Severe toxicity following supratherapeutic co‑ingestion of duloxetine and dexzopiclone in a young patient with major depressive disorder: a case report

Abstract A 23-year-old female with major depressive disorder (MDD), non-suicidal self-injury and generalized somatic pain was treated with duloxetine hydrochloride enteric-coated capsules, quetiapine fumarate tablets, and aripiprazole orally disintegrating tablets, with significant pain relief. Dexzopiclone tablets were added for insomnia, and all medications were kept by her mother. Despite compliance with medication, the patient had persistent suicidal ideation and secretly ingested 4500 mg duloxetine and 63 mg dexzopiclone on February 18, 2021. She was rushed to hospital 3.5 h later and received emergency treatment including oxygen inhalation, gastric lavage and high-dose vitamin B6/C infusion. Combined with psychological suggestion and cognitive therapy, she recovered and was discharged 12 days later. At the 4.5-year follow-up (September 2025), the patient had discontinued lurasidone and quetiapine, both of which were started during index hospitalization; she demonstrated normal daily functioning with no recurrent suicidal ideation or self-injury. To our knowledge, severe toxicity from co-ingestion of supratherapeutic doses of duloxetine and dexzopiclone has been rarely documented; this report details the clinical management and differential diagnosis strategies for this rare drug-combination toxicity.