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Re: Serotonin Syndrome

Posted by Elizabeth on February 5, 1999, at 18:57:17

In reply to Re: Serotonin Syndrome, posted by Shelley on February 4, 1999, at 20:14:26


Serotonin syndrome (I've also heard TSS (toxic serotonin syndrome) and CSS (central serotonin syndrome)) is more common than reported, but it really isn't all that common in general, especially since people know about - well, most of the most dangerous combos.

It's been reported with (not necessarily a complete list):

MAOIs (*including selegiline, moclobemide, clorgyline, etc.*) in combination with SSRIs, tricyclics (especially clomipramine), fenfluramine, dextromethorphan (found in "DM" and "Maximum Strength" cough syrups), Demerol (meperidine or pethidine), tramadol (Ultram), tryptophan (not in food, only the supplements), various street drugs (in particular, MDMA or "Ecstasy"), Imitrex, dihydroergotamine, and even lithium. (MAOIs are combined with lithium frequently with no problem; they also have been combined safely with tryptophan and tricyclics.)

SSRIs (including clomipramine)/Effexor with dextromethorphan, tramadol, Imitrex.

SSRIs and MAOIs in overdose. (It probably would be reported with TCAs in overdose too, but those are toxic in so many other ways it's hard to separate out what's due to what.)

Use of MAOIs in patients with carcinoid tumors.

Possible cases have also been reported with SSRIs in combination with benzodiazepines (clonazepam (Klonopin/Rivotril), alprazolam (Xanax)), BuSpar, trazodone, and amphetamines.

I'm not trying to scare you; what I'm trying to say is, yes, there may be risk of serotonin syndrome, but there is always a risk of adverse effects, and if you are careful, the risk may be far outweighed by the possible benefits.

(There have been some small studies that suggest that it is safe to combine two SSRIs, and it is done sometimes. I think in certain situations it is quite appropriate.)





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