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Antidepressants and the risk of hyponatraemia: A class-by-class review of the literature
Psychosomatics, 09/15/14
De Picker L, et al. – The study aimed to determine the relationship between hyponatraemia and antidepressants, defining incidence and odds ratios (ORs) for antidepressant classes. The authors conclude that hyponatraemia is a potentially dangerous side effect of antidepressants, not exclusive to SSRIs. Current evidence suggests a relatively higher risk of hyponatraemia with SSRIs and venlafaxine, especially combined with patient risk factors, warranting clinicians to be aware of this complication. The risks associated with mirtazapine and TCAs are moderate, supporting these antidepressants as alternative treatments for patients with (an increased risk of) hyponatraemia.
  • A review of the literature published until March 2013 was performed using Web of Science and PubMed employing combinations of search strings "antidepressants" and antidepressant class and generic drug names with "hyponatr(a)emia", "SIADH" or "inappropriate ADH".

  • 21 effect studies and over 100 case reports were considered, the majority concerning SSRIs.
  • Because of variations in study designs, populations and cut-off values, incidence rates diverged between 0.06-40% for SSRIs and 0.08-70% for venlafaxine.
  • Although based on less solid evidence, incidence figures for mirtazapine and TCAs were lower.
  • Regarding classes, ORs for SSRIs (1.5-21.6) were consistently higher than for TCAs (1.1-4.9).
  • The risks associated with MAO inhibitors, reboxetine and bupropion could not be established due to insufficient information.
  • Patient risk factors included older age (OR 6.3) and concomitant use of (thiazide) diuretics (OR 11.2-13.5).

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