e-pearls newsletter, January 2009:

As we all know, SSRI’s (as well as SSNRI’s) are often used in the treatment of serious depression. These agents act by inhibiting the re-uptake of serotonin into nerve cells in the brain. This causes serotonin molecules to linger in their synapses (spaces between nerve cells), which in turn allows serotonin to remain in contact with nerve cells that are being stimulated. This results in an enhanced serotonin signal being transmitted.

Problems may arise in people who are also taking another class of drugs, called triptans, for their migraine headaches. Ordinarily, triptans are meant to be taken sparingly, and only at the first sign of a migraine, in order to abort that particular headache occurrence. However, it is not uncommon for people either to take this medication on a regular basis in order to prevent their headaches in the first place, or exceed the recommended per-headache dosage. This causes a further increase in serotonin transmission, because triptans enhance the effects of serotonin by binding to its receptors in the brain. This may easily result in a serious over-enhancement of the effects of serotonin on the brain, due to the combined actions of the client’s triptan and SSRI (or SSNRI).

When this occurs, it is referred to as the so-called serotonin syndrome and is characterized by stupor (reduced alertness), coma (unresponsiveness), seizures, and hyperthermia (markedly elevated body temperature). If not recognized, it can be fatal.

Therefore, it might be wise to ask your migraine-suffering clients that are taking an SSRI or SSNRI whether they are also taking a triptan. You just might be doing them a great service.