A Case of Serotonin Syndrome with Antidepressant Treatment and Concomitant use of The Herbal Remedy (Peganum Harmala)

摘要

A forty-two-year-old male patient with a 22 year history of mood disorder, not otherwise specified using quetiapine 1000 mg/day and fluoxetine 40 mg/day for the past six years was admitted to the emergency unit with complaints of nausea, vomiting, sweating, and tremor following the ingestion of harmal (peganum harmala) to treat his hemorrhoids. In the following hours the patient developed confusion along with visual hallucinations and became agitated with a loss of orientation. Other possible causes of delirium and neuroleptic malignant syndrome (NMS) were excluded by biochemical analyses. A diagnosis of serotonin syndrome was confirmed and the patient was hospitalized in the intensive care unit. All psychiatric medications were discontinued immediately and cyproheptadine solution 32 mg/day, chlorpromazine 25 mg/day, and diazepam 30 mg/day were initiated. Nausea, vomiting, and agitated delirium were dissolved in 48 hours. Herbal supplements are sold without any control at herb sellers may interact with many medications, thus giving rise to toxic reactions or a decrease in the effectiveness of medications. An interaction between SSRIs and herbal supplements can cause serotonin syndrome.?ZETBa?ka türlü s?n?fland?r?lamayan duygudurum bozuklu?u tan?s? ile 22 y?ld?r izlenen, 6 y?ld?r ketiapin 1000 mg/gün ve fluoksetin 40 mg/gün kullanan 42 ya??nda erkek hasta hemoroidini tedavi etmek i?in üzerlik otu (peganum harmala) ald?ktan sonra hastanemizin acil servisine bulant?, kusma, terleme ve titreme ?ikayetleri ile ba?vurdu. ?lerleyen saatlerde hastada g?rsel halüsünasyonlar?n e?lik etti?i konfüzyon geli?ti ve y?nelim kayb? yan?s?ra ajitasyon g?zlendi. Biokimyasal tetkikler sonucu hastada deliryumun di?er olas? sebepleri ve n?roleptik malign sendrom (NMS) tan?s? d??land?. Serotonin sendromu tan?s?yla hasta yo?un bak?m ünitesine yat?r?ld?. Tüm psikiyatrik tedavisi kesildi ve siproheptadin solüsyon 32 mg/gün, klorpromazin 25 mg/gün, diazepam 30 mg/gün tedavisi ba?land?. Bulant?, kusma ve ajite deliryum tablosu 48 saat i?inde kayboldu. Denetime tabi olmaks?z?n aktarlarda sat?lan bitkisel ila?lar, bir ?ok ila?larla etkile?mekte, toksik reaksiyonlara yol a?makta ya da tedavide kullan?lan ila?lar?n etkinli?ini azaltabilmektedir. SSRI s?n?f? antidepresanlar ile bitkisel tedavilerin birlikte kullan?m? serotonin sendromu olu?turabilir.