Antiepileptic drugs and serotonin syndrome- A systematic review of case series and case reports

Prakash, Sanjay; Rathore, Chaturbhuj; Rana, Kaushik; Patel, Harsh

doi:10.1016/j.seizure.2021.06.004

Cited by 16 publications

(6 citation statements)

References 99 publications

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“…Several migraine medications, both prophylactic and abortive, act on 5-HT receptors. In addition to antidepressants, migraine preventive medications with proserotonergic properties include sodium valproate, topiramate and gabapentin 4 17. These medications can cause SS, either alone or in combination with other medications.…”

Section: Discussionmentioning

confidence: 99%

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Medication-overuse headache overlapping with serotonin syndrome

Prakash,

Patel,

Shah

2024

BMJ Case Rep

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Serotonin syndrome (SS) is an iatrogenic, drug-induced clinical syndrome caused by an increase in the intrasynaptic concentration of serotonin. Serotonin plays a significant role in the pathophysiology of migraines. Upregulation of 5-HT2A receptors is found in medication-overuse headache (MOH). Several migraine medications, both preventative and abortive drugs, act on serotonin receptors. We report two patients with chronic migraine who developed MOH. Besides headache, patients had frequent attacks of dizziness, restlessness, irritability, insomnia, excessive sweating, abdominal discomforts and tremors. These symptoms were suggestive of withdrawal headache. However, on physical examinations, we elicited hyperreflexia, hypertonia, clonus, tachycardia, hypertension, mydriasis and hyperactive bowel sound. Both patients also met the criteria for SS. Cyproheptadine was started. All features, including headaches, got better after cyproheptadine administration within 24 hours. In 7 days, there was practically total improvement. Both patients continued to take cyproheptadine as a preventative medicine, and migraine frequency was under control.

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Section: Discussionmentioning

confidence: 99%

“…Serotonin plays a significant role in the pathophysiology of migraines 3. Several preventative and abortive drugs act on serotonin receptors 1 4. Headache has been reported as one of the symptoms of SS 2.…”

Section: Introductionmentioning

confidence: 99%

Medication-overuse headache overlapping with serotonin syndrome

Prakash,

Patel,

Shah

2024

BMJ Case Rep

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“…This inhibitory property is linked with CBZ's ability to block biogenic amine transporters. As a result, CBZ is a serotoninreleasing agent as well as a serotonin reuptake inhibitor (Rodrigues et al, 2023;Prakash et al, 2021;Rissardo and Caprara, 2020).…”

Section: (B) Gaba Neurotransmissionmentioning

confidence: 99%

Carbamazepine and Bipolar Disorder: Pharmacodynamics, Pharmacokinetics, Pharmacogenomics, and Adverse Drug Reactions- A Comprehensive Review

P.,

Banerjee,

Bansal

et al. 2023

Asian J Pharm Pharmacol

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Bipolar disorder is a chronic recurring illness marked by swings in mood and energy. Regardless of nationality, ethnic background, or socioeconomic status, it affects more than 1% of the world's population1. It is marked by recurring episodes of mania and depression in bipolar disorder (Carvalho et al., 2020) and of hypomania and depression in bipolar disorder (Harrison et al., 2018). Patients with bipolar disorder usually have additional medical conditions in addition to their serious mental disorders (Zareifopoulos et al., 2018). There is evidence of a neurotransmission imbalance, polygenic inheritance, and illness progression in these individuals. Patients frequently take many medications at once, with varying degrees of therapeutic efficacy, especially in the case of depression. Numerous people commit suicide (Dome et al., 2019). In comparison to the general population, the suicide rate is 5-17 times greater, with a lifetime risk of 10%-20% (Miller and Black, 2020).Anticonvulsant medications are frequently prescribed for these psychiatric purposes. Although various additional anticonvulsant medications have been tested with conflicting or inconclusive results, carbamazepine, valproate, and lamotrigine are known mood stabilizers for bipolar disorder (Simonetti et al., 2020). Carbamazepine (CBZ) is a crucial second-line treatment for bipolar disorder when treatment with a conventional antipsychotic alone fails. CBZ otherwise is typically used in the treatment of seizure disorders and neuropathic pain (Sparacino et al., 2022). CBZ is structurally similar to tricyclic antidepressant imipramine. In 2002, the FDA gave CBZ the drug approved for the treatment of acute mania (Sparacino et al., 2022). Hence this review in detail discusses carbamazepine for the treatment of bipolar disorder, its underlying mechanism, and adverse effects.

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“…Severe cases of SS may present with coarse tremor and are observed in patients taking simultaneously SSRI and IMAO [38]. Several anticonvulsants have also been reported in patients with SS owing to their effects in serotoninergic pathways, but the majority of patients also had concomitant use of SSRIs and only 12% of patients were only on anticonvulsants [39].…”

Section: Antidepressants and Mood Stabilizer [Ssris Snris Lithium Ami...mentioning

confidence: 99%