Delayed Serotonin Syndrome Following the Concurrent Use of an Unregulated Supplement and Selective Serotonin Reuptake Inhibitors (SSRIs): A Case Report

Serotonin syndrome results from an excess accumulation of serotonin, which can be life-threatening if not promptly recognized. It typically arises from recent changes in antidepressant regimens or interactions with other medications and supplements. The diagnosis is clinical and features a spectrum of symptoms, from mild agitation and tremor to severe complications such as renal failure, seizures, and death. Early identification and intervention are crucial, typically resulting in the resolution of symptoms within 24 hours. With antidepressant use on the rise, serotonin syndrome is increasingly encountered in clinical practice. Patients prescribed serotonergic agents should be made aware of toxicity signs and cautioned about potential interactions with over-the-counter supplements. This report describes a 27-year-old lady who presented with delayed onset of serotonin toxicity symptoms after two months of taking CutXtreme, an unregulated weight-loss supplement popularized on social media. She had a stable history on sertraline with no previous adverse effects. Discontinuation of both sertraline and CutXtreme, combined with supportive care, led to complete symptom resolution within 24 hours. This case emphasizes the importance of patient education on the potential risks of unregulated supplements, along with early recognition of serotonin toxicity and the need for clinical vigilance in unusual or atypical serotonin syndrome presentations.