Serotonin Syndrome Induced by the Pharmacological Interaction of Withania Somnifera and Escitalopram: A Case Report
Fiona M Hanly-Jorda1, Sophie M Bilik1, Neil Patel1, Alfred J Bilik2
1University of Miami Miller School of Medicine, 2Urology, Florida Urology Specialist
Background:
Trends and variations in antidepressant prescribing practices have shown a national and global increase in antidepressant use. In 2018, selective serotonin reuptake inhibitors (SSRIs) such as Lexapro® (Escitalopram) were the most commonly prescribed antidepressants. Concurrently, there has been a significant rise in reports highlighting the benefits of Withania somnifera (ashwagandha). Ashwagandha, classified as an adaptogen, is a natural compound known to improve an individual’s stress response. A prevalent challenge in pharmaceutical prescribing is the potential for under-researched drug interactions, particularly with natural supplements, which can lead to severe complications. This case report details the development of serotonin syndrome resulting from the interaction between Withania somnifera and Escitalopram.
Design/Methods:
A 22-year-old female presented with symptoms including limb myoclonus, eyelid flutter, tachycardia, pyrexia, emesis, mydriasis, and cardiac arrhythmia. Her history included two years of Lexapro®, 10 mg daily, for anxiety. Two days pre-admission, she consumed high-dose ashwagandha (600 mg pill, 1520 mg tea). Examination revealed signs of serotonin syndrome, suggesting an SSRI-herbal supplement interaction.
Results:
Interventions involved discontinuing serotonergic agents, administering benzodiazepines, and providing supportive care. Evaluation included medication history and tests. Psychiatry and toxicology were consulted.
Conclusions:
This case illustrates the development of serotonin syndrome as a result of the interaction between escitalopram and Withania somnifera. As the rising prevalence of SSRI use is matched with a growing interest in ashwagandha’s potential as a viable, alternative natural remedy across numerous disease etiologies, it becomes clinically relevant to understand the potential interactions between widely used FDA-approved pharmaceuticals and less-regulated natural supplements. Recognition of serotonin syndrome as a possible side effect of this interaction is critical to the prompt institution of appropriate therapy and prevention of a fatal progression.
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