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

Letter to the Editor

Sir: Serotonin syndrome is a potentially lethal conditioncaused by excessive serotonergic activity and is diagnosed bythe 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 2serotomimetic agents, 1 of which is often (but not always) amonoamine oxidase inhibitor. To our knowledge, the followingis the first report of serotonin syndrome involving the combinationof nefazodone, a 5-HT₂ antagonist, and fluoxetine, a selectiveserotonin reuptake inhibitor (SSRI).