Serotonin Syndrome Caused by a Clomipramine-Moclobemide Interaction

Sir: The serotonin syndrome is a toxic reaction attributed to excess brain serotonin. Such a syndrome may be induced by a single serotonergic agent, but most cases involve the combination of 2 agents, either coadministered or successively instituted. The combination of reversible monoamine oxidase inhibitors (RIMAs) and serotonergic agents has been reported to cause a serotonin syndrome, but the patient in 1 case was also treated by other potentially causative agents (L-dopa and bromocriptine4) and the remaining 2 patients had ingested massive doses of both moclobemide and clomipramine.