Transient Serotonin Toxicity Evoked by Combination of Electroconvulsive Therapy and Fluoxetine

Klysner, R.; B, Bjerg Bendsen; Ms, Hansen

doi:10.1155/2014/162502

Cited by 9 publications

(4 citation statements)

References 6 publications

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“…We conducted a literature review by searching databases, including PubMed and Scopus, to identify case reports of SS being precipitated by ECT, ketamine, or both (Table 5). We found 5 case reports of ECT precipitating SS in patients with pre-existing risk factors 22–26 . We found only 1 case report of ketamine being linked to the onset of SS 27 .…”

Section: Discussionmentioning

confidence: 89%

“…We found 5 case reports of ECT precipitating SS in patients with pre-existing risk factors. [22][23][24][25][26] We found only 1 case report of ketamine being linked to the onset of SS. 27 We did not find any case reports in which concomitant use of ketamine and ECT was linked to SS, nor did we find any cases of recurrent SS occurring under these conditions.…”

Section: Discussionmentioning

confidence: 90%

“…Okamoto et al 2012 22 Paroxetine+ECT SS following bilateral ECT #1 with propofol in a 67-year-old female Klysner et al 2014 23 Fluoxetine+ECT A 31-year-old female who developed SS after 9 bilateral ECT sessions Cheng et al 2015 24 Bupropion, trazodone, and quetiapine+ECT SS after bilateral ECT #1 with propofol in a 70-year-old female Deuschle et al 2017 25 Mirtazapine, venlafaxine, quetiapine, and lithium+ECT A 45-year-old female with SS following unilateral ECT #5…”

Section: Case Report Possible Inciting Cause Descriptionmentioning

confidence: 99%

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Recurrent Serotonin Syndrome After Ketamine-assisted Electroconvulsive Therapy: A Case Report and Review of the Literature

Deka,

Joseph,

Sharma

et al. 2024

Journal of Psychiatric Practice

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Serotonin (5-HT) syndrome (SS) consists of changes in mental status as well as autonomic and neuromuscular changes. Though not well understood, serotonergic pathways have been implicated in the mechanism of action of electroconvulsive therapy (ECT). Ketamine has been used as an induction agent in ECT and as therapy for treatment-resistant depression. Utilizing a case report and literature review, we explored the underlying serotonergic mechanisms of ECT and ketamine by which a syndrome of serotonin toxicity may be precipitated. We describe the case of a 72-year-old woman who developed recurrent SS on 2 occasions in similar circumstances involving the administration of ketamine for ECT. In our literature review, we found 5 cases in which SS was associated with ECT and 1 case linking ketamine to SS. There is emerging evidence that the mechanism of ECT involves 5-HT1A and 5-HT2A receptors, the same receptors that are involved in SS. ECT can transiently increase the permeability of the blood-brain barrier, leading to increased levels of antidepressants in the brain. ECT can, therefore, enhance 5-HT transmission and the likelihood of SS in the presence of serotonergic agents. The effect of ketamine on 5-HT transmission is mediated by the glutamate α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor. Ketamine increases α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid activity in the medial prefrontal cortex, which leads to downstream 5-HT release through glutamate. Through this mechanism, ketamine can increase 5-HT transmission, leading to SS. To our knowledge, this is the only case report of recurrent SS with concurrent use of ECT and ketamine. As ketamine is frequently used in ECT and many patients undergoing ECT are on serotonergic medications, it is important to recognize ketamine as a potential risk factor for SS. There is no evidence for added efficacy when combining ECT and ketamine. Thus, one should proceed with caution when combining these treatments. The burgeoning use of ketamine in ambulatory settings makes it necessary to elucidate the risks, which we discuss further. More research is needed into the mechanisms of ketamine and ECT, specifically how the combination of these treatments influence 5-HT levels.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 90%

Section: Case Report Possible Inciting Cause Descriptionmentioning

confidence: 99%

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Recurrent Serotonin Syndrome After Ketamine-assisted Electroconvulsive Therapy: A Case Report and Review of the Literature

Deka,

Joseph,

Sharma

et al. 2024

Journal of Psychiatric Practice

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“…Although it has been asserted that serotonin syndrome (SS) is a form of catatonia ( Fink and Taylor, 2001 ), there is currently insufficient systematic evidence to support this claim ( Katus and Frucht, 2016 ; Keck and Arnold, 2000 ; Mann et al, 2022 ; Rosebush and Mazurek, 2010 ). Furthermore, although ECT, a core intervention for catatonia, has been advocated for the treatment of SS ( Fink, 1996 ; Fink and Taylor, 2003 , 2009 ), recent reports suggest that it is ineffective and, in fact, may exacerbate SS ( Cheng et al, 2015 ; Katus and Frucht, 2016 ; Klysner et al, 2014 ).…”

Section: Clinical Assessmentmentioning

confidence: 99%

Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

et al. 2023

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The British Association for Psychopharmacology developed an evidence-based consensus guideline on the management of catatonia. A group of international experts from a wide range of disciplines was assembled. Evidence was gathered from existing systematic reviews and the primary literature. Recommendations were made on the basis of this evidence and were graded in terms of their strength. The guideline initially covers the diagnosis, aetiology, clinical features and descriptive epidemiology of catatonia. Clinical assessments, including history, physical examination and investigations are then considered. Treatment with benzodiazepines, electroconvulsive therapy and other pharmacological and neuromodulatory therapies is covered. Special regard is given to periodic catatonia, malignant catatonia, neuroleptic malignant syndrome and antipsychotic-induced catatonia. There is attention to the needs of particular groups, namely children and adolescents, older adults, women in the perinatal period, people with autism spectrum disorder and those with certain medical conditions. Clinical trials were uncommon, and the recommendations in this guideline are mainly informed by small observational studies, case series and case reports, which highlights the need for randomised controlled trials and prospective cohort studies in this area.

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Management of Serotonin Syndrome and Neuroleptic Malignant Syndrome

Katus¹,

Frucht²

2016

Curr Treat Options Neurol

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Serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) can present similarly and range in severity from mild to life-threatening. Although they are easily misdiagnosed, each is distinct clinically and pathophysiologically. It is important to distinguish between the two, as therapeutic options differ. An accurate and thorough medication history plus knowledge of the various clinical presentations of both syndromes are the first steps in management. After this, removing the offending agents and aggressive supportive care are crucial. This includes controlling muscle rigidity and hyperthermia, providing cardiovascular support, and alleviating agitation. In severe cases, paralysis, sedation, and intubation are required. Agents to reverse either surplus serotonergic activity or dopamine blockage can be useful. However, the diagnosis must be clear, as use of these agents in the incorrect syndrome can worsen symptoms. In pharmacologically refractory cases of NMS, electroconvulsive therapy should be pursued.

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Transient Serotonin Toxicity Evoked by Combination of Electroconvulsive Therapy and Fluoxetine

Abstract: The serotonin syndrome has been described only in rare instances for electroconvulsive therapy combined with an antidepressant medication. We describe a case of serotonin toxicity induced by electroconvulsive therapy in combination with fluoxetine.

Cited by 9 publications

References 6 publications

Recurrent Serotonin Syndrome After Ketamine-assisted Electroconvulsive Therapy: A Case Report and Review of the Literature

Recurrent Serotonin Syndrome After Ketamine-assisted Electroconvulsive Therapy: A Case Report and Review of the Literature

Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

Management of Serotonin Syndrome and Neuroleptic Malignant Syndrome

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