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Characteristics, prevalence, risk factors, and underlying mechanism of hyponatremia in elderly patients treated with antidepressants: a cross-sectional study.
Maturitas 2013; 76(4):357-63M

Abstract

OBJECTIVES

The aims of this study were to describe the characteristics of hyponatremia in elderly users of antidepressants, to determine the prevalence and risk factors for hyponatremia, and to identify the underlying mechanisms.

STUDY DESIGN

Cross-sectional study (March 2007-April 2009) with prospectively collected data. Patients were older than 60 years, used antidepressants, and had a complete geriatric assessment.

MAIN OUTCOME MEASURES

Serum sodium and antidiuretic hormone levels, serum osmolality, urine sodium level, and urine osmolality were measured. The prevalence of hyponatremia (serum sodium <135 mM) as an adverse reaction to an antidepressant (AR-AD), defined with Naranjo's algorithm, was calculated. Hyponatremic patients were compared to normonatremic patients with regard to gender, age, weight, history of hyponatremia, hyponatremia-associated medications and disorders, and type and duration of antidepressant use.

RESULTS

Of 358 eligible patients, 345 were included. The prevalence of hyponatremia as an AR-AD was 9.3%. Risk factors were a history of hyponatremia (adjusted OR 11.17, 95%CI 2.56-40.41), weight<60 kg (adjusted OR 3.47, 95%CI 1.19-10.13), and psychosis (adjusted OR 3.62, 95%CI 1.12-11.73). Non-suppressed ADH was found in a minority of hyponatremic patients.

CONCLUSIONS

In elderly patients, the prevalence of hyponatremia as adverse reaction to all types of antidepressants was 9%. Patients with previous hyponatremia, weight <60 kg, and psychosis were at risk. Beside SIADH, the nephrogenic syndrome of inappropriate antidiuresis, in which ADH secretion was normal, is postulated as an underlying mechanism. This has consequences for treatment of antidepressant-induced hyponatremia with vasopressin receptor antagonists.

Authors+Show Affiliations

Department of Geriatric Medicine, Vlietland Hospital, Vlietlandplein 2, 3118 JH Schiedam, The Netherlands. Electronic address: cmannesse@vlietlandziekenhuis.nl.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24094459

Citation

Mannesse, Cyndie K., et al. "Characteristics, Prevalence, Risk Factors, and Underlying Mechanism of Hyponatremia in Elderly Patients Treated With Antidepressants: a Cross-sectional Study." Maturitas, vol. 76, no. 4, 2013, pp. 357-63.
Mannesse CK, Jansen PA, Van Marum RJ, et al. Characteristics, prevalence, risk factors, and underlying mechanism of hyponatremia in elderly patients treated with antidepressants: a cross-sectional study. Maturitas. 2013;76(4):357-63.
Mannesse, C. K., Jansen, P. A., Van Marum, R. J., Sival, R. C., Kok, R. M., Haffmans, P. M., & Egberts, T. C. (2013). Characteristics, prevalence, risk factors, and underlying mechanism of hyponatremia in elderly patients treated with antidepressants: a cross-sectional study. Maturitas, 76(4), pp. 357-63. doi:10.1016/j.maturitas.2013.08.010.
Mannesse CK, et al. Characteristics, Prevalence, Risk Factors, and Underlying Mechanism of Hyponatremia in Elderly Patients Treated With Antidepressants: a Cross-sectional Study. Maturitas. 2013;76(4):357-63. PubMed PMID: 24094459.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characteristics, prevalence, risk factors, and underlying mechanism of hyponatremia in elderly patients treated with antidepressants: a cross-sectional study. AU - Mannesse,Cyndie K, AU - Jansen,Paul A F, AU - Van Marum,Rob J, AU - Sival,Rob C, AU - Kok,Rob M, AU - Haffmans,P M Judith, AU - Egberts,Toine C G, Y1 - 2013/09/07/ PY - 2013/05/06/received PY - 2013/08/05/revised PY - 2013/08/26/accepted PY - 2013/10/8/entrez PY - 2013/10/8/pubmed PY - 2014/7/8/medline KW - 95% confidence interval(s) KW - 95%CI(s) KW - ADH KW - AR-AD KW - Adverse drug reaction KW - Antidepressants KW - DSM-IV-TR KW - Diagnostic and Statistical Manual of Mental Disorders 4th edition with text revision KW - Elderly KW - Hyponatremia KW - MAO-inhibitors KW - OR(s) KW - SIAD KW - SIAD(H) KW - SIADH KW - SSRI KW - TCA KW - adjOR(s) KW - adjusted odds ratio(s) KW - adverse drug reaction of antidepressant(s) KW - antidiuretic hormone KW - monoamine-oxidase inhibitor KW - odds ratio(s) KW - selective serotonin reuptake inhibitor KW - syndrome of inappropriate antidiuresis KW - syndrome of inappropriate secretion of antidiuretic hormone KW - tricyclic antidepressant SP - 357 EP - 63 JF - Maturitas JO - Maturitas VL - 76 IS - 4 N2 - OBJECTIVES: The aims of this study were to describe the characteristics of hyponatremia in elderly users of antidepressants, to determine the prevalence and risk factors for hyponatremia, and to identify the underlying mechanisms. STUDY DESIGN: Cross-sectional study (March 2007-April 2009) with prospectively collected data. Patients were older than 60 years, used antidepressants, and had a complete geriatric assessment. MAIN OUTCOME MEASURES: Serum sodium and antidiuretic hormone levels, serum osmolality, urine sodium level, and urine osmolality were measured. The prevalence of hyponatremia (serum sodium <135 mM) as an adverse reaction to an antidepressant (AR-AD), defined with Naranjo's algorithm, was calculated. Hyponatremic patients were compared to normonatremic patients with regard to gender, age, weight, history of hyponatremia, hyponatremia-associated medications and disorders, and type and duration of antidepressant use. RESULTS: Of 358 eligible patients, 345 were included. The prevalence of hyponatremia as an AR-AD was 9.3%. Risk factors were a history of hyponatremia (adjusted OR 11.17, 95%CI 2.56-40.41), weight<60 kg (adjusted OR 3.47, 95%CI 1.19-10.13), and psychosis (adjusted OR 3.62, 95%CI 1.12-11.73). Non-suppressed ADH was found in a minority of hyponatremic patients. CONCLUSIONS: In elderly patients, the prevalence of hyponatremia as adverse reaction to all types of antidepressants was 9%. Patients with previous hyponatremia, weight <60 kg, and psychosis were at risk. Beside SIADH, the nephrogenic syndrome of inappropriate antidiuresis, in which ADH secretion was normal, is postulated as an underlying mechanism. This has consequences for treatment of antidepressant-induced hyponatremia with vasopressin receptor antagonists. SN - 1873-4111 UR - https://www.unboundmedicine.com/medline/citation/24094459/Characteristics_prevalence_risk_factors_and_underlying_mechanism_of_hyponatremia_in_elderly_patients_treated_with_antidepressants:_a_cross_sectional_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0378-5122(13)00278-8 DB - PRIME DP - Unbound Medicine ER -