:Background:Antidepressant-induced hyponatremia/syndrome of inappropriate antidiuretic hormone (SIADH) can cause significant morbidity and mortality. Antidiuretic hormone release due to stimulation of central serotonin 5HT1C, 5HT2 and α-1 adrenergic receptors is thought to cause this adverse effect (Spigset, 1995). Evidence on which antidepressants are more likely to cause hyponatremia is inconsistent (Coupland, 2011; Leth-Moller, 2016). Owing to its uncommon use, there is limited and conflicting data on the risk of hyponatremia with Moclobemide, a reversible inhibitor of monoamine oxidase A (Mercier, 1997; Mazhar, 2019). There are few reports of hyponatremia induced by multiple antidepressant classes in the same patient.Objective:To add to the literature on risk of hyponatremia with Moclobemide and other antidepressants.Methods:We report a case of hyponatremia sequentially induced by multiple different antidepressant classes who was treated with Moclobemide with no recurrence of hyponatremia. We review existing literature on antidepressant-induced hyponatremia.Results:A 67-year-old man with a history of hypertension, dyslipidemia and gout was first diagnosed with major depressive disorder at age 50 after presenting with pervasive depressed mood, anhedonia, insomnia, poor concentration and feelings of worthlessness. Investigations found no medical causes of depression. His depression remitted on Venlafaxine 75mg/day with no hyponatremia induced. During a second depressive episode 4 years later, his serum sodium (Na) dropped from a normal baseline to 122mmol/L after Venlafaxine was restarted. He appeared euvolemic on physical examination. Investigations found no other causes of hyponatremia and were consistent with SIADH, which was attributed to Venlafaxine. His depression later remitted on Mirtazapine 30mg/day with no hyponatremia induced. During his third depressive episode at age 67, he developed hyponatremia (serum Na 123mmol/L) a week after restarting Mirtazapine. His clinical picture was consistent with SIADH. He later developed hyponatremia after initiating the following antidepressants sequentially: Fluvoxamine, Agomelatine, Nortriptyline, Bupropion. Hyponatremia resolved with fluid restriction and cessation of the implicated antidepressant each time before the next was initiated. He eventually tolerated Moclobemide 300mg/day with no recurrence of hyponatremia.Conclusions:Agomelatine, Nortriptyline and Bupropion are reported to have a low risk of hyponatremia but were implicated in this case. Venlafaxine and Mirtazapine did not cause hyponatremia when first taken but were implicated when restarted after a period of cessation, underscoring the idiosyncratic nature of antidepressant-induced hyponatremia. Moclobemide can be considered for depressed patients with recurrent antidepressant-induced hyponatremia. Serum Na should be regularly monitored in patients taking antidepressants who are at high risk of hyponatremia.

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127 吗氯贝胺成功治疗多类抗抑郁药引起的复发性低钠血症后的重度抑郁症

: 背景：抗抑郁药引起的低钠血症/抗利尿激素不当综合征 (SIADH) 可导致显着的发病率和死亡率。由于刺激中枢血清素 5HT1C、5HT2 和 α-1 肾上腺素能受体而释放的抗利尿激素被认为会导致这种不利影响（Spigset，1995）。关于哪种抗抑郁药更可能导致低钠血症的证据并不一致（Coupland，2011；Leth-Moller，2016）。由于其不常见的用途，关于吗氯贝胺（一种单胺氧化酶 A 的可逆抑制剂）的低钠血症风险数据有限且相互矛盾（Mercier，1997；Mazhar，2019）。同一患者因多种抗抑郁药导致低钠血症的报道较少。目的：增加吗氯贝胺等抗抑郁药发生低钠血症风险的文献。方法：我们报告了一例由多种不同抗抑郁药顺序诱导的低钠血症病例，该病例接受吗氯贝胺治疗，低钠血症未复发。我们回顾了关于抗抑郁药引起的低钠血症的现有文献。结果：一名有高血压、血脂异常和痛风病史的 67 岁男性在 50 岁时首次被诊断为重度抑郁症，表现为普遍抑郁情绪、快感缺乏、失眠、差专注力和无价值感。调查没有发现抑郁症的医学原因。服用文拉法辛 75 毫克/天后，他的抑郁症得到缓解，没有引起低钠血症。在 4 年后的第二次抑郁发作期间，他的血清钠 (Na) 在文拉法辛重新启动后从正常基线降至 122 mmol/L。体格检查时，他的血容量正常。调查未发现低钠血症的其他原因，并且与 SIADH 一致，这归因于文拉法辛。后来服用米氮平 30 毫克/天后，他的抑郁症得到缓解，没有引起低钠血症。在他 67 岁的第三次抑郁发作期间，他在重新开始使用米氮平一周后出现了低钠血症（血清 Na 123 mmol/L）。他的临床表现与 SIADH 一致。他后来在依次使用以下抗抑郁药后出现低钠血症：氟伏沙明、阿戈美拉汀、去甲替林、安非他酮。每次开始下一次之前，低钠血症通过限制液体和停止所牵连的抗抑郁药得到解决。他最终耐受吗氯贝胺 300mg/天，没有再发生低钠血症。结论：阿戈美拉汀，据报道去甲替林和安非他酮发生低钠血症的风险较低，但与该病例有关。文拉法辛和米氮平在首次服用时不会引起低钠血症，但在停药一段时间后重新开始服用时会引起低钠血症，这强调了抗抑郁药引起的低钠血症的特殊性。吗氯贝胺可以考虑用于抗抑郁药引起的复发性低钠血症的抑郁患者。对于服用抗抑郁药的低钠血症高风险患者，应定期监测血清钠。吗氯贝胺可以考虑用于抗抑郁药引起的复发性低钠血症的抑郁患者。对于服用抗抑郁药的低钠血症高风险患者，应定期监测血清钠。吗氯贝胺可以考虑用于抗抑郁药引起的复发性低钠血症的抑郁患者。对于服用抗抑郁药的低钠血症高风险患者，应定期监测血清钠。