EDITORWe 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 fluoxetine^3 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 levels that were measurable initially and which . . . [Full text of this article]