Antidepresanların neden olduğu hiponatremi

Hiponatremi antidepresanların potansiyel olarak tehlikeli bir yan etkisidir. 1,2 Hiponatremi klinik uygulamada en yaygın karşılaşılan elektrolit bozukluğudur. 3 Antidepresanların neden olduğu hiponatremi morbidite ve ölüme neden olabilir. Her antidepresan hiponatremiye neden olabilir. 1,4-9 Görülme oranları seçici serotonin gerialım önleyiciler (SSGÖ) için %0.06-40, venlafaksin için %0.08-70 arasındadır. Bu oran trisiklik antidepresanlar ve mirtazapinde diğer antidepresanlardan daha düşüktür. 1 SSGÖ kullanan yaşlılar hiponatremi açısından daha yüksek risk altındadır. 5 Hiponatremi yaşamı tehdit edici olabilir, ciddi nörolojik ve psikiyatrik belirtilere neden olabilir. 1,2,4 Hiponatreminin klinik sonuçları nörolojik işlev bozukluğu, zihinsel işlevlerde azalma, serebral ödem, yürüme bozuklukları, osteoporoz ve kırıkları kapsar. 3 Mirtazapinle hiponatremi riski orta düzeydedir, bu nedenle mirtazapin hiponatremi riskindeki hastalar için alternatif bir antidepresan olabilir. 1,6 Klinisyenler antidepresanların bu komplikasyonunun farkında olmalıdır.

Antidepressants-induced hyponatrem ia

Hyponatremia is a potentially dangerous side effect of antidepressants. 1,2 Hyponatremia is the most common electrolyte disorder encountered in clinical practice. 3 Antidepressant-induced hyponatremia can cause significant morbidity and mortality. Hyponatremia has been reported with the use of various antidepressants. 1,4-9 Incidence rates of hyponatremia varies between 0.06% and 40% for selective serotonin re-uptake inhibitors (SSRIs) and 0.08% and 70% for venla- faxine. This rate for mirtazapine and tricyclic anti- depressants are lower than the other antidepres- sants.1 The elderly patients on an SSRI is at greater risk for hyponatremia. 5 Hyponatremia can be a life-threatening medical condition, and may lead to severe neurological and psychiatric symptoms. 1,2,4 Clinical consequ- ences of hyponatremia include neurologic dysfunctions, decreased mental functions, cerebral edema, gait disturbances and falls, osteoporosis, and fractures. 3 The risk of hyponatremia with mirtazapine is moderate, therefore mirtazapine may be as an alternative treatment for patients with risk of hyponatremia.1,6 Clinicians must be aware of this complication of antidepressants.

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1. De Picker L, Van Den Eede F, Dumont G, Moor- kens G, Sabbe BGC. Antidepressants and the risk of hyponatremia: a class-by-class review of litera- ture.http://dx.doi.org/10.1016/j.psym.2014.01.010
2. Letmaier M, Painold A, Holl AK, Vergin H, Engel R, Konstantinidis A, et al. Hyponatraemia during psychopharmacological treatment: results of a drug surveillance programme. Int J Neuropsychophar- macol 2012; 15(6):739-748.
3. Patterson JH. The impact of hyponatremia. Phar- macotherapy 2011; 31(Suppl.5):5S-8S.
4. Roxanas M, Hibbert E, Field M. Venlafaxine hypo- natraemia: incidence, mechanism and manage- ment. Aust N Z J Psychiatry 2007; 41(5):411-418.
5. Jung YE, Jun TY, Kim KS, Bahk WM. Hyponatre- mia associated with selective serotonin reuptake inhibitors, mirtazapine, and venlafaxine in Korean patients with major depressive disorder. Int J Clin Pharmacol Ther 2011; 49(7):437-443.
6. Mogi T, Yoshino A, Ikemoto G, Nomura S. Mirtaza- pine as an alternative for selective-serotonin-reup- take-inhibitor-induced syndrome of inappropriate secretion of antidiuretic hormone. Psychiatry Clin Neurosci 2012; 66(1):80.
7. Koelkebeck K, Domschke K, Zwanzger P, Hetzel G, Lang D, Arolt V. A case of non-SIADH-induced hyponatremia in depression after treatment with reboxetine. World J Biol Psychiatry 2009; 10(4Pt2):609-611.
8. Kate N, Grover S, Kumar S, Modi M. Bupropion- induced hyponatremia. Gen Hosp Psychiatry 2013; 35(6):681.e11-12.
9. Safdieh JE, Rudominer R. A case of hyponatremia induced by duloxetine. J Clin Psychopharma- col 2006; 26(6):675-676.