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Pharmacopsychiatry 2007; 40(3): 129-131
DOI: 10.1055/s-2007-973837
Letter

© Georg Thieme Verlag KG · Stuttgart · New York

Successful Mirtazapine Treatment of an 81-Year-old Patient With Syndrome of Inappropriate Antidiuretic Hormone Secretion

C. Jagsch 1 , J. Marksteiner 2 , E. Seiringer 3 , E. Windhager 1
  • 1Psychiatrische Klinik Wels, Linzerstrasse 89, A-4600 Wels, Austria
  • 2Department of General Psychiatry, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
  • 3Department of Medicine/Nephrology, Krankenhaus der Barmherzigen Schwestern vom Hl. Kreuz, Grieskirchnerstrasse, A-4600 Wels, Austria
Further Information

Publication History

received 17. 10. 2006 revised 19. 02. 2007

accepted 13. 03. 2007

Publication Date:
01 June 2007 (online)

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Abstract

Elderly patients are at a higher risk for inappropriate antidiuretic hormone secretion when treated with antidepressants. In response to severe depressive symptoms, we initiated treatment with citalopram of an 81-year-old female patient with slightly reduced sodium and chloride levels. The sodium and chloride levels decreased continuously during treatment with citalopram; six days after the citalopram was discontinued, sodium and chloride levels returned to normal. We then switched treatment to mirtazapine. Close monitoring revealed that the patient's sodium and chloride levels never decreased and the patient did not relapse for more than two months. This case study indicates that treatment with citalopram may worsen preexisting hyponatremia. Mirtazapine appears to be safe for use in high-risk, elderly patients.

References

  • 1 Azaz-Livshits T, Hershko A, Ben Chetrit E. Paroxetine associated hepatotoxicity: a report of 3 cases and a review of the literature.  Pharmacopsychiatry. 2002;  35 112-115
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Barclay TS, Lee AJ. Citalopram-associated SIADH.  Ann Pharmacother. 2002;  36 1558-1563
    CrossrefPubMedSearch in Google Scholar
  • 3 Blass DM, Pearson VE. SIADH with multiple antidepressants in a geriatric patient.  J Clin Psychiatry. 2000;  61 448-449
    PubMedSearch in Google Scholar
  • 4 Degner D, Grohmann R, Kropp S, Ruther E, Bender S, Engel RR, Schmidt LG. Severe adverse drug reactions of antidepressants: Results of the German multicenter drug surveillance program AMSP.  Pharmacopsychiatry. 2004;  37 (Suppl 1) 39-45
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Flores G, Perez-Patrigeon S, Cobos-Ayala C, Vergara J. Severe symptomatic hyponatremia during citalopram therapy: a case report.  BMC Nephrol. 2004;  5 2
    CrossrefPubMedSearch in Google Scholar
  • 6 Kirby D, Harrigan S, Ames D. Hyponatraemia in elderly psychiatric patients treated with Selective Serotonin Reuptake Inhibitors and venlafaxine: a retrospective controlled study in an inpatient unit.  Int J Geriatr Psychiatry. 2002;  17 231-237
    CrossrefPubMedSearch in Google Scholar
  • 7 Leung VP, Chiu HF, Lam LC. Hyponatremia associated with paroxetine.  Pharmacopsychiatry. 1998;  31 32-34
    PubMedSearch in Google Scholar
  • 8 Liu BA, Mittmann N, Knowles SR, Shear NH. Hyponatremia and the syndrome of inappropriate secretion of antidiuretic hormone associated with the use of selective serotonin reuptake inhibitors: a review of spontaneous reports.  CMAJ. 1996;  155 519-527
    PubMedSearch in Google Scholar
  • 9 Miehle K, Paschke R, Koch CA. Citalopram therapy as a risk factor for symptomatic hyponatremia caused by the syndrome of inappropriate secretion of antidiuretic hormone (SIADH): a case report.  Pharmacopsychiatry. 2005;  38 181-182
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Odeh M, Beny A, Oliven A. Severe symptomatic hyponatremia during citalopram therapy.  Am J Med Sci. 2001;  321 159-160
    PubMedSearch in Google Scholar
  • 11 Pollock BG. Adverse reactions of antidepressants in elderly patients.  J Clin Psychiatry. 1999;  60 (Suppl 20) 4-8
    PubMedSearch in Google Scholar
  • 12 Rai A, Whaley-Connell A, McFarlane S, Sowers JR. Hyponatremia, arginine vasopressin dysregulation, and vasopressin receptor antagonism.  Am J Nephrol. 2006;  26 579-589
    CrossrefPubMedSearch in Google Scholar
  • 13 Roxanas MG. Mirtazapine-induced hyponatraemia.  Med J Aust. 2003;  179 453-454
    PubMedSearch in Google Scholar
  • 14 Settle Jr EC. Antidepressant drugs: disturbing and potentially dangerous adverse effects.  J Clin Psychiatry. 1998;  59 (Suppl 16) 25-30
    PubMedSearch in Google Scholar
  • 15 Sharma H, Pompei P. Antidepressant-induced hyponatraemia in the aged. Avoidance and management strategies.  Drugs Aging. 1996;  8 430-435
    PubMedSearch in Google Scholar
  • 16 Spigset O, Hedenmalm K. Hyponatremia and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) induced by psychotropic drugs.  Drug Safety. 1995;  12 209-225
    PubMedSearch in Google Scholar

Correspondence

Dr. C. Jagsch

Psychiatrische Klinik Wels

Linzerstrasse 89

4600 Wels

Austria

Phone: +43/7242/40 70

Fax: +43/7242/407/510

Email: christian.jagsch@gespag.at