From the FDA Drug Label
In patients with symptomatic hyponatremia, discontinue mirtazapine tablets and institute appropriate medical intervention Elderly patients, patients taking diuretics, and those who are volume- depleted may be at greater risk of developing hyponatremia [see Use in Specific Populations (8.5)].
The best antidepressant for a patient with hyponatremia is not explicitly stated in the provided drug labels. Mirtazapine may cause hyponatremia as a side effect, and patients with symptomatic hyponatremia should discontinue the medication and receive appropriate medical intervention.
- Key considerations for patients with hyponatremia include:
- Discontinuing mirtazapine tablets if symptomatic hyponatremia occurs
- Instituting appropriate medical intervention
- Being aware that elderly patients, those taking diuretics, and volume-depleted patients may be at greater risk of developing hyponatremia 1
From the Research
For patients with hyponatremia, bupropion (Wellbutrin) is often considered the best antidepressant choice, typically started at 150 mg daily and potentially increased to 300 mg daily if needed, due to its lower risk of worsening hyponatremia compared to other antidepressants. This recommendation is based on the fact that bupropion works differently than selective serotonin reuptake inhibitors (SSRIs) by affecting dopamine and norepinephrine rather than serotonin, making it less likely to cause or worsen hyponatremia through SIADH (syndrome of inappropriate antidiuretic hormone secretion) 2.
Some key points to consider when treating patients with hyponatremia include:
- Avoiding SSRIs like escitalopram, sertraline, or fluoxetine, which can worsen hyponatremia through SIADH 3, 4
- Considering mirtazapine (Remeron) as an alternative, usually started at 15 mg at bedtime and potentially increased to 30-45 mg, although it may also pose a moderate risk of hyponatremia 5, 6
- Carefully monitoring sodium levels in patients with a history of hyponatremia, with checks recommended at baseline, after 1-2 weeks of treatment, and periodically thereafter
- Being aware of patient risk factors, such as older age and concomitant use of (thiazide) diuretics, which can increase the risk of hyponatremia 2
Overall, the goal is to minimize the risk of worsening hyponatremia while effectively treating depression, and bupropion is generally considered a safer option for patients with this condition.