From the Guidelines
The patient's magnesium level is at the lower limit of normal (1.8 mg/dL), which is acceptable but could be optimized, and I recommend maintaining the current SSRI treatment with sertraline while considering mild magnesium supplementation with 200-300 mg of magnesium glycinate or magnesium citrate daily. The patient has been experiencing anxiety, panic attacks, and palpitations, but the current SSRI treatment with sertraline has been effective in managing these symptoms, as evidenced by the improvement in palpitations 1. Considering the patient's magnesium level, which has been consistently at the lower limit for at least a year, gentle supplementation is reasonable to bring levels to mid-normal range, which may further help with anxiety symptoms and cardiac function, as low magnesium can contribute to anxiety symptoms and palpitations, and SSRIs may work more effectively with optimal magnesium levels 1. The patient should take magnesium supplements with food to improve absorption and minimize gastrointestinal side effects. Dietary changes to increase magnesium intake would also be beneficial, including more leafy greens, nuts, seeds, whole grains, and legumes. It is essential to continue monitoring both symptoms and magnesium levels at the next follow-up visit to assess the effectiveness of the supplementation and adjust the treatment plan as needed, taking into account the potential risks and benefits of SSRI treatment, including the risk of suicidal thinking and behavior, behavioral activation/agitation, and serotonin syndrome 1.
From the Research
Patient's Magnesium Levels
- The patient's magnesium level is 1.8 mg/dL, which is at the lower limit of the reference range (1.8 - 2.5 mg/dL) 2.
- According to a study, hypomagnesemia is defined as a serum magnesium level less than 1.8 mg/dL (< 0.74 mmol/L), and the patient's level is exactly at this threshold 2.
- Another study suggests that serum magnesium values of less than 0.85 mmol/L (2.07 mg/dL) are associated with increased health risks, and the patient's level is close to this value 3.
Potential Health Risks
- Low magnesium intake or low serum levels are risk factors for type 2 diabetes and cardiovascular diseases 3.
- Hypomagnesemia may result from inadequate magnesium intake, increased gastrointestinal or renal losses, or redistribution from extracellular to intracellular space 2.
- One of the most life-threatening effects of hypomagnesemia is ventricular arrhythmia, which could be related to the patient's previous complaints of palpitations 2.
Treatment and Management
- Asymptomatic patients with hypomagnesemia should be treated with oral magnesium supplements 2.
- Parenteral magnesium should be reserved for symptomatic patients with severe magnesium deficiency (< 1.2 mg/dL) 2.
- A study found that magnesium supplementation can lower systolic blood pressure in hypertensive patients on beta blockers, which could be relevant to the patient's treatment plan 4.