Migraine medications and antidepressants: A risky mix?

Research suggests that combining migraine medications called triptans with certain antidepressants — including selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) — may increase the risk of a rare but serious condition called serotonin syndrome. Although the risk appears to be quite low, debate continues about the level of risk.

Serotonin syndrome occurs when your body has too much serotonin — a chemical found in your nervous system. Triptans, SSRIs and SNRIs naturally raise serotonin levels on their own. When these medications are taken together, the effect may be more pronounced.

Signs and symptoms of serotonin syndrome occur quickly — within minutes to hours — and may include:

• Nausea, vomiting and diarrhea
• Fever
• Increased heart rate (tachycardia)
• Changes in blood pressure
• Overactive reflexes (hyperreflexia)
• Extreme agitation or restlessness
• Hallucinations
• Loss of coordination
• Seizures
• Coma

With prompt treatment — including stopping any medications that may be increasing your serotonin level — signs and symptoms of serotonin syndrome usually stop within 24 hours. Left untreated, serotonin syndrome may be fatal.

Less seriously, there may be a risk of interactions between other antidepressants and migraine medications. A class of antidepressants known as monoamine oxidase inhibitors (MAOIs) can affect how triptans work — increasing the level of triptans in your blood. And SSRIs and MAOIs should be used sparingly with migraine medications called ergotamines, since these antidepressants can slow down the speed at which ergotamines break down.

If you're taking migraine medications and antidepressants, talk to your doctor — especially if you notice any changes in your health. Don't stop or change the dosages of any of your medications on your own. If you experience signs or symptoms of serotonin syndrome, seek immediate medical attention.