Bupropion induced serotonin syndrome: a case report

Area of Science:

• Neuroscience
• Clinical Toxicology
• Pharmacology

Background:

• Serotonin syndrome (SS) is a potentially life-threatening condition associated with excessive serotonergic activity.
• Bupropion is an antidepressant known to affect neurotransmitter levels, including serotonin.

Observation:

• A 15-year-old male presented with hallucinations, tonic-clonic activity, confusion, and agitation.
• Physical examination revealed tachycardia, hypertension, mydriasis, and lower extremity rigidity with hyperreflexia and clonus.
• Toxicology screening confirmed bupropion and naproxen, with significantly elevated serum bupropion and hydroxybupropion levels.

Findings:

• This case presents a potential instance of serotonin syndrome secondary to bupropion ingestion alone, despite no prior documented cases.
• Elevated serum levels of bupropion and its metabolite hydroxybupropion were observed, exceeding therapeutic ranges.
• The patient's symptoms resolved within 24 hours of admission and supportive care.

Implications:

• This case underscores the potential for bupropion, even when ingested alone, to contribute to serotonin syndrome.
• Clinicians should maintain a high index of suspicion for SS in patients presenting with relevant symptoms after bupropion exposure.
• Further research is warranted to fully elucidate the risk and mechanisms of bupropion-induced serotonin syndrome.