Serotonin Syndrome Associated With Clozapine Withdrawal
Abstract
IMPORTANCE: We describe a case of serotonin syndrome secondary to clozapine withdrawal and concomitant use of citalopram hydrobromide, a phenomenon that has been rarely reported. OBSERVATIONS: This is a case report of a 47-year-old woman admitted to an academic medical center intensive care unit with coma, hypersalivation, hyperreflexia, and stimulus-induced clonus. The patient received a diagnosis of serotonin syndrome attributed to abrupt clozapine withdrawal with concomitant use of citalopram. She improved only minimally with supportive treatment (intravenous fluids, benzodiazapines, and withdrawal of selective serotonin-reuptake inhibitor) and received cyproheptadine hydrochloride on her third day of symptoms. Four hours after she received the loading dose of cyproheptadine, she was alert and oriented and at her baseline mental status, although some clonus remained. CONCLUSIONS AND RELEVANCE: Serotonin syndrome can result from the abrupt withdrawal of a 5-hydroxytryptamine receptor 2A antagonist from a treatment regimen that also includes a medication that increases serotonin availability.
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Stopping clozapine due to complications such as agranulocytosis or myocarditis not uncommonly results in rebound psychosis.
“This is not uncommon when stopping clozapine as a result of complications such as agranulocytosis or myocarditis.4”
From Stopping and switching antipsychotic drugs (2019) · cites this paper as [4]
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References 12 · Cited by 39
- Authors
- Stevenson, E., Schembri, F., Green, D. M., & Burns, J. D.
- Affiliations
- Boston University (US)
- Boston Medical Center (US)
- Venue
- JAMA Neurology
- Publisher
- American Medical Association (AMA)
- Published
- 2013-08-01
- Volume
- 70
- Issue
- 8
- Pages
- 1054
- ISSN
- 2168-6149 (ISSN-L)
- OpenAlex
- W2007529171
- Cited by
- 39
- References
- 12
- Citations by year
- 2026: 2 · 2024: 5 · 2023: 4 · 2022: 2 · 2021: 2 · 2020: 7 · 2019: 3 · 2018: 1 · 2017: 3 · 2016: 3 · 2015: 3 · 2014: 3 · 2013: 1
- FWCI
- 2.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA Neurology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Keywords
- serotonin syndrome, clozapine withdrawal, citalopram, selective serotonin reuptake inhibitors, cyproheptadine, 5-HT2A receptor antagonist, drug interactions, coma, clonus, hyperreflexia, hypersalivation
- MeSH terms
- Benzodiazepines, Clozapine, Cyproheptadine, Female, Humans, Middle Aged, Serotonin Antagonists, Substance Withdrawal Syndrome, Citalopram, Selective Serotonin Reuptake Inhibitors, Serotonin Syndrome
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