Clinical Monitoring of Various SSRI’s for their Drug Induced Hyponatremia in Hospitalized Psychiatric Patients

Hyponatremia is a rare complication of the anti-depressant selective serotonin reuptake inhibitor therapy affecting early stages of treatment. The clinical monitoring of the serum natremic levels is done to identify the development of hyponatemia associated with the use of SSRI anti-depressants. The mechanism of hyponatremia is thought to be the syndrome of inappropriate secretion of antidiuretic hormone. Hyponatremia and SIADH can cause such complications as seizure, coma, and rarely death for SSRI users. To clinically monitor hyponatremia induced by use of SSRIs in psychiatric patients and its risk factors and to identify the time duration resulting in hyponatremia of each individual drug. The study was carried out in the department of psychiatry in Pushpagiri Medical College, Kerala. The source population were the in-patients on SSRI therapy with normal serum sodium concentration, meeting eligibility criteria of the study. The depression in the patients are confirmed by Hamilton rating scale for depression and major (ICD-10) depression inventory and hospital anxiety and depression scale. The residual blood samples of the patients were collected on 2 nd , 6 th and 10 th day of treatment and analyzed for serum sodium concentration. We found a moderately strong positive correlation between the use of SSRIs and occurrence of hyponatremia with a p value of .026.Mean ± SD for overall time to detection of hyponatremia was 134.6182± 1.96 days. Medication adherence improved after patient counselling by significant rate. Main symptoms of hyponatremia were identified during the study. Hyponatremia is an under recognized and potentially serious complication of SSRI therapy. The results provide a foundation for understanding the safety profile of anti-depressants in a clinical setting of hyponatremia and its impact on suitable monitoring and treatment strategy. KEYWORDS