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What is the risk of taking an antidepressant plus a triptan for migraines?

Dawn Marcus
Neurology
Because triptans (like sumatriptan or Imitrex) and mood elevators share similar effects on serotonin receptors, pharmacists have often cautioned patients about the potential risk for developing “serotonin syndrome” when using both a triptan for migraine and an antidepressant, which may be used for mood, migraine prevention, or other reasons. Serotonin syndrome may cause agitation, confusion, sweating, diarrhea, headaches, and more serious effects. Although there is a theoretical risk when combining triptans with antidepressants, symptoms have generally only been reported for patients using high doses and/or combinations of antidepressants when also taking triptans.

A review of available information on serotonin syndrome by Dr. Evans from Baylor College of Medicine and colleagues in an American Headache Society position paper was published in the journal Headache. This paper helps reduce concerns for the average migraine sufferer who might be using typical doses of an antidepressant with the occasional triptan medication.

According to Dr. Evans, “It is not clear at this time what role, if any, triptans might play in contributing to serotonin syndrome with or without SSRIs or SNRIs [serotonin reuptake inhibitor antidepressants].” The authors concluded, “The currently available evidence does not support limiting the use of triptans with SSRIs or SNRIs, or the use of triptan monotherapy, due to concerns for serotonin syndrome.”

While doctors will need to continue to be vigilant for possible side effects in all of their patients, they will likely feel more comfortable prescribing these therapies for appropriate patients. Another tip, the older antidepressants are generally more effective for preventing migraines than the newer SSRI and SNRI antidepressants discussed in this report. Older antidepressants also affect serotonin receptors and are unlikely to need to be restricted in people using typical doses of triptans.

If you are using an antidepressant and a triptan or any medication and are having side effects or other problems, be sure to contact your healthcare provider to address these issues.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.