SPEECH DYSFUNCTION DUE TO TRAZODONE-FLUOXETINE COMBINATION IN TRAUMATIC BRAIN INJURY

New serotonin reuptake inhibitors are available for the treatment of a ffective disorders and sleep dysfunction in traumatic brain injury (TB I) patients. Commonly reported serotonergic side-effects include nause a, headache, dizziness, nervousness, and orthostatic hypotension. Traz odone, a nonselective serotonin reuptake inhibitor, is often used in c onjunction with fluoxetine, a selective serotonin reuptake inhibitor, in order to combat the insomnia associated with fluoxetine. Successful use of this combination is generally limited by the cumulative seroto nergic side-effects of the two medications. This paper describes the f irst reported case of speech dysfunction as a complication of combined trazodone and fluoxetine use. A 43-year-old male suffered bilateral w rist fractures and a moderate TBI during a fall. Within 1 week of addi ng fluoxetine to trazodone the patient developed new-onset dysarthria and speech blocking. Upon discontinuation of fluoxetine, speech return ed to normal. Possible mechanisms include inhibition of hepatic metabo lism, unmasking of caudate nucleus injury, increased noradrenergic act ivity or previously unreported serotonergic effects. This case illustr ates the importance of monitoring drug combinations for unexpected sid e-effects in the TBI population.