Selective Serotonin Reuptake Inhibitors

Deliberate self-poisoning with the selective serotonin reuptake inhibitors (SSRIs) antidepressants is common and usually follows a benign course. Serotonin toxicity develops in a small minority. Among the SSRIs, citalopram and escitalopram appear to be unique in their ability to cause dose-dependent QT interval prolongation.

References

• Isbister GK, Bowe SJ, Dawson A et al. Relative toxicity of selective serotonin reuptake inhibitors (SSRIs) in overdose. Clinical Toxicology 2004; 42(3): 277-285.
• Isbister GK, Friberg LE, Duffull SB. Application of pharmacokinetic-pharmacodynamic modelling in the management of QT abnormalities after citalopram overdose. Intensive Care Medicine 2006; 32(7):1060-1065.
• Van Gorp F, Whyte IM, Isbister GK.  Clinical and ECG effects of escitalopram overdose.  Annals of Emergency Medicine 2009: 54(3): 404-408.
• Jimmink A, Caminada K, Hunfeld NG et al.  Clinical Toxicology of citalopram after acute intoxication with the osle drug or in combination with other drugs: overview of 26 cases.  Therapeutic Drug Monitoring 2008; 30(3):365-71.
• Hayes BD, Klein-Schwartz, Clark RF et al.  Comparison of toxicity of acute overdose with citalopram and escitalopram.  Journnal of Emergency Medicine 2008; Dec 10 (Epub ahead of print).
• Isbister GK, Friberg LE, Stokes B et al.  Activated charcoal decreases QT prlongation after citalopram overdose.  Annals of Emergency Medicine 2008; 52(1):86-87.