BOF: 2.50
A 40 year old female who is know to be depressed has
recently been started on citalopram as she had shown no response to the
dosulepin that she had been taking earlier.
She presents with a history of diarrhoea and she is found
to be febrile, tremulous, tachycardic, hypertensive, confused and agitated.
This state is likely to be due to:
a)
Co-existent phaeochromocytoma
b)
Concomitant use of alcohol
c)
Combination of dosulepin and citalopram
d)
Sudden withdrawal of treatment
e)
Thyrotoxic crisis precipitated by the drugs
Answer:
c)
The serotonin syndrome is a toxic serotonergic state that
may be induced by the combination of two or more drugs that increase serotonin
levels.
This may be a selective serotonin reuptake inhibitor
combined with a monoamine oxidase inhibitor, tricyclic antidepressant or
dopaminergic drug.
Treatment for this condition is supportive.
In this patient
the likelihood is that she used the two drugs in combination
