Serotonin Syndrome after Initiation of Pregabalin on a Stable Regimen of Antidepressant Medication
Lena Jellestad *
Department of Psychiatry and Psychotherapy, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
Lea Stocker
Department of Psychiatry and Psychotherapy, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
Josef Jenewein
Department of Psychiatry and Psychotherapy, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
Soenke Boettger
Department of Psychiatry and Psychotherapy, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
*Author to whom correspondence should be addressed.
Abstract
Aims: Serotonin syndrome is a potentially life-threatening drug interaction caused by excess serotonin concentration in the central nervous system and/or peripheral nervous system leading to cognitive, autonomic and somatic effects ranging from barely perceptible to fatal. A number of drugs and drug interactions cause serotonin syndrome, however, the exact mechanisms often remain elusive.
Presentation of Case: In the following case, serotonin syndrome was caused by the addition of pregabalin in a patient with recurrent major depressive disorder and concurrent medication with paroxetine and trazodone.
Discussion: This case illustrates the risk of polypsychopharmacology leading to an increased vulnerability towards serotonin syndrome.
Conclusion: Pregabalin with its serotonergic action has a liability to cause serotonin syndrome. This should be especially kept in mind in patients with polypsychopharmacology.
Keywords: Serotonin syndrome, pregabalin, paroxetine, trazodone