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Differences in Associations of Antidepressants and Hospitalization Due to Hyponatremia

      Abstract

      Background

      Selective serotonin reuptake inhibitors (SSRIs) and other antidepressants are important as a cause of hyponatremia. However, most studies have focused on the effect on sodium levels regardless of clinical symptoms, or have been too small to be able to discriminate between the effects of specific antidepressant drugs. The objective of the present study was to investigate the association between different groups of antidepressants and the risk of hospitalization due to hyponatremia.

      Methods

      In this register-based case-control study of patients in the general Swedish population, we identified 14,359 individuals with a main diagnosis of hyponatremia. For every case, 4 matched controls were included (n = 57,382). To investigate the temporal aspects of drug-induced hyponatremia, antidepressant exposure was divided into patients with newly initiated and ongoing treatment. Univariable and multivariable logistic regression was used to analyze the association of antidepressant use and hospitalization.

      Results

      For newly initiated antidepressants, adjusted odds ratios (95% confidence interval) for a main diagnosis of hyponatremia compared with controls were: citalopram 5.50 (4.71-6.44); sertraline 4.96 (3.81-6.48); venlafaxine 5.28 (3.20-8.83); tricyclic antidepressants 1.59 (1.13-2.24); and mirtazapine 2.54 (2.04-3.16). Adjusted odds ratio (confidence interval) for individuals with ongoing treatment ranged from 0.57 (0.52-0.63) for citalopram to 1.08 (0.85-1.36) for other SSRIs.

      Conclusions

      There was a strong association between newly initiated treatment with SSRIs or venlafaxine and hospitalization due to hyponatremia. The association for tricyclic antidepressants and mirtazapine was small to moderate. In contrast, there was no evidence that ongoing treatment with antidepressants increases the risk for hospitalization due to hyponatremia.

      Keywords

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      Linked Article

      • Corrigendum to “Differences in Associations of Antidepressants and Hospitalization Due to Hyponatremia” AmJMed, 131(01);56-63
        The American Journal of MedicineVol. 134Issue 4
        • Preview
          Regarding the authors’ previously published paper on the association of antidepressants and hospitalization due to hyponatremia: In preparation of a new manuscript based on the same data published, 2 errors have been discovered in the dataset. Instead of only including patients with a primary diagnosis of hyponatremia, some cases with hyponatremia as a secondary diagnosis had been included. When corrected, the number of cases admitted with a primary diagnosis of hyponatremia were 11,213 instead of 14,359 as reported in the manuscript, and thus the number of matched controls was 44,801 instead of 57,382.
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