Escitalopram, the pure S-enantiomer of its racemic derivative, i.e. citalopram belongs to the selective serotonin reuptake inhibitors (SSRI) class of anti-depressants. Ever since its introduction, it has now rapidly become one of the therapeutic mainstays for major depressive disorders and a spectrum of anxiety disorders. Despite escitalopram being a relatively safe SSRI, there have been a few reports implicating it as the offending agent in causing life-threatening Hyponatraemia[1-4]. The incidence of hyponatraemia varies from 0.5-25% with different types of SSRIs[4]. However, our literature search revealed only eight cases of escitalopram induced hyponatraemia …show more content…
The patient was receiving a combination of oral prednisolone, hydroxychloroquine and methotrexate for her complaints of seronegative spondyloarthropathy. Further, to counter her dysthymia, she had been initiated on oral escitalopram two weeks prior to presenting in our hospital. Her blood sugar levels were being managed using a combination of fast and long acting insulin. Further, on obtaining a detailed history and after a thorough clinical examination, the mild abdominal pain was attributed to severe constipation. Her initial work-up revealed her to be severely hyponatraemic with serum sodium level of 107 mmol/L. Her previous sodium levels, prior to starting escitalopram, was normal (137.6 mmol/L). At this juncture, in view of a possibility of drug induced hyponatraemia, escitalopram was withheld. Further investigations revealed high urinary sodium level (36 mmol\L), elevated urinary osmolality (291 mmol/kg) and reduced serum osmolarity (235 mmol\kg). The low serum urea (11.0 mg/dL), serum creatinine (0.4mg\dL) and low uric acid (2.2 mg/dL) added substance to the …show more content…
Hence it could be missed very easily[5]. The median time duration required for the onset of hyponatraemia following SSRI usage has been pegged at 13 days[7]. However, hyponatraemia has been reported as late as 3 months after initiating patients on SSRI[7]. In addition, as evidenced by many previous reports, various patient attributes that may contribute to the possibility of developing hyponatraemia following escitalopram use have emerged over the years[3,5]. Hence, such patients who are at-risk of developing hyponatraemia, could be monitored for lethargy, insomnia, irritability, confusion and other features indicative of hyponatraemia. If noted, then it should immediately raise a suspicion of SSRI induced Hyponatraemia[2]. Our patient fits the bill here as duration of onset of hyponatremia in her case was around 2 weeks approximately. In addition, she possessed risk factors like female gender, concomitant medication usage for co-morbidities like diabetes mellitus[3]. However, it is important to bear in mind that the absence of risk factors does not preclude the patients receiving SSRIs from developing hyponatraemia, possibly SIADH. In light of the
-The patient was having pitting edema and inspiratory rales because the increase of sodium caused an increase of fluid in the vascular system and lungs.
I interviewed a different friend of mine, Leona, (not her real name) who is clinically depressed. She had used typical antidepressants since her diagnosis, but was always telling me how she felt like they did nothing to help her. Leona constantly complained about how they made her so dizzy and sleepy that she didn’t feel like doing anything and wanted to sleep all day. These things only increased her depression, and she realized that later once she looked back on her time of antidepressant use. Before Leona’s use of antidepressants,
...n also occur. This can occur due to increased serotonin at the synaptic levels which causes inhibition of the release of dopamine through specific presynaptic serotonin receptor subtypes. Another typical side-effect includes bleeding such as brusing, epistaxis, and gastrointestinal bleeding. SSRIs inhibit platelet functions and this could lengthen the time and risk of bleeding. When serotonin receptors are hyperstimulated, a condition called serotonin syndrome can occur. This syndrome brings about nausea, diarrhea, restlessness, delirium, extreme agitation, seizure, hyperreflexia, and many other symptoms. This syndrome can occur if SSRIs are taken together with a monoamine oxidase inhibitor (a member of a different class of antidepressants).
...ossible adverse interactions between an antidepressant medication and the substances a patient is abusing (such as the potential for increased sedation or intoxication).” (p 29).
Hypercium has become popular in the United States because of its scientifically documented antidepressant properties with much of the evidence coming from European countries . Because the FDA has not approved Hypercium for any medical purpose, there are many varying reports of its effectiveness (Cracchiolo, 1999). The said effectiveness often seems to be correlated with the purposes of the reporting organization, and therefore, any information about hypercium should be regarded with caution.
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
FDA research has shown that tricyclic antidepressants such as Paxil can actually increase the severity of depression and suicidal behavior in teens and young adults. In the shocking expose “Treating the Mentally Ill,” medical journalist Rob Waters warns “Antidepressants including Paxil, Prozac, Zoloft, and Effexor have provoked hostile behavior and thoughts about suicide in a number of teenagers who have been prescribed the drugs. Some of th...
In the early 20th century, depression therapeutic strategies ranged from invasive therapeutics like insulin coma therapy, chemical and electrical shock therapy to administration of some addictive chemicals like chloral hydrate, barbiturates, amphetamines and opiates (Lopez-Munoz & Alamo C, 2009). In 1950s, Ipronizide, which was previously used as anti-tuberculosis, was introduced as the first Mono-amino-oxidase inhibitor (MAOI) and the first antidepressant ever marketed. Then Imipramine was int...
Approximately 5% of the United States' population experiences a depressive episode that requires psychopharmacological treatment; in any one year, 10-12 million Americans are affected by depression, with the condition twice as common in females than in males. It has been estimated that 15% of patients hospitalized for depression will commit suicide. These figures are incredible, so finding the root of the problem when it comes to depression is extremely important. "Alterations in serotonin metabolism may be an important factor in the etiology and treatment of depression." (7).
Jane had not slept for 72 hours and had poor diet and was observed not to be drinking fluids. Jane has a diagnosis of Bipolar
...ents from sleeping, patients may be prescribed anti-anxiety medications. As a last resort, doctors may use antidepressants in conjunction with mood stabilizers because using antidepressants solely could potentially make the manic moods more extreme.
At first it was the cure all people were looking for. Then it became the drug they were afraid to take. Somewhere between these two extremes lies the truth about the drug Flouxetine, better known as Prozac, the most widely prescribed drug on the globe. It is mainly prescribed to patients suffering from clinical depression. It was first brought to the market in 1988 by the pharmaceutical giant Eli Lilly co. Even though it was originally prescribed for depression, it has been prescribed for everything from eating disorders to insomnia. It was first considered the wonder drug of the new decade because of the way it helped depression patients when no other anti-depressant could and then also found to help many other personality disorders as well. But now it is frowned upon by many. Some of the side effects contributed to the growing opposition of Prozac include nausea, constipation, memory impairment, and excess sweating, just to name a few.
Fluvoxamine, a common serotonin reuptake medication, has a discontinuation rate of 70% (Ferguson, 2001). Other common antidepressant medications like fluoxetine or setraline have discontinuation rates of 45% and 40%, respectively (Ferguson, 2001). These unfortunate figures leave a person susceptible to irritating withdrawal symptoms. Many patients may experience anxiety, sleep disturbances, and flulike symptoms days after stopping their medication. These symptoms are especially apparent when a patient abruptly ends their prescription without tapering or when there is poor adherence. With such complications that accompany antidepressant medication use and our understanding that there are imbalances occurring in the brain, is there an alternative or supplemental treatment that can be
Jureidini, J., & Tonkin, A. (2006). Overuse of antidepressant drugs for the treatment of depression. CNS Drugs, 20(8), 623-632. Retrieved from
SSRIs (Selective serotonin reuptake inhibitors): It is mainly used to treat the patient suffering from the major depression disorder. Although it is considered the safest kind of antidepressant among others, it also should be noted that most of the patient have a relapse soon after they just stop taking this kind of antidepressant.