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Increased Risk Of Hyponatremia Seen In Older Patients with Depression who Take Paroxetine

Older patients with depression who are being treated with paroxetine may be at increased risk of hyponatremia, indicate results of a longitudinal study.

Hyponatremia, which was defined as plasma sodium level of less than 135Eq/L after initiation of drug therapy, is both under-recognised and a potentially serious complication of paroxetine therapy in older patients, say researchers led by Dr. Tanya Fabian of the University of Pittsburgh in Pittsburgh, Pennsylvania.

The researchers point out major depression is common among older adults, affecting from 10% to 20% of medically hospitalised elderly patients. It also affects 10% to 34.5% of older people living in the community. First-line treatment often includes prescription of SSRIs, including paroxetine.

The 75 study participants, aged from 63 to 90 years, were treated at the University of Pittsburgh Western Psychiatric Institute and Clinic between August 1999 and September 2002. They were diagnosed with a major depressive episode using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Each had a score of 15 or more on the Hamilton Rating Scale for Depression and a score of 18 or higher on the Folstein Mini-Mental State Examination.

Complete medical, psychiatric and medication histories were taken at baseline. Adrenal, renal and thyroid function were normal, and glucose levels had to be within physiological limits.

The investigators found a 12% incidence of hyponatremia developed within 1 to 14 days after therapy initiation in patients with depression. Mean time to hyponatremia development was 9.3 days.

Risk factors included lower baseline sodium levels and lower body mass index. Female sex approached significance, although it was not a significant predictor of the condition.

"Results obtained from this prospective study provide a foundation for understanding the aetiology and risk factors associated with paroxetine-induced hyponatremia," the researchers state. "Development and implementation of a rational plan for prescribing and safely monitoring of selective serotonin reuptake inhibitors (SSRIs) in the aged should be based on an increased understanding of this common adverse event."

Patients who developed hyponatremia did not have concurrent medical conditions or had been prescribed other medications known to cause the condition at baseline.




Archives of Internal Medicine 2004;164:327-332.

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