An unusual presentation of sertraline and trazodone overdose

OBJECTIVE: To report an unusual and life-threatening presentation of an ove rdose of sertraline and trazodone. CASE SUMMARY: A patient with a history of depression ingested sertraline 60 00 mg and trazodone 1300 mg in a suicide attempt. Twenty-four hours after a ntidepressant administration, the patient presented with symptoms of select ive serotonin-reuptake inhibitor (SSRI) overdose and serotonin syndrome, an d later developed an enlarged tongue consistent with angioedema. A compromi sed airway resulted and endotracheal intubation was necessary. After intuba tion, the symptoms subsided and the patient recovered. DISCUSSION: Although SSRIs and trazodone are generally considered to be rel atively safe in single-agent overdose, serious delayed reactions can occur, especially if several agents are involved. In this case the patient initia lly presented with symptoms typical of an SSRI overdose that did not appear to be exceptionally dangerous. Over time, symptoms consistent with angioed ema appeared that necessitated intubation. Although previous reports on ang ioedema have been reported with SSRIs, this is the first report, to our kno wledge, of a presentation this severe. CONCLUSIONS: This case demonstrated that overdose with the newer antidepres sants can result in unusual and delayed presentations and must be treated w ith caution.