Phototherapy-mediated syndrome of inappropriate secretion of antidiuretic hormone in an in utero selective serotonin reuptake inhibitor-exposed newborn infant
ABSTRACT Although selective serotonin reuptake inhibitors (SSRIs) have gained wide acceptance in the off-label treatment of mental disorders in pregnant women, there seems to be an increased risk for serotonergic adverse effects in newborn infants who are exposed to SSRIs during late pregnancy. Hyponatremia as a result of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a relatively common serious side effect of the use of SSRIs in (mostly elderly) adults. Severe hyponatremia as a result of an SIADH is proposed here as part of a neonatal serotonin toxicity syndrome in a newborn infant who was exposed prenatally to an SSRI. The definite reversal to normal serum sodium levels after fluid restriction, the lack of any alternative cause for the SIADH, and the positive temporal relation with a high score on a widely used adverse drug reaction probability scale offer solid support for the hypothesis of a causal relationship between the SIADH and the prenatal sertraline exposure in our neonate. Moreover, accumulative data on the acute enhancement of serotonergic transmission by intense illumination led us to hypothesize that phototherapy used to treat hyperbilirubinemia in the newborn infant could have been the ultimate environmental trigger for this proposed new cause of iatrogenic neonatal SIADH. The speculative role of phototherapy as a physical trigger for this drug-related adverse event should be confirmed in other cases by thorough study of the serotonin metabolism, assay of SSRI levels in cord blood, and serial measurement of plasma levels in exposed neonates. As phototherapy is used frequently in jaundiced neonates and an apparently increasing number of infants are born to mothers who take SSRIs, serotonin toxicity in neonates deserves increased attention.
SourceAvailable from: Derya Büyükkayhan
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ABSTRACT: Purpose: To review the literature on hyponatremia as a complication of selective serotonin reuptake inhibitors (SSRIs) in the elderly; to summarize the prevalence, clinical findings, treatment modalities, and likely pathophysiological mechanisms related to the problem.Data sources: All published articles that could be located since Food and Drug Administration approval of this class of medications in 1987, using MEDLINE, CINAHL, and PsychInfo databases and a case study.Conclusions: Hyponatremia is a potentially serious complication of the use of SSRIs and is statistically more prevalent in the elderly and in females. Few clinical guidelines exist for managing this potential reaction. No evidence-based guidelines could be located.Implications for practice: Since articles describing this phenomenon have been primarily case studies, many healthcare providers may not be aware of this potentially serious complication. Monitoring of serum sodium in elderly female patients starting SSRI therapy seems prudent.Journal of the American Academy of Nurse Practitioners 01/2008; 20(1):47 - 51. DOI:10.1111/j.1745-7599.2007.00280.x · 0.71 Impact Factor
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ABSTRACT: Selective Serotonin Reuptake Inhibitors (SSRIs) have become the drug of choice for the treatment of depression and have shown to be effective in the treatment for other mental disorders. Recently, seve-ral articles have reported about the adverse effects observed in new-borns after maternal exposure to these drugs during the last trimester of pregnancy. In this work, a review of literature is presented, regar-ding the above mentioned adverse effects. Moreover, some guidelines for the rational use of these drugs during the last trimester of pregnancy and for the management of prenatally exposed newborns are provided.Medicina Clínica 04/2007; 128(15):584-589. DOI:10.1157/13101615 · 1.25 Impact Factor