Serotonin Syndrome in an Adolescent Following Overdose of Escitalopram and Lithium: A Case Report

Abstract

Abstract In routine clinical practice, some patients consume overdose of more than one medication, that makes it difficult to identify the toxic syndrome. In this report, we present the case of a 16-year female who was brought to the emergency with an alleged account of an overdose of tablet lithium and tablet escitalopram. A 16-year female, suffering from depression for about 4-months, and was on treatment consumed approximately 3000 mg of lithium and 150 mg of escitalopram with the intention to die. At presentation (after 12 h of the overdose), her Glasgow Coma Scale score was E3V1M6, her blood pressure was 70/50 mm Hg, her pulse rate was 84 beats/min, her respiratory rate was 24 breaths/min, and she was afebrile. On physical examination, she was found to have diaphoresis, mydriasis, ocular clonus, patellar clonus, ankle clonus, hyperreflexia, rigidity, increased bowel sound, and whole-body tremulousness. On mental state examination she was found to be delirious to stuporous. In view of the toxicity, initially a diagnosis of serotonin syndrome and lithium toxicity was considered. Considering the availability of antidote, it was decided to manage the patient first in the line of serotonin syndrome. She should dramatic improvement with cyproheptadine and stabilized in 48 h. Her lithium levels also normalized with supportive management during the same time frame. The index case highlights the fact that when a patient presents with toxicity of more than one psychotropic, with antidepressants being one of them, SS should always be suspected and managed rapidly with the antidote.