Exploring the Link Between Co-Prescriptions and the Risk of Serotonin Syndrome

Study Examines Co-Prescription of Antidepressants and Migraine Medications

Background on Depression and Migraines

A research group in Boston investigated the potential risk of serotonin syndrome associated with the simultaneous prescription of antidepressants and migraine medications. Depression and migraines often occur together, leading to the common practice of prescribing triptan antimigraine drugs alongside SSRI/SNRI antidepressants. In 2006, the US Food and Drug Administration (FDA) issued a warning about the risk of serotonin syndrome when these medications are co-prescribed, though the actual risk remains uncertain.

Understanding Serotonin Syndrome

Serotonin syndrome is a serious condition caused by elevated serotonin levels in the body. It can lead to symptoms such as tachycardia, unstable blood pressure, hyperthermia, nausea, vomiting, and diarrhea. To explore the relationship between serotonin syndrome and the combined use of migraine medications and SSRI/SNRI antidepressants, researchers recently published their findings in JAMA Neurology.

Research Methodology

The study involved reviewing medical records of nearly 20,000 Americans. Researchers utilized the Partners Research Patient Data Registry (RPDR), which contains information on over six million individuals. Through this registry, they identified 19,017 cases where patients received both triptans and SSRI/SNRI antidepressants. They then focused on a subgroup of patients displaying signs of extrapyramidal syndrome (EPS), which includes serotonin syndrome, and requested their medical records. A meticulous analysis of these records allowed researchers to determine if the original diagnoses met the criteria for serotonin syndrome.

Findings on Co-Prescription and Serotonin Syndrome

The study revealed that co-prescribing triptans did not significantly increase the incidence of serotonin syndrome. Regardless of using conservative or more liberal estimates, only 17 cases of suspected serotonin syndrome were documented among the patients, resulting in an incidence rate of 0 to 4 cases per 10,000 person-years of exposure.

The research utilized high-quality data from a large patient population, which strengthens its conclusions. However, it is important to note that some patient information may have been inaccurately coded in the registry, raising concerns about the reliability of certain data. Additionally, as the symptoms of serotonin syndrome can be transient, it is possible that many cases went unreported.

Implications of the Study

The outcomes of this research suggest that the concurrent use of SSRIs/SNRIs and triptans is safe. Despite the FDA’s warning in 2006, the rate of co-prescription has not declined. These findings indicate a need for the FDA to reconsider its stance on the use of serotonin medications in conjunction with triptans.

Author Information

Written by Michael Healy, BSc, MSc
Reference: vOrlova E, et al. (2018) Association of Coprescription of Triptan Antimigraine Drugs and Selective Serotonin Reuptake Inhibitor or Selective Norepinephrine Reuptake Inhibitor Antidepressants With Serotonin Syndrome. JAMA Neurol.