Comparison of clinicodemographic characteristics in patients with selective serotonin reuptake inhibitors poisoning: A cross-sectional study

Abstract

BACKGROUND: Our objective of this study was to evaluate patients of Selective Serotonin Reuptake Inhibitors (SSRIs) overdose and compare the toxicological effects of citalopram overdose with other SSRIs in adult poisoning cases. METHODS: This cross-sectional study focused on acute, known-type SSRI ingestions. Demographic and toxicological data were collected on the patients. The outcomes analyzed were length of hospital stay, coma, seizures, electrocardiographic abnormalities, abnormal heart examination, and the presence of serotonin syndrome. RESULTS: There were a total of 199 cases, with 165 (82.9) being women. The majority of cases (n = 76, 38.2) were attributed to citalopram, followed by sertraline (n = 67, 33.7), fluoxetine (n = 33, 16.6), fluvoxamine (n = 10, 5), escitalopram (n = 6, 3), paroxetine (n = 1, 0.5), and mixed (n = 6, 3). The most common symptoms were nausea and vomiting (n = 96, 48.2). Most patients (58.3) were conscious, with only 7 patients (3.5) experiencing seizures. Among those with seizures, six patients had taken citalopram, with 50 of them ingesting 400 mg of citalopram. Tachycardia was observed in 62 (31.2) patients, while no QT interval prolongation, PR interval changes, or arrhythmias were reported. Serotonin toxicity was noted in only 6 patients (3), with 4 of them being poisoned with citalopram. The incidence of seizures with citalopram was significantly higher than with other SSRIs (odds ratio (OR) = 10.457; 1.6-2.88, P = 0.008), while nausea and vomiting were significantly more common in poisoning cases involving other SSRIs (OR = 0.51; 0.2-0.9, P = 0.02). There were no reported deaths. CONCLUSION: Ingesting SSRIs results in minimal toxicity. However, seizures are more likely to occur with citalopram compared to other SSRIs.