Serotonin Syndrome

• SS life threatening emergency from excess CNS 5HT (serotonin)

• caused by combining 5HT enhancing drugs or giving SSRIs too close to discontinuation of MAOIs.

• Prozac is the SSRI most likely to cause the syndrome because of its long half-life

Serotonin Syndrome

• Confusion, disorientation, mania• Autonomic dysfunction• Neuromuscular activity– muscle rigidity– hyperreflexia– myoclonic jerking– Ataxia

Common side effects SSRI

• Insomnia, agitation• Headache• Weight loss• Sexual dysfunction

Other side effects

Priapism with trazodone (Desyrel)Prolonged penile erection.

• Hepatic failure with nefazodone (Serzone)– Jaundice, anorexia, GI complaints

Monoamine Oxidase Inhibitors (MAOI)

• diet restrictions tyramine-containing foods– cheese, fermented or aged protein, pickled or

smoked fish– Chianti & vermouth wines, draft beer– Yeast, liver, sausages, pepperoni, salami, canned

ham

MAOIs Hypertensive Crisis

• Sudden elevation of b.p.• Explosive occipital headache• Head & face flushed• Palpitations, chest pain• Sweating, fever, nausea, vomiting• Dilated pupils, photophobia

Treatment of MAOI crisis

• Hold MAOI dose• Do not lie down• IM chlorpromazine (Thorazine)• IV phentolamine --blocks norpinephrine

Mood Stabilizing Drugs

• Lithium (1.0-1.5) for acute mania)– Renal– Thyroid– Physical, ECG, fasting bl. Sugar, CBC

• (Diet adequate in salt)

Lithium side effects

• Drowsiness, dizziness, headache• Dry mouth, thirst• GI upset• Fine hand tremors • Hypertension• Polyuria, dehydration• Wt. gain

Mood Stabilizing Drugs

• Anticonvulsants– Carbamazepine (Tegretol)– Valproate (Depakote)

Tegretol , Depakote, and Klonapin

• inhibit kindling & enhance inhibitory neurotransmitter GABA

• kindling: brain becomes sensitized to stressors & responds without event– bipolar– panic– craving