Serotonin syndrome: case report and review of the literature.
We present the case of a 35-year-old woman who developed serotonin syndrome after receiving a single dose of the cyclic antidepressant imipramine (Tofranil). She was already being treated for depression with paroxetine (Paxil), a selective serotonin reuptake inhibitor. Two hours after receiving imipramine, the patient developed tachycardia, delirium, bizarre movements, and myoclonus, all classic findings of serotonin syndrome. Her antidepressants were discontinued and she was treated with intravenous fluids, sedation, and a short course of cyproheptadine, a serotonin receptor antagonist. All symptoms resolved completely within 24 hours. In this case report, we review the drug interactions that can precipitate serotonin syndrome, and give recommendations for the diagnosis and treatment of this potentially fatal disorder.
Weiner
A L
AL
Connecticut Poison Control Center, USA. aweiner@harthosp.org
Tilden
F F
FF
McKay
C A
CA
D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects* / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy; D004357:Drug Synergism; D064420:Drug-Related Side Effects and Adverse Reactions / Q000139:chemically induced* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007099:Imipramine / Q000009:adverse effects* / Q000627:therapeutic use; D017374:Paroxetine / Q000009:adverse effects* / Q000627:therapeutic use; D012701:Serotonin / Q000502:physiology*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D013577:Syndrome
D000929:Antidepressive Agents, Tricyclic; D007099:Imipramine; D017374:Paroxetine; D012701:Serotonin; D017367:Selective Serotonin Reuptake Inhibitors