Hyponatremia in Older Patients Who Begin Second-Generation Antidepressants

January 19, 2017

Hyponatremia in Older Patients Who Begin Second-Generation Antidepressants

  1. Allan S. Brett, MD

Excess risk for hyponatremia at 30 days was small but statistically significant.

  1. Allan S. Brett, MD

So-called second-generation antidepressants have been associated with hyponatremia, attributed to the syndrome of inappropriate antidiuretic hormone (SIADH). In this population-based Canadian study, researchers used several Ontario databases to estimate short-term risk for hyponatremia in older adults (age, ≥65) who were diagnosed with mood or anxiety disorders and received first prescriptions for citalopram, escitalopram, fluoxetine, paroxetine, fluvoxamine, venlafaxine, duloxetine, mirtazapine, or sertraline. Propensity-score matching identified 138,000 patients who were started on one of these drugs and 138,000 clinically and demographically similar patients who did not receive them.

The 30-day incidence of hospitalization with hyponatremia listed among discharge diagnoses was significantly higher in the antidepressant group than in the control group (0.33% vs. 0.06%). In a subpopulation for which in-hospital lab results could be linked to other data, the incidence of hospitalization with serum sodium levels <132 mEq/L also was significantly higher in the antidepressant group (1.74% vs. 0.43%).

Comment

Older patients who begin use of second-generation antidepressants appear to have a small but statistically significant excess risk for hospitalization with hyponatremia during the month after starting such drugs. The extent to which hyponatremia was a contributing reason for hospitalization (as opposed to a clinically unimportant incidental finding) cannot be determined from this study.

Editor Disclosures at Time of Publication

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

Citation(s):

Reader Comments (1)

nitya mitra Physician, Family Medicine/General Practice, Singapore, Now retired.

How to manage hyponatremia in a patient who has to continue taking antidepresents.

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