Tolerability of combined treatment with lithium and paroxetine in patientswith bipolar disorder and depression

Patients with bipolar disorder are often prescribed lithium in combination with a selective serotonin reuptake inhibitor. Doubts still remain, however , about the safety of the combination, particularly with regard to the risk of developing a serotonin syndrome. The authors retrospectively evaluated the safety of the combination of lithium and paroxetine when the two medica tions were sequentially prescribed in patients with bipolar disorder. The a uthors examined a sample of 17 patients with bipolar disorder who were trea ted with lithium during a depressive episode and who required paroxetine as an adjunctive antidepressant to ongoing lithium treatment. Averaging acros s all subjects, no statistically significant increase was found for any of the somatic symptoms that were assessed before and after paroxetine was add ed to ongoing lithium therapy. Examining the clinical records of each patie nt in detail; however, four patients who developed significant adverse even ts, possibly related to an emerging serotonin syndrome were identified. Cli nicians should be aware of the possible development of a serotonin syndrome among patients in whom paroxetine is added to ongoing lithium treatment.