hypericum and Serotonin-Syndrome

Antidepressants are commonly used drugs with potential for numerous drug interactions. This study aims to systematically review the literature on drug interactions with antidepressants.. We searched MEDLINE (1966 to November 2003) and EMBASE (1980 to 2003), using the heading drug interactions combined with individual antidepressant names. We restricted searches to English-language articles and human studies. We screened drug interaction texts and review articles for relevant studies. We included articles reporting original human data on drug interactions with antidepressants commonly used in North America. Articles were independently evaluated by 2 reviewers on clinical effect, clinical significance, and quality of evidence. Discrepancies were resolved by consensus.. There were 904 eligible interactions, involving 9509 patients, for a total of 598 summary interactions. Of these, 439 (73%) demonstrated an interaction, 148 (25%) had no effect, and 11 (2%) had conflicting evidence. For 510 interactions (85%), the quality of evidence was poor. It was fair for 67 (11%) interactions and good for 10 (2%) interactions. There were no interactions with excellent quality of evidence. There were 145 (24%) interactions of major clinical significance. These were predominantly hypertensive emergencies and serotonin syndrome. Most interacting drugs had central nervous system (CNS) activity. As expected, monoamine oxidase inhibitors (MAOIs) appear to be the most problematic family in terms of potential for serious drug interactions.. Drug interactions with antidepressants are an important cause for concern, but this concern is based primarily on poor evidence. We recommend caution when combining antidepressants with other CNS drugs, particularly when coadministering MAOIs with other substances.

Topics: Cytochrome P-450 Enzyme System; Depressive Disorder, Major; Drug Interactions; Drug Therapy; Drug-Related Side Effects and Adverse Reactions; Humans; Hypericum; Hypertension; Monoamine Oxidase Inhibitors; Phytotherapy; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome

Nurses need to become more aware of serotonin syndrome to avoid its development and to ensure a therapeutic response when early symptoms emerge. While polypharmacy tends to put individuals at greatest risk for the syndrome, use of a single serotonergic agent may also provoke an adverse response. Because the onset and progression of serotonin syndrome are rapid, prompt action may be needed to avoid potentially life-threatening consequences.

Topics: Adult; Antidepressive Agents, Second-Generation; Depressive Disorder; Drug Therapy, Combination; Female; Fluoxetine; Humans; Hypericum; Incidence; Medical History Taking; Migraine Disorders; Nurse's Role; Nursing Assessment; Phototherapy; Primary Prevention; Selective Serotonin Reuptake Inhibitors; Serotonin Receptor Agonists; Serotonin Syndrome; Sumatriptan

The study investigated the use of serotonergic antidepressants (SSRIs: selective serotonin reuptake inhibitors; SNRIs: serotonin-norepinephrine reuptake inhibitors) and St John's wort in a large NSW-based community sample, and sought to identify a potentially dangerous concomitant use of these medications.. Cross-sectional data from 266,848 participants from the '45 and Up' study were used. The questionnaire captures self-reported treatment for depression or anxiety and antidepressant medications in the last four weeks.. 5.8% of participants received treatment for depression or anxiety, with 4.7% taking an SSRI and 1.3% an SNRI. St John's wort was taken by 0.3% of the participants. Use of SSRIs and SNRIs was reported more frequently by females than males (respectively, 64.1% vs 35.9%, 66.9% vs 33.1%). The gender difference was even more pronounced for St John's wort (75.6% vs. 24.4%). Use of antidepressants decreased after the age of 65 years. One hundred and forty people reported concurrent use of an SSRI and an SNRI, and 11 people of an SSRI with St John's wort.. Around 7% of the study population aged 45-65 years reported the use of SSRIs or SNRIs, decreasing to 5% above 70 years of age. It is of concern that some individuals used an SSRI concurrently with St John's wort.

Topics: Age Distribution; Aged; Antidepressive Agents; Anxiety; Australia; Cohort Studies; Depressive Disorder; Drug Interactions; Female; Humans; Hypericum; Male; Middle Aged; Phytotherapy; Plant Preparations; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome; Sex Distribution; Surveys and Questionnaires

Topics: Adult; Drug Therapy, Combination; Female; Fluoxetine; Humans; Hypericum; Migraine Disorders; Rhabdomyolysis; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome; Tryptamines

Topics: Adult; Drug Therapy, Combination; Female; Fluoxetine; Humans; Hypericum; Migraine Disorders; Rhabdomyolysis; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome; Tryptamines

Topics: Adult; Antidepressive Agents, Second-Generation; Humans; Hypericum; Male; N-Methyl-3,4-methylenedioxyamphetamine; Nonprescription Drugs; Plant Preparations; Self Medication; Serotonin Syndrome; Substance Withdrawal Syndrome; Tryptophan

Topics: Adult; Agoraphobia; Buspirone; Drug Interactions; Female; Humans; Hypericum; Psychiatric Status Rating Scales; Serotonin Receptor Agonists; Serotonin Syndrome

To report 2 cases of adverse reactions to St John's wort, a popular herbal treatment for depression.. We present 2 case histories and review the existing literature regarding St John's wort.. St John's wort may cause serotonin syndrome in sensitive patients. In addition, St John's wort may be associated with hair loss.. For clinical reasons, it is important to recognize and report adverse reactions to herbal remedies and to document that these treatments have side effects commensurate with their potent action on brain neurochemistry.

Topics: Adult; Alopecia; Depressive Disorder; Dose-Response Relationship, Drug; Female; Humans; Hypericum; Male; Phytotherapy; Plants, Medicinal; Schizophrenia; Serotonin Syndrome

Topics: Depression; Drug Interactions; Humans; Hypericum; Phytotherapy; Plants, Medicinal; Serotonin Syndrome

Topics: Cyclohexanols; Female; Humans; Hypericum; Male; Plants, Medicinal; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome; Venlafaxine Hydrochloride

Topics: Cytochrome P-450 CYP3A; Cytochrome P-450 Enzyme System; Drug Interactions; Humans; Hypericum; Mixed Function Oxygenases; Plants, Medicinal; Serotonin Syndrome; United States; United States Food and Drug Administration