Bavbek Nuket, Kargili Ayse, Akcay Ali, Kaya Arif
Department of Nephrology, Fatih University Medical School, Ankara, Turkey.
Am J Kidney Dis. 2006 Oct;48(4):e61-2. doi: 10.1053/j.ajkd.2006.07.011.
Depression is a common problem in elderly patients and frequently is treated with antidepressants. We present the case of a 67-year-old depressed woman who began treatment with citalopram. Two months later, hyponatremia was diagnosed, most likely syndrome of inappropriate antidiuretic hormone secretion. After discontinuation of citalopram therapy, serum sodium concentrations normalized. Later, she began treatment with mirtazapine. Five months after initiating mirtazapine therapy, she developed symptomatic hyponatremia. After mirtazapine therapy was discontinued, serum sodium concentrations normalized. In this case, unlike those previously reported, hyponatremia recurred 5 months after switching from citalopram to mirtazapine, which is believed to be a safe antidepressant. In conclusion, patients older than 60 years should have baseline electrolyte measurements before starting therapy with an antidepressant, and these should be monitored not only in the first weeks of treatment, but throughout the full course.
抑郁症是老年患者的常见问题，常采用抗抑郁药治疗。我们报告一例67岁的抑郁症女性患者，她开始接受西酞普兰治疗。两个月后，诊断为低钠血症，很可能是抗利尿激素分泌不当综合征。停用西酞普兰治疗后，血清钠浓度恢复正常。后来，她开始接受米氮平治疗。开始米氮平治疗五个月后，她出现了有症状的低钠血症。停用米氮平治疗后，血清钠浓度恢复正常。在本病例中，与先前报道的病例不同，从西酞普兰换用米氮平5个月后低钠血症复发，而米氮平被认为是一种安全的抗抑郁药。总之，60岁以上的患者在开始使用抗抑郁药治疗前应进行基线电解质测量，这些测量不仅应在治疗的最初几周进行监测，而且应在整个疗程中进行监测。
