The association between selective serotonin reuptake inhibitors (SSRIs) and hyponatraemia has been well documented, the elderly appearing to be at greatest risk. An analysis of data of hyponatraemia in the elderly using SSRIs from all published cases and from the Committee on Safety of Medicines found that the mean time to detection was about 3 weeks after commencing SSRIs. A wide range of time to detection (1-253 days) and non-specific symptoms suggest hyponatraemia is detected by chance rather than being specifically looked for. In the elderly there are physiological changes, a high prevalence of medical illnesses and concomitant drug use, which may precipitate hyponatraemia. Together with a risk of altered water regulation in psychiatric illness this may account for the particular susceptibility of the elderly to hyponatraemia whilst using SSRIs.
Ball C.J., Herzberg J. (1994) Hyponatraemia and selective serotonin reuptake inhibitors. Int J Geriat Psychiat9: 819-822
5.
Bartter F.C., Schwartz W.B. (1967) The syndrome of inappropriate secretion of antidiuretic hormone. Am J Med42: 790
6.
Blacksten J.V., Birt JA ( 1993) Syndrome of inappropriate secretion of antidiuretic hormone secondary to fluoxetine. Ann Pharmacother27: 723-724
7.
Bouman W.P., Johnson H., Pinner G. (1997) Inappropriate antidiuretic hormone secretion and SSRIs. Br J Psychiat170: 88-91
8.
Caird F.I., Andrews G.R., Kennedy R.D. (1973) Effect of posture on blood pressure in the elderly . Br Heart J35: 527-530
9.
Chua T.P., Vong S.K. (1993) Hyponatraemia associated with paroxetine. Br Med J306:143
10.
Cohen BJ, Mahelsky M., Adler L. (1990) More cases of SIADH with fluoxetine. Am J Psychiat147: 948-949
11.
Crews J.R., Potts N L S, Schreiber J., Lipper S. (1993) Hyponatremia in a patient treated with sertraline . Am J Psychiat150: 1564
12.
Druckenbrod R., Mulsant B.H. (1994) Fluoxetine-induced syndrome of inappropriate antidiuretic hormone secretion: a geriatric case report and a review of the literature . J Geriat Psychiat Neurol7: 254-256
13.
Flint A.J., Crosby J., Genik J.L. (1996) Recurrent hyponatremia associated with fluoxetine and paroxetine. Am J Psychiat153:134
Girault C., Richard J.C., Chevron V., Goulle J.P., Droy J.M., Bonmarchand G., Leroy J. (1997) Syndrome of inappropriate secretion of antidiuretic hormone in two elderly women with elevated serum fluoxetine. Clin Tox35: 93-95
16.
Goddard C., Paton C. (1992) Hyponatraemia associated with paroxetine. BMJ305:1332
17.
Gommans J.H., Edwards R.A. (1990) Fluoxetine and hyponatraemia. N Z Med J103: 106
18.
Grundy E. (1992) The epidemiology of aging. In Brocklehurst J C, Tallis R C, Fillit H M (eds), Textbook of geriatric medicine and gerontology. Churchill Livingstone, Edinburgh, pp. 3-20
19.
Helderman J.H., Vestal R.E., Rowe J.W., Tobin J.D., Andres R., Robertson G.L. (1978) The response of arginine vasopressin to intravenous ethanol and hypertonic saline in man: the impact of aging. J Gerontol33: 39-47
20.
Hwang AS, Macgraw R.M. (1989) Syndrome of inappropriate secretion of antidiuretic hormone due to fluoxetine. Am J Psychiat146: 399
21.
Jackson C., Carson W., Markowitz J., Mintzer J. (1995) SIADH associated with fluoxetine and sertraline therapy. Am J Psychiat152: 809-810
22.
Jackson E.K. (1996) Vasopressin and other agents affecting the renal conservation of water. In Hardman JG, Limbird LE (eds), Goodman and Gilmans' the pharmacological basis of therapeutics. McGraw-Hill, New York, pp. 715-731
23.
Johnson AG, Crawford G.A., Kelly D., Nguyen TV, Gyory A.Z. (1994) Arginine vasopressin and osmolality in the elderly . J Am Geriat Soc42: 399-404
24.
Kazal L.A., Hall D.L., Miller L.G., Noel M.L. (1993) Fluoxetine-induced SIADH: a geriatric occurrence ? J Fam Pract36: 341-343
25.
Kennedy P G E, Mitchell D.M., Hoffbrand B.I. (1978) Severe hyponatraemia in hospital inpatients. BMJ2: 1251-1253
26.
Kessler J., Samuels S.C. (1996) Sertraline and hyponatremia. N Engl J Med335: 524
27.
Kovacs L., Robertson G.L. (1992) Syndrome of inappropriate anti-diuresis. Endocrinol Metabol Clin N Am21: 859-875
28.
Leung M., Remick R. (1995) Sertraline-associated hyponatremia. Can J Psychiatr40: 497-498
29.
Lindeman RD, Van Buren HC, Raisz LG (1960) Osmolar renal concentrating ability in healthy young men and hospitalized patients without renal disease. N Engl J Med262: 1306-1309
30.
Lindesay J., Briggs K., Murphy E. (1989) The Guy's/Age Concern Survey: prevalence rates of cognitive impairment, depression and anxiety in an urban elderly community . Br J Psychiat155: 317-346
31.
Liu B.A., Mittmann N., Knowles S.R., Shear N.H. (1996) Hyponatremia and the syndrome of inappropriate secretion of antidiuretic hormone associated with the use of selective serotonin reuptake inhibitors: a review of spontaneous reports. Can Med Ass J155: 519-527
32.
Llorente M.D., Gorelick M., Silverman M.A. (1994) Sertraline as the cause of inappropriate antidiuretic hormone secretion. J Clin Psychiat55: 543-544
33.
Marick P.E.,Van HeerdenW., SteenkampV. (1990) Fluoxetine-induced syndrome of inappropriate antidiuretic hormone excretion. S Afr Med J78: 760-761
34.
McAskill R., Taylor D. (1997) Psychotropics and hyponatraemia. Psychiat Bull21: 33-35
35.
McHardy KC (1993) Syndrome of inappropriate antidiuretic hormone secretion due to fluvoxamine therapy. Br J Clin Pharmac47: 62-63
36.
Miller M., Morley J.E., Rubenstein L.Z. (1995) Hyponatremia in a nursing home population. J Am Geriat Soc43: 1410-1413
37.
Miller M., Hecker M.S., Friedlander DA, Carter J.M. (1996) Apparent idiopathic hyponatremia in an ambulatory geriatric population. J Am Geriat Soc44: 404-408
38.
Ng D., Alderman C.P. (1996) Syndrome of inappropriate antidiuretic hormone secretion associated with selective serotonin reuptake inhibitors. Aust J Hosp Pharmac26: 358-360
39.
Ohashi M., Fujio N., Nawata H., Kato K., Ibayashi H., Kangawa K., Matsuo H. (1987) High plasma concentrations of human atrial natriuretic polypeptide in aged men. J Clin Endocrinol Metab64: 81-85
40.
Ohsawa H., Kishimoto T., Hirai M., Shimayoshi N., Matsumura K., Oribe H., Hirao F., Ikawa G., Nakai T., Miyake M., Kurata S. (1992) An epidemiological study on hyponatremia in psychiatric patients in mental hospitals in Nara Prefecture. Jap J Psychiat Neurol46: 883-889
41.
Phillips PA, Rolls B.J., Ledingham J G G, Forsling M.L., Morton J.J., Crowe M.J., Wollner L. (1984) Reduced thirst after water depletion in healthy elderly men. N Engl J Med311: 753-759
42.
Pillans P.I., Coulter DM (1994) Fluoxetine and hyponatremia - a potential hazard in the elderly. N Z Med J107: 85-86
43.
Robinson D., Brooks J., Mahler E., Sheikh JI (1996) SIADH— compulsive drinking or SSRI influence ? Ann Pharmacother30: 886
44.
Rowe JW ( 1992) Nephrology and the genitourinary system. In Evans JG, Williams T F (eds), Oxford textbook of geriatric medicine. Oxford University Press, Oxford, pp.425-426
45.
Rowe JW, Minaker KL, Sparrow D., Robertson G.L. (1982) Age-related failure of volume-pressure-mediated vasopressin release. J Clin Endocrinol Metab54: 661-664
46.
Staab J.P., Yerkes S.A., Cheney E.M., Clayton A.H. (1990) Transient SIADH associated with fluoxetine. Am J Psychiat147: 1569-1570
47.
Suzman R., Kinsella KG, Myers G.C. (1992) Demography of older populations in developed countries . In Evans JG, Williams TF (eds), Oxford textbook of geriatric medicine . Oxford University Press, Oxford , pp. 3-20
48.
Taylor I.C., McConnell J.G. (1995) Severe hyponatraemia associated with selective serotonin reuptake inhibitors. Scott Med J40: 147-148
49.
Ten Holt W.L., van Iperen C.E., Schrijver G., Bartelink A K M (1996) Severe hyponatremia during therapy with fluoxetine . Archs Int Med156: 681-682
50.
Thomas A., Verbalis J.G. (1995) Hyponatraemia and the syndrome of inappropriate antidiuretic hormone secretion associated with drug therapy in psychiatric patients. CNS Drugs4: 357-369
51.
Thornton S.L., Resch D.S. (1995) SIADH associated with sertraline therapy. Am J Psychiat152: 809
52.
Voegeli J., Baumann P. (1996) Inappropriate secretion of antidiuretic hormone and SSRIs. Br J Psychiat169: 524-525
