title: Possible association of severe major depression with acute cessation of long-term excessive triptan use.
abstract: OBJECTIVE
  Triptans are approved medications introduced for the acute treatment of migraine, classified as high-affinity serotonin 5-HT(1B/D) receptor agonists with lower affinity for 5-HT(1A) receptors. Both migraine and treatment of migraine with triptans have been associated with the development of major depression. However, little is known about the adverse effects of acute cessation of long-term overdose triptan use.
  
  
  METHODS
  We report a case of a 49-year-old male patient with first onset of severe major depression following cessation of daily excessive triptan use for 8 years. The depressive disorder was resistant to prior serotonergic antidepressant therapy. Antidepressant treatment with a non-serotonergic agent was successful in resolving depressive symptoms.
  
  
  CONCLUSIONS
  The present case report demonstrates for the first time that acute cessation of long-term excessive triptan use has the potential to induce severe major depression, presumably due to persistent alterations in the serotonergic system including downregulation and desensitization of 5-HT(1) receptors. In this case, treatment with a non-serotonergic agent could be a promising therapeutic strategy.
authors.affiliation: Department of Neurology, Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Ostermann
authors.forename: G
authors.initials: G
authors.lastname: Juckel
authors.forename: P
authors.initials: P
authors.lastname: Roser
mesh_terms: D003865:Major Depressive Disorder / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome / Q000150:complications*; D013997:Time Factors; D014363:Tryptamines / Q000008:administration & dosage*
chemical_list: D014363:Tryptamines