Misdiagnosis of Serotonin Syndrome as Fibromyalgia and the Role of Physical Therapists – Source: Physical Therapy, Apr 17 2008

[Note: serotonin syndrome or “toxicity” has been associated with a large number of drugs, several herbs, and drug interactions/combinations.]

Background and purpose: With increased use of serotonergic medications, a condition triggered by serotonin excess within the brain and spinal cord has emerged and may be gaining prevalence. The purposes of this case report are to describe how to identify serotonin syndrome in a patient who is taking citalopram (a selective serotonin reuptake inhibitor [antidepressant]) on the basis of signs and symptoms and to promote the ability of physical therapists to recognize such signs and symptoms.

Case description: The patient was a 42-year-old woman referred for physical therapy with a diagnosis of fibromyalgia. The physical therapist recognized that the patient's symptoms did not resemble those of fibromyalgia and recommended referral to a neurologist for further diagnostic testing.

Outcomes: The patient was referred to a neurologist, who diagnosed serotonin syndrome related to the use of citalopram.

The patient was weaned off citalopram and made a successful recovery, with scores on the Oswestry Disability Index decreasing from 70% to 28% at discharge from the physical therapy treatment and to 0% at the 6-month follow-up. The patient has since returned to her prior activity level, which includes skiing, motorcycle riding, and working at her consulting firm.

Discussion: This case report demonstrates how careful evaluation by the physical therapist indicated that signs and symptoms were not consistent with Fibromyalgia, and further medical evaluation revealed the actual diagnosis of serotonin syndrome.

Source: Physical Therapy, Apr 17, 2008 [Epub ahead of print] PMID: 18420814, by Alnwick GM. Genesis Rehabilitation Services, Gorham Outpatient Clinic, Gorham, New Hampshire, USA. Mailing address: 4 Woodbound Rd, Gorham, NH 03581 (USA). [E-mail: gainwick@ne.rr.com]

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3 thoughts on “Misdiagnosis of Serotonin Syndrome as Fibromyalgia and the Role of Physical Therapists – Source: Physical Therapy, Apr 17 2008”

  1. harboreen says:

    Makes me wonder why the patient was given this med in the first place. It’s often the very first medication prescribed to those diagnosed with fibromyalgia.
    In this person’s case she was very lucky to have a fibromyalgia educated therapist to catch this misdiagnoses, others are seldom or never as lucky.

  2. fight4acure says:

    This is a prime example of why all doctors should study Fibromyalgia and Chronic Fatigue Syndrome before they start their practice as MDs. Dumb doctor did not know how to diagnose the patient, so he instantly tossed the person in the FMS category. Doctors should be penalized when they make stupid errors such as this.

  3. Aberlaine says:

    Like other articles posted on this site, it just “teased” us with very little information. I would have liked to know what the symptoms of Serotonin Syndrome are.

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