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SIADH and anti-depressants
SIADH is a clinical syndrome that is relatively common and may result in significant hyponatremia. Fundamentally, SIADH is regarded as a condition whereby water excretion is compromised because of the body’s inability to suppress the abnormally elevated secretion of anti-diuretic hormone (ADH), an abnormality in the kidneys response to ADH, or the production of abnormal hormone-like compounds that produce effects similar to ADH (such as that observed in the context of some forms of malignant neoplasm). SIADH is also associated with a range of medications, in particular antidepressants including the SSRI drugs. The hallmark of SIADH is hyponatremia in the context of an abnormally elevated urinary osmolarity, and to make the diagnosis accurately it is necessary to measure both serum and urinary electrolytes.
The risk for development of SIADH after the initiation of antidepressant treatment appears to be highest in the first month of treatment, but may persist over time. It appears that the highest risk amongst the anti-depressants is associated with SSRIs and also SNRIs, whereas the risk with tricyclic antidepressants and mirtazapine appear to be lower. Risk factors include older age, female gender, and low body weight. Treatment with sodium supplements will not correct hyponatremia associated with SIADH, and strategies such as fluid restriction may be effective in the short term. However, for the most part if SIADH develops in association with the initiation of a drug the most appropriate course of action will be to discontinue the drug and trial and alternative therapy if possible. Many experts suggest that a drug from a structurally and mechanistically different class would be a reasonable option.
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