Drug-Induced Serotonin Syndrome

2017 ◽  
Vol 37 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Dana Bartlett
Keyword(s):  
Monoamine Oxidase ◽  
Serotonin Receptor ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Syndrome ◽  
Serotonin Metabolism ◽  
Drug Induced ◽  
Confirmatory Tests ◽  
Life Threatening ◽  
Serotonin Receptor Agonists ◽  
Norepinephrine Reuptake

Serotonin syndrome is a potentially fatal condition caused by drugs that affect serotonin metabolism or act as serotonin receptor agonists. Monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors are the medications most commonly associated with serotonin syndrome. Serotonin syndrome can be mild and of short duration, but a prolonged course, life-threatening complications, and death are possible. Detection of serotonin syndrome is not difficult if the diagnostic criteria are understood and properly used, but the syndrome has no confirmatory tests and other drug-induced syndromes can, to a degree, mimic serotonin syndrome. The treatment is symptomatic and supportive. Antidotal therapies are available, but the evidence for their effectiveness is limited. If serotonin syndrome is promptly identified and aggressively treated, the patient should fully recover.

scholarly journals Ankle edema after administration of selective serotonin reuptake inhibitors

2018 ◽  
Vol 10 (1) ◽  
pp. 25-26
Author(s):  
Konstantinos Kontoangelos ◽  
Marina Ecomomou ◽  
Charalambos Papageorgiou
Keyword(s):  
Psychotropic Medication ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Clinical Manifestations ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Drug Induced ◽  
Skin Reactions ◽  
Wide Range ◽  
Life Threatening

Clinical manifestations of drug-induced skin reactions include a wide range of symptoms, from mild drug-induced exanthemas to dangerous and life-threatening generalized systematic reactions. Drug-induced skin reactions to psychotropic medication are usually associated with antiepileptic drugs. However, a significant role can be assigned to selective serotonin reuptake inhibitors. We report a case of a female patient, who after approximately one month therapy with escitalopram developed a bilateral ankle edema, which resolved completely within the first week following its discontinuation. Although serious complications are rare, clinicians should be aware of severe skin complications in patients treated with antidepressants, which necessitate careful clinical monitoring and management. Individualization of pharmacotherapy is crucial, together with regular evaluation of safety and tolerance of the treatment.

scholarly journals Interaction between Monoamine Oxidase B Inhibitors and Selective Serotonin Reuptake Inhibitors

2018 ◽  
Vol 71 (3) ◽  
Author(s):  
Abdullah Aboukarr ◽  
Mirella Giudice
Keyword(s):  
Monoamine Oxidase ◽  
Parkinson Disease ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Syndrome ◽  
Case Reports ◽  
Potential Interaction ◽  
Monoamine Oxidase B ◽  
Study Group ◽  
Maladie De Parkinson ◽  
Mao B

<p>ABSTRACT</p><p>Background: Monoamine oxidase B (MAO-B) inhibitors are used to treat the motor symptoms of Parkinson disease. Depression is commonly associated with Parkinson disease, and selective serotonin reuptake inhibitors (SSRIs) are often used for its management. Tertiary sources warn that the combination of MAO-B inhibitors and SSRIs can result in increased serotonergic effects, leading to serotonin syndrome.</p><p>Objective:To explore the mechanism, clinical significance, and management of this potential drug interaction through a review of the supporting evidence.</p><p>Data Sources: PubMed, MEDLINE (1946 forward), Embase (1947 forward), PsycINFO (1806 forward), and International Pharmaceutical Abstracts (1970 forward) were searched on February 4, 2017. Study Selection and Data Extraction: Studies and case reports describing aspects of the potential interaction between MAO-B inhibitors and SSRIs in patients with Parkinson disease and published in English were identified by both title and abstract.</p><p>Data Synthesis: The search identified 8 studies evaluating the potential interaction between SSRIs and the MAO-B inhibitors selegiline and rasagiline. The largest, a retrospective cohort study of 1504 patients with Parkinson disease, found no cases of serotonin syndrome with coadministration of rasagiline and an SSRI. A survey of 63 investigators in the Parkinson Study Group identified 11 potential cases of serotonin syndrome among 4568 patients treated with the combination of selegiline and antidepressants (including SSRIs). In addition, 17 case reports describing the onset of serotonin syndrome with coadministration of an SSRI and either selegiline or rasagiline were identified. Following discontinuation or dose reduction of one or both of the agents, the symptoms of serotonin syndrome gradually resolved in most cases, with none being fatal.</p><p>Conclusions: According to the literature, serotonin syndrome occurs rarely, and the combination of SSRI and MAO-B inhibitor is well tolerated. Therefore, SSRIs and MAO-B inhibitors can be coadministered, provided that their recommended doses are not exceeded and the SSRI dose is kept at the lower end of the therapeutic range. Among the SSRIs, citalopram and sertraline may be preferred.</p><p>RÉSUMÉ</p><p>Contexte : Les inhibiteurs de la monoamine oxydase B (MAO-B) sont employés dans le traitement des symptômes moteurs de la maladie de Parkinson, maladie à laquelle la dépression est souvent associée et fréquemment traitée à l’aide d’inhibiteurs sélectifs de la recapture de la sérotonine (ISRS). Des sources tertiaires mettent en garde contre la combinaison d’inhibiteurs de la MAO-B et d’ISRS car elle peut mener à une augmentation des effets sérotoninergiques, dégénérant en un syndrome sérotoninergique.</p><p>Objectif : Chercher à connaître le mécanisme, la signification clinique et la prise en charge de cette potentielle interaction médicamenteuse en procédant à une revue des preuves à l’appui.</p><p>Sources des données : Les bases de données PubMed, MEDLINE (depuis 1946), Embase (depuis 1947), PscyINFO (depuis 1806), et International Pharmaceutical Abstracts (depuis 1970) ont été interrogées le 4 février 2017.</p><p>Sélection des études et extraction des données : Des études et des observations cliniques, publiées en anglais, portant sur des aspects de la potentielle interaction entre les inhibiteurs de la MAO-B et les ISRS chez les patients atteints de la maladie de Parkinson ont été repérées par une recherche ciblant les titres et les résumés.</p><p>Synthèse des données : La recherche a permis de trouver 8 études analysant la potentielle interaction entre les ISRS et deux inhibiteurs de la MAO-B : la sélégiline et la rasagiline. La plus importante d’entre elles, une étude de cohorte rétrospective sur 1504 patients atteints de la maladie de Parkinson, n’a relevé aucun cas de syndrome sérotoninergique en présence d’une prise concomitante de rasagiline et d’un ISRS. Une enquête auprès de 63 chercheurs dans le Parkinson Study Group a permis de relever 11 potentiels cas de syndrome sérotoninergique chez 4568 patients traités avec une combinaison de sélégiline et d’antidépresseurs (notamment des ISRS). De plus, 17 observations cliniques qui décrivaient un début de syndrome sérotoninergique en présence d’une prise concomitante d’un ISRS et de sélégiline ou de rasagiline ont été recensées. Suivant la réduction de la posologie ou l’interruption d’un ou des deux médicaments, les symptômes du syndrome sérotoninergique se sont graduellement résolus dans la plupart des cas, et il n’y a eu aucune mortalité.</p><p>Conclusions : Selon la documentation, le syndrome sérotoninergique est rare et la combinaison d’ISRS et d’inhibiteurs de la MAO-B est bien tolérée. Ainsi, les deux types d’inhibiteurs peuvent être administrés conjointement pourvu que l’on ne dépasse pas la posologie recommandée et que la dose d’ISRS demeure dans le bas de l’intervalle thérapeutique. Parmi les ISRS, il peut être préférable d’employer le citalopram ou la sertraline.</p>

Movement Disorders Emergencies

2019 ◽  
Vol 39 (01) ◽  
pp. 125-136 ◽  
Author(s):  
Suraj Rajan ◽  
Bonnie Kaas ◽  
Emile Moukheiber
Keyword(s):  
Movement Disorders ◽  
Serotonin Syndrome ◽  
Clinical Presentation ◽  
Treatment Modalities ◽  
Drug Induced ◽  
Status Dystonicus ◽  
Life Threatening ◽  
At Risk Populations ◽  
Clinical Phenomenology ◽  
Malignant Catatonia

AbstractMany acute and potentially life-threatening medical conditions have hyperkinetic or hypokinetic movement disorders as their hallmark. Here we review the clinical phenomenology, and diagnostic principles of neuroleptic malignant syndrome, malignant catatonia, serotonin syndrome, Parkinsonism hyperpyrexia, acute parkinsonism, acute chorea-ballism, drug-induced dystonia, and status dystonicus. In the absence of definitive lab tests and imaging, only a high index of clinical suspicion, awareness of at-risk populations, and variations in clinical presentation can help with diagnosis. We also discuss the principles of management and rationale behind treatment modalities in the light of more recent evidence.

scholarly journals Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions

2019 ◽  
Vol 12 ◽  
pp. 117864691987392 ◽  
Author(s):  
William J Scotton ◽  
Lisa J Hill ◽  
Adrian C Williams ◽  
Nicholas M Barnes
Keyword(s):  
Serotonin Syndrome ◽  
Tryptophan Hydroxylase ◽  
Monoamine Oxidase Inhibitor ◽  
Receptor Activation ◽  
Clinical Findings ◽  
Oxidase Inhibitor ◽  
Health Concern ◽  
Drug Induced ◽  
Life Threatening ◽  
Serotonergic Drugs

Serotonin syndrome (SS) (also referred to as serotonin toxicity) is a potentially life-threatening drug-induced toxidrome associated with increased serotonergic activity in both the peripheral (PNS) and central nervous systems (CNS). It is characterised by a dose-relevant spectrum of clinical findings related to the level of free serotonin (5-hydroxytryptamine [5-HT]), or 5-HT receptor activation (predominantly the 5-HT1A and 5-HT2A subtypes), which include neuromuscular abnormalities, autonomic hyperactivity, and mental state changes. Severe SS is only usually precipitated by the simultaneous initiation of 2 or more serotonergic drugs, but the syndrome can also occur after the initiation of a single serotonergic drug in a susceptible individual, the addition of a second or third agent to long-standing doses of a maintenance serotonergic drug, or after an overdose. The combination of a monoamine oxidase inhibitor (MAOI), in particular MAO-A inhibitors that preferentially inhibit the metabolism of 5-HT, with serotonergic drugs is especially dangerous, and may lead to the most severe form of the syndrome, and occasionally death. This review describes our current understanding of the pathophysiology, clinical presentation and management of SS, and summarises some of the drugs and interactions that may precipitate the condition. We also discuss the newer novel psychoactive substances (NPSs), a growing public health concern due to their increased availability and use, and their potential risk to evoke the syndrome. Finally, we discuss whether the inhibition of tryptophan hydroxylase (TPH), in particular the neuronal isoform (TPH2), may provide an opportunity to pharmacologically target central 5-HT synthesis, and so develop new treatments for severe, life-threatening SS.

scholarly journals A Review Article on Selective Serotonin Reuptake Inhibitors (SSRIS)

2019 ◽  
Vol 7 (6) ◽  
pp. 72-75
Author(s):  
Devi Meena ◽  
Subhash Subhash Chand ◽  
Deovrat Kumar
Keyword(s):  
Adverse Reaction ◽  
Half Life ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Syndrome ◽  
Meta Analysis ◽  
Fold Increase ◽  
Serum Concentrations ◽  
Prescribing Trends ◽  
Life Threatening ◽  
Anxiety Depression

Depression, tension and mental health have been ignored as a serious issue since ages. Depression can be fatal or life-threatening, if not treated to this problem. Antidepressants are also regularly used to treat many other conditions, such as social phobia, fibromyalgia, panic disorder, anxiety/anxiety depression, PTSD, OCD, PMDD, and menopause. The major antidepressant used in the study followed oral prescribing trends. A “serious adverse reaction means an adverse reaction which is fatal, life-threatening, disabling, incapacitating, or which results in or prolongs hospitalization.” Material method collect from Google, Wikipedia, Elsevier, PubMed, Google scholar, Sci-Hub etc. This is a meta-analysis study. Fluoxetine have the longest half-life, but Fluvoxamine have short half-life. SSRIs increase the serum concentrations of the latter two drugs, potentiating their effects and increasing the risk of toxicity. Fluoxetine and Paroxetine specifically, are known to cause a 5-fold increase in serum TCA concentration upon co-administration. By in the addition of combination therapy SSRIs associated many types of adverse drug reaction and some time it can cause serotonin syndrome also.  

Switching Antidepressants vs. Conventional Augmentation Strategies

CNS Spectrums ◽  
2009 ◽  
Vol 14 (S4) ◽  
pp. 11-14 ◽  
Author(s):  
George I. Papakostas
Keyword(s):  
Monoamine Oxidase ◽  
Mechanism Of Action ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Tricyclic Antidepressants ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Augmentation Strategies ◽  
The 1960S ◽  
Norepinephrine Reuptake

Antidepressants have been available since the 1950s, when the monoamine oxidase inhibitors were first discovered. Since then, our armamentarium of antidepressants has progressively expanded with the discovery of the tricyclic antidepressants (TCAs) in the 1960s, the selective serotonin reuptake inhibitors (SSRIs) in the 1980s, and, subsequently, the serotonin norepinephrine reuptake inhibitors (SNRIs), and other agents possessing a diverse mechanism of action including buproprion, and mirtazapine.

Treatment of obsessive-compulsive spectrum disorders with SSRIs

1998 ◽  
Vol 173 (S35) ◽  
pp. 7-12 ◽  
Author(s):  
E. Hollander
Keyword(s):  
Serotonin Receptor ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Body Dysmorphic Disorder ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Serotonergic Activity ◽  
Pharmacological Challenge ◽  
Spectrum Disorders ◽  
Serotonin Receptor Agonists ◽  
The Relationship

Background Obsessive-compulsive spectrum disorders (OCSDs) are now recognised as distinct diagnostic entities related to obsessive-compulsive disorder (OCD). The features of OCSDs and OCD overlap in many respects including demographics, repetitive intrusive thoughts or behaviours, comorbidity, aetiology and preferential response to anti-obsessional drugs such as the selective serotonin reuptake inhibitors (SSRIs).Method Literature was reviewed and preliminary data from various studies were re-examined to assess the relationship between compulsivity and impulsivity, and between OCD and OCSDs.Results OCSDs include both compulsive and impulsive disorders and these can be viewed as lying at opposite ends of the dimension of risk avoidance. Compulsiveness is associated with increased frontal lobe activity and increased serotonergic activity, while impulsiveness is associated with reduced activity of these variables. Neural circuits affected by serotonergic pathways have been identified and pharmacological challenge of OCSD patients with serotonin receptor agonists have supported the involvement of serotonergic processes.Conclusions SSRIs such as fluvoxamine have established efficacy in OCD and preliminary studies indicate that they are also effective in OCSDs. The features of three specimen OCSDs –body dysmorphic disorder, pathological gambling and autism – and their treatment with SSRIs are reviewed.

scholarly journals Serotonin syndrome

1999 ◽  
Vol 23 (12) ◽  
pp. 742-747 ◽  
Author(s):  
Shameem Mir ◽  
David Taylor
Keyword(s):  
Monoamine Oxidase ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Syndrome ◽  
Case Reports ◽  
Individual Case ◽  
Drug Combinations ◽  
Clinical Implications ◽  
Review Of Literature ◽  
Long Acting

Aims and methodTo define serotonin syndrome and its symptoms and to discover which drugs or drug combinations are likely to cause it. A review of literature (including case reports) relating to serotonin syndrome collated from searches of MedLine and Micromedex covering the period January 1991 to July 1998.ResultsMost of the data found were either individual case reports or reviews of case reports. Reports of serotonin syndrome seem to be growing, certainly since the introduction of selective serotonin reuptake inhibitors. Particular combinations seem most likely to induce serotonin syndrome. Awareness of this syndrome as a distinct clinical entity seems to be growing.Clinical implicationsSerotonin syndrome is more likely to occur with drug combinations, especially those involving monoamine oxidase inhibitors. It can also occur when swapping antidepressant therapy, especially If changing from a long acting antidepressant such as fluoxetine. Caution is needed when changing antidepressants and particularly when they are used in combination.

Postoperative Serotonin Syndrome Following Methylene Blue Administration for Vasoplegia After Cardiac Surgery: A Case Report and Review of the Literature

2020 ◽  
pp. 108925322096025
Author(s):  
Mafdy N. Basta
Keyword(s):  
Methylene Blue ◽  
Case Report ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Syndrome ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Medical Emergency ◽  
Serotonergic Activity ◽  
Threatening Condition ◽  
Life Threatening

Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. The increasing incidence of this condition is thought to parallel the increasing use of serotonergic agents in medical practice. The selective serotonin reuptake inhibitors are perhaps the most commonly implicated group of medications associated with serotonin syndrome. This case report describes the occurrence of postoperative serotonin syndrome in a patient on long-term sertraline who underwent coronary artery bypass graft and was treated with methylene blue for perioperative vasoplegia. It delineates the various clinical features commonly encountered and illustrates the recommended management modalities, including prevention, for this potentially lethal medical emergency. With prompt diagnosis and expeditious treatment, the patient has had full recovery.

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