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Third year in clerkship, had a pt come in who was prescribed Lexapro at 10mg. Took their first dose in the evening before bed and presented to the ER 5 hours later after waking up nauseated, sweating, as well as internal tremors and GI distress. ER doc cleared them to go home. For the next 2 months the pt experienced a subtle involuntary jerking of their head but by the date of their appointment this had resolved.
Both the ER doc and the GP I work under considered it just a bad reaction and the GP switched pt to Bupropion.
While this may be of little clinical significance, some literature points to the symptoms experienced by this pt as mild (and not life threatening) serotonin syndrome, whereas Hunter criteria does not. I was wondering if a specialist would consider this to be ss, especially given the post-continuation symptom after a single titration dose.
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Do you tend to not choose Lexapro first in Caucasian’s for this reason?