OBJECTIVE:Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed for
depressive and anxiety disorders and are generally considered safe. Nevertheless, rare
dermatological and immunological adverse reactions have been reported. This poster
aims to present a rare case of facial hyperpigmentation and unilateral periorbital edema
following escitalopram treatment, evaluated in the context of underlying dermatological
sensitivity and systemic comorbidities.
CASE (The patient consent must be provided and specified with appropriate terms.):A
41-year-old woman presented to the psychiatry outpatient clinic with stress, generalized
pruritus, and depressive symptoms. Her medical history included hypothyroidism and
iron deficiency anemia, for which she was receiving oral iron supplementation. Due to
persistent pruritus, she was also under dermatological follow-up. Following psychiatric
evaluation, escitalopram was initiated at a dose of 10 mg/day.
On the 10th day of treatment, the patient developed brownish facial hyperpigmentation
accompanied by marked swelling around the left eye, consistent with unilateral
periorbital edema. No systemic symptoms, infectious findings, or alternative allergic
triggers were identified. Considering a possible drug-induced reaction, escitalopram
was discontinued. After drug cessation, both the pigmentation and periorbital edema
regressed rapidly.
Written informed consent was obtained from the patient for publication of this case.
DISCUSSION:This case illustrates rare dermatological adverse effects associated with
escitalopram. Pre-existing pruritus and ongoing dermatological follow-up suggest
increased cutaneous sensitivity. Additionally, systemic conditions such as hypothyroidism and iron deficiency anemia may contribute to immune dysregulation,
potentially predisposing patients to drug-induced hypersensitivity reactions. The rapid
resolution of symptoms after discontinuation strongly supports a causal relationship
between escitalopram and the observed findings. Clinicians should be attentive to
atypical dermatological reactions during SSRI treatment, particularly in patients with
dermatological vulnerability or systemic comorbidities, and interdisciplinary
collaboration may facilitate timely diagnosis and management.
Keywords: drug-induced hyperpigmentation, Escitalopram, hypersensitivity reaction,
periorbital edema, SSRI
OBJECTIVE Vortioxetine is a multimodal antidepressant that is generally considered well
tolerated, with a favorable side-effect profile compared to selective serotonin reuptake
inhibitors. Although gastrointestinal and central nervous system adverse effects are
most commonly reported, serious hypersensitivity reactions are rare.This report aims to
describe a case of recurrent anaphylactic reactions temporally associated with
vortioxetine use and to emphasize the clinical importance of recognizing rare but
potentially serious drug-related hypersensitivity reactions. CASE A31-year-old woman
had been followed in a psychiatry outpatient clinic for eight years with a diagnosis of
major depressive disorder. Her family history was notable for generalized anxiety
disorder in her mother and bipolar disorder in a sibling.She had no history of allergic or
systemic medical conditions.The patient had been using vortioxetine regularly for
approximately two and a half years.During the final year of treatment, she developed
recurrent episodes of angioedema, wheezing, and urticaria.Blood pressure remained
stable, and no laryngeal edema was observed.A comprehensive allergy evaluation did
not reveal an identifiable trigger. Symptoms resolved with antihistamine treatment, and
hospitalization was not required. After discontinuation of vortioxetine, no further
reactions occurred. However, two months later, the patient self-administered a leftover
5 mg dose of vortioxetine, which rapidly led to recurrence of similar symptoms. Based
on the temporal relationship and recurrence after re-exposure, a diagnosis of
vortioxetine-associated idiosyncratic anaphylaxis was made. Written informed consent
was obtained from the patient for publication of this case. DISCUSSION This case
highlights that vortioxetine may rarely induce recurrent hypersensitivity reactions within
the anaphylactic spectrum.The reproducibility of symptoms upon re-exposure supports
a drug-specific immunological sensitivity rather than a dose-dependent effect.Although
the clinical severity was mild to moderate, the presence of cutaneous and respiratory symptoms warrants careful evaluation. Increased clinical awareness and systematic
reporting of such rare adverse reactions are essential for patient safety and
pharmacovigilance.
Keywords: Anaphylaxis, Antidepressant, Hypersensitivity, Vortioxetine
OBJECTIVE:Selective serotonin reuptake inhibitors (SSRIs) are first-line treatments for
major depressive disorder but may cause extrapyramidal symptoms and, rarely,
dermatological adverse effects that impair tolerability. Vortioxetine, a multimodal
antidepressant, may be a suitable alternative in patients with SSRI intolerance. This
report presents a patient who developed motor and dermatological adverse effects
during SSRI treatment and improved after switching to vortioxetine.
CASE (The patient consent must be provided and specified with appropriate terms.):A
47-year-old woman presented with low mood, anhedonia, and reduced motivation. Her
medical history was notable only for psoriasis, with no known drug allergies.
Escitalopram 5 mg/day was initiated. After one month, tremor involving the hands and
jaw developed. Due to intolerance, treatment was switched to sertraline 12.5 mg/day;
however, tremor and jaw clenching recurred after dose escalation.
The patient also reported non-pruritic, fluid-like appearing papular lesions on her
fingertips that became more prominent after hand washing. The lesions were non
exudative and atypical for psoriasis. Mental status examination revealed mild depressive
affect without psychotic symptoms or suicidal ideation. Laboratory investigations were
unremarkable. Treatment was changed to vortioxetine 5 mg/day, later increased to 10
mg/day, with adjunctive propranolol 20 mg/day. Tremor resolved completely, and
depressive symptoms improved markedly.
Written informed consent was obtained from the patient for publication of this case.
DISCUSSION:SSRI-induced tremor is a common dose-related adverse effect that may
necessitate treatment modification. Dermatological reactions to SSRIs are uncommon
and may present atypically, particularly in patients with underlying dermatological
vulnerability such as psoriasis. Vortioxetines multimodal serotonergic profile may explain its favorable tolerability in patients with SSRI intolerance. This case highlights
the importance of monitoring both motor and dermatological adverse effects during
antidepressant treatment and supports vortioxetine as an effective alternative.
Keywords: dermatological adverse effects, SSRI-induced tremor, vortioxetine
About this publication
Turkish Journal of Psychiatry
Turkish Journal of Psychiatry (Turk Psikiyatri Derg) is the scientific journal of Turkish Association of Nervous and Mental Health. The journal has been published on a subscription basis four issues annually in March, June, September and December since 1990. Turkish Journal of Psychiatry is indexed in PubMed, Index Medicus, TUBITAK Tıp, Psych-Info, Türkiye Atıf Dizini and has been ranked in Social Science Citation Index (SSCI) since 2005.
