The risk of antidepressant-induced hyponatremia: A meta-analysis of antidepressant classes and compounds
Abstract Background Hyponatremia (hypoNa) is a potentially serious adverse event of antidepressant treatment. Previous research suggests the risk of drug-induced hyponatremia differs between antidepressants. This meta-analysis sought to determine the risk of antidepressant-induced hypoNa, stratified...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2024-01-01
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| Series: | European Psychiatry |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933824000117/type/journal_article |
| _version_ | 1827320206113898496 |
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| author | Tim Gheysens Filip Van Den Eede Livia De Picker |
| author_facet | Tim Gheysens Filip Van Den Eede Livia De Picker |
| author_sort | Tim Gheysens |
| collection | DOAJ |
| description | Abstract
Background
Hyponatremia (hypoNa) is a potentially serious adverse event of antidepressant treatment. Previous research suggests the risk of drug-induced hyponatremia differs between antidepressants. This meta-analysis sought to determine the risk of antidepressant-induced hypoNa, stratified by different compounds and classes.
Methods
A PRISMA-compliant systematic search of Web of Science and PubMed databases was performed from inception until Jan 5, 2023, for original studies reporting incidences or risks of hypoNa in adults using antidepressants. We modelled random-effects meta-analyses to compute overall event rates and odds ratios of any and clinically relevant hypoNa for each compound and class, and ran head-to-head comparisons based on hypoNa event rates. We conducted subgroup analyses for geriatric populations and sodium cut-off value. The study is registered with PROSPERO, CRD42021269801.
Results
We included 39 studies (n = 8,175,111). Exposure to antidepressants was associated with significantly increased odds of hypoNa (k = 7 studies, OR = 3.160 (95%CI 1.911-5.225)). The highest event rates were found for SNRIs (7.44%), SSRIs (5.59%), and TCAs (2.66%); the lowest for mirtazapine (1.02%) and trazodone (0.89%). Compared to SSRIs, SNRIs were significantly more likely (k = 10, OR = 1.292 (1.120 – 1.491), p < 0.001) and mirtazapine significantly less likely (k = 9, OR = 0.607 (0.385 – 0.957), p = 0.032) to be associated with hypoNa.
Conclusion
Our meta-analysis demonstrated that, while no antidepressant can be considered completely risk-free, for hypoNa-prone patients mirtazapine should be considered the treatment of choice and SNRIs should be prescribed more cautiously than SSRIs and TCAs.
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| first_indexed | 2024-03-07T21:43:30Z |
| format | Article |
| id | doaj.art-630eadad7d5c476fac1d25531d3b83ed |
| institution | Directory Open Access Journal |
| issn | 0924-9338 1778-3585 |
| language | English |
| last_indexed | 2024-04-25T00:41:45Z |
| publishDate | 2024-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj.art-630eadad7d5c476fac1d25531d3b83ed2024-03-12T08:34:48ZengCambridge University PressEuropean Psychiatry0924-93381778-35852024-01-016710.1192/j.eurpsy.2024.11The risk of antidepressant-induced hyponatremia: A meta-analysis of antidepressant classes and compoundsTim Gheysens0https://orcid.org/0000-0001-7432-2414Filip Van Den Eede1https://orcid.org/0000-0002-1942-1601Livia De Picker2https://orcid.org/0000-0002-6883-0559Collaborative Antwerp Psychiatric Research Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies, University Psychiatric Centre Campus Duffel, Duffel, BelgiumCollaborative Antwerp Psychiatric Research Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium Department of Psychiatry, Antwerp University Hospital, Edegem (Antwerp), BelgiumCollaborative Antwerp Psychiatric Research Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies, University Psychiatric Centre Campus Duffel, Duffel, BelgiumAbstract Background Hyponatremia (hypoNa) is a potentially serious adverse event of antidepressant treatment. Previous research suggests the risk of drug-induced hyponatremia differs between antidepressants. This meta-analysis sought to determine the risk of antidepressant-induced hypoNa, stratified by different compounds and classes. Methods A PRISMA-compliant systematic search of Web of Science and PubMed databases was performed from inception until Jan 5, 2023, for original studies reporting incidences or risks of hypoNa in adults using antidepressants. We modelled random-effects meta-analyses to compute overall event rates and odds ratios of any and clinically relevant hypoNa for each compound and class, and ran head-to-head comparisons based on hypoNa event rates. We conducted subgroup analyses for geriatric populations and sodium cut-off value. The study is registered with PROSPERO, CRD42021269801. Results We included 39 studies (n = 8,175,111). Exposure to antidepressants was associated with significantly increased odds of hypoNa (k = 7 studies, OR = 3.160 (95%CI 1.911-5.225)). The highest event rates were found for SNRIs (7.44%), SSRIs (5.59%), and TCAs (2.66%); the lowest for mirtazapine (1.02%) and trazodone (0.89%). Compared to SSRIs, SNRIs were significantly more likely (k = 10, OR = 1.292 (1.120 – 1.491), p < 0.001) and mirtazapine significantly less likely (k = 9, OR = 0.607 (0.385 – 0.957), p = 0.032) to be associated with hypoNa. Conclusion Our meta-analysis demonstrated that, while no antidepressant can be considered completely risk-free, for hypoNa-prone patients mirtazapine should be considered the treatment of choice and SNRIs should be prescribed more cautiously than SSRIs and TCAs. https://www.cambridge.org/core/product/identifier/S0924933824000117/type/journal_articleadverse drug eventsantidepressive agentshyponatremiainappropriate ADH syndromepsychiatry |
| spellingShingle | Tim Gheysens Filip Van Den Eede Livia De Picker The risk of antidepressant-induced hyponatremia: A meta-analysis of antidepressant classes and compounds European Psychiatry adverse drug events antidepressive agents hyponatremia inappropriate ADH syndrome psychiatry |
| title | The risk of antidepressant-induced hyponatremia: A meta-analysis of antidepressant classes and compounds |
| title_full | The risk of antidepressant-induced hyponatremia: A meta-analysis of antidepressant classes and compounds |
| title_fullStr | The risk of antidepressant-induced hyponatremia: A meta-analysis of antidepressant classes and compounds |
| title_full_unstemmed | The risk of antidepressant-induced hyponatremia: A meta-analysis of antidepressant classes and compounds |
| title_short | The risk of antidepressant-induced hyponatremia: A meta-analysis of antidepressant classes and compounds |
| title_sort | risk of antidepressant induced hyponatremia a meta analysis of antidepressant classes and compounds |
| topic | adverse drug events antidepressive agents hyponatremia inappropriate ADH syndrome psychiatry |
| url | https://www.cambridge.org/core/product/identifier/S0924933824000117/type/journal_article |
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