You may have seen the new warning from the FDA warning you about taking certain migraine medications like Imitrex® with depression medication like Prozac®, Cymbalta® or Effexor®. This is actually a very common combination as many people with depression also suffer from migraines. The FDA is concerned that this medication combination can lead to a problem called 'serotonin syndrome'. This is a condition where there is too much of a brain chemical called serotonin in the body. As a result, patients may become nauseated, confused, and have hallucinations, restlessness, poor coordination, rapid heart beat, tremors and/or sweating.

Rest assured that while this is a litgitamate concern, this recommendation is not based on any new data and the condition is very rare. So it is ok to take migraine and depression medications together is most cases. Still, it is a good idea to be aware of the symptoms of serotonin syndrome and tell your doctor immediately if you experience any of them. Also, see the list below for more medications that can cause serotonin syndrome. Serotonin syndrome can be a serious, life-threatening condition that may require prompt medical attention.

Author: Christi Larson, Pharm. D.

REFERENCES:

1. Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med 2005;352:1112-20.
2. Keck PE Jr. Serotonin syndrome. http://www.nmsis.org/Related_Syndromes.shtml. (Accessed January 8, 2006).
3. Martin TG. Serotonin syndrome. Ann Emerg Med 1996;28:520-6. .
4. Bijl D. The serotonin syndrome. Neth J Med 2004;62:309-13.
5. Birmes P, Coppin D, Schmitt L, Lauque D. Serotonin syndrome: a brief review. CMAJ 2003;168:1439-42.
6. Fisher AA, Davis MW. Serotonin syndrome caused by selective serotonin reuptake-inhibitors-metoclopramide interaction. Ann Pharmacother 2002;36:67-71.
7. Mason BJ, Blackburn KH. Possible serotonin syndrome associated with tramadol and sertraline coadministration. Ann Pharmacother 1997;31:175-7.