Warning on antidepressant and antipsychotic drugs: Drug-drug interaction

A 45-year old man from Boston had been taking four drugs for depression when he had ankle surgery in December. When the anesthetic wore off, he was given Fentanyl in the recovery room. He suddenly developed tremors and violent shaking, and started cracking his teeth, according to his wife. Moved to the Intensive Care Unit, he thrashed and flailed, oblivious to those around him, and had to be restrained physically. Two weeks later, he was still in intensive care, very confused, well after his drugs had been discontinued. The same “serotonin syndrome” had caused the death of Libby Zion in 1984.

At especially high risk of such serotonin poisoning are patients on combinations of antidepressant drugs and antipsychotic drugs that are sometimes prescribed to treat resistant depression. It can result from a combination of an SSRI (Selective Serotonin Reuptake Inhibitor, like Zoloft, Prozac, or Paxil) or an MAOI (Monoamine Oxidase Inhibitor, like Marplan, Nardil, and Eldepryl, and another serotonin-raising substance.

Advice to patients taking these drugs: Ask your pharmacist and doctor about possible drug-drug interactions.

Read another of
our stories of a drug-drug interaction, or the blog post of Dr. R. W. Donnell, Jane Brody’s story in today’s NY Times, “A Mix of Medicines that can be Lethal,” and the review article in the New England Journal of Medicine.