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Delirium during fluoxetine treatment. A case report
E Leinonen1, H Koponen, U Lepola
1Psychiatric Research Clinic of Kuopio, Finland.
Summary
High serum concentrations of selective serotonin reuptake inhibitors (SSRIs) are rarely linked to severe cognitive effects. This case report details a patient experiencing acute hyperkinetic delirium associated with elevated fluoxetine levels.
Area of Science:
- Neuroscience
- Clinical Pharmacology
- Psychiatry
Background:
- Tricyclic antidepressant (TCA) serum concentrations correlate with central nervous system (CNS) side effects.
- Limited data exist on the relationship between serum concentrations of selective serotonin reuptake inhibitors (SSRIs) and their toxicity.
- High citalopram levels (> 600 nmol/L) in elderly patients have been linked to somnolence and movement difficulties.
Observation:
- A patient presented with acute hyperkinetic delirium.
- This condition was observed in conjunction with a high serum total fluoxetine concentration.
Findings:
- This is the first report linking widespread cognitive disorders, specifically delirium, to high serum SSRI levels.
- The patient's delirium was directly connected to elevated fluoxetine (fluoxetine plus desmethylfluoxetine) levels.
Implications:
- Clinicians should consider monitoring serum SSRI levels in patients presenting with unexplained cognitive disturbances.
- This finding may necessitate a re-evaluation of the neurotoxic potential of SSRIs at high concentrations.
- Further research is warranted to explore the association between SSRI serum levels and cognitive side effects.