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Serotonin Syndrome Induced by Low-Dose Venlafaxine

Psychiatrist, Department of Psychiatry, Taipei Medical University–Wan Fang Hospital, Taipei, Taiwan

Winston W Shen, MD

Psychiatrist and Professor, Department of Psychiatry, Taipei Medical University–Wan Fang Hospital and Taipei Medical University.

Reprints: Winston W Shen MD, Department of Psychiatry, Taipei Medical University–Wan Fang Hospital, No. 111, Hsing-Long Rd. Sec. 3, Taipei 116 Taiwan, FAX 886-2-29334920, E-mail ShenWinW{at}aol.com

OBJECTIVE: To report the case of a patient with serotonin syndrome induced by low-dose venlafaxine.

CASE SUMMARY: A 29-year-old Taiwanese woman with major depressive disorder abruptly developed serotonin syndrome during low-dose (37.5 mg/d) venlafaxine monotherapy, with symptoms of restlessness, tremor, shivering, diarrhea, vomiting, ataxia, tachycardia, and myoclonus. The patient recovered in 2 hours after receiving prochlorperazine and lorazepam in the emergency department. Venlafaxine was discontinued, and she was discharged home. Two weeks later, the patient started to receive fluoxetine 20 mg/d and reported no adverse adverse effects during follow-up clinic visits.

DISCUSSION: The clinical manifestations of this case meet Sternbach's criteria of serotonin syndrome. Its possible etiologic factors include panic attack, adverse drug reaction, pharmacodynamic interaction, and congenital absence of CYP2D6 enzyme activity. The Naranjo probability scale suggested a probable causality of venlafaxine treatment and serotonin syndrome.

CONCLUSIONS: Clinicians should be aware of the risk of serotonin syndrome when the patient receives not only a combination of 2 antidepressants, but also the single potent serotonergic agent venlafaxine.

Key Words: serotonin, serotonin syndrome, SNRI, venlafaxine

Published Online, December 30, 2002. www.theannals.com, DOI

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