An Unusual Presentation of Sertraline and Trazodone Overdose

A patient with a history of depression ingested sertraline & trazodone in a suicide attempt. Twenty-four hours after drug administration, the patient presented with symptoms of selective serotonin-reuptake inhibitor (SSRI) overdose & serotonin syndrome, & later developed an enlarged tongue due to angioedema. A compromised airway resulted & endotracheal intubation was necessary. Although SSRIs and trezodone are considered relatively safe in single-agent overdose, serious delayed reactions can occur, especially if several agents are involved. Although previous reports of angioedema have been reported with SSRIs, this is the first report of a presentation this severe. (15 refs.)