title: Serotonin syndrome after lithium add-on medication to paroxetine.
abstract: A 59-year-old female patient was hospitalized on account of a depressive episode in the course of a long-standing bipolar disorder. On a combination of lithium (400 mg/day) and paroxetine (30 mg/day) she developed symptoms of shivering, high-frequency tremor of the upper and lower limbs, skin flush in the face, agitation, and slight impairment of mental focusing, suggestive of a serotonin syndrome. At this stage serum lithium and paroxetine levels were 0.63 mmol/l, and 693 ng/ml, respectively; the latter was six times higher than the upper concentrations seen in patients on this dosage of the drug. Consequently, the dosage of paroxetine was reduced to 10 mg/day, and lithium was continued. This regimen resulted in a steady-state paroxetine serum level of 390 ng/ml. The patient became symptom-free and the depressive episode attenuated, thus enabling us to discharge the patient.
authors.affiliation: Department of Psychiatry, Faculty of Medicine, University of Bonn, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Sobanski
authors.forename: M
authors.initials: M
authors.lastname: Bagli
authors.forename: G
authors.initials: G
authors.lastname: Laux
authors.forename: M L
authors.initials: ML
authors.lastname: Rao
mesh_terms: D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects* / Q000627:therapeutic use; D018692:Antimanic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008094:Lithium / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D017374:Paroxetine / Q000009:adverse effects* / Q000627:therapeutic use; D012701:Serotonin / Q000502:physiology*
chemical_list: D018687:Antidepressive Agents, Second-Generation; D018692:Antimanic Agents; D012701:Serotonin; D017374:Paroxetine; D008094:Lithium