Agomelatine as Antidepressant Treatment in Elderly Patients With Previous Hyponatremia Due To SSRI Use: Case Series

To evaluate agomelatine treatment in elderly patients with major depressive disorder (MDD) who developed hyponatremia while using selective serotonin receptor inhibitors (SSRIs).

Patients (60 years or older) with hyponatremia after SSRI treatment for MDD were changed to agomelatine 50 mg/day during one month to observe sodium levels during the treatment and change in depressive symptoms. Montgomery-Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression Scale (CGI) of severity were used before and after treatment with agomelatine.

The mean age of our sample (five patients) was 75.3 (SD ± 7.8) years. Sodium levels while using SSRIs were reported with a mean of 122.54 (SD ± 10.8) mEq/L. Mean MADRS and CGI scores on SSRIs before treatment with agomelatine were 27.8 (SD ± 3.90) and 5 (SD ± 0.71) respectively. After 4 weeks of treatment with agomelatine 50 mg/day, mean scores of sodium were reported at 135.48 (SD ± 1.6) mEq/L, and mean MADRS and CGI scores were 13.6 (SD ± 8.35) and 2.4 (SD ± 1.5). The difference in means of the MADRS scale before and after treatment with agomelatine was found to be statistically significant (27.8 [3.89] versus 13.6 [8.35], p = < 0.01).

Our open observational study suggests that agomelatine represents a safe and effective treatment option for elderly patients with major depressive disorder and previous SSRIs-induced hyponatremia.