Silins Edmund, Copeland Jan, Dillon Paul
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
Aust N Z J Psychiatry. 2007 Aug;41(8):649-55. doi: 10.1080/00048670701449237.
Growth of the antidepressant market and widespread use of the illicit drug ecstasy (methylenedioxymethamphetamine; MDMA) creates a need to delineate the potential harms associated with the concomitant use of ecstasy and serotonergic pharmaceutical drugs. One such harm is serotonin syndrome. The study aimed to synthesize the risk of serotonin syndrome associated with the concomitant use of ecstasy and other serotonergic substances in a clinically relevant hierarchy for psychiatrists and other medical practitioners. An extensive online database search was carried out of the literature on serotonin syndrome, in relation to illicit drugs and simultaneous use of other substances. Numerous licit and illicit substances implicated in serotonin syndrome, when used with ecstasy, have potential for increased toxicity and are presented in a resulting hierarchy of risk. Substances that inhibit serotonin re-uptake are less likely to lead to life-threatening elevations in serotonin when used with ecstasy. High doses or repeated use of stimulants such as methamphetamine and cocaine with ecstasy increase the risk of serotonin syndrome; as does the use of pharmaceutical amphetamine and ecstasy. Serotonin precursors also influence the course of serotonin syndrome when used with ecstasy. Substances that inhibit monoamine oxidase are most likely to lead to serious increases in serotonin when used with ecstasy. Findings highlight the importance of screening for the use of ecstasy and other serotonergic substances when prescribing antidepressant drugs.
抗抑郁药市场的增长以及非法药物摇头丸（亚甲二氧基甲基苯丙胺；MDMA）的广泛使用，使得有必要明确同时使用摇头丸和血清素能药物可能带来的危害。其中一种危害就是血清素综合征。该研究旨在为精神科医生和其他医学从业者，在一个具有临床相关性的层级体系中，综合分析与同时使用摇头丸和其他血清素能物质相关的血清素综合征风险。针对与非法药物及其他物质同时使用相关的血清素综合征文献，进行了广泛的在线数据库搜索。许多与血清素综合征有关的合法和非法物质，在与摇头丸同时使用时，都有增加毒性的可能性，并在由此产生的风险层级中列出。与摇头丸同时使用时，抑制血清素再摄取的物质不太可能导致危及生命的血清素升高。高剂量或重复使用甲基苯丙胺和可卡因等兴奋剂与摇头丸会增加血清素综合征的风险；使用药用苯丙胺和摇头丸也是如此。血清素前体与摇头丸同时使用时也会影响血清素综合征的病程。与摇头丸同时使用时，抑制单胺氧化酶的物质最有可能导致血清素严重升高。研究结果凸显了在开具抗抑郁药物时筛查是否使用摇头丸和其他血清素能物质的重要性。
