Reversible Cerebral Vasoconstriction Syndrome Associated With Fluoxetine

Area of Science:

• Neurology
• Pharmacology
• Psychiatry

Background:

• Reversible cerebral vasoconstriction syndrome (RCVS) is a neurological condition characterized by severe headaches and temporary narrowing of brain arteries.
• RCVS can lead to cerebral ischemia, and its association with serotonergic medications is increasingly recognized.

Observation:

• A literature review and case report highlight RCVS in patients using selective serotonin reuptuptake inhibitors (SSRIs) and other serotonergic drugs.
• A 32-year-old woman experienced progressive cerebral ischemia, which resolved only after discontinuing fluoxetine, a commonly prescribed SSRI.

Findings:

• A review identified 15 patients with RCVS associated with serotonergic medication use across 10 case reports (2002-2019).
• Fluoxetine was identified as a potential iatrogenic cause of RCVS in a patient with a complex psychiatric history.

Implications:

• Psychiatrists must be aware of RCVS as a potential, albeit rare, complication of prescribing SSRIs and other serotonergic agents.
• Identifying alternative, safe psychiatric treatments is essential for patients with RCVS who require such medications.