Serotonin Syndrome after Initiation of Pregabalin on a Stable Regimen of Antidepressant Medication

Aims: Serotonin syndrome is a potentially life-threatening drug interaction caused by excess serotonin concentration in the central nervous system and/or peripheral nervous system leading to cognitive, autonomic and somatic effects ranging from barely perceptible to fatal. A number of drugs and drug interactions cause serotonin syndrome, however, the exact mechanisms often remain elusive.

Presentation of Case: In the following case, serotonin syndrome was caused by the addition of pregabalin in a patient with recurrent major depressive disorder and concurrent medication with paroxetine and trazodone.

Discussion: This case illustrates the risk of polypsychopharmacology leading to an increased vulnerability towards serotonin syndrome.

Conclusion: Pregabalin with its serotonergic action has a liability to cause serotonin syndrome. This should be especially kept in mind in patients with polypsychopharmacology.