Serotonin syndrome in a Parkinson disease patient after intake of an ethanol-containing homeopathic medication.

Serotonin syndrome is due to excess serotonin in the nervous system. We document a case of an elderly Parkinson disease patient who has been neurologically stable on rasagiline and escitalopram for 1 year but developed serotonin syndrome after intake of an ethanol-containing homeopathic medication. The patient presented with seizures, autonomic dysfunction and neuromuscular hyperexcitability. Maintenance medications were discontinued, hydration, sedation and respiratory support were provided with resolution of the symptoms. The combination of escitalopram and ethanol, both metabolized by the cytochrome P450 enzyme system can lead to serotonin syndrome. Our case highlights the importance of drug interactions in patients taking several medications. Additionally, the intake of medicines, may it be conventional or homeopathic medicine, without the guidance of a trained and competent physician, may lead to serious consequences for the patient.

Risk of serotonin syndrome with complementary and alternative medicines: importance to child and adolescent psychiatry.

OBJECTIVES: Evaluate how child and adolescent psychiatrists rate themselves regarding their knowledge and clinical skills in assessing interactions between non-prescribed complementary and alternative medicines (CAM) and prescribed medications. METHODOLOGY: A brief questionnaire about the practice of asking patients about CAM use was given to child and adolescent psychiatrists. RESULTS: The questionnaire was completed by 20 child and adolescent psychiatrists. Only 35% of the sample stated that they always asked about CAM use although 55% stated that they aware of the importance of prescribed drug interactions with CAM. Of the sample, 90% stated that they could recognize serotonin syndrome, but only 65% answered correctly to the description of the syndrome. Given a list of possible CAM that could interact with prescribed drugs to produce serotonin syndrome, only 10% identified all the drugs correctly. CONCLUSION: CAM training should be included in training programs and in continued education curriculums for practicing child psychiatrists.

Adverse reactions to St John's Wort.

OBJECTIVE: To report 2 cases of adverse reactions to St John's wort, a popular herbal treatment for depression. METHOD: We present 2 case histories and review the existing literature regarding St John's wort. RESULTS: St John's wort may cause serotonin syndrome in sensitive patients. In addition, St John's wort may be associated with hair loss. CONCLUSIONS: For clinical reasons, it is important to recognize and report adverse reactions to herbal remedies and to document that these treatments have side effects commensurate with their potent action on brain neurochemistry.