Subscribe to RSS
DOI: 10.1055/s-0030-1268420
© Georg Thieme Verlag KG Stuttgart · New York
Serotonin Syndrome after Discontinuation of Olanzapine in a Combined Treatment with Duloxetine –Case Report
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
- 1 Shelton RC, Tollefson GD, Tohen M. et al . A novel augmentation strategy for treating resistant major depression. Am J Psychiatry. 2001; 158 131-134
- 2 National Institute for Health and Clinical Excellence (NICE) . Depression: the treatment and management of depression in adults (update). NICE [Internet]. 2009 [cited 2010 Jan 20]. Available from: http://guidance.nice.org.uk/CG9
- 3 Sternbach H. The serotonin syndrome. Am J Psychiatry. 1991; 148 705-713
- 4 Dunkley EJC, Isbister GK, Sibbritt D. et al . The Hunter serotonin toxicity criteria: simple and accurate diagnostic decision rules for serotonin toxicity. Q J Med. 2003; 96 635-642
- 5 Hegerl U, Bottlender R, Gallinat J. et al . The serotonin syndrome scale: first results on validity. Eur Arch Psychiatry Clin Neurosci. 1998; 248 96-103
- 6 Hadikusumo B, Ng B. Serotonin syndrome induced by duloxetine. Aust N Z J Psychiatry. 2009; 43 581-582
- 7 Jimenez-Genchi A. Immediate switching from moclobemide to duloxetine may induce serotonin syndrome. J Clin Psychiatry. 2006; 67 1821-1822
- 8 Strouse T, Kerrihard TN, Forscher CA. et al . Serotonin syndrome precipitated by linezolid in a medically ill patient on duloxetine. J Clin Psychopharmacology. 2006; 26 681-683
- 9 Dursun SM, Burke JG, Reveley MA. Toxic serotonin syndrome or extrapyramidal side-effects?. Br J Psychiatry. 1995; 166 401-402
- 10 Boyer EW, Shanon M. The serotonin syndrome. N Engl J Med. 2005; 352 1112-1120
- 11 Sun-Edelstein C, Tepper SJ, Shapiro RE. Drug-induced serotonin syndrome: a review. Expert Opin Drug Saf. 2008; 7 587-596
- 12 Duggal HS, Fetchko J. Serotonin syndrome and atypical antipsychotics. Am J Psychiatry. 2002; 159 672-673
- 13 Haslett CD, Kumar S. Can olanzapine be implicated in causing serotonin syndrome?. Psychiatry Clin Neurosci. 2002; 56 533-535
- 14 Isbister GF, Downes F, Whyte IM. Olanzapine and serotonin toxicity. Psych Clin Neurosci. 2003; 57
- 15 Richelson E. Receptor pharmacology of neuroleptics: relation to clinical effects. J Clin Psychiatry. 1999; 60 (suppl 10) 5-14
- 16 Richelson E, Souder T. Binding of antipsychotic drugs to human brain receptors: Focus on newer generation compounds. Life Sci. 2000; 68 29-39
- 17 Boddy R, Ali R, Dowsett R. Use of sublingual olanzapine in serotonin syndrome (abstract). Clin Toxicol. 2004; 42 725
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