Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-22T08:36:08.620Z Has data issue: false hasContentIssue false
  • English
  • Français

Serotonin Syndrome Associated with the Use of Escitalopram

Published online by Cambridge University Press:  07 November 2014

Matthew T. Huska ,
Glenn Catalano  and
Maria C. Catalano
Get access Rights & Permissions [Opens in a new window]

Abstract

Escitalopram is the newest selective serotonin reuptake inhibitor (SSRI) available for use in the United States. It has been approved for the treatment of major depression and generalized anxiety disorder. It is the S-enantiomer of the SSRI citalopram and is highly serotonin specific as it has minimal effect on the reuptake of dopamine or norepinephrine. It is also a well-tolerated medication, with a side-effect profile comparable to the other SSRIs. While a number of side effects have been seen during escitalopram therapy, such as insomnia, nausea, and increased sweating, there are no reported cases of serotonin syndrome associated with escitalopram therapy to date. We present the case of a 24-year-old woman who developed serotonin syndrome after an increase in her escitalopram to 30 mg/day. We will review the diagnostic criteria of serotonin syndrome and the clinical scenarios in which serotonin syndrome can develop. We will also discuss the proposed treatments and role that polypharmacology may play in the development of this clinical entity.

Type
Case Report
Information
CNS Spectrums , Volume 12 , Issue 4 , April 2007 , pp. 270 - 274
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Burke, WJ, Gergel, I, Bose, A. Fixed-dosed trial of the single isomer SSRI escitalopram in depressed outpatients. J Clin Psychiatry. 2002;63:331–336.CrossRefGoogle Scholar
2.Physicians' Desk Reference. 60th ed. Montvale, NJ: Medical Economics Company; 2006.Google Scholar
3.Sadock, BJ, Sadock, VA. Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 9th ed. Philadelphia, Penn: Lippincott Williams & Wilkins; 2003.Google Scholar
4.Mosby's Drug Consult. 15th ed. St. Louis, MO: Mosby, Inc.; 2005.Google Scholar
5.Nirmalani, A, Stock, SL, Catalano, G. Syndrome of inappropriate antidiuretic hormone associated with escitalopram therapy. CNS Spectr. 2006;11:429–432.CrossRefGoogle ScholarPubMed
6.Zelefsky, JR, Fine, HF, Rubenstein, VJ, Hsu, IS, Finger PT. Escitalopram-induced uveal effusions and bilateral angle closure glaucoma. Am J Ophthalmol. 2006;141:1144–1147.CrossRefGoogle ScholarPubMed
7.Ozalp, E, Soygur, H, Cankurtaran, ES, et al.Sertraline, escitalopram and tianeptine related abnormal movements but not with bupropion: a case report. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30:1337–1339.CrossRefGoogle Scholar
8.Saper, CB. Brain stem modulation of sensation, movement, and consciousness. In: Kandel, ER, Schwartz, JH, Jessell, TM, eds. Principles of Neural Science. 4th ed. New York, NY: McGraw-Hill; 2000:889–909.Google Scholar
9.Boyer, EW, Shannon, M. The serotonin syndrome. N Engl J Med. 2005;352:1112–1120.CrossRefGoogle ScholarPubMed
10.Isbister, GK. Comment: serotonin syndrome, mydriasis, and cyproheptadine. Ann Pharmacother. 2001;35:1672–1673.CrossRefGoogle ScholarPubMed
11.Isbister, GK, Whyte, IM. Serotonin toxicity and malignant hyperthermia: role of 5-HT2 receptors. Br J Anaesth. 2002;88:603–604.Google Scholar
12.Nisijima, K, Shioda, K, Yoshino, T, Takano, K, Kato, S. Memantine, an NMDA antagonist, prevents the development of hyperthermia in an animal model for serotonin syndrome. Pharmacopsychiatry. 2004;37:57–62.Google Scholar
13.Nisijima, K, Yoshino, T, Yui, K, Katoh, S. Potent serotonin (5-HT)(2A) receptor antagonists completely prevent the development of hyperthermia in an animal model of the 5-HT syndrome. Brain Res. 2001;890:23–31.CrossRefGoogle Scholar
14.Van Oekelen, D, Megens, A, Meert, T, Luyten, WH, Leysen, JE. Functional study of rat 5-HT2A receptors using antisense oligonucleotides. J Neurochem. 2003;85:1087–1100.CrossRefGoogle ScholarPubMed
15.Demirkiran, M, Jankivic, J, Dean, JM. Ecstasy intoxication: an overlap between serotonin syndrome and neuroleptic malignant syndrome. Clin Neuropharmacol. 1996;19:157–164.CrossRefGoogle ScholarPubMed
16.Done, CJ, Sharp, T. Biochemical evidence for the regulation of central noradrenergic activity by 5-HT1A and 5-HT2 receptors: microdialysis studies in the awake and anaesthetized rat. Neuropharmacology. 1994;33:411–421.CrossRefGoogle ScholarPubMed
17.Fink, M. Toxic serotonin syndrome or neuroleptic malignant syndrome? Pharmacopsychiatry. 1996;29:159–161.CrossRefGoogle ScholarPubMed
18.Kline, SS, Mauro, LS, Scala-Barnett, DM, Zick, D. Serotonin syndrome versus neuroleptic malignant syndrome as a cause of death. Clin Pharm. 1989;8:510–514.Google ScholarPubMed
19.Nisijima, K, Shioda, K, Yoshino, T, Takano, K, Kato, S. Diazepam and chlormethiazole attenuate the development of hyperthermia in an animal model of the serotonin syndrome. Neurochem Int. 2003;43:155–164.CrossRefGoogle Scholar
20.Mann, SC, Caroff, SN, Keck, PE, Lazarus, A. Neuroleptic Malignant Syndrome and Related Conditions. 2nd ed. Washington, DC: American Psychiatric Publishing, Inc; 2003.Google Scholar
21.Sternbach, H. The serotonin syndrome. Am J Psychiatry. 1991;148:705–713.Google ScholarPubMed
22.Birmes, P, Coppin, D, Schmitt, L, et al.Serotonin syndrome: a brief review. CMAJ. 2003;168:1439–1442.Google ScholarPubMed
23.Smith, B, Prochop, DJ. Central-nervous-system effects of ingestin of L-tryptophan by normal subjects. N Engl J Med. 1962;267:1338–1341.CrossRefGoogle Scholar
24.Curzon, G, Ettlinger, G, Cole, M, et al.The biochemical, behavioral and neurologic effects of high L-tryptophan intake in the rhesus monkey. Neurology. 1963;12:431–438.CrossRefGoogle Scholar
25.Oates, JA, Sjoerdsma, A. Neurologic effects of tryptophan in patients receiving a monoamine oxidase inhibitor. Neurology. 1960;10:1076–1078.CrossRefGoogle ScholarPubMed
26.Beaumont, G. Drug interactions with clomipramine (Anafranil). J Int Med Res. 1973;1:480–484.CrossRefGoogle Scholar
27.White, K, Simpson, G. Combined MAOI-tricyclic antidepressant treatment: a reevaluation. J Clin Psychopharmacol. 1981;1:264–281.CrossRefGoogle ScholarPubMed
28.Kinzie, E, Meltzer-Brody, S. Possible serotonin syndrome with citalopram following cross-titration of clozapine to ziprasidone. Gen Hosp Psychiatry. 2005;27:223–224.CrossRefGoogle ScholarPubMed
29.Marlowe, K, Schirgel, D. Quetiapine and citalopram: aetiological significance in serotonin syndrome. N Z Med J. 2006;119:1237.Google ScholarPubMed
30.Bernard, L, Stern, R, Lew, D, Hoffmeyer, P. Serotonin syndrome after concomitant treatment with linezolid and citalopram. Clin Infect Dis. 2003;36:1197.CrossRefGoogle ScholarPubMed
31.Debellis, RJ, Schaefer, OP, Liquori, M, Volturo, GA. Linezolid associated serotonin syndrome after concomitant treatment with citalopram and mirtazepine in a critically ill bone marrow transplant recipient. J Intensive Care Med. 2005;20:351–353.CrossRefGoogle Scholar
32.Tahir, N. Serotonin syndrome as a consequence of drug-resistant infections: an interaction between linezolid and citalopram. J Am Med Dir Assoc. 2004;5:111–113.CrossRefGoogle ScholarPubMed
33.Dams, R, Benjits, TH, Lambert, WE, et al.A fatal case of serotonin syndrome after combined moclobemide-citalopram intoxication. J Anal Toxicol. 2001;25:147–151.CrossRefGoogle ScholarPubMed
34.Isbister, GK, McGettigan, P, Dawson, A. A fatal case of moclobemide-citalopram intoxication. J Anal Toxicol. 2001;25:716–717.CrossRefGoogle ScholarPubMed
35.Voirol, P, Hodel, PF, Zullino, D, Baumann, P. Serotonin syndrome after small doses of citalopram or sertraline. J Clin Psychopharmacol. 2000;20:713–714.CrossRefGoogle ScholarPubMed
36.Mahlberg, R, Kunz, D, Sasse, J, Kirchheiner, J. Serotonin syndrome with tramadol and citalopram. Am J Psychiatry. 2004;161:1129.CrossRefGoogle ScholarPubMed
37.Gillman, PK. The serotonin syndrome and its treatment. J Psychopharmacol. 1999;13:100–109.CrossRefGoogle ScholarPubMed