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A cohort study of serotonin–norepinephrine re-uptake inhibitors and risk of hyponatremia
Örebro University, School of Medical Sciences. Örebro University Hospital.ORCID iD: 0000-0001-6968-6934
Örebro University, School of Medical Sciences, Örebro, Sweden.
Karolinska Institutet, Medical Epidemiology and Biostatistics, Stockholm, Sweden.
2020 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 63, no Suppl. 1, p. S486-S486Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Introduction: Hyponatremia is a potential side effect of antidepressants and the risk differs across antidepressant subclasses. There is conflicting evidence whether noradrenergic antidepressants are associated with lower risk of hyponatremia than SSRIs.

Objectives: To compare hyponatremia risk following initiation of SNRIs versus SSRIs.

Methods: Registry based cohort study including laboratory data on sodium measurements and complete information on drugs dispensed at Swedish pharmacies. New users of an SSRI (citalopram, sertraline,escitalopram, fluoxetine, paroxetine, fluvoxamine) or SNRI (venlafaxine, duloxetine) in Stockholm county 2007-2010 were included. Persons with diabetes mellitus or age <18 years were excluded. Follow up was until death, 2 years, or antidepressant discontinuation. Those lacking a follow-up sodium measurement were excluded from analysis. Hyponatremia was defined as < 136 mmol/L on the firstfollow-up test.

Results: A total of 37020 persons started treatment with an SSRI (n = 33822) or SNRI (n = 3198). SNRI userswere younger (50 vs 54 years, p <0.001), more often male (40% vs 35%, p <0.001) and had a lower incidence of hyponatremia compared to SSRI users (5.9% vs 7.6%, p <0.001). SNRI users had a lowerrisk of hyponatremia in unadjusted logistic regression analysis (OR 0.77, 95% CI 0.66-0.89, p < 0.001)but differences were attenuated when adjusting for age and sex (OR 0.9, 95% CI 0.78-1.1, p = 0.21).

Conclusions: Although hyponatremia was more common in SSRI users, our results were compatible with no difference in hyponatremia risk between SSRIs and SNRIs after multivariable adjustment. We speculate that previously observed differences may be due to residual confounding.

Place, publisher, year, edition, pages
Cambridge University Press, 2020. Vol. 63, no Suppl. 1, p. S486-S486
Keywords [en]
hyponatremia, pharmacopeidemiology, Antidepressants
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-83705DOI: 10.1192/j.eurpsy.2020.6ISI: 000582502501537OAI: oai:DiVA.org:oru-83705DiVA, id: diva2:1447845
Conference
28th European Congress of Psychiatry (EPA 2020), virtual meeting, Madrid, Spain, July 4-7, 2020
Available from: 2020-06-26 Created: 2020-06-26 Last updated: 2020-12-03Bibliographically approved

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Nilsson, Erik

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