Serotonin Syndrome Risk – A Case Example
When I’ve had students with me, they will often ask about multiple serotonin related drugs and risk of serotonin syndrome. A classic example of this is a patient on an SSRI and Tramadol. This combination is used frequently in practice.
Serotonin syndrome is very serious, but extremely rare. We should never exclude anything, but if I have a patient on Zoloft 25 mg daily and is taking a prn Ultram 50 mg once or twice a week, serotonin syndrome is not going to be the first thing on my radar to say the least.
Now take this example of a patient on Zoloft 200 mg daily and Effexor 400 mg daily. My concern for serotonin is obviously much greater and we would need to thoroughly investigate why those high doses (and why this combination) is necessary and if we’ve had to ramp up to these doses on both medications, have they really been effective? Given the Effexor/Zoloft combo above, my level of concern for Serotonin Syndrome risk would be much higher than simply on a low dose SSRI and Tramadol. Side effects could also certainly be more prevalent on these higher doses.
Have you seen a case of serotonin syndrome?
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3 thoughts on “Serotonin Syndrome Risk – A Case Example”
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Yes, serotonin syndrome ruined a year of my life. I am a 30 year old healthy female. My psychiatrist had me on effexor XR 150 QD and Wellbutrin SR 300 qd. She diagnosed me almost a year into our treatment with bipolar disorder! My BP and pulse was always high, couldn’t concentrate, did bad in school, always slept, was disorderly to say the least, not myself.
I took myself off of wellbutrin first, then lamictal, and haven’t had a manic episode since.
I have to repeat my third year of pharmacy school and she and the school refused to accept that the meds had a huge impact on me.
I failed one class by less than 1% and the other by less than 2% . That is automatic dismissal from the school and I had to beg my way back in. I am now trying to get a private loan for this year and am finding it almost impossible.
I share this because I wonder how prevalent this is? I see high doses of “serotonin ” drugs all the time as I work in a pharmacy.
As a teenage I had a bout of depression and seen my PCP for treatment. We started on Prozac because of it’s success rate with teens. Over the course of several weeks I became increasingly outspoken, aggitated and aggressive over minor issues that would normally warrant no reaction. I felt fine, even great, but felt like everyone was getting on my case and annoying me. My mother, with no medical education, realized the change and called the doctor. The symptoms she described suggested Serotonin Syndrome. After stopping the meds I eventually returned to normal. I don’t remember much of those weeks. Just the aggressive nature.
A case I recall was a patient receiving Sertraline 200mg per day and was started on zyvox 600mg twice a day. Developed unusual symptoms of confusion, grasping at the air, hallucinations within 2 days. What was interesting was this was brought to our attention by a physical therapist who remarked that the patient was no longer making progress and was in fact getting worse. Stopped the zyvox and patient improved to baseline within one day. Good collaboration!