Sertraline Overdose Leads to Case of SSRI-Induced Pancreatitis
SAN ANTONIO, TX—Does an overdose of a selective serotonin reuptake inhibitor (SSRI) increase risk of occurrence of pancreatitis? That's the question U.S. Psychiatric & Mental Health Congress attendees were asked about a reported case of acute pancreatitis associated with an overdose of sertraline.
Angela Sureen, MD, and Maher Kozman, MD, of the Department of Psychiatry at Kaiser Permanente in Fontana, CA, reviewed the case of a 46-year-old female with a past psychiatric history of depression and anxiety who presented to the emergency department with abdominal and chest pain after overdosing on sertraline.
The “patient stated that she overdosed on 28 pills of 100mg” of sertraline, they noted. “She did not drink alcohol and had no history of any type of substance abuse.”
Her heart rate was 114bpm; temperature, 98.9°F; respiratory rate, 16; weight, 170 pounds; and arterial oxygen saturation, 98%. Laboratory tests were lipase 389 U/L, WBC 15.1, and K+ 3.3. On physical examination, vague diffuse abdominal tenderness was noted; CT and ultrasound were negative for gallstones. No evidence of biliary tract or endocrine disease was found.
The case “was discussed with poison control,” the authors noted, which recommended supportive care.
After 1 day, she showed clinical improvement and her lipase decreased to 37 U/L. She discontinued sertraline and started on fluoxetine 10mg, to be titrated up as tolerated, and was transferred to a psychiatric facility for danger to self.
Based on her case, the authors sought to understand the potential complications of overdosing on SSRIs, all of which are metabolized in the liver by CYP450.
“The main risk factors of acute pancreatitis include gallstones and alcohol consumption; however, certain drugs are also known to be a risk factor,” they noted.
Serotonin affects both pancreatic secretion and endocrine pancreatic function. Although 2% of all cases of pancreatitis are drug induced and incidence rates of acute pancreatitis are increasing, reasons are not clearly understood. The mechanism of development of acute pancreatitis—characterized as acute abdominal pain and elevated pancreatic enzymes—is largely unknown. Approximately 25% of all pancreatitis attacks are severe, with hospital mortality rates around 10%.
Previous studies found evidence of SSRIs causing acute pancreatitis but attributed these results to confounding by other risk factors, including those associated with depression: excessive smoking, high alcohol intake, and overeating, a possible risk factor for gallstones.
“For patients who present with abdominal pain and have concurrent SSRI use, acute pancreatitis should be considered” on differential diagnosis, they concluded.