified five SS cases following antipsychotic discontinuation while maintaining serotonergic agents.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Non-suicidal cases of SS during regular prescription were less serious than SS cases associated with intentional overdose. The emerging role of non-antidepressant agents (e.g., several opioids and antiparkinsonian drugs) as potential precipitants support tailored interprofessional medication review in poly-medicated subjects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00228-026-04118-3","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T01:29:41Z","timestamp":1784251781000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Precipitants and clinical features of serotonin syndrome: a systematic review with patient-level analysis of published case reports and series"],"prefix":"10.1007","volume":"82","author":[{"given":"Bohdan","family":"Blyzniuk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maksym","family":"Danukalo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Gastaldon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrado","family":"Barbui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sermin","family":"Toto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuel","family":"Raschi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erich","family":"Seifritz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2699-8422","authenticated-orcid":false,"given":"Nazar","family":"Kuzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Schoretsanitis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"4118_CR1","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1176\/ajp.148.6.705","volume":"148","author":"H Sternbach","year":"1991","unstructured":"Sternbach H (1991) The serotonin syndrome. 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Erich Seifritz has received educational grants, consulting fees and lecture honoraria from Janssen Cilag, Lundbeck, Angelini, Otsuka, Servier, Ricordati, Vifor, Sunovion, Schwabe and Mepha. Nazar Kuzo has received educational grants from Lundbeck. Georgios Schoretsanitis has served as a consultant for Dexcel, HLS Therapeutics, and Thermo Fisher and has received speaker\u2019s fees from HLS Therapeutics, Lundbeck and Saladax. Other co-authors have no conflicts of interest to declare. All co-authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.","order":2,"name":"Ethics","label":"Conflicting interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"During the preparation of this manuscript, authors used Microsoft Copilot integrated into Microsoft Word to assist with language editing such as improving clarity, style, and grammar. 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