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

ABSTRACTA 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...