What are the health risks associated with taking migraine medications and antidepressants at the same time?
Answers from Jerry W. Swanson, M.D.
Reports suggest that combining migraine medications called triptans with certain antidepressants — including selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) — may increase the risk of a serious condition called serotonin syndrome.
Serotonin syndrome occurs when your body has too much serotonin, which is a chemical found in your nervous system. Triptans, SSRIs and SNRIs naturally raise serotonin levels. When these medications are taken together, it causes much higher levels of serotonin in your system than you'd experience if you were taking only one of these medications. Fortunately, serotonin syndrome appears to be rare in people who are taking triptans and antidepressant medications.
Signs and symptoms of serotonin syndrome occur within minutes to hours and may include:
- Nausea, vomiting and diarrhea
- Increased heart rate (tachycardia)
- Changes in blood pressure
- Overactive reflexes (hyperreflexia)
- Extreme agitation or restlessness
- Loss of coordination
If you experience signs or symptoms of serotonin syndrome, seek immediate medical attention. Left untreated, serotonin syndrome may be fatal.
There may also be a risk of interactions between other antidepressants and migraine medications. Antidepressants known as monoamine oxidase inhibitors (MAOIs) can cause an increase in the level of triptans in your blood and slow the breakdown of serotonin.
If you're taking migraine medications and antidepressants, talk to your doctor, especially if you notice any changes in your health. Don't stop or change the dosages of any of your medications on your own.
Feb. 21, 2013
- Tintinalli JE, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, N.Y.: The McGraw Hill Companies; 2011. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=40. Accessed Dec. 4, 2012.
- Information for healthcare professionals: Selective serotonin reuptake inhibitors (SSRIs), selective serotonin-norepinephrine reuptake inhibitors (SNRIs), 5-hydroxytryptamine receptor agonists (triptans). U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm085845.htm. Accessed Dec. 4, 2012.
- Celexa (prescribing information). New York, N.Y.: Forest Laboratories; 2012. http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020822s037,021046s015lbl.pdf. Accessed Dec. 4, 2012.
- Wenzel RG, et al. Serotonin syndrome risks when combining SSRI/SNRI drugs and triptans: Is the FDA's alert warranted? The Annals of Pharmacotherapy. 2008;42:1692.
- Iqbal MM, et al. Overview of serotonin syndrome. Annals of Clinical Psychiatry. 2012;24:310.