A Case Report of Serotonin Syndrome Associated With Combined Nefazodone and Fluoxetine

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Letter to the Editor

Sir: Serotonin syndrome is a potentially lethal condition caused by excessive serotonergic activity and is diagnosed by the presence of at least 3 of 10 symptoms: mental status changes (confusion, hypomania), agitation, myoclonus, hyperreflexia, diaphoresis, shivering, tremor, diarrhea, incoordination, and fever. It most frequently develops after coadministration of 2 serotomimetic agents, 1 of which is often (but not always) a monoamine oxidase inhibitor. To our knowledge, the following is the first report of serotonin syndrome involving the combination of nefazodone, a 5-HT2 antagonist, and fluoxetine, a selective serotonin reuptake inhibitor (SSRI).

J Clin Psychiatry 2000;61(2):146-147