Repetition of serotonin syndrome after reexposure to SSRI--a case report

We describe here the occurrence of a serotonin syndrome (SS) in a 64-year-old depressed female patient with alcoholic hepatic cirrhosis after treatment with SSRIs. Two weeks after the increase of the dosage of sertraline, the patient developed a full-blown SS, which resolved completely after the discontinuation of the drug. The therapy with citalopram led again to development of milder SS, this time immediately after the increase of the dosage. Our case illustrates the variability of the clinical presentation and the temporal evolution of SS in a patient with preexisting medical illness affecting hepatic metabolism. Reexposure of patients with a history of SS to another serotoninergic drug should be avoided; if necessary, it must be carried out with the utmost caution.