Antidepressants and the risk of hyponatremia: a Danish register-based population study

Leth-Møller, Katja; Hansen, Annette Højmann; Torstensson, Maia; Andersen, Stig Ejdrup; Ødum, Lars; Gislasson, Gunnar; Torp‐Pedersen, Christian; Holm, Ellen

doi:10.1136/bmjopen-2016-011200

Cited by 84 publications

(83 citation statements)

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“…Researchers proposed several pathogenic mechanisms and the effects of psychotropic drugs could be one of them (15). Hyponatremia is a rare but well-documented adverse effect of both antidepressant and antipsychotic agents while occasional reports revealed the disturbances of some other electrolytes in patients with serious mental conditions including drug-treated ones (16)(17)(18)(19). The regulation of vitamin D metabolism is interconnected with homeostatic regulations of bone minerals and certain major electrolytes get indirectly involved in them.…”

mentioning

confidence: 99%

Vitamin D Deficiency and Associated Factors in Patients with Mental Disorders Treated in Routine Practice

Ristic

Živanović

Milovanovic

et al. 2017

J Nutr Sci Vitaminol

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SummaryThis research aimed to investigate factors associated with vitamin D deficiency and to provide data about its prevalence in patients suffering from different psychiatric illnesses. The study had a cross-sectional design and it included 220 patients of both genders, aged from 19-81 y, with a wide range of mental disorders (F00-F89), and treated in routine ambulatory and hospital practice. The researchers collected data from three sources: medical records, a study questionnaire and biochemical analysis of patients' serum samples (concentration of vitamin D measured as 25(OH)D, calcium, phosphorus, magnesium, sodium and potassium). Data were analyzed using descriptive statistics, methods for hypothesis testing and binary logistic regression, at the p#0.05 level. A total of 140 patients (64%) had a deficiency of vitamin D (,12 ng/mL), and 45 (20%) had inadequate vitamin D serum levels (12-20 ng/mL), while 35 (16%) had sufficient vitamin D serum concentrations (.20 ng/mL). Among variables related to demographics, life style habits, mental illness, comorbid disorders and drugs, two of them, female gender (odds ratio (OR)52.5, 95% confidence interval (CI)51.3-4.9, p50.006) and using clozapine (OR515.6, 95% CI 1.7-144.7, p50.02), were significantly associated with vitamin D deficiency. Physical activity (OR5 0.4, p50.02), exercising (OR50.2, 95% CI , p50.02) and offal in the diet (OR50.5, 95% CI 0.3-0.9, p50.03) significantly aggregated in the patients who had a 25(OH)D serum concentration above the deficiency cut-off level. Patients with mental disorders are at high risk for vitamin D deficiency, particularly females and clozapine users as well as those having no adequate physical activity or dietary habits.

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mentioning

confidence: 99%

Vitamin D Deficiency and Associated Factors in Patients with Mental Disorders Treated in Routine Practice

Ristic

Živanović

Milovanovic

et al. 2017

J Nutr Sci Vitaminol

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“…Pozwala to stwierdzić, że wszystkie wymienione leki, z wyjątkiem mianseryny, mają związek z występowaniem hiponatremii. Największe ryzyko stanowi terapia citalopramem [35] .…”

Section: Przyczynyunclassified

“…This gives the grounds to say that all of these drugs, with the exception of mianserin, are associated with hyponatremia. The greatest risk is posed by citalopram therapy [35].…”

Section: Siadh and Antidepressantsmentioning

confidence: 99%

Hiponatremia in the practice of a psychiatrist. Part 1: SIADH syndrome and drug-induced hyponatremia.

Stelmach

Hołownia

Słotwiński

et al. 2017

Current Problems of Psychiatry

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Introduction. Hyponatremia is an important part of psychiatric practice. In order to analyze its causes and symptoms, the literature on hyponatremia in psychiatric patients has been reviewed. The work has been divided into two separate manuscripts. In the first one the authors discuss the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and hyponatremia occurring with the use of psychotropic drugs (antidepressants, antipsychotics, normotimics), while the second paper discusses research on psychogenic polydipsia. The causes of hyponatremia in patients treated in psychiatric wards include: water intoxication associated with polydipsia, somatic comorbidities, side effect of internal medicine and psychiatric drugs. The most common mechanism leading in these cases to hyponatremia is the syndrome of inappropriate secretion of vasopressin (SIADH). The SIADH syndrome is a group of symptoms, first described in 1967 by Schwartz and Bartter in The American Journal of Medicine, which results from the hypersecretion of antidiuretic hormone, also called vasopressin, which causes patients to develop normovolemic hyponatremia. The phenomenon of drug-induced hyponatremia in psychiatric practice is generally observed with the use of antidepressants, antipsychotics and anti-epileptic drugs (used in psychiatry as normotimic drugs).Aim and method. The first manuscript includes a review of literature on the syndrome of inappropriate secretion of vasopressin (SIADH) and hyponatremia occurring after the use of psychotropic drugs, and is divided into two subsections: 1. The syndrome of inappropriate secretion of vasopressin (SIADH), 2. Hyponatremia and psychotropic drugs (antidepressants, antipsychotics, normotimics).Conclusion. In the view of the reviewed literature it is extremely important to control the natremia level during pharmacotherapy using the above mentioned drugs, especially in the initial period of therapy.

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“…The main symptoms of escitalopram-induced hyponatremia are delirium, fatigue or instability, and reduced cognitive functions. [3] …”

Section: Introductionmentioning

confidence: 99%

“…It is the S-enantiomer of the racemic derivative citalopram which selectively inhibits serotonin reuptake with little or no effect on norepinephrine or dopamine reuptake. Hyponatremia, due to selective serotonin reuptake inhibitors, may be caused as a result of syndrome of inappropriate antidiuretic hormone secretion [3,4] that is induced by a non-osmotic antidiuretic hormone release. The syndrome is characterized by a low level of sodium concentration in serum, that is, <135 mmol/l, urinary osmolality exceeding 200 mOsm/kg, serum osmolality of <280 mOsm/kg, and urinary sodium concentration exceeding 20 mmol/l.…”

Section: Introductionmentioning

confidence: 99%

Escitalopram-induced hyponatremia

Thomas¹,

Abraham²,

James³

et al. 2017

Natl J Physiol Pharm Pharmacol

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Escitalopram is an antidepressant belonging to the class of selective serotonin reuptake inhibitors. It is effective in the treatment of generalized anxiety and major depressive disorders. It also has an off-labeled use of treating mild agitation associated with dementia in non-psychotic patients. The most common adverse effects of escitalopram are a headache, fatigue, and diarrhea. Escitalopram-induced hyponatremia is rare; it is seen in elderly, especially in women. This is a rare case of escitalopram-induced hyponatremia which was observed in a 73-year-old female patient who was admitted, with complaints of increased tension and palpitation, in the psychiatry department. She also had a history of asthma for the past 30 years, a surgery done for carpel tunnel syndrome 6 years back and had no history of liver or renal disease. Tablet Nexito (escitalopram) 10 mg 1-0-0 was started as an antidepressant, and after 1 day, she developed fatigue due to hyponatremia which was evident from the laboratory values of sodium. The sodium level was found to be 122.3 mmol/l, the normal range is between 135 and 145 mmol/l. Hence, she was advised to include 2 g of salt in her diet. As she had hyponatremia, NS 3% was added, and also her dose of escitalopram was decreased to 5 mg OD, resulting in a gradual increase in the sodium level. This case showed a causality score of 8 according to Naranjo Scale and the causality to be probable.

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Antidepressants and the risk of hyponatremia: a Danish register-based population study

Cited by 84 publications

References 44 publications

Vitamin D Deficiency and Associated Factors in Patients with Mental Disorders Treated in Routine Practice

Vitamin D Deficiency and Associated Factors in Patients with Mental Disorders Treated in Routine Practice

Hiponatremia in the practice of a psychiatrist. Part 1: SIADH syndrome and drug-induced hyponatremia.

Escitalopram-induced hyponatremia

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