SS in MDMA

Q: A 22-year-old female is admitted to the ICU with a clinical diagnosis of serotonin syndrome (SS) after being found having trismus and 'acting weird' at a dance club on Saturday night. Friends informed about ingesting 'ecstasy' prior to the party. Which concomitant drug is suspected to increase the risk of SS with ecstasy (MDMA)?

Answer: SSRI

Unfortunately, 3,4-methylenedioxymethamphetamine (MDMA), popularly known as ecstasy or Molly, is widely available in society. With the rise of use of Selective Serotonin Reuptake Inhibitors (SSRIs) in society, particularly among college-going students, the concurrent use of MDMA and SSRIs greatly increases the risk of SS. 

MDMA causes SS via stimulation of massive serotonin release. 

#toxicity

#pharmacology

References:

1. Mueller PD, Korey WS. Death by "ecstasy": the serotonin syndrome? Ann Emerg Med 1998; 32:377.

2. Singh AN, Catalan J. Rave drug (ecstasy) and selective serotonin reuptake inhibitor anti-depressants. Indian J Psychiatry. 2000 Apr;42(2):195-7. PMID: 21407935; PMCID: PMC2957712.

3. Dobry Y, Rice T, Sher L. Ecstasy use and serotonin syndrome: a neglected danger to adolescents and young adults prescribed selective serotonin reuptake inhibitors. Int J Adolesc Med Health. 2013;25(3):193-9. doi: 10.1515/ijamh-2013-0052. PMID: 24006318.