Sertraline Induced Hepatotoxicity: A Case Report and Review of Literature

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Introduction:Depression is a common disorder amongst the general population and frequently encountered by most physicians (1). Selective Serotonin Re-Uptake Inhibitors (SSRI’s) have become the most commonly prescribed antidepressants due to their superiority compared to other antidepressants in the treatment of acute major depression (2). Although exceedingly rare, hepatotoxicity resulting from Sertraline use has been previously reported (3-7). In these case reports, the liver injury pattern was predominately hepatocellular. Unlike previous cases, we report the case of a patient presenting with markedly elevated cholestatic enzymes and painless jaundice while taking Sertraline for treatment of depression. Case Presentation:A 61-year-old Caucasian female presented with a history of fatigue, malaise, anorexia, and painless jaundice. She had taken Sertraline 100 mg daily for one year for management of her depression. However, due to a suboptimal therapeutic response, her dose was increased to 200 mg daily three weeks prior to presentation. She was also taking hormone replacement therapy (Premarin 0.625mg daily and Prometrium 100mg daily) to control menopausal symptoms. Liver enzymes obtained at the time of admission showed an ALT of 207 U/L, AST 161 U/L, Total Bilirubin 164 umol/L, Direct Bilirubin 135 umol/L, ALP 915 U/L, and GGT 4412 U/L. Laboratory and radiological investigations were inconclusive and a liver biopsy was consistent with a drug-induced hepatitis. Our patient’s symptoms and liver biochemistry improved following cessation of Sertraline therapy. Conclusion:Heightened awareness amongst prescribing physicians is warranted for patients taking Sertraline in the treatment of depression for the development of hepatotoxicity. These effects may be compounded by patients also on hormone replacement therapy.