Serotonin syndrome from sertraline monotherapy

Area of Science:

• Pharmacology
• Clinical Toxicology

Background:

• Serotonin syndrome (SS) is a potentially fatal adverse drug reaction.
• Selective serotonin reuptake inhibitors (SSRIs) are common culprits, though SS from SSRI monotherapy is infrequent.

Observation:

• A 36-year-old male presented with autonomic and neuromuscular symptoms.
• He was on a therapeutic dose of sertraline for less than three months.
• Symptoms included hyperreflexia and inducible ankle clonus, leading to a diagnosis of moderate SS via Hunter criteria.

Findings:

• The patient's symptoms resolved within 24 hours after treatment with lorazepam, IV fluids, and sertraline discontinuation.
• This case demonstrates probable sertraline-induced SS.

Implications:

• Emergency departments must maintain a high index of suspicion for SS.
• Clinical awareness is crucial even with SSRI monotherapy at therapeutic doses.