Evaluating the risk of mild serotonin syndrome in primary care: a retrospective case series of patients with treatment-resistant depression
File(s)
Published version
Author(s)
Jerjes, Waseem
Kopunova, Rachel
Type
Journal Article
Abstract
Background: Serotonin syndrome is an adverse drug reaction characterised by the excess of serotonin activity in the central nervous system. It is a condition of great concern in primary care where some patients, usually with treatment-resistant depression, get treatment with multiple serotonergic agents.
Case Description: This retrospective case series looked at 20 primary care patients with treatment-resistant depression who developed mild serotonin syndrome after starting a second antidepressant. The patients were, on average, 40.4 years old, with 55% being female, and had been in treatment for about 5.3 years. The study also considered other health conditions and medications the patients were using. Interventions included stopping or reducing the dose of the second antidepressant, adjusting medications, and educating the patients. Symptoms occurred 1 to 4 weeks after introduction of the second antidepressant, with duration before presentation to the primary care physician ranging from 2 to 11 weeks. Symptoms resolved between 7–21 days after interventions for all patients, and 85% of cases were resolved in under 2 weeks. The most common intervention was stopping or reducing the dose of serotonergic medications in 70% of cases. All patients had improved, with an excellent response to well-targeted interventions in the primary care setting.
Conclusions: This study highlights the need for careful monitoring of serotonin syndrome in patients with treatment-resistant depression, especially in the case of polypharmacy. Early recognition of symptoms by primary care providers and close management ensure patient safety through proper medication management and education.
Case Description: This retrospective case series looked at 20 primary care patients with treatment-resistant depression who developed mild serotonin syndrome after starting a second antidepressant. The patients were, on average, 40.4 years old, with 55% being female, and had been in treatment for about 5.3 years. The study also considered other health conditions and medications the patients were using. Interventions included stopping or reducing the dose of the second antidepressant, adjusting medications, and educating the patients. Symptoms occurred 1 to 4 weeks after introduction of the second antidepressant, with duration before presentation to the primary care physician ranging from 2 to 11 weeks. Symptoms resolved between 7–21 days after interventions for all patients, and 85% of cases were resolved in under 2 weeks. The most common intervention was stopping or reducing the dose of serotonergic medications in 70% of cases. All patients had improved, with an excellent response to well-targeted interventions in the primary care setting.
Conclusions: This study highlights the need for careful monitoring of serotonin syndrome in patients with treatment-resistant depression, especially in the case of polypharmacy. Early recognition of symptoms by primary care providers and close management ensure patient safety through proper medication management and education.
Date Issued
2025-01-30
Date Acceptance
2024-09-30
Citation
AME Case Reports, 2025, 9
ISSN
2523-1995
Publisher
AME Publishing Company
Start Page
34
End Page
34
Journal / Book Title
AME Case Reports
Volume
9
Copyright Statement
© AME Publishing Company. This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/39866251
PII: acr-09-24-123
Subjects
Serotonin syndrome
case series
primary care
treatment-resistant depression
Publication Status
Published
Coverage Spatial
China
Date Publish Online
2024-11-13