Neonatal paroxetine withdrawal syndrome or actually serotonin syndrome?

Editor—We would like to comment on the article “Neonatal paroxetine withdrawal syndrome” in the March 2001 issue of the journal.1 The authors describe what they have called “neonatal paroxetine withdrawal syndrome”. However the syndrome reported in the 4 neonates appears to be more consistent with serotonin toxicity, rather than withdrawal of paroxetine. The literature to date contains one large series,2 two similar case reports with fluoxetine3 4 and two case reports with paroxetine.5 6 In the fluoxetine cases the syndrome was not described as a withdrawal phenomenon. In the first, a neonate born to a mother on fluoxetine had jitteriness, irritability, tachypnoea, temperature instability, tremors, increased muscle tone, and a hyperactive Moro reflex.3 All except the last of these are clinical features seen in serotonin toxicity in adults using selective serotonin uptake inhibitors (SSRIs) therapeutically or in overdose.7 8 The neonate in this case had fluoxetine …