Antidepressant-Induced Serotonin Syndrome a Danger for the Elderly
研究人員發現，服用抗抑鬱藥的老年患者中有 25% 患有血清素綜合症，這可能會危及生命。
Researchers found that 25% of elderly patients taking antidepressants had serotonin syndrome, which is potentially life-threatening.
彼得·西蒙斯-2022 年 6 月 14 日

在一項新研究中，研究人員發現，服用抗抑鬱藥的老年患者中有 25% 患有血清素綜合症，這可能會危及生命。此外，服用多種抗抑鬱藥或更高劑量的女性和患者的風險增加。
In a new study, researchers found that 25% of elderly patients taking antidepressants had serotonin syndrome, which is potentially life-threatening. In addition, women and patients on multiple antidepressant drugs or a higher dose were at increased risk.

由增加體內血清素水平的藥物（如抗抑鬱藥）引起的血清素綜合症可能會危及生命。症狀包括高血壓、發燒、激動、震顫和腹瀉。此外，該綜合徵可導致癲癇發作、肝損傷和肌肉組織破壞。
//血清素綜合症 https://en.wikipedia.org/wiki/Serotonin_syndrome
Serotonin syndrome, caused by medications that increase levels of serotonin in the body—such as antidepressants—is potentially life-threatening. Symptoms involve high blood pressure, fever, agitation, tremors, and diarrhea. In addition, the syndrome can lead to seizures, liver damage, and the destruction of muscle tissue.

研究人員寫道：“在老年人中廣泛單一或聯合使用抗抑鬱藥代表了對 [5-羥色胺綜合症] 的臨床關注度增加。因此，醫生應該注意接受血清素能藥物，尤其是抗抑鬱藥的老年患者的這種與藥物相關的併發症。”
The researchers write, “The widespread single or combined use of antidepressants in older adults represents an increased clinical concern for [serotonin syndrome]. Therefore, physicians should be aware of this drug-related complication in older patients receiving serotonergic agents, especially antidepressants.”

老年科學專家在土耳其的各個機構進行了這項研究，包括加濟安泰普大學老年醫學系、Dokuz Eylul 大學、Adana Numune 培訓和研究醫院以及老年科學協會。
Geriatric science experts conducted the study at various Turkish institutions, including the Departments of Geriatric Medicine at Gaziantep University, Dokuz Eylul University, and Adana Numune Training and Research Hospital, as well as the Geriatric Science Association.

參與者是 238 名年齡超過 60 歲的門診患者，他們被收入研究人員的老年病診所。所有 238 人都服用抗抑鬱藥。（服用其他類型 5-羥色胺能藥物的患者被排除在研究之外，以確保效果可以可靠地追溯到單獨使用抗抑鬱藥。）
The participants were 238 outpatients older than age 60 who were admitted to the researchers’ geriatric clinic. All 238 were taking antidepressants. (Patients who were taking other types of serotonergic medications were excluded from the study to ensure that the effect could be reliably traced to antidepressant use alone.)

在 238 名參與者中，60 名（25.2%）患有血清素綜合症。在 31.7% 的患者中，血清素綜合症被認為是輕度的，而在 68.3% 的患者中，它被歸類為中度。（雖然輕度血清素綜合症不太可能致命，但它仍然使人衰弱，並且可能會持續存在，除非停用血清素能藥物。）
Of the 238 participants, 60 (25.2%) had serotonin syndrome. In 31.7% of the patients, the serotonin syndrome was considered mild, while in 68.3%, it was classed as moderate. (Although mild serotonin syndrome is unlikely to be fatal, it is still debilitating and will likely persist unless the serotonergic drug is discontinued.)

女性患血清素綜合症的可能性是男性的兩倍。服用至少兩種抗抑鬱藥的人患血清素綜合徵的風險也增加了一倍。服用 SSRI 和 SNRI 的人患血清素綜合症的可能性要高出 18 倍。服用 SSRI 和米氮平的風險是 4.82 倍，而服用曲唑酮和米氮平的風險是 2.41 倍。
Women were twice as likely as men to have serotonin syndrome. Those taking at least two antidepressants were also at twice the risk of serotonin syndrome. Those taking an SSRI and an SNRI were 18 times more likely to have serotonin syndrome. Those who took an SSRI and mirtazapine were at 4.82 times the risk, while those on trazodone and mirtazapine were at 2.41 times the risk.

研究人員停用了所有血清素綜合徵患者的抗抑鬱藥物，並用苯二氮卓類藥物或賽庚啶治療以緩解症狀。
The researchers discontinued the antidepressant drugs in all patients with serotonin syndrome and treated them with benzodiazepines or cyproheptadine to resolve the symptoms.

他們敦促臨床醫生在服用抗抑鬱藥的老年患者中留意血清素綜合症的跡象，尤其是（但不僅是）女性和高劑量服用者：
They urge clinicians to be on the lookout for the signs of serotonin syndrome in older patients taking antidepressants, especially (but not solely) women and those on a high dose:

“[5-羥色胺綜合症] 應考慮用於表現出震顫和反射亢進的老年患者，尤其是女性、使用任何联合治療的患者，尤其是 SSRI 與 SNRI 的患者，以及使用更高劑量抗抑鬱藥的患者。”
“[Serotonin syndrome] should be considered in older patients showing tremor and hyperreflexia, especially in females, those using any combination therapy and particularly SSRI with SNRI, and those using higher doses of antidepressant.”

他們補充說，如果醫生能夠及早發現血清素綜合症並成功停用抗抑鬱藥，可能會挽救患者的生命。
They add that if doctors can spot serotonin syndrome early and successfully discontinue antidepressants, it may save the lives of their patients.

“及早發現這種可能危及生命且易於識別的並發症可以防止這些易受傷害的患者進行不必要的干預、多種藥物、級聯處方，甚至是發病率和死亡率。”
“Early detection of this potentially life-threatening and easily recognizable complication can prevent these vulnerable patients from unnecessary interventions, polypharmacy, prescribing cascade, or even morbidity and mortality.”

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Erken, N., Kaya, D., Dost, FS, Ates Bulut, E., & Isik, AT (2022)。老年患者抗抑鬱藥誘導的血清素綜合症：一項橫斷面研究。老年精神科。2022 年 5 月 13 日在線發布。DOI：10.1111/psyg.12849 （鏈接）
//老年患者抗抑鬱藥誘導的血清素綜合症：一項橫斷面研究
Antidepressant-induced serotonin syndrome in older patients: a cross-sectional study
https://pubmed.ncbi.nlm.nih.gov/35562169/