{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:40:18Z","timestamp":1756291218352,"version":"3.44.0"},"reference-count":18,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,4,1]]},"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:p>Serotonin syndrome (SS) is a drug-induced clinical syndrome characterised by a combination of cognitive, neuromuscular and autonomic dysfunctions. The symptoms may include mild non-specific symptoms such as tremors and diarrhoea to coma and sudden death. Herein, we describe a case of SS in which acute dizziness was associated with supine hypertension and orthostatic hypotension. A man in his mid-30s had a 10-month history of anxiety, depression and chronic tension-type headache. He had been on amitriptyline (25\u2009mg daily) and sertraline (50\u2009mg daily). Increment of sertraline (75\u2009mg daily) and amitriptyline (75\u2009mg daily) and the addition of tramadol led to the development of acute severe dizziness. Physical examinations demonstrate supine hypertension and orthostatic hypotension. He also met the diagnostic criteria of SS. The administration of cyproheptadine provided a complete response to dizziness, supine hypertension, orthostatic hypotension and other clinical features of SS.<\/jats:p>","DOI":"10.1136\/bcr-2024-260229","type":"journal-article","created":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T13:28:27Z","timestamp":1713274107000},"page":"e260229","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Serotonin syndrome presenting as acute dizziness with supine hypertension and orthostatic hypotension"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7322-904X","authenticated-orcid":false,"given":"Sanjay","family":"Prakash","sequence":"first","affiliation":[{"name":"Neurolgy, SBKS Medical Institute and Research Centre, Vadodara, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravisha","family":"Gupta","sequence":"additional","affiliation":[{"name":"Medicine, Smt BK Shah Medical Institute & Research Centre, Waghodia, Gujarat, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maitree M","family":"Raval","sequence":"additional","affiliation":[{"name":"Medicine, Smt BK Shah Medical Institute & Research Centre, Waghodia, Gujarat, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charu","family":"Tibrewal","sequence":"additional","affiliation":[{"name":"Medicine, The Gujarat Research & Medical Institute, Ahmedabad, Gujarat, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,4,16]]},"reference":[{"key":"2025082703171785000_17.4.e260229.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra041867"},{"key":"2025082703171785000_17.4.e260229.2","doi-asserted-by":"crossref","first-page":"52","DOI":"10.4103\/aian.AIAN_344_18","article-title":"Refining the clinical features of serotonin syndrome: a prospective observational study of 45 patients","volume":"22","author":"Prakash","year":"2019","journal-title":"Ann Indian Acad Neurol"},{"key":"2025082703171785000_17.4.e260229.3","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcg109"},{"key":"2025082703171785000_17.4.e260229.4","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.148.6.705"},{"key":"2025082703171785000_17.4.e260229.5","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.46.5.1470","article-title":"Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. 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