Antidepressants and the Risk of Hyponatremia: A Class-by-Class Review of Literature

Abstract

Hyponatremia is a potentially dangerous side effect of antidepressants and is not exclusive to SSRIs. Current evidence suggests a relatively higher risk of hyponatremia with SSRIs and venlafaxine, especially when combined with patient risk factors, warranting clinicians to be aware of this complication. The risks associated with mirtazapine are moderate, supporting this antidepressant as an alternative treatment for patients with (an increased risk of) hyponatremia.

Differenze nell’associazione tra antidepressivi e ospedalizzazione dovuta a iponatremia

“…In pazienti trattati cronicamente con antidepressivi, un rischio significativamente maggiore di ricovero con diagnosi di iponatremia era osservato per coloro che erano in terapia con triciclici (OR 0,77), mirtazapina (OR 0,76), sertralina (OR 0,75), escitalopram (OR 0,63), citalopram (OR 0,57). Questi farmaci sono quelli già riportati in una precedente review su farmaci antidepressivi e iponatremia [2].…”

“…In pazienti trattati cronicamente con antidepressivi, un rischio significativamente maggiore di ricovero con diagnosi di iponatremia era osservato per coloro che erano in terapia con triciclici (OR 0,77), mirtazapina (OR 0,76), sertralina (OR 0,75), escitalopram (OR 0,63), citalopram (OR 0,57). Questi farmaci sono quelli già riportati in una precedente review su farmaci antidepressivi e iponatremia [2].Come gli stessi autori riconoscono, uno studio longitudinale di coorte permetterebbe di avere una visione più esatta dei rischi di ricovero per iponatremia associati all'esposizione cronica ad antidepressivi.Tuttavia, i dati presentati in questo studio indicano come vi sia una forte associazione tra esposizione recente a inibitori selettivi del reuptake della serotonina e venlafaxina e ospedalizzazione dovuta a iponatremia. Gli autori suggeriscono di considerare in questi pazienti un trattamento antidepressivo alternativo.…”

Guidelines of the Polish Psychiatric Association – Wroclaw Division, the Polish Society of Family Medicine and the College of Family Physicians in Poland for diagnosis and treatment of depressive disorders in primary health care

“…in patients treated with antidepressants, such as ssris or venlafaxine, it is important to periodically monitor electrolytes due to the risk of hyponatremia [39]. due to the risk of the significant dose-dependent prolongation of the Qtc interval during pharmacotherapy with ssris (especially with citalopram and escitalopram) or tricyclic antidepressants (tCas), it is advisable to perform, prior to such treatment, an electrocardiographic examination, especially in patients at risk of Qtc interval prolongation and those receiving several medicines that affect the potassium channels in the electrical conduction system [40].…”

Reduction in the volume of the front part of the hippocampus in schizophrenics with hyponatremia on hospital admission

“…Hyponatremia in schizophrenics may be caused by primary polydipsia (excessive liquid drinking) [1], periods of starvation [2], and represent a side effect of antipsychotic drugs [3] or mood altering drugs (in particular, carbamazepine and selective serotonin reuptake inhibitors) [4,5]. Disease duration [1] and tobacco smoking [6] are other risk factors in hyponatremia.…”

“…Hippocampal volume depends on a number CEL U 3% chorujących przewlekle na schizofrenię dochodzi do pierwotnego zaburzenia wydalania wody, w wyniku którego pojawiają się nawracające stany hiponatremii i hipoosmolemii oraz, wtórnie, zagrażające życiu epizody zatrucia wodnego [1]. Hiponatremia u chorych ze schizofrenią może być spowodowana polidypsją pierwotną (wypijaniem nadmiernych ilości płynów) [1], okresami głodzenia [2], stanowić efekt uboczny leków przeciwpsychotycznych [3] lub modyfikujących nastrój (w szczegól-ności karbamazepiny i inhibitorów wychwytu zwrotnego serotoniny) [4,5]. Czynnikami ryzyka rozwoju hiponatremii są też czas trwania choroby [1] i palenie tytoniu [6].…”