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Serotonin syndrome after lithium
add-on medication to paroxetine.
Sobanski T, Bagli
M, Laux G, Rao ML.
Department of Psychiatry, Faculty of
Medicine, University of Bonn, Germany.
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.
PMID: 9211572 [PubMed - indexed for