Clinical toxicity and management of selective serotonin reuptake inhibitor (SSRI) poisoning: a comprehensive review

Abstract

Introduction: Selective Serotonin Reuptake Inhibitors (SSRIs) are widely prescribed. With the global rise in SSRI prescriptions, the incidence of overdose has increased. SSRI overdose can result in severe toxicity, including serotonin syndrome, seizures, and QT interval prolongation. This review summarizes the clinical features, management, and outcomes associated with SSRI poisoning. Methods: A narrative review was conducted using a structured search in PubMed, Web of Science, Embase, and Scopus through January 2025. Fifteen studies, including case reports and cohort studies, were identified. The results of SSRI exposure, clinical symptoms (cardiac, neurologic), treatment, and outcome are summarized. Results: SSRI overdose most commonly results in mild symptoms, such as nausea, vomiting, and drowsiness. Serious complications are less frequent and include serotonin syndrome (up to 19.3), seizures (1–8), and QT prolongation (3–50.5), particularly following citalopram overdose. Management is primarily supportive, with activated charcoal and benzodiazepines used when indicated. Intensive care unit admission (2.3–11.4) and mortality (<0.1) are uncommon, and most patients recover within 24 h. Discussion: Among SSRIs, citalopram is associated with a higher risk of severe neurological and cardiac complications. Variability in diagnostic criteria and dose reporting across studies limits direct comparisons and highlights the need for standardized reporting. Conclusion: SSRI poisoning is generally associated with favorable outcomes; however, continuous monitoring is essential for early detection of serious complications. Clinicians should remain vigilant for neurological and cardiac toxicity, particularly in citalopram overdose, where electrocardiographic monitoring is crucial for identifying QTc prolongation. © 2026 The Authors. Published by Elsevier Ltd on behalf of International Society for the Study of Emerging Drugs. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/