Pharmacopsychiatry 2011; 44(2): 75-77
DOI: 10.1055/s-0030-1268420
Letter

© Georg Thieme Verlag KG Stuttgart · New York

Serotonin Syndrome after Discontinuation of Olanzapine in a Combined Treatment with Duloxetine –Case Report

H. Himmighoffen1 , E. Seifritz1 , H. Boeker1
  • 1Hospital for Affective Disorders and General Psychiatry Zurich East, Center for Affective and Anxiety Disorders, University of Zurich, Zurich, Switzerland
Further Information

Publication History

received 02.07.2010 revised 06.09.2010

accepted 01.10.2010

Publication Date:
15 December 2010 (online)

Combinations of serotonergic antidepressants and atypical antipsychotics and higher doses of antidepressants are common strategies in the management of treatment-resistant depression. This approach is associated with an increased risk of adverse drug interactions. We report on a patient who was treated with high-dose duloxetine in combination with olanzapine and developed a serotonin syndrome after withdrawal of olanzapine. Previous studies suggest that the activation of 5HT-2A receptors in the brain contribute to the pathophysiology of serotonin syndrome. Olanzapine, like many other atypical antipsychotics, shows a high affinity and occupancy of 5HT-2A receptors, blocking postsynaptic serotonergic action. Therefore, discontinuation of olanzapine in a patient on a high-dose SSRI or SNRI may precipitate a serotonin syndrome. We hypothesize that a serotonin syndrome may be prevented by olanzapine co-administration.

References

Correspondence

H. HimmighoffenMD 

Hospital for Affective Disorders and General Psychiatry Zurich East

Center for Affective and Anxiety Disorders

University of Zurich

Lenggstraße 31

P.O. Box 1931

8032 Zurich

Switzerland

Phone: +41/44/384 2364

Fax: +41/44/383 4456

Email: holger.himmighoffen@puk.zh.ch