Serotonin Syndrome Precipitated by Escitalopram

Abstract

Depression is characterized by symptoms like sad mood, loss of interest and pleasure, low energy, worthlessness, guilt, psychomotor retardation or agitation, change in appetite and/or sleep and suicidal thoughts, etc. It may be a unipolar or a bipolar cyclic disorder in which cycles of mood swings from mania to depression occur over time. Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Citalopram and Escitalopram are the various SSRIs( Selective Serotonin Reuptake Inhibitors) preferred as first line of drug in such conditions. Among the SSRIs, Escitalopram exerts a highly selective, potent, and dose-dependent inhibitory effect on the human serotonin transport. By inhibiting the reuptake of serotonin into presynaptic nerve endings, this drug enhances the activity of serotonin in the central nervous system. Herein we report a case of a 82 year old male who presented with altered sensorium, tachycardia, hypertension and restlessness to emergency department of our hospital. Patient was known case of Adjustment disorder with Depressed mood and was on treatment with Tablet Escitalopram 10 mg OD and Tablet Zolpidem 10 mg OD since 1 month. Patient overdosed himself with 4 Escitalopram tablets of 10 mg. He presented with features similar to serotonin syndrome.