Citation

Muzyk AJ, Jakel RJ, Preud'homme X. Psychosomatics 2010; 51(5): 437-442.

Copyright

(Copyright © 2010, Academy of Psychosomatic Medicine, Publisher Elsevier Publishing)

DOI

10.1176/appi.psy.51.5.437

PMID

unavailable

Abstract

BACKGROUND: Serotonin syndrome is a condition resulting from an overabundance of serotonin at postsynaptic receptors. The syndrome usually responds to cyproheptadine and benzodiazepines. However, some patients do not respond to conventional treatment.

OBJECTIVE: The authors report on the history and management of a patient, a 55-year-old man, who had taken a massive overdose of paroxetine, controlled-release.

METHOD: The authors present a case report of history and treatment. Paroxetine levels were measured on Days 3 and 7 after admission, with rising values of the drug. The patient received a course of cyproheptadine and lorazepam, to which he was unresponsive, and he was transferred to the Medical Intensive Care Unit for heavy sedation.

RESULTS: The patient had initially presented with minor symptoms of serotonin syndrome, but these quickly progressed in severity, and he eventually died from resulting complications: a pulmonary embolism 9 days after admission, despite appropriate prophylaxis with enoxaparin.

CONCLUSION: The authors are the first to report on a paroxetine overdose of this magnitude, and they provide one of the few reports on a prolonged course of serotonin syndrome that was unresponsive to standard treatment. © 2010 The Academy of Psychosomatic Medicine.

Language: en

Keywords

adult; human; male; case report; suicide attempt; enoxaparin; drug overdose; article; prescription; hospital admission; amfebutamone; clinical feature; paroxetine; sedation; doxycycline; lorazepam; anamnesis; serotonin syndrome; cyproheptadine; laboratory test; deep vein thrombosis; drug dose increase; blood culture; Rocky Mountain spotted fever; urine culture