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Serotonin Syndrome in Elderly Patients Treated for Psychotic Depression with Atypical Antipsychotics and Antidepressants: Two Case Reports

Published online by Cambridge University Press:  07 November 2014

Izchak Kohen ,
Marc L. Gordon  and
Peter Manu
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Abstract

We report two cases of serotonin syndrome in elderly patients during treatment of psychotic depression with atypical antipsychotics and antidepressants. The first case is a 69-year-old man who was admitted for depression with psychosis and treated with trazodone, risperidone, and sertraline. Subsequently, he developed myoclonus, tremor, cogwheel rigidity, and diaphoresis. The second case is a 72-year-old female initially admitted to a medical inpatient unit for a change in mental status that presented as increased confusion, lethargy, slurred speech, and a fever of 101.5°. She had been on phenelzine and quetiapine. In both cases, all symptoms resolved within 24 hours of the psychotropics being stopped. In both cases, we believe that serotonin syndrome was produced by a combination of an antidepressant and an atypical antipsychotic. There have been several case reports of serotonin syndrome from similar combinations of antidepressant and atypical antipsychotic treatment. Clinicians treating elderly patients with a combination of serotonergic antidepressants and atypical antipsychotics for psychotic depression should be aware of the potential for serotonin syndrome.

Type
Case Report
Information
CNS Spectrums , Volume 12 , Issue 8 , August 2007 , pp. 596 - 598
Copyright
Copyright © Cambridge University Press 2007

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References

REFERENCES

1.Boyer, EW, Shannon, M. The serotonin syndrome. N Engl J Med. 2005;352:1112–1120.CrossRefGoogle ScholarPubMed
2.Karki, SD, Masood, GR. Combination risperidone and SSRI-induced serotonin syndrome. Ann Pharmacother. 2003;37:388–391.CrossRefGoogle ScholarPubMed
3.Bodner, RA, Lynch, T, Lewis, L, Kahn, D. Serotonin syndrome. Neurology. 1995;45:219–223.CrossRefGoogle ScholarPubMed
4.Reeves, RR, Mack, EJ, Beddingfield, JJ. Neurotoxic syndrome associated with risperidone and fluvoxamine. Ann Pharmacother 2002;36:440–443.CrossRefGoogle ScholarPubMed
5.Hamilton, S, Malone, K. Serotonin syndrome during treatment with paroxetine and risperidone. J Clin Psychopharmacol. 2000;20:103–105.CrossRefGoogle ScholarPubMed
6.Marlowe, K, Schrigel, D. Quetiapine and citalopram: aetological significances in serotonin syndrome. N Z Med J. 2006;119:U2058.Google Scholar
7.Vena, J, Dufel, S, Paige, T. Acute olanzapine-induced akathisia and dystonia in a patient discontinued from fluoxetine. J Emerg Med. 2006;30:311–317.CrossRefGoogle Scholar
8.Kinzie, E, Meltzer-Brody, S. Possible seroronin syndrome with citalopram following crosstitration of clozapine to ziprasidone. Gen Hosp Psychiatry. 2005;27:223–224.CrossRefGoogle Scholar
9.Haslett, CD, Kumar, S. Can olanzapine be implicated in causing serotonin syndrome? Psychiatry Clin Neurosci. 2002;56:533–535.CrossRefGoogle ScholarPubMed
10.Duggal, HS, Fetchko, J. Serotonin syndrome and atypical antipsychotics. Am J Psychiatry. 2002;159:672–673.CrossRefGoogle ScholarPubMed
11.Alvarez-Pérez, FJ, Roca, M, et al.Serotonin syndrome: report of two cases and review of the literature [Spanish]. Rev Neurol. 2005;40:159–162.Google ScholarPubMed
12.Radomski, JW, Dursun, SM, Reveley, MA, Kutcher, SP. An exploratory approach to the serotonin syndrome: an update of clinical phenomenology and revised diagnostic criteria. Med Hypotheses. 2000;55:218–224.CrossRefGoogle Scholar
13.Sternbach, H. The serotonin syndrome. Am J Psychiatry. 1991;146:705–713.Google Scholar
14.Berry, LL, Segal, R, Sherrin, TP, Fudge, KA. Sensitivity and specificity of three methods of detecting adverse drug reactions. Am J Hosp Pharm. 1988;45:1534–1539.Google ScholarPubMed