Case series suggesting an association between sertraline and urinary side effects in a Sheffield child and adolescent mental health services (CAMHS) population

Abstract

AimsTo suggest a link between sertraline and urinary side effects in a Sheffield Child and Adolescent Mental Health Service population.BackgroundEvidence suggests that Serotonin has an important role in bladder control through central and peripheral neurological pathways. Increased serotonergic activity leads to parasympathetic inhibition, which results in urine retention. It is through this mechanism of action and their effect on pre-synaptic serotonin 1A and peripheral 5-HT3 receptors that SSRIs were observed to have anti-enuretic effect. At low 5-HT concentrations, micturition is inhibited whereas at high levels, an excitatory effect is achieved. This may suggest a dose-dependent relationship between Sertraline and urinary side effects.MethodInclusion criteria:Under 18 years of ageOn SertralineReported urinary side effectsExclusion criteria:Above 18 yearsNot on SertralineAssociated urinary problemsDid not report urinary side effectsClinical records of eligible patients were accessed to gauge temporal relationship between initiation of sertraline and reported urinary side effects.ResultThree cases were identified in the authors’ clinical practice at Sheffield CAMHS that were suggestive of a link between sertraline and urinary side effects.ConclusionIt's important for clinicians to bear in mind the genitourinary side effects of SSRIs, which may be debilitating for patients in the CAMHS population. It's equally important for us as clinicians to educate young people and their parents about these potential side effects and how they can be managed. It has also been observed that higher doses of Sertraline have shown a possible link between onset of urinary side effects.

Optimising the management of children with concomitant bladder dysfunction and behavioural disorders

“…This was also found in a Dutch study of 13,531 SSRI users demonstrating a risk ratio 1.75 for developing DUI when taking an SSRI [ 23 ]. In a case series of 3 children with anxiety and/or depression, sertraline lead to urinary symptoms with the change to fluoxetine resolving the symptoms in one case [ 24 ]. This change from sertraline to fluoxetine and resolution of urinary symptoms was also noted in a case reported by Maalouf [ 25 ].…”

Urinary Incontinence Associated with Sertraline use in a Young SSRI-Naïve Female Patient: a Case Report

“…Firstly, 5-HT4 receptor activation may potentiate M3 cholinergic neuromuscular transmission in the detrusor muscle [23], increasing the efficiency and frequency of bladder voiding. This excitatory effect is more pronounced at higher concentrations of serotonin [24]. Secondly, compared to other SSRIs, sertraline is a relatively strong inhibitor of the dopamine (DA) reuptake in the central nervous system (CNS) [25].…”

“…Furthermore, we do not know the pattern of use of sertraline to cause UI. A case series by Chaudhry and Alex [24], report three cases of UI occurring at a dose of 150 mg, 200 mg, and 200 mg respectively. Another report by Pease et al [27].…”