Serotonin Syndrome Associated With Nefazodone and Paroxetine

A 51-year-old woman was brought to the emergency department unresponsive, hyponatremic, and diaphoretic, with muscle rigidity. Her condition improved dramatically after supportive treatment and dantrolene. The patient had received nefazodone for 6 months, but the drug had been discontinued 2 days before admission after a tapering period. One day before admission, paroxetine 20 mg/day was started. A repeat challenge with paroxetine 7 days after discontinuation of nefazodone did not result in recurrence of the patient's symptoms. We believe this to be the first report of serotonin syndrome associated with nefazodone and paroxetine.