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Published Online, 9 August 2005, www.theannals.com, DOI 10.1345/aph.1G169.
 The Annals of Pharmacotherapy: Vol. 39, No. 10, pp. 1755-1757. DOI 10.1345/aph.1G169
© 2005 Harvey Whitney Books Company.
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Antidepressant-Induced Adverse Reactions in a Patient with Hemorrhagic Stroke

Zoran Bogdanovic, MD1, Jhansi R Nalamati, MD2, John K Kilcullen, MD JD MPH3, and Sunil Dhuper, MD4

1 Attending Physician, Department of Medicine, North Central Bronx Hospital, Bronx, NY
2 Associate Professor, Department of Medicine, North Central Bronx Hospital, and Albert Einstein College of Medicine, Bronx
3 Attending Physician, Department of Medicine, North Central Bronx Hospital
4 Associate Professor, Department of Medicine, North Central Bronx Hospital, and Albert Einstein College of Medicine

Reprints: Dr. Bogdanovic, Department of Medicine, North Central Bronx Hospital, 3424 Kossuth Ave., Bronx, NY 10467-2410, fax 718/519-3734, suzbog{at}msn.com

OBJECTIVE: To report a case of antidepressant-induced adverse drug reactions in a patient with hemorrhagic stroke.

CASE SUMMARY: A 56-year-old man developed life-threatening adverse reactions after fluoxetine was added to his previously prescribed regimen of buspirone and olanzapine. One week after starting fluoxetine 60 mg/day, the patient developed syndrome of inappropriate antidiuretic hormone secretion and serotonin syndrome concurrently. The patient had experienced a hemorrhagic stroke before the adverse drug reactions occurred.

DISCUSSION: A patient with a history of hemorrhagic stroke developed serious adverse drug reactions when fluoxetine was added to his drug therapy. When the combination therapy was stopped, all adverse effects gradually disappeared and laboratory abnormalities were corrected. The likelihood that the adverse reactions were caused by fluoxetine is probable according to the Naranjo probability scale. In addition, a history of stroke may be a risk factor for the development of such reactions.

CONCLUSIONS: Today, patients with depression after experiencing a stroke are treated more effectively, but antidepressant-induced adverse drug reactions may be serious. A growing number of patients are treated for post-stroke depression; they require close supervision and careful dosing of antidepressants to prevent full-blown adverse reactions from occurring.

Key Words: antidepressant, hemorrhagic stroke, serotonin syndrome, SIADH

Published Online, August 9, 2005. www.theannals.com, DOI 10.1345/aph.1G169




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