Severe hyponatremia and syndrome of inappropriate secretion of antidiuretic hormone (SIADH) induced by duloxetine

Shu-Ju Yang^a, Po-Lun Wu^b

^a Department of Psychiatry, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^b Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan

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Abstract
Hyponatremia is a significant complication of treatment with selective serotonin reuptake inhibitors. There are a limited number of case reports of hyponatremia following treatment with duloxetine. We describe a case of a 57-year-old woman who had begun taking duloxetine for depression. Three weeks later, she reported fatigue, weakness, lethargy and drowsiness. During an emergency room evaluation, laboratory examination revealed hyponatremia and serum hypo-osmolarity. She had duloxetine-induced syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and duloxetine was discontinued. Hyponatremia correction was started and, in one week, the mental status of the patient gradually improved, paralleling the resolution of her hyponatremia. She was started on trazodone 25 mg/day for depression without recurrence of hyponatremia.

Keywords
Duloxetine; Hyponatremia; SIADH