Management of severe arterial hypertension associated with serotonin syndrome: a case report analysis based on systematic review techniques

Ott, Michael; Mannchen, Julie K.; Jamshidi, Fariba; Werneke, Ursula

doi:10.1177/2045125318818814

Cited by 19 publications

(13 citation statements)

References 294 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This claim should, however, be tempered with the risk of serotoninergic syndrome, a rare potential life-threatening condition occurring when SSRIs are used at high doses or combined with other 5-HT agonists. The massive release of 5-HT leads to activation of central 5-HT 1A and 5-HT 2A receptors ( 92 ) and induces neuromuscular hyperactivity (myoclonus, hyperreflexia, and rhabdomyolysis), cognitive dysfunction (agitation and confusion), autonomic symptoms (hyperthermia, tachycardia, and hypertensive crisis), and, in rare cases, multi-organ failure syndrome ( 19 , 92 , 93 ). Posterior reversible encephalopathy syndrome has also been reported as a complication of severe hypertension ( 94 ).…”

Section: Methodsmentioning

confidence: 99%

Antidepressant Drugs Effects on Blood Pressure

Calvi

Fischetti

Verzicco

et al. 2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Individuals suffering from depressive disorders display a greater incidence of hypertension compared with the general population, despite reports of the association between depression and hypotension. This phenomenon may depend, at least in part, on the use of antidepressant drugs, which may influence blood pressure through different effects on adrenergic and serotoninergic pathways, as well as on histaminergic, dopaminergic, and cholinergic systems. This review summarizes extant literature on the effect of antidepressant drugs on blood pressure. Selective serotonin reuptake inhibitors are characterized by limited effects on autonomic system activity and a lower impact on blood pressure. Thus, they represent the safest class—particularly among elderly and cardiovascular patients. Serotonin–norepinephrine reuptake inhibitors, particularly venlafaxine, carry a greater risk of hypertension, possibly related to greater effects on the sympathetic nervous system. The norepinephrine reuptake inhibitor reboxetine is considered a safe option because of its neutral effects on blood pressure in long-term studies, even if both hypotensive and hypertensive effects are reported. The dopamine–norepinephrine reuptake inhibitor bupropion can lead to blood pressure increases, usually at high doses, but may also cause orthostatic hypotension, especially in patients with cardiovascular diseases. The norepinephrine–serotonin modulators, mirtazapine and mianserin, have minimal effects on blood pressure but may rarely lead to orthostatic hypotension and falls. These adverse effects are also observed with the serotonin-reuptake modulators, nefazodone and trazodone, but seldomly with vortioxetine and vilazodone. Agomelatine, the only melatonergic antidepressant drug, may also have limited effects on blood pressure. Tricyclic antidepressants have been associated with increases in blood pressure, as well as orthostatic hypotension, particularly imipramine. Oral monoamine–oxidase inhibitors, less frequently skin patch formulations, have been associated with orthostatic hypotension or, conversely, with hypertensive crisis due to ingestion of tyramine-containing food (i.e., cheese reaction). Lastly, a hypertensive crisis may complicate antidepressant treatment as a part of the serotonin syndrome, also including neuromuscular, cognitive, and autonomic dysfunctions. Clinicians treating depressive patients should carefully consider their blood pressure status and cardiovascular comorbidities because of the effects of antidepressant drugs on blood pressure profiles and potential interactions with antihypertensive treatments.

show abstract

Section: Methodsmentioning

confidence: 99%

Antidepressant Drugs Effects on Blood Pressure

Calvi

Fischetti

Verzicco

et al. 2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…[9,10]. Examples of non-CNS applications of drugs targeting the 5-HT system include gastroprokinetic drugs (such as Tegaserod, a 5-HT 4 R agonist [11]), but there is also evidence for the role of 5-HTR agonists in the arterial blood pressure control [12,13] and regulation of inflammatory response [14].…”

Section: Introductionmentioning

confidence: 99%

Low Basicity as a Characteristic for Atypical Ligands of Serotonin Receptor 5-HT2

Podlewska

Bugno

Lacivita

et al. 2021

IJMS

View full text Add to dashboard Cite

Serotonin receptors are extensively examined by academic and industrial researchers, due to their vital roles, which they play in the organism and constituting therefore important drug targets. Up to very recently, it was assumed that the basic nitrogen in compound structure is a necessary component to make it active within this receptor system. Such nitrogen interacts in its protonated form with the aspartic acid from the third transmembrane helix (D3x32) forming a hydrogen bond tightly fitting the ligand in the protein binding site. However, there are several recent studies that report strong serotonin receptor affinity also for compounds without a basic moiety in their structures. In the study, we carried out a comprehensive in silico analysis of the low-basicity phenomenon of the selected serotonin receptor ligands. We focused on the crystallized representatives of the proteins of 5-HT1B, 5-HT2A, 5-HT2B, and 5-HT2C receptors, and examined the problem both from the ligand- and structure-based perspectives. The study was performed for the native proteins, and for D3x32A mutants. The investigation resulted in the determination of nonstandard structural requirements for activity towards serotonin receptors, which can be used in the design of new nonbasic ligands.

show abstract

“…For this review, we used three methods: (i) a literature review, (ii) calculation of the expected number of SS cases per year from published statistics concerning antidepressant use, and (iii) quantitative analysis of a database of published SS cases collated from a previously conducted systematic review (Ott et al, 2019;Werneke et al, 2016;Wikström, 2019).…”

Section: Methodsmentioning

confidence: 99%

“…For a potential association between monoamine oxidase inhibitors (MAOI) and severe SS, we also calculated odds ratios (OR) and 95% confidence intervals (CI). The systematic review method underlying this database has been published in detail elsewhere (Ott et al, 2019;Werneke et al, 2016;Wikström, 2019).…”

Section: Quantitative Analysis Of a Database Of Published Casesmentioning

confidence: 99%