In a frail, elderly, depressed patient, hyponatremia can present a difficult diagnostic and management challenge. We report the case of a severely depressed 83-year-old woman presenting with severe hyponatremia, eventually attributed to a syndrome of inappropriate, antidiuretic hormone (SIADH) secretion induced by fluoxetine. This case is discussed in the context of the multiple potential causes of hyponatremia in an elderly depressed patient, with a focus on fluoxetine-induced SIADH, as reported in 9 other published cases.
Get full access to this article
View all access options for this article.
References
1.
1. Miller M.Disorders of water and sodium balance. In: Abrams WB, Berkow R, Eds. The Merck manual of geriatrics. Rahway, NJ: Merck Sharp & Dohme Research Laboratories, 1990:24–35.
2.
2. Abbott R.Hyponatremia due to antidepressant medications. Ann Emerg Med1983; 12:708–710.
3.
3. Beckstrom D, Reding R, Cerletty J.Syndrome of inappropriate antidiuretic hormone secretion associated with amitriptyline administration [letter]. JAMA179; 241:133.
4.
4. Fort S, Bannister P, Manning A, et al. Inappropriate antidiuretic hormone secretion associated with dothiepin [letter]. Lancet1985; 2:551.
5.
5. Garson M.Syndrome of dilutional hyponatremia secondary to tricyclic antidepressant. Practitioner1979; 222:411–412.
6.
6. Hamburger S, Langley H, Bowers G.The syndrome of inappropriate secretion of antidiuretic hormone associated with amitriptyline or trifluoperazine administration. J Kans Med Soc1980; 81:469–470.
7.
7. Henkin Y, Kaplan Z, Alkan M.Psychiatric presentation of hyponatremia associated with the use of amitriptyline: a report of two cases. Isr J Med Sci1989; 25:587–589.
9. Luzecky M, Barmon K, Schultz ER. The syndrome of inappropriate secretion of antidiuretic hormone associated with amitriptyline administration. South Med J1979; 67:495–497.
10.
10. Madhusoodanan S, Osnos R.Amitriptyline-induced hyponatremia: a case report. Mt Sinai J Med1981; 48:431–433.
11.
11. Matuk F, Kalyanaraman K.Syndrome of inappropriate secretion of antidiuretic hormone in patients treated with psychotropic drugs. Arch Neurol1977; 34:374–375.
12.
12. Mitsch RA, Lee AK. Syndrome of inappropriate antidiuretic hormone with imipramine. Drug Intell Clin Pharm1986; 20:787–789.
13.
13. Parker WA. Imipramine-induced syndrome of inappropriate antidiuretic hormone secretion. Drug Intell Clin Pharm1984; 18:890–894.
15. Solammaderi SV. Inappropriate antidiuresis during amitriptyline therapy [letter]. J Clin Psychopharmacol1984; 4:146–147.
16.
16. Peterson JC, Pollack RW, Mahoney JJ, et al. Inappropriate antidiuretic hormone secondary to a monamine oxidase inhibitor. JAMA1978; 239:1422–1423.
17.
17. Brown RP, Kocsis JH, Cohen SK. Delusional depression and inappropriate antidiuretic hormone secretion. Biol Psychiatry1983; 18:1059–1063.
18.
18. Finlayson AJR, Vieweg WVR, Wilkey WD, et al. Hyponatremic seizure following ECT. Can J Psychiatry1989; 34:463–464.
19.
19. MacMillan HL, Gibson JC, Steiner M.Hyponatremia and depression. J Nerv Ment Dis1990; 178:720–722.
20.
20. Zubenko GS, Altesman RI, Cassidy JW, et al. Disturbances of thirst and water homeostasis in patients with affective illness. Am J Psychiatry1984; 141:436–437.
21.
21. Zubenko GS. Water homeostasis in psychiatric patients. Biol Psychiatry1987; 22:121–125.
22.
22. Hwang AS, Magraw RM. Syndrome of inappropriate secretion of antidiuretic hormone due to fluoxetine. Am J Psychiatry1989; 146:399.
23.
23. Gommans JH, Edwards RA. Fluoxetine and hyponatraemia. N Z Med J1990; 103:106.
24.
24. Cohen BJ, Mahelsky M, Adler L.More cases of SIADH with fluoxetine. Am J Psychiatry1990; 147:948–949.
25.
25. Staab JP, Yerkes SA, Cheney EM, et al. Transient SIADH associated with fluoxetine. Am J Psychiatry1990; 147:1569–1570.
27. Vishwanath BM, Navalgund AA, Cusano W, et al. Fluoxetine as a cause of SIADH. Am J Psychiatry1991; 148:542–543.
28.
28. Rousseau P.Hyponatremia among older individuals. S Med J1991; 84:1114–1118.
29.
29. Benfield P, Heel RC, Lewis SP. Fluoxetine: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness. Drugs1986; 32:481–508.
30.
30. Faull CM, Rooke P, Baylis PH. The effect of a highly specific serotonin agonist on osmoregulated vasopressin secretion in healthy man. Clin Endocrinol1991; 35:423–430.
