Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
J Psychopharmacol. 2021 Aug;35(8):928-933. doi: 10.1177/02698811211001082. Epub 2021 Apr 16.
Selective serotonin reuptake inhibitors (SSRIs) have a wide and increasing use for the treatment of depression and anxiety. Previous studies have indicated an increased risk of hyponatremia during the first months of treatment. We aimed to investigate the detailed time-course of SSRI-associated hyponatremia with a high temporal resolution, using registry data encompassing the total Swedish population.
This was a population-based case control study using several national registers. Patients hospitalized with a principal diagnosis of hyponatremia ( = 11,213) were compared with matched controls ( = 44,801). Multivariable regression was applied to explore time-dependent associations between SSRIs and hospitalization due to hyponatremia.
Individuals initiating treatment with SSRIs were exposed to an immediately increased risk for hospitalization at week 1, reaching an adjusted odds ratio (aOR) (95% confidence interval) of 29 (19-46). The associations then gradually declined, reaching an aOR of 2.1 (1.0-4.2) by week 13. The aOR for individuals treated for longer than 13 weeks was 0.78 (0.71-0.85).
This study revealed a dramatically increased risk of hyponatremia exclusively related to newly initiated treatment. Consequently, even subtle symptoms consistent with hyponatremia during the first weeks of SSRI treatment should prompt analysis of sodium levels. In patients treated with SSRIs for several months or years, other causes should primarily be sought in the event of hyponatremia.
选择性 5-羟色胺再摄取抑制剂（SSRIs）在治疗抑郁症和焦虑症方面的应用越来越广泛。先前的研究表明，在治疗的头几个月中，低钠血症的风险增加。我们旨在使用包含全瑞典人口的登记数据，以高时间分辨率研究与 SSRIs 相关的低钠血症的详细时间过程。
这是一项基于人群的病例对照研究，使用了多个国家的登记处。将因主要诊断为低钠血症（ = 11213）而住院的患者与匹配的对照（ = 44801）进行比较。应用多变量回归来探索 SSRIs 与因低钠血症而住院之间的时间依赖性关联。
开始使用 SSRIs 治疗的个体在第 1 周就面临住院的风险增加，调整后的优势比（aOR）（95%置信区间）为 29（19-46）。然后，这种关联逐渐下降，在第 13 周时达到 aOR 为 2.1（1.0-4.2）。对于治疗超过 13 周的个体，aOR 为 0.78（0.71-0.85）。
这项研究揭示了一种与新开始的治疗特别相关的、明显增加的低钠血症风险。因此，即使在 SSRIs 治疗的最初几周出现与低钠血症一致的轻微症状，也应促使分析钠水平。对于接受 SSRIs 治疗数月或数年的患者，在出现低钠血症时应主要寻找其他原因。
