Serotonin syndrome caused by a CYP2C19-mediated interaction between low-dose escitalopram and clopidogrel: a case report
BackgroundSerotonin syndrome has been recognized as a serious adverse reaction to antidepressants and is characterized by sudden or severe autonomic nerve dysfunction and neuromuscular symptoms. Without an accurate diagnosis and prompt treatment, serotonin syndrome progresses rapidly and can be life...
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| Format: | Article |
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Psychiatry |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1257984/full |
| _version_ | 1827795613379461120 |
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| author | Jianhong Wu Jianhong Wu Jiao Yu Jiao Yu Kankan Qu Kankan Qu Jiajun Yin Jiajun Yin Chunming Zhu Chunming Zhu Xiaowei Liu Xiaowei Liu |
| author_facet | Jianhong Wu Jianhong Wu Jiao Yu Jiao Yu Kankan Qu Kankan Qu Jiajun Yin Jiajun Yin Chunming Zhu Chunming Zhu Xiaowei Liu Xiaowei Liu |
| author_sort | Jianhong Wu |
| collection | DOAJ |
| description | BackgroundSerotonin syndrome has been recognized as a serious adverse reaction to antidepressants and is characterized by sudden or severe autonomic nerve dysfunction and neuromuscular symptoms. Without an accurate diagnosis and prompt treatment, serotonin syndrome progresses rapidly and can be life-threatening. It is usually related to the dose of 5-hydroxytryptamine drugs, and the dose is the basis for diagnosis. Therefore, serotonin syndrome induced by low-dose antidepressants rarely occurs, and clinicians are more likely to misdiagnose patients who take low-dose antidepressants with similar symptoms. Here, we present a case study of serotonin syndrome caused by a relatively low dose of escitalopram, which is not common in past references.Case summaryThe patient was a 74-year-old Asian woman with a 42-year history of schizophrenia. After 6 weeks of antidepressant treatment, our patient presented with characteristic myoclonus in the lower limbs and closed eyes with fluttering. Initially, she was misdiagnosed with neuroleptic malignant syndrome (NMS) due to antipsychotic medication and was treated accordingly, even with discontinuation of clozapine. However, her symptoms persisted, and then therapeutic drug monitoring was initiated with the involvement of a clinical pharmacist. Eventually, she was diagnosed with serotonin syndrome due to escitalopram levels reaching the warning level. Subsequently, the patient’s treatment was modified, and her clinical outcome was satisfactory without any other serious adverse reactions. Gene detection was also performed, and a cytochrome P450 enzyme (CYP) 2C19-mediated interaction between low-dose escitalopram and clopidogrel seems to be a possible mechanism.ConclusionData on this is extremely scarce, and to the best of our knowledge, serotonin syndrome caused by low-dose antidepressants has not yet been discussed to any great extent in the literature. Our case provides more clinical experience in the treatment of serotonin syndrome. |
| first_indexed | 2024-03-11T18:52:57Z |
| format | Article |
| id | doaj.art-c367d174a9d74c5485c7d44d027efd10 |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-03-11T18:52:57Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-c367d174a9d74c5485c7d44d027efd102023-10-11T07:55:14ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402023-10-011410.3389/fpsyt.2023.12579841257984Serotonin syndrome caused by a CYP2C19-mediated interaction between low-dose escitalopram and clopidogrel: a case reportJianhong Wu0Jianhong Wu1Jiao Yu2Jiao Yu3Kankan Qu4Kankan Qu5Jiajun Yin6Jiajun Yin7Chunming Zhu8Chunming Zhu9Xiaowei Liu10Xiaowei Liu11The Affiliated Mental Health Center, Jiangnan University, Wuxi, ChinaWuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, ChinaThe Affiliated Mental Health Center, Jiangnan University, Wuxi, ChinaWuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, ChinaThe Affiliated Mental Health Center, Jiangnan University, Wuxi, ChinaWuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, ChinaThe Affiliated Mental Health Center, Jiangnan University, Wuxi, ChinaWuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, ChinaThe Affiliated Mental Health Center, Jiangnan University, Wuxi, ChinaWuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, ChinaThe Affiliated Mental Health Center, Jiangnan University, Wuxi, ChinaWuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, ChinaBackgroundSerotonin syndrome has been recognized as a serious adverse reaction to antidepressants and is characterized by sudden or severe autonomic nerve dysfunction and neuromuscular symptoms. Without an accurate diagnosis and prompt treatment, serotonin syndrome progresses rapidly and can be life-threatening. It is usually related to the dose of 5-hydroxytryptamine drugs, and the dose is the basis for diagnosis. Therefore, serotonin syndrome induced by low-dose antidepressants rarely occurs, and clinicians are more likely to misdiagnose patients who take low-dose antidepressants with similar symptoms. Here, we present a case study of serotonin syndrome caused by a relatively low dose of escitalopram, which is not common in past references.Case summaryThe patient was a 74-year-old Asian woman with a 42-year history of schizophrenia. After 6 weeks of antidepressant treatment, our patient presented with characteristic myoclonus in the lower limbs and closed eyes with fluttering. Initially, she was misdiagnosed with neuroleptic malignant syndrome (NMS) due to antipsychotic medication and was treated accordingly, even with discontinuation of clozapine. However, her symptoms persisted, and then therapeutic drug monitoring was initiated with the involvement of a clinical pharmacist. Eventually, she was diagnosed with serotonin syndrome due to escitalopram levels reaching the warning level. Subsequently, the patient’s treatment was modified, and her clinical outcome was satisfactory without any other serious adverse reactions. Gene detection was also performed, and a cytochrome P450 enzyme (CYP) 2C19-mediated interaction between low-dose escitalopram and clopidogrel seems to be a possible mechanism.ConclusionData on this is extremely scarce, and to the best of our knowledge, serotonin syndrome caused by low-dose antidepressants has not yet been discussed to any great extent in the literature. Our case provides more clinical experience in the treatment of serotonin syndrome.https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1257984/fullserotonin syndromeCYP2C19escitalopramclopidogrelcase report |
| spellingShingle | Jianhong Wu Jianhong Wu Jiao Yu Jiao Yu Kankan Qu Kankan Qu Jiajun Yin Jiajun Yin Chunming Zhu Chunming Zhu Xiaowei Liu Xiaowei Liu Serotonin syndrome caused by a CYP2C19-mediated interaction between low-dose escitalopram and clopidogrel: a case report Frontiers in Psychiatry serotonin syndrome CYP2C19 escitalopram clopidogrel case report |
| title | Serotonin syndrome caused by a CYP2C19-mediated interaction between low-dose escitalopram and clopidogrel: a case report |
| title_full | Serotonin syndrome caused by a CYP2C19-mediated interaction between low-dose escitalopram and clopidogrel: a case report |
| title_fullStr | Serotonin syndrome caused by a CYP2C19-mediated interaction between low-dose escitalopram and clopidogrel: a case report |
| title_full_unstemmed | Serotonin syndrome caused by a CYP2C19-mediated interaction between low-dose escitalopram and clopidogrel: a case report |
| title_short | Serotonin syndrome caused by a CYP2C19-mediated interaction between low-dose escitalopram and clopidogrel: a case report |
| title_sort | serotonin syndrome caused by a cyp2c19 mediated interaction between low dose escitalopram and clopidogrel a case report |
| topic | serotonin syndrome CYP2C19 escitalopram clopidogrel case report |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1257984/full |
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