Triptans with antidepressants for headache

A National Migraine Centre factsheet

Triptans are a mainstay of migraine treatment – but are they safe to take with antidepressants?

What is serotonin?

Serotonin is a naturally occurring protein that is found mostly in the gastrointestinal system, certain blood cells and the central nervous system (that is, the brain and brain stem). It acts as a messenger, sending signals around the body.

Changes in this messenger protein have been linked to both migraine and depression. Medications that modify serotonin in the body can therefore be effective in treating both disorders.

Such medications include:

  • for migraine, triptans, like sumatriptan
  • for depression, selective serotonin reuptake inhibitors (SSRIs), like fluoxetine, citalopram, sertraline and paroxetine, and selective serotonin/norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine and duloxetine

Migraine with depression

Migraine often overlaps with depression. Each disorder occurs more frequently in individuals affected by the other condition than it does in the general population.

As a result, many patients may be prescribed both a triptan (for acute migraine) and an SSRI or SNRI (to treat depression).

Since both types of drugs work to promote serotonin activity, taken together they could theoretically result in the body producing too much of the protein, resulting in a collection of symptoms that have been termed ‘serotonin syndrome’.

What are the symptoms of serotonin syndrome?

Serotonin syndrome isn’t common, but it can have serious effects. As well as drugs like triptans and SSRIs/SNRIs, other over-the-counter products and natural remedies like St John’s Wort can also increase risks when taken in combination.

The NHS lists symptoms of serotonin syndrome as:

  • agitation
  • muscle twitching
  • sweating
  • shivering
  • diarrhoea

If you are experiencing these symptoms, stop taking your medication and speak to your GP or specialist right away.

Severe serotonin syndrome symptoms include:

  • seizures (fits)
  • irregular heartbeat
  • unconsciousness
  • a temperature of 38C or above

If you or someone you know experiences symptoms of severe serotonin syndrome, call 999 and request an ambulance immediately.

Is taking triptans with antidepressants really a risk?

This potential risk of taking a combination of triptans with antidepressants will be flagged up by electronic prescribing systems, such as those used by GPs.

However, clinically significant serotonin syndrome from simultaneous use of these medications appears to be extremely rare.

Many experts believe the benefit of effective treatment for both migraine and depression appears to far outweigh the very low risk of serotonin syndrome.

If you are taking an antidepressant medication and your GP or headache specialist recommends a triptan medication (or vice versa), this is very widely used combination of medications that is safely used by a large number of people with headache every day.

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