What causes serotonergic crises?

If you have a pt on MAOIs and give him/her essentially any of the antidepressants (TCA, atypical, SSRIs, St. John’s wort), you can induce a serotonergic crisis. Tryptophan can do it as well, but it as not marketed as much anymore. The other thing to note is that synthetic opiates such as meperidine (demerol) and dextromethorphan (DM in over-the-counter cough meds) cause serotonergic crises in pts on MAOIs. St. John’s wort probably causes serotonic crises bc it acts as many of the other antidepressants. It has also been noted to cause serotonergic crises in conjunction with SSRIs. A problem we face now, however, is that pts can find things including potato chips that are laced with St. John’s wort. Thus, we must have pts on MAOIs read labels on practically everything to avoid serious adverse reactions.

Category: Pharmacology Notes