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Vasovagal syncope is believed to be due to poor vasomotor regulation by some combination of neurotransmitters, including serotonin. This trial tested whether paroxetine, a selective serotonin reuptake inhibitor better known for its antidepressant effects, would prevent vasovagal syncope.
Sixty-eight patients with recurrent syncope and a positive tilt table test were randomized to receive paroxetine (20 mg) or a placebo daily. All patients had been unresponsive to beta-blockers and other conventional therapies. After one month of treatment, repeat tilt table testing was negative in 62 percent of the paroxetine group, versus 38 percent of the placebo group. During two years of follow-up, spontaneous syncope occurred in 18 percent of the paroxe…