title: Interaction of serotonergic antidepressants and opioid analgesics: Is serotonin syndrome going undetected?
abstract: OBJECTIVE
  To describe the potential for interaction between opioids and serotonergic antidepressants leading to the development of serotonin syndrome (SS), mechanism of the interaction, and the spectrum of SS in elderly residents of a long-term care facility.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Long-term care facility (LTCF) in California.
  
  
  METHODS
  Four elderly LTCF residents treated with serotonergic antidepressants including selective serotonin reuptake inhibitor (SSRI) or mirtazapine and opioids.
  
  
  METHODS
  Signs and symptoms suggestive of SS.
  
  
  RESULTS
  We describe 4 cases of probable SS among elderly residents of a LTCF. The spectrum of serotonin toxicity ranged from visual hallucinations, muscle rigidity, myoclonus, or hypertension in patients taking an opiate with an SSRI to lethargy, hypotension, and hypoxia in a patient taking tramadol and mirtazapine.
  
  
  CONCLUSIONS
  While many can benefit from coadministration of serotonergic antidepressants and opioids, it appears that some individuals are at increased risk for SS. Since SS is a clinical diagnosis, heightened clinician awareness of the possibility of SS among patients receiving SSRI or mirtazapine in combination with opioids may lead to earlier detection and avoidance of potentially lethal consequences.
authors: Jewish Home for the Aging, Reseda, CA, USA. nallini@pacbell.net
authors: Nallini
authors: N
authors: Gnanadesigan
authors: Randall T
authors: RT
authors: Espinoza
authors: Rick
authors: R
authors: Smith
authors: Michelle
authors: M
authors: Israel
authors: David B
authors: DB
authors: Reuben
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000494:pharmacology*; D000928:Antidepressive Agents / Q000494:pharmacology*; D004347:Drug Interactions; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008803:Mianserin / Q000031:analogs & derivatives* / Q000494:pharmacology; D000078785:Mirtazapine; D009735:Nursing Homes; D018490:Serotonin Agents / Q000494:pharmacology*; D020230:Serotonin Syndrome / Q000209:etiology*
chemical_list: D000701:Analgesics, Opioid; D000928:Antidepressive Agents; D018490:Serotonin Agents; D008803:Mianserin; D000078785:Mirtazapine