Selective Serotonin Reuptake Inhibitor Toxicity Differential Diagnoses

  • Author: Tracy A Cushing, MD, MPH, FACEP, FAWM; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Apr 19, 2012
 
 

Diagnostic Considerations

Conditions to consider in the differential diagnosis of serotonin toxicity include the following:

  • Malignant hyperthermia
  • Delirium tremens
  • Anticholinergic toxicity
  • Antidepressant toxicity
  • Antihistamine toxicity
  • Carbamazepine toxicity
  • Cocaine toxicity
  • MDMA toxicity
  • Methamphetamine toxicity
  • MAOI toxicity
  • Neuroleptic agent toxicity
  • Phencyclidine toxicity
  • Sympathomimetic toxicity

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Tracy A Cushing, MD, MPH, FACEP, FAWM  Assistant Professor, Department of Emergency Medicine, University of Colorado School of Medicine; Attending Physician, Denver Health Medical Center

Tracy A Cushing, MD, MPH, FACEP, FAWM is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Theodore I Benzer, MD, PhD  Assistant Professor in Medicine, Harvard Medical School; Director of Clinical Operations, Director of Toxicology, Chair of Quality and Safety, Department of Emergency Medicine, Massachusetts General Hospital

Theodore I Benzer, MD, PhD is a member of the following medical societies: Alpha Omega Alpha and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Additional Contributors

John G Benitez, MD, MPH Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center; Managing Director, Tennessee Poison Center

John G Benitez, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT Associate Clinical Professor, Department of Surgery/Emergency Medicine and Toxicology, University of Texas School of Medicine at San Antonio; Medical and Managing Director, South Texas Poison Center

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

  1. Sternbach H. The serotonin syndrome. Am J Psychiatry. Jun 1991;148(6):705-13. [Medline].

  2. Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. Mar 17 2005;352(11):1112-20. [Medline].

  3. Olfson M, Marcus SC, Druss B, Elinson L, Tanielian T, Pincus HA. National trends in the outpatient treatment of depression. JAMA. Jan 9 2002;287(2):203-9. [Medline].

  4. Pirraglia PA, Stafford RS, Singer DE. Trends in Prescribing of Selective Serotonin Reuptake Inhibitors and Other Newer Antidepressant Agents in Adult Primary Care. Prim Care Companion J Clin Psychiatry. Aug 2003;5(4):153-157. [Medline].

  5. Lawrence KR, Adra M, Gillman PK. Serotonin toxicity associated with the use of linezolid: a review of postmarketing data. Clin Infect Dis. Jun 1 2006;42(11):1578-83. [Medline].

  6. Kaplan H, Sadock B. Serotonin-specific reuptake inhibitors. In: Synopsis of Psychiatry. 8th ed. Williams and Wilkins; 1988:1083-92.

  7. Hirsch M, Birnbaum R. Pharmacology of Antidepressants. UpToDate [serial online]. 2004;v 11.3..

  8. Lane R, Baldwin D. Selective serotonin reuptake inhibitor-induced serotonin syndrome: review. J Clin Psychopharmacol. Jun 1997;17(3):208-21. [Medline].

  9. Flanagan RJ. Fatal toxicity of drugs used in psychiatry. Hum Psychopharmacol. Jan 2008;23 Suppl 1:43-51. [Medline].

  10. Gillman PK. The serotonin syndrome and its treatment. J Psychopharmacol. 1999;13(1):100-9. [Medline].

  11. Birmes P, Coppin D, Schmitt L, Lauque D. Serotonin syndrome: a brief review. CMAJ. May 27 2003;168(11):1439-42. [Medline].

  12. Ener RA, Meglathery SB, Van Decker WA, Gallagher RM. Serotonin syndrome and other serotonergic disorders. Pain Med. Mar 2003;4(1):63-74. [Medline].

  13. Mason PJ, Morris VA, Balcezak TJ. Serotonin syndrome. Presentation of 2 cases and review of the literature. Medicine (Baltimore). Jul 2000;79(4):201-9. [Medline].

  14. Isbister GK, Bowe SJ, Dawson A, Whyte IM. Relative toxicity of selective serotonin reuptake inhibitors (SSRIs) in overdose. J Toxicol Clin Toxicol. 2004;42(3):277-85. [Medline].

  15. US Food and Drug Administration. Celexa (citalopram hydrobromide): Drug Safety Communication – Abnormal Heart Rhythms Associated With High Doses. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm269481.htm. Accessed August 24, 2011.

  16. Celexa (citalopram hydrobromide) [package insert]. St. Louis, Missouri: Forest Pharmaceuticals, Inc; August, 2011. [Full Text].

  17. Targownik LE, Bolton JM, Metge CJ, Leung S, Sareen J. Selective serotonin reuptake inhibitors are associated with a modest increase in the risk of upper gastrointestinal bleeding. Am J Gastroenterol. Jun 2009;104(6):1475-82. [Medline].

  18. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Giffin SL. 2009 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th Annual Report. Clin Toxicol (Phila). Dec 2010;48(10):979-1178. [Medline].

  19. Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM. Sep 2003;96(9):635-42. [Medline].

  20. Chechani V. Serotonin syndrome presenting as hypotonic coma and apnea: potentially fatal complications of selective serotonin receptor inhibitor therapy. Crit Care Med. Feb 2002;30(2):473-6. [Medline].

  21. [Guideline] Nelson LS, Erdman AR, Booze LL, Cobaugh DJ, Chyka PA, Woolf AD, et al. Selective serotonin reuptake inhibitor poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). May 2007;45(4):315-32. [Medline].

  22. Evans CE, Sebastian J. Serotonin syndrome. Emerg Med J. Apr 2007;24(4):e20. [Medline].

  23. Marx J, Hockberger R, Walls R. Rosen's Emergency Medicine. 5th ed. CV Mosby; 2002:2087-2103.

  24. Carbone JR. The neuroleptic malignant and serotonin syndromes. Emerg Med Clin North Am. May 2000;18(2):317-25, x. [Medline].

  25. Isbister GK, Buckley NA, Whyte IM. Serotonin toxicity: a practical approach to diagnosis and treatment. Med J Aust. Sep 17 2007;187(6):361-5. [Medline].

  26. Mills KC. Serotonin syndrome. Am Fam Physician. Oct 1995;52(5):1475-82. [Medline].

 
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