Bupropion Induced Hyponatremia in an Elderly Patient: A Case Report and Review of the Literature
Hyponatremia’s clinical symptoms can be misinterpreted as a worsening of the primary psychiatric illness, leading to potentially serious consequences if not properly evaluated. We recommend that clinicians be aware of this side effect and that sodium levels be checked within the first two weeks of starting treatment.
1. Introduction
Bupropion is an antidepressant that works by blocking dopamine and noradrenaline reuptake. Hyponatremia has been linked to the use of SSRIs and SNRIs, but only rarely with bupropion. Some researchers believe it’s due to a serotonin-induced increase in ADH, mediated by hypothalamic serotonin receptors.
2. History of Present Illness
A 72-year-old woman was admitted to the hospital for evaluation of worsening depression and passive suicidal ideation of putting a blanket over her head and “just going to sleep.” The patient had been diagnosed with depression in her early twenties and had been reportedly stable since.
3. Course of Hospitalization
To treat the symptoms of depression and anxiety, the patient was started on bupropion 37.5u2009mg PO BID with clonazepam. The patient’s sodium level at admission was 132u2009MEQ/L (135u2013150), and all other lab tests were within normal limits.
4. Discussion
Serotonergic antidepressants (SSRIs, venlafaxine, and clomipramine combined) are the most likely to cause hyponatremia. Bupropion’s primary pharmacological action is to inhibit norepinephrine-dopamine reuptake. Clinicians should be aware of the increased risk and signs of hyponatremia associated with certain antidepressants. Other risk factors include diuretic drug use and recent or curing hyponatr
Competing Interests
The authors declare that they have no competing interests in the publication of this paper, which is distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, as long as the original work is properly cited. Copyright 9 2016 Sahil Munjal and Smolin.
What is the safest antidepressant for the elderly?
Citalopram, escitalopram, and sertraline are SSRIs with the best safety profile in the elderly, with the lowest potential for drug-drug interactions based on their cytochrome P-450 interactions.
Why are antidepressants bad for elderly?
Antidepressants have been linked to an increased risk of falls, osteoporosis, and fractures, with falls being a known risk for older tricyclic antidepressants due to their increased risk of orthostatic hypotension.
Which antidepressant medication has the least side effects in the elderly?
Most experts recommend SSRIs, or selective norepinephrine reuptake inhibitors (SNRIs), as antidepressants for seniors because they help increase the brain chemicals serotonin and norepinephrine and have fewer serious side effects and drug interactions than older antidepressants on the market.
When should you not take Wellbutrin?
If you are allergic to bupropion or if you have any of the following conditions, you should not take Wellbutrin.
- If you have suddenly stopped using alcohol, seizure medications, or sedatives (such as Xanax, Valium, Fiorinal, Klonopin, and others)
- or if you have suddenly stopped using alcohol, seizure medications, or sedatives (such as Xanax, Valium, Fiorinal, Klonopin, and others).
What is the best anti anxiety medication for elderly?
Buspirone, an anti-anxiety drug that has been shown to be effective in older adults, and benzodiazepines, another anti-anxiety drug that is effective but should be prescribed with caution in older adults due to the risk of memory loss, unsteadiness, and falls.
What is the best muscle relaxer for elderly?
Which Muscle Relaxants Are the Most Beneficial for Neck and Back Pain?
- 1) Methocarbamol (Robaxin). Methocarbamol (Robaxin) is a well-studied back pain medication.
- 2) Cyclobenzaprine.
- 3) Carisoprodol.
- 4) Metaxalone.
- 5) Tizanidine.
- 6) Baclofen.
- 7) Oxazepam and diazepam.
At what age are you considered elderly?
According to the Social Security Administration, 9 out of 10 people over the age of 65 are eligible for Social Security benefits, and 65 is the legal age at which U.S. citizens are considered seniors.
What is the safest antidepressant with the least side effects?
The following antidepressants have the lowest rate of sexual side effects:
- Bupropion (Wellbutrin XL, Wellbutrin SR)
- Mirtazapine (Remeron)
- Viibryd (Vilazodone)
- Trintellix (Vortioxetine)
What is the most common psychiatric disorder in the elderly?
The Importance of Depression Depression, a type of mood disorder, is the most common mental health issue among senior citizens.
What is the #1 antidepressant?
The most commonly prescribed antidepressant is Zoloft; nearly 17% of those surveyed in the 2017 antidepressant use study said they had taken it. 1 Paxil (paroxetine): If you choose Paxil over other antidepressants, you may be more likely to experience sexual side effects.
What are the top 5 antidepressants?
A Psychiatrist’s List of the Top 12 Most Popular and Effective Antidepressants
- Celexa (citalopram)
- Wellbutrin (bupropion)
- Paxil (paroxetine)
- Savella (milnacipran)
- Prozac (fluoxetine)
- Cymbalta (duloxetine)
- Luvox (fluvoxamine)
- Vestra (reboxetine)
What is the most tolerated antidepressant?
These were the best-tolerated depression drugs, according to the researchers: Celexa (citalopram), Lexapro (escitalopram), and Prozac (fluoxetine).
Does Wellbutrin make you horny?
But wait, says Elizabeth Nolan Brown of Blisstree, who bravely shared her personal experience with Wellbutrin, it not only helped her quit smoking and deal with the anxiety that came with it, but it also increased her sex drive and had appetite-suppressing properties.
What are the worst side effects of Wellbutrin?
Agitation, dry mouth, insomnia, headache/migraine, nausea/vomiting, constipation, tremor, dizziness, excessive sweating, blurred vision, tachycardia, confusion, rash, hostility, cardiac arrhythmia, and auditory disturbance are all common side effects in people taking WELLBUTRIN.
Does bupropion give you energy?
Bupropion, on the other hand, is unique among antidepressants in that it has a positive effect on energy, which means that when patients are up and active during the day, they are more likely to sleep better at night.