title: [Case of prolonged recovery from serotonin syndrome caused by paroxetine].
abstract: We report a case of serotonin syndrome in a patient being treated with paroxetine for depression. Despite prompt discontinuation of medication, his serotonin syndrome continued for 10 days before full consciousness was restored. The patient was a 48-year-old male with chief complaints of hypobulia and suicidal thoughts. He consulted as a psychiatric outpatient, and oral paroxetine 20 mg/day, etizolam 1.0 mg/day, and brotizolam 0.25 mg/day were immediately started. Upsurge of feeling and disinhibition state were noted the following day, then on treatment day 6 his condition deteriorated to substupor state and he was admitted for further treatment. On admission, change of mental condition (consciousness disturbance), perspiration, hyperreflexia, myoclonus and tremor were seen, and serotonin syndrome caused by paroxetine was suspected. Paroxetine was thus discontinued, and under intravenous drip his condition gradually improved. However, it was not until the 10th hospital day that he became fully alert. In examinations, no infectious, metabolic or organic diseases were detected. The patient's condition often improves with in 24 hours of discontinuation of the causative medication in serotonin syndrome. Symptoms continued for 10 days in this patient, however, perhaps because paroxetine was administered for 6 days before discontinuation. In addition, interaction with other medications may have occurred. Therefore, when serotonin syndrome is suspected, prompt discontinuation of the suspected causative medication, followed by close monitoring of the pharmacokinetics is warranted.
authors.affiliation: Department of Psychiatry, Jikei University School of Medicine.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ochiai
authors.forename: Hisatoshi
authors.initials: H
authors.lastname: Katsu
authors.forename: Shinji
authors.initials: S
authors.lastname: Okino
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Wakutsu
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakayama
mesh_terms: D000657:Amoxapine / Q000008:administration & dosage; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics; D003863:Depression / Q000188:drug therapy; D003937:Diagnosis, Differential; D004347:Drug Interactions; D006801:Humans; D008297:Male; D008875:Middle Aged; D017374:Paroxetine / Q000009:adverse effects*; D011110:Polymorphism, Genetic; D020230:Serotonin Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013997:Time Factors
chemical_list: D017374:Paroxetine; D019389:Cytochrome P-450 CYP2D6; D000657:Amoxapine