Serotonin syndrome.
We describe a patient treated with trazodone, isocarboxazid, and methylphenidate hydrochloride who developed confusion, agitation, poor concentration, rigidity, myoclonus, involuntary movements, orthostatic hypotension, and hyperreflexia. CK was normal, and the syndrome resolved spontaneously over 12 hours. The serotonin syndrome occurs following the use of serotomimetic agents (serotonin reuptake inhibitors, tricyclic and tetracyclic antidepressants, tryptophan, 3,4-methylenedioxy-methamphetamine, dextromethorphan, meperidine, S-adenosylmethionine) alone or in combination with monoamine oxidase inhibitors. It is characterized by various combinations of myoclonus, rigidity, hyperreflexia, shivering, confusion, agitation, restlessness, coma, autonomic instability, low-grade fever, nausea, diarrhea, diaphoresis, flushing, and rarely, rhabdomyolysis and death.
Bodner
R A
RA
Department of Neurology, Cleveland Clinic Foundation, OH 44195-5245.
Lynch
T
T
Lewis
L
L
Kahn
D
D
D003866:Depressive Disorder / Q000188:drug therapy*; D006801:Humans; D007520:Isocarboxazid / Q000627:therapeutic use; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use; D008875:Middle Aged; D009422:Nervous System Diseases / Q000139:chemically induced* / Q000503:physiopathology; D012701:Serotonin / Q000378:metabolism*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D013577:Syndrome; D014196:Trazodone / Q000009:adverse effects* / Q000627:therapeutic use
D007520:Isocarboxazid; D008774:Methylphenidate; D012701:Serotonin; D017367:Selective Serotonin Reuptake Inhibitors; D014196:Trazodone