Here we report a case of serotonin syndrome caused by fluoxetine 20 mg and duloxetine 60 mg independently eight week apart. A 65-year old man developed fever, agitation and change of mental status after two weeks treatment with 20 mg of fluoxetine for depressive disorder. He was diagnosed unknown fever origin and discharged when fever subsided as antidepressant stopped. Eight weeks later he was prescribed 60 mg of duloxetine for the treatment of depressed mood. After 18 days on duloxetine he developed fever, agitation, myoclonus and change in mental status again. He improved rapidly after discontinuation of offending drug with supportive care. Despite serotonin syndrome is usually caused by poly-pharmacy of serotonergic drugs, this case shows unusual serotonin syndrome developed by therapeutic dose of two drugs of different classes independently.
Depressive Disorder ; Dihydroergotamine ; Fever ; Fluoxetine ; Humans ; Myoclonus ; Serotonin ; Serotonin Agents ; Serotonin Syndrome ; Thiophenes ; Duloxetine Hydrochloride

Serotonin syndrome is an unexpected adverse reaction of serotonergic medication. Some drugs used by anesthesiologists may cause serotonin syndrome. Serotonin syndrome is known to be related to 5-hydroxytryptamine 1A and 5-hydroxytryptamine 2A agonism. However, recent research has revealed evidence that 5-hydroxytryptamine 3 (5-HT3) antagonism can also play a role in serotonin syndrome. Among the 5-HT3 antagonists, palonosetron is the most highly specific. In this study, we present the first case of fentanyl- and meperidine-induced serotonin syndrome precipitated by palonosetron in general anesthesia.
Anesthesia, General ; Felodipine ; Fentanyl* ; Meperidine* ; Serotonin 5-HT3 Receptor Antagonists ; Serotonin Syndrome* ; Serotonin*

Tramadol can increase the serum level of serotonin, causing serotonin syndrome, which is a potentially life-threatening condition. Serotonin syndrome occurs when tramadol is used in combination with other drugs that affect serotonin. A patient who had been taking selective serotonin reuptake inhibitor and stopped at 10 days before surgery experienced intermittent heart rate elevation, tremor of the upper extremities and mental change after receiving an infusion of tramadol for postoperative pain control. Although he did not show the typical triad of serotonin syndrome (systemic autonomic dysfunction, neuromuscular impairment and mental status change), the patient was suspected to have serotonin syndrome caused by tramadol.
Heart Rate ; Humans ; Pain, Postoperative ; Serotonin Syndrome* ; Serotonin Uptake Inhibitors ; Serotonin* ; Tramadol ; Tremor ; Upper Extremity

Currently available pharmacotherapies for depression still have a limited antidepressant efficacy with a delayed onset of several weeks, and still cause side effects. These unmet needs represent important reasons to continue to search for novel treatment options. A disorganization of circadian rhythms has been suggested to play an important role in the pathophysiology of major depression. Agomelatine is a new agent with a unique pharmacological profile. Agomelatine is both an agonist of melatonergic MT(1) and MT(2) receptors and a serotonergic 5-HT(2C) receptor antagonist. Many clinical trials have demonstrated the superior efficacy of agomelatine in comparison with placebo in the treatment major depressive disorder at the standard dose of 25 mg/day, with the possibility of increasing doses to 50 mg/day in those patients with insufficient improvement. Agomelatine was even effective in severely depressed patients. The safety and tolerability of agomelatine was comparable to placebo. It does not induce the side effects including serotonin syndrome and sexual dysfunction or discontinuation syndrome typical to other therapies, such as selective serotonin reuptake inhibitors. These properties give agomelatine a definite clinical advantage in the treatment of depression.
Acetamides ; Circadian Rhythm ; Depression ; Depressive Disorder, Major ; Humans ; Imidazoles ; Nitro Compounds ; Receptor, Serotonin, 5-HT2C ; Serotonin Syndrome ; Serotonin Uptake Inhibitors

Dextromethorphan and chlorpeniramine are common ingredients of over-the-counter (OTC) cough pills. They are known to be safe when used alone, however, combination with other serotonergic drugs or use of an overdose can cause serotonergic toxicity. We report on a 43-year-old male and a 57-year-old female who ingested an overdose of antitussive drugs containing dextromethorphan and chlorpeniramine. They commonly presented with altered mentality and hyperreflexia on both upper and lower extremities. After conservative therapies, they were discharged with alert mentality. These cases are meaningful in that there are few cases of serotonin syndrome with an overdose of a combination of dextromethorphan and chlorpeniramine. Careful use with medication counseling for OTC cough pills is needed in order to prevent overdose of these ingredients.
Adult ; Antitussive Agents ; Cough ; Counseling ; Dextromethorphan ; Female ; Humans ; Lower Extremity ; Male ; Middle Aged ; Reflex, Abnormal ; Serotonin ; Serotonin Agents ; Serotonin Syndrome

Major depression is a common mental illness, associated with high morbidity and mortality. Antidepressants have been the first-line therapies due to their confirmed efficacy, however, considering high rate of poor treatment response to these therapies, distressing side effects, and delayed onset of their efficacy, there has been much effort to find alternative treatments for major depression. Recently, evidence regarding disturbed circadian rhythms involved in the pathophysiology of major depression has emerged, the interest on this area has been increasing. Agomelatine is an emerging antidepressant, with a unique profile of selective antagonist at serotonin 2C (5-HT2C) receptors and melatonin receptor agonist. Previous studies have shown its superior efficacy over placebo in treating major depression. Previous trials have shown comparable antidepressant efficacy of agomelatine compared to other standard antidepressants including venlafaxine, sertraline, and fluoxetine. Regarding safety profile of agomelatine, it seems to be not associated with sexual dysfunction and it has less potential for serotonin syndrome or discontinuation syndrome than standard antidepressants including selective serotonin reuptake inhibitors. Considering favorable results on the efficacy and safety of agomelatine in treating depression, it could be a good, safe treatment alternative in the treatment of depression.
Antidepressive Agents ; Circadian Rhythm ; Depression ; Fluoxetine ; Mortality ; Receptors, Melatonin ; Serotonin ; Serotonin Syndrome ; Serotonin Uptake Inhibitors ; Sertraline ; Venlafaxine Hydrochloride

We report a 47-year old traumatic brain injury male patient who was treated for the rigidity and tremor with sinemet (carbidopa levodopa) and artane (trihexyphenidyl). He came to the emergency room ten days after the stopping of sinemet. Acute onset of increased obtunded, immobile, rigid, deep coma, and minimal response to a deep pain was presented. There was no evidence of the focal neurological signs. Over the next two days, he awoke with a normal mental status. His muscle tone become normal and he returned to home without residual medical problems or complications. We report a serotonin syndrome in a traumatic brain injury patient who was treated with sinemet and artane, which resulted in a dysregulation of serotonin activity.
Brain Injuries* ; Coma ; Emergency Service, Hospital ; Humans ; Male ; Middle Aged ; Serotonin Syndrome* ; Serotonin* ; Tremor ; Trihexyphenidyl

Many reproductive women, at least 20-50%, suffered from premenstrual syndrome and 2-8% of them have premenstrual dysphoric disorder(PMDD). Prospective daily records during 2 menstrual cycles are required to differentiate PMDD from other various similar conditions such as concurrent psychiatric or medical diseases or their premenstrual magnification and also to determine the efficacy of treatment. The etiology of PMDD is largely unknown. Recently as several randomized placebo-controlled trial in women with PMDD have reported the efficacy of serotonin reuptake inhibitors(SSRIs), SSRIs have been preferred to other treatment regimens though response rates to SSRIs were variable with high placebo response rate and though their long-term and preventive effect were not yet determined.
Female ; Humans ; Menstrual Cycle ; Premenstrual Syndrome ; Prospective Studies ; Serotonin

Paroxetine is a well-known selective serotonin reuptake inhibitor, and has been reported to be advantageous for chronic pain control. Paroxetine is increasingly used for various types of chronic pain because of its safety; however, hyponatremia, or syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with paroxetine, has been reported. This complication is relatively rare, but some patients have presented with severe neurological symptoms. Here, we report the first case of SIADH associated with paroxetine in Korea.
Chronic Pain ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Korea ; Paroxetine ; Serotonin

A significant proportion of chronic constipation patients are dissatisfied with their treatment. Recently, a number of new medications have been introduced for patients refractory to conventional laxatives, such as prucalopride, lubiprostone, linaclotide, and elobixibat. Prucalopride is a novel gastrointestinal prokinetic agent that acts as a 5-hydroxytryptamine type 4 (5-HT4) agonist. Compared with older nonselective 5-HT4 agonists, the higher selectivity of prucalopride for 5-HT4 receptors can reduce the risk of significant adverse cardiovascular events. Prucalopride improves stool frequency and consistency, and reduces the need for rescue medications. Lubiprostone, a chloride channel activator, increases the secretion of intestinal fluid, improves the stool frequency and consistency, and reduces straining. Linaclotide, a guanylate cyclase-C agonist, is effective in treating patients with chronic constipation and its effect on visceral sensitivity, as shown mainly in animal studies, provides an attractive pharmaceutical option for patients with irritable bowel syndrome with constipation. Elobixibat is an ileal sodium-dependent bile acid transporter inhibitor that blocks the enterohepatic circulation of bile acids, increasing the bile acid concentration in the intestine, which accelerates colonic transit and softens the stool. A phase III trial of the treatment of chronic constipation and irritable bowel syndrome with constipation is underway. The clinical application of new-generation laxatives will contribute to the management of chronic constipation refractory to conventional laxatives.
Animals ; Bile ; Bile Acids and Salts ; Chloride Channels ; Colon ; Constipation ; Enterohepatic Circulation ; Humans ; Intestines ; Irritable Bowel Syndrome ; Laxatives* ; Receptors, Serotonin, 5-HT4 ; Serotonin ; Serotonin 5-HT4 Receptor Agonists ; Lubiprostone