Risk of serotonin syndrome in patients prescribed triptans for migraine, antidepressants

The FDA issued an advisory in 2006 about the risk of serotonin syndrome associated with concomitant use (at the same time) of triptan antimigraine drugs and selective serotonin reuptake inhibitor (SSRIs) or selective norepinephrine reuptake inhibitor (SNRIs) antidepressants. The severity of serotonin syndrome can vary, with symptoms including rapid heart rate, unstable blood pressure, vomiting and diarrhea, but the condition also can be fatal. Depression and migraine are disabling conditions that frequently occur together but the risk of serotonin syndrome in patients prescribed both antidepressants and triptans is unknown.

19,017 patients prescribed both triptans and antidepressants in the greater Boston area from 2001 through 2014 based on electronic health record data.

Estimates suggest the incidence of serotonin syndrome was 0 to 4 cases per 10,000 person years (a unit of time for different people observed over different periods of time); the proportion of patients with triptan and antidepressant prescriptions was stable during the study and ranged from 21 percent to 29 percent.

The quality of medical documentation can vary and it is possible clinicians who did not recognize serotonin syndrome might have used other diagnostic codes.