(B) Serotonin syndrome # Clomipramine oral & Escitalopram oral both increase affecting serotonin levels in the blood.> Too much serotonin is a potentially life-threatening situation. Severe signs and symptoms include high blood pressure and increased heart rate that lead to shock.> Symptoms of this potentially dangerous Serotonin syndrome range from minimal in patients starting selective serotonin reuptake inhibitors (SSRIs) to fatal in those combining monoamine oxidase inhibitors (MAOIs) with serotonergic agents.# Serotonin syndrome is characterized by changes in autonomic, neuromotor, and cognitive-behavioral function triggered by increased serotonergic stimulation.> It typically results from pharmacodynamic and/or pharmacokinetic interactions between drugs that increase serotonin activityRECOGNITION OF SEROTONIN SYNDROMESystemClinical Signs & Symptoms* AutonomicDiaphoresis, hyperthermia, hypertension, tachycardia, pupillary dilatation, nausea, diarrhea, shivering* NeuromotorHyperreflexia, myoclonus, restlessness, tremor, incoordination, rigidity, clonus, teeth chattering, trismus, seizures* Cognitive-behavioralConfusion, agitation, anxiety, hypomania, insomnia, hallucinations, headache# Most Moclobemide-SSRI interactions--including fatalities--involved overdoses in suicide attempts, although toxic symptoms have been reported with clomipramine or meperidine taken at normal dosages.> Switch medication from clomipramine to Escitalopram.> Stop clomipramine> Before day 1: Gradually reduce dosage of clomipramine to a maximum of 50 mg/day.> Day 1: Reduce dosage of clomipramine to 25 mg/day.> Day 3: Reduce dosage of clomipramine to 10 mg/day.> Day 8: Stop administration of clomipramine. Start Escitalopram> Day 1: Simultaneously start administration of escitalopram in a normal dosage of 10 mg/day.