A client with depression is prescribed fluoxetine. On a return visit to the clinic, the client tells the nurse that he also just started taking St. John's wort to feel better. The nurse assesses the client for which of the following?
A) Water intoxication
B) Increased depressive symptoms
C) Serotonin syndrome
D) Hypertensive crisis
Ans: C
Fluoxetine is a selective serotonin reuptake inhibitor that, when combined with St. John's wort, can lead to serotonin syndrome. Water intoxication is possible with mood stabilizers such as lithium. The combination of fluoxetine and St. John's wort leads to an increase in intrasynaptic serotonin. Thus a potential for toxicity is present. Hypertensive crisis occurs when MAOIs are taken with tyramine-rich foods.
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