SSRIs and Serotonin Syndrome

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SSRIs and Serotonin Syndrome

  1. 1. Psychiatric Mental Health Nursing Presenter: Teresa Chahine MSN, PMHNP Oakland University, School of Nursing Awareness of Serotonin Syndrome •Recognition •Management •Prevention
  2. 2. Chronic Disease. CDC. Winter 2003, Vol. 16; No. 1
  3. 3. Numberofdrugmentioner100visits Drug mention rates for NSAIDs, antidepressants, and antihistamines at physician office visits, 1995-2002 3 4 5 6 7 8 9 1995 1996 1997 1998 1999 2000 2001 2002 NSAIDs Antihistamines Antidepressants Trends shown are significant (p<0.05). NSAIDs are nonsteroidal anti-inflammatory drugs. Numberofdrugmentionsper100visits
  4. 4. The purpose of this power point is: – to provide a thorough review of the potentially life-threatening complications that are preventable by raising awareness.
  5. 5. Conclusion is clear, unlike the black box warnings that the FDA requires regarding suicidality within the first few weeks of initiating SSRI therapy, serotonin toxicity remains an elusive concept for even mental health professionals.
  6. 6. Two or more of a combination of the following drugs can increase the potential of developing toxic effects: •MAOIs •SSRI & SNRIs •Amphetamines (including MDMA-ecstasy) •Opiate Analgesics (Demerol) •Antiemetics •Antimigraine Agents •Antibiotics •OTC Cough Syrups •Weight-reduction agents •Body building supplements containing L-Trytophan (also found in turkey and aged cheeses) •Herbal products such as St. John’s Wort and SAMI
  7. 7. Diagnostic Criteria
  8. 8. Management of Serotonin Toxicity •Discontinue causative agents. •Benzodiazapines are first line therapy regardless of severity to address agitation, hyperreflexia, muscle rigidity, tremors and the underlying cause of hyperthermia. • In more severe cases, cardiac, respiratory and thermal abnormalities must be aggressively treated to reestablish system stability. •It is worth noting that hyperthermic patients will not respond to an antipyretic agent because the fever state is associated with excessive muscle activity. In a severe hyperthermic crisis immediate “paralysis is recommended followed by intubation and ventilation. •Atypical antipsychotic agents such as Zyprexa (olanzapine) have also been used successfully for treating mild symptoms of serotonin syndrome.
  9. 9. With heightened awareness by clinicians regarding toxic symptoms and early recognition as well as patient education on potential drug interactions, serotonin syndrome can be prevented. Take Home Message
  10. 10. Burt, C.W., (2004, July 14). Analyzing data on medications collected inAnalyzing data on medications collected in the National Health Care Survey.the National Health Care Survey. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Disease Control and Prevention, National Center for Health Statistics Retrieved March 24, 2008, from www.cdc.gov/nchs/ppt/ahcd/Sess_48_drug_use_BURT.ppt References Boyer E. & Shannon, M. (2005). Current concepts: The serotoninCurrent concepts: The serotonin syndrome [Electronic version].syndrome [Electronic version]. New England Journal of Medicine, 352, 1112-1120. Mackay, F.J., Dunn, N.R., & Mann, R.D. (1999). Antidepressants and theAntidepressants and the serotonin syndrome in general practice [Electronic version].serotonin syndrome in general practice [Electronic version]. British Journal of General Practice, 49, 871-874.

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