Resident Physician Inspira Medical Center, United States
Introduction: Serotonin reuptake inhibitors (SSRIs) are the drug of choice for the treatment of various psychological disorders, primarily due to their low side effect profile. It is essential to remain vigilant about adverse reactions associated with these medications. Ogilvie Syndrome, also known as acute colonic pseudo-obstruction, is a rare but well-described complication of tricyclic antidepressants (TCAs). This condition's association with SSRIs has not yet been described. This case highlights the development and subsequent management of Ogilvie syndrome following a citalopram overdose.
Description: A 60 y/o male with hypertension, hyperlipidemia, depression, and alcohol use disorder presented to the Emergency Department with left-sided rib pain after a fall. He endorsed taking 30 tablets of citalopram 50 mg in a suicide attempt. In the emergency room, he was febrile, tachycardic, and demonstrated myoclonus. Labs were significant for a WBC 17, creatinine 1.36, bicarbonate 19, anion gap 17, CK 926, AST 27, and ALT 44. Poison control recommended Librium for the treatment of alcohol withdrawal and serotonin syndrome. Cyproheptadine was not recommended or given. Throughout his hospitalization, his abdomen became increasingly distended, accompanied by respiratory distress, severe pain, and cessation of flatus. X-ray of his abdomen demonstrated Ogilvie syndrome. Despite a trial of a nasogastric tube and bilevel-positive airway pressure, he required intubation and an urgent colonoscopy to decompress his colon. Subsequently, his bowel function returned, and he was extubated and discharged to an inpatient psychiatric ward.
Discussion: Acute colonic pseudo-obstruction is a serious condition with devastating complications. While medications that affect the autonomic nervous system have been shown to play a role in the development of Ogilvie syndrome, SSRIs are absent from this list. In light of any other risk factors, we suspect that this patient’s misuse of citalopram played a role in his development of Ogilvie syndrome. As SSRIs become increasingly popular, more research is needed on their side effect profile. Recognizing Ogilvie syndrome as a potential complication of SSRIs is essential as we equip ourselves to provide the most informed care for our patients.
