Serotonin Syndrome With Concomitant Antidepressant and Tramadol: A Case Report

Serotonin syndrome (SS) is a potentially life-threatening condition that results from the excess of serotonergic activity in the central nervous system. It is classically described as a triad of neuromuscular abnormalities, altered mental status, and autonomic hyperactivity; these are, most often, due to iatrogenic drug interactions or intentional overdose. This case study is about a 58-year-old woman who was being treated with venlafaxine and tramadol due to her past medical history of major depressive disorder and neuropathic pain. These symptoms appeared after a mastectomy, which was performed to treat an invasive ductal carcinoma. The sudden increase of the antidepressant medication and the interaction with another drug that inhibits serotonin reuptake (tramadol) led to tremor, hyperreflexia, diarrhea, tachycardia, hypertension, and fever, meeting Hunter's criteria for diagnosis of serotonergic syndrome. She received supportive care and diazepam, and the offending agents were removed. The signs and symptoms were reverted in less than 24 hours. An increased use of agents affecting the serotonergic system to treat different medical conditions raises the likelihood of a higher prevalence and clinical impact of SS in the future. For this reason, it is crucial to raise awareness of this condition to prevent adverse outcomes.