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Pharmacopsychiatry 2000; 33(4): 150-152
DOI: 10.1055/s-2000-11225
Case Report
© Georg Thieme Verlag Stuttgart · New York

Suicide Attempt by Pure Citalopram Overdose Causing Long-lasting Severe Sinus Bradycardia, Hypotension and Syncopes: Successful Therapy with a Temporary Pacemaker

H.-B. Rothenhäusler1 , C. Haberl3 , S. Ehrentraut1 , H.-P. Kapfhammer1 , M. M. Weber2
  • 1Departments of Psychiatry, 2Medicine II, and 3Medicine III, Ludwig-Maximilians-University of Munich, Germany
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Publication History

15.06.1999

13.01.2000

Publication Date:
31 December 2000 (online)

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In few cases, pure citalopram overdose at doses above 600 mg showed electro-cardiographic changes with prolonged QT intervals and sinus bradycardia gradually resolving within 12 - 24 hours after intoxication. We report on a 32-year-old patient with borderline personality disorder (BPD) who ingested a total of 800 mg citalopram to attempt suicide due to an interpersonal disappointment. She developed severe sinus bradycardia with a minimal pulse rate of 41/min within about 4 hours after intoxication lasting up to six days during intensive care unit (ICU) treatment. Further, hypotension and syncopes occurred. No QT interval prolongations were recorded. To our knowledge, this is the first case report of pure citalopram overdose-induced long-lasting sinus bradycardia associated with severe hypotension and intermittent syncopes that required therapy with a temporary pacemaker.

References

  • 1 Barbey J T, Roose S P. SSRI safety in overdose.  J. Clin. Psychiatry. 1998;  59 Suppl 15 42-48
    PubMedGoogle Scholar
  • 2 Bazett H C. An analysis of the time-relations of electrocardiograms.  Heart. 1920;  7 353-370
    PubMedGoogle Scholar
  • 3 Boeck V, Jørgensen A, Overø K F. Comparative animal studies on cardiovascular toxicity of tri- and tetracyclic antidepressants and citalopram; relation to drug plasma levels.  Psychopharmacology. 1984;  82 275-281
    CrossrefPubMedGoogle Scholar
  • 4 Brion F, Brion N, Durigon M. Fatal overdose with citalopram?.  The Lancet. 1996;  348 1380
    PubMedGoogle Scholar
  • 5 Coumel P. The fuzzy set of long QT intenral, torsade de pointes and the autonomic nervous system. In: Butrous, G.S., P. Schwartz (Eds.): Clinical aspects of ventricular repolarization. London: Farrand Press 1989: 311
    Google Scholar
  • 6 Freemantle N, House A, Song F, Mason J, Sheldon T. Prescribing selective serotonin reuptake inhibitors as strategy for prevention of suicide.  Br. Med. J.. 1994;  309 249-253
    PubMedGoogle Scholar
  • 7 Grundemar L, Wohlfart B, Lagerstedt C, Bengtsson F. Symptoms and signs of severe citalopram overdose.  The Lancet. 1997;  349 1602
    PubMedGoogle Scholar
  • 8 Henry J, Alexander C, Sener E. Relative mortality from overdose of antidepressants.  Br. Med. J.. 1995;  310 221-224
    PubMedGoogle Scholar
  • 9 Hyttel J. Citalopram - pharmacological profile of a specific serotonin uptake inhibitor with antidepressant activity.  Prog. Neuropsychopharmacol. Biol. Psychiatry. 1982;  6 277-295
    CrossrefPubMedGoogle Scholar
  • 10 Isacsson G, Bergman U. Risks with citalopram in perspective.  The Lancet. 1996;  348 1033
    PubMedGoogle Scholar
  • 11 Kapfhammer H P, Hippius H. Special feature: Pharmacotherapy in personality disorders.  Journal of Personality Disorders. 1998;  12 277-288
    PubMedGoogle Scholar
  • 12 Klein-Schwartz W, Anderson B. Analysis of sertraline-only overdoses.  Am. J. Emerg. Med.. 1996;  14 456-458
    CrossrefPubMedGoogle Scholar
  • 13 Lepola U, Leinonen E, Koponen H. Serum drug levels and electroencephalographic findings after citalopram intoxication.  Nord. J. Psychiatry. 1996;  50 61-62
    PubMedGoogle Scholar
  • 14 Mendelowitz A, Dawkins K, Lieberman J A. Antidepressants.  In: J.A. Lieberman, A. Tasman (eds.): Psychiatric drugs. W.B. Saunders Company, Philadelphia 2000: 72-75
    Google Scholar
  • 15 Muldoon C. The safety and tolerability of citalopram.  International Clinical Psychopharmacology. 1996;  11 (Suppl. 1) 35-40
    PubMedGoogle Scholar
  • 16 Ohberg A, Vuori E, Klaukka T, Lonnqvist J. Antidepressants and suicide mortality.  Journal of Affective Disorders. 1998;  50 225-233
    CrossrefPubMedGoogle Scholar
  • 17 Öström M, Eriksson A, Thorson J, Spigset O. Fatal overdose with citalopram.  The Lancet. 1996;  348 339-340
    PubMedGoogle Scholar
  • 18 Personne M, Sjöberg G, Persson H. Citalopram overdose - review of cases treated in Swedish hospitals.  Clinical Toxicology. 1997;  35 237-240
    PubMedGoogle Scholar
  • 19 Power A. Drug treatment of depression. Citalopram in overdose may result in serious morbidity and death.  British Medical Journal. 1998;  316 307-308
    PubMedGoogle Scholar
  • 20 Rich C, Isacsson G. Suicide and antidepressants in South Alabama: evidence for improved treatment of depression.  J. Affect. Disord.. 1997;  45 135-142
    CrossrefPubMedGoogle Scholar
  • 21 Rothenhäusler H B, Kapfhammer H P. Der Verlauf von Borderline-Störungen.  Fortschritte der Neurologie Psychiatrie. 1999;  67 200-217
    PubMedGoogle Scholar
  • 22 Sindrup S H, Brosen K, Hansen M G J, Aes-Jorgensen T, Overo K, Gram L F. Pharmacokinetics of citalopram in relation to the sparteine and the mephenytoin oxidation polymorphisms.  Ther. Drug Monit.. 1993;  15 11-7
    PubMedGoogle Scholar
  • 23 Zehender M, Hohnloser S, Just H. QT-interval prolonging drugs: mechanisms and clinical relevance of their arrhythmogenic hazards.  Cardiovascular Drugs and Therapy. 1991;  5 515-530
    PubMedGoogle Scholar

Dr. med. Hans-Bernd Rothenhäusler

Psychiatrische Klinik und Poliklinik der LMU München

Nußbaumstraße 7

80336 München

Germany

Phone: +49-89-7095-2718

Fax: +49-89-7095-2715

Email: rothenh@kons.med.uni-muenchen.de

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