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July 10, 1996

A 61-Year-Old Man With Parkinson's Disease-Reply

Author Affiliations

Beth Israel Hospital Boston, Mass

JAMA. 1996;276(2):104. doi:10.1001/jama.1996.03540020026024

In Reply.  —Dr Hayes' points regarding the potential interaction between selegiline and SSRIs are worthy of consideration. It was not my intent to minimize the seriousness of the serotonin reaction, merely to represent that this reaction has primarily been described with the combination of an SSRI and nonselective MAO inhibitors. In contrast, this reaction is rare with drugs that selectively inhibit only the MAO-B isoform such as selegiline. Somerset Pharmaceuticals, the distributors of selegiline in the United States, have only 48 reports of possible serotonin interactions on file despite the many thousands of patients who have received selegiline in combination with antidepressants during the 10 years the drug has been approved for use in the United States.1 Parkinson Study Group investigators report a serotoninlike syndrome in only 11 (0.24%) of 4568 patients taking selegiline with an antidepressant and only 2 (0.04%) of these were deemed to be serious.2 It is