A Case Of Serotonin Syndrome

A 35-year-old man with depression presents to the emergency department with flushing, diarrhea, sweating, and muscle rigidity. During the physical examination, he says that he began seeing a new psychiatrist because his sertraline was not working for him. His new doctor gave him a different medication, but he decided to use both medicines to “get rid of the depression.”
Which of the following medications did the new doctor most likely prescribe for this patient?

(A) Citalopram
(B) Lithium
(C) Nortriptyline
(D) Tranylcypromine
(E) Trazodone

Answer And Discussion:


The correct answer is D.
Tranylcypromine is a nonselective monoamine oxidase inhibitor and may lead to serotonin syndrome if taken with SSRIs due to an overall increase in serotonin.

Serotonin syndrome is characterized by mental status changes, autonomic changes (e.g., fever, diaphoresis, tachycardia), and neuromuscular changes (e.g., tremor or rigidity). The treatment of serotonin syndrome consists of prompt discontinuation of the implicated agent(s) and supportive care including intravenous fluids, benzodiazepines for control of delirium, cooling measure for hyperthermia, and neuromuscular blockers such as dantrolene for hyperthermia, muscle rigidity, and the prevention of rhabdomyolysis.