低钠血症：对服用选择性5-羟色胺再摄取抑制剂（SSRI）和5-羟色胺去甲肾上腺素再摄取抑制剂（SNRI）的老年精神病患者的一项审计。

Hyponatraemia: an audit of aged psychiatry patients taking SSRIs and SNRIs.

作者信息

Giorlando Francesco, Teister Julia, Dodd Seetal, Udina Marc, Berk Michael

机构信息

Department of Psychiatry, Melbourne University, Parkville, VIC, Australia.

出版信息

Curr Drug Saf. 2013 Jul;8(3):175-80. doi: 10.2174/15748863113089990036.

DOI:10.2174/15748863113089990036

PMID:23841535

Abstract

OBJECTIVE

Hyponatraemia is a serious adverse event commonly reported in elderly people treated with serotonergic antidepressants. The mechanism, incidence and risk factors for antidepressant induced hyponatraemia are not fully understood.

METHOD

In a retrospective chart analysis, depressed patients aged >63 years were investigated for change in serum sodium levels between two time points, separated by a median period of 45.5 days, with the first specimen taken prior to treatment. Patients were grouped into three cohorts; treated with an SSRI or SNRI (n=77), treated with an antidepressant other than an SSRI or SNRI (n=54) and not treated with an antidepressant (n=128).

RESULTS

For change in sodium level between measurements and total number of patients with hyponatraemia, there was no significant difference between cohorts. However, the rate of reduction of serum sodium levels between time points was significantly greater for SSRI and SNRI treated patients (p<0.001) and patients treated with other antidepressants (p=0.03) compared to patients not treated with antidepressants. Moreover, the distribution of values of change in serum sodium was skewed towards reduced serum sodium in patients treated with SSRI or SNRIs (skew -0.43) and patients treated with other antidepressants (skew -0.09) but not for patients without antidepressants (skew 0.25).

CONCLUSIONS

These data suggest that antidepressant treatment is associated with hyponatraemia affecting a subgroup of individuals only. Generalised linear modelling showed that the risk of hyponatraemia increases with increased age, female gender, and particularly the antidepressant agents sertraline and escitalopram. The findings are of clinical significance as they demonstrate that hyponatraemia can occur rapidly with antidepressants, and SSRI/SNRI medications induce more rapid changes. They support the use of electrolyte monitoring early in antidepressant treatment in patients receiving antidepressants.

摘要

目的

低钠血症是使用血清素能抗抑郁药治疗的老年人中常见的严重不良事件。抗抑郁药诱发低钠血症的机制、发生率和危险因素尚未完全明确。

方法

在一项回顾性病历分析中，对年龄大于63岁的抑郁症患者在两个时间点之间的血清钠水平变化进行调查，两个时间点间隔的中位数为45.5天，第一个样本在治疗前采集。患者被分为三组；接受选择性5-羟色胺再摄取抑制剂（SSRI）或5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRI）治疗（n=77），接受除SSRI或SNRI以外的抗抑郁药治疗（n=54），未接受抗抑郁药治疗（n=128）。

结果

对于测量期间钠水平的变化以及低钠血症患者总数，各组之间没有显著差异。然而，与未接受抗抑郁药治疗的患者相比，接受SSRI和SNRI治疗的患者（p<0.001）以及接受其他抗抑郁药治疗的患者（p=0.03）在两个时间点之间血清钠水平的降低速率明显更大。此外，接受SSRI或SNRI治疗的患者（偏度-0.43）和接受其他抗抑郁药治疗的患者（偏度-0.09）血清钠变化值的分布偏向血清钠降低，但未接受抗抑郁药治疗的患者则不然（偏度0.25）。

结论

这些数据表明，抗抑郁药治疗仅与影响一部分个体的低钠血症有关。广义线性模型显示，低钠血症的风险随着年龄增加、女性以及特别是抗抑郁药舍曲林和艾司西酞普兰而增加。这些发现具有临床意义，因为它们表明使用抗抑郁药时低钠血症可能迅速发生，并且SSRI/SNRI药物会引起更快的变化。它们支持在接受抗抑郁药治疗的患者中尽早进行电解质监测。