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Pharmacopsychiatry 2008; 41(4): 129-133
DOI: 10.1055/s-2008-1058105
Original Paper

© Georg Thieme Verlag KG Stuttgart · New York

The Association between Concomitant Use of Serotonergic Antidepressants and Lithium-Induced Polyuria. A Multicenter Medical Chart Review Study

I. Wilting 1 , 2 , 3 , A. C. G. Egberts 1 , 3 , K. L. L. Movig 4 , J. H. M. van Laarhoven 5 , E. R. Heerdink 1 , W. A. Nolen 6
  • 1Utrecht University, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology & Pharmacotherapy, Utrecht, The Netherlands
  • 2Department of Clinical Pharmacy, TweeSteden hospital and St Elisabeth Hospital, Tilburg, The Netherlands
  • 3Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
  • 4Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands
  • 5Department of Psychiatry, St Elisabeth Hospital, Tilburg, The Netherlands
  • 6Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Further Information

Publication History

received 01.10.2007 revised 05.01.2008

accepted 16.01.2008

Publication Date:
23 July 2008 (online)

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Abstract

Background: A previous study aimed at revealing the prevalence and determinants of lithium induced polyuria suggested an increased risk of polyuria (urine volume ≥3 L/24 h) in those using serotonergic antidepressants next to lithium.

Objective: The objective of our study was to re-evaluate this secondary finding in another study population.

Methods: We performed a multicenter medical chart review study in patients using lithium in whom a 24-hour urine volume had been determined.

Results: We included 116 patients, twelve (26%)of the 46 patients with polyuria used serotonergic antidepressants compared to ten (14%) of the 70 patients without polyuria. We found an increased risk of polyuria in lithium users concurrently using serotonergic antidepressants (oddsratio 2.86; 95% confidence interval 1.00–8.21), adjusted for age, gender, use of antiepileptics and thyreomimetics.

Conclusion: Our results confirm the previous secondary finding of an increased risk of polyuria in patients using serotonergic antidepressants next to lithium. Physicians should take this into account when evaluating polyuria in patients using lithium and when choosing an antidepressant in patients using lithium.

References

  • 1 Adam P. Evaluation and management of diabetes insipidus.  Am Fam Physician. 1997;  55 2146-2153
    PubMedGoogle Scholar
  • 2 Andersson KE. Changes in bladder tone during filling: pharmacological aspects.  Scand J Urol Nephrol Suppl. 1999;  201 67-72 , ; discussion 76-99
    PubMedGoogle Scholar
  • 3 Asplund R, Johansson S, Henriksson S, Isacsson G. Nocturia, depression and antidepressant medication.  BJU Int. 2005;  95 820-823
    CrossrefPubMedGoogle Scholar
  • 4 Bendz H, Aurell M, Balldin J, Mathe AA, Sjodin I. Kidney damage in long-term lithium patients: a cross-sectional study of patients with 15 years or more on lithium.  Nephrol Dial Transplant. 1994;  9 1250-1254
    PubMedGoogle Scholar
  • 5 Boton R, Gaviria M, Batlle DC. Prevalence, pathogenesis, and treatment of renal dysfunction associated with chronic lithium therapy.  Am J Kidney Dis. 1987;  10 329-345
    PubMedGoogle Scholar
  • 6 Candura SM, Messori E, Franceschetti GP, D'Agostino G, Vicini D, Tagliani M. et al . Neural 5-HT4 receptors in the human isolated detrusor muscle: effects of indole, benzimidazolone and substituted benzamide agonists and antagonists.  Br J Pharmacol. 1996;  118 1965-1970
    PubMedGoogle Scholar
  • 7 Cavanaugh GL, Martin RE, Stenson MA, Robinson DD. Venlafaxine and urinary incontinence: possible association.  Ann Pharmacother. 1997;  31 372
    PubMedGoogle Scholar
  • 8 Crammer JL. Drinking, thirst and water intoxication.  Br J Psychiatry. 1991;  159 83-89
    PubMedGoogle Scholar
  • 9 Demling JH, Huang ML, Remmerie B, Mannaert E, Sperling W. Pharmacokinetics and safety of combination therapy with lithium and risperidone.  Pharmacopsychiatry. 2006;  39 230-231
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Dunner DL. Optimizing lithium treatment.  J Clin Psychiatry. 2000;  61 ((Suppl 9)) 76-81
    PubMedGoogle Scholar
  • 11 Geddes JR, Burgess S, Hawton K, Jamison K, Goodwin GM. Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials.  Am J Psychiatry. 2004;  161 217-222
    CrossrefPubMedGoogle Scholar
  • 12 Gitlin M. Lithium and the kidney: an updated review.  Drug Saf. 1999;  20 231-243
    PubMedGoogle Scholar
  • 13 Gitlin MJ. Lithium-induced renal insufficiency.  J Clin Psychopharmacol. 1993;  13 276-279
    PubMedGoogle Scholar
  • 14 Hansen LK. Venlafaxine-induced increase in urinary frequency in 3 women.  J Clin Psychiatry. 2004;  65 877-878
    PubMedGoogle Scholar
  • 15 Hegde SS, Eglen RM. Peripheral 5-HT4 receptors.  Faseb J. 1996;  10 1398-1407
    PubMedGoogle Scholar
  • 16 Lin D, Mok H, Yatham LN. Polytherapy in bipolar disorder.  CNS Drugs. 2006;  20 29-42
    CrossrefPubMedGoogle Scholar
  • 17 Maldonado G, Greenland S. Simulation study of confounder-selection strategies.  Am J Epidemiol. 1993;  138 923-936
    PubMedGoogle Scholar
  • 18 MacCreadie RG, Morrison DP. The impact of lithium in South-west Scotland. I. Demographic and clinical findings.  Br J Psychiatry. 1985;  146 70-74
    PubMedGoogle Scholar
  • 19 Movig KL, Baumgarten R, Leufkens HG, Laarhoven JH van, Egberts AC. Risk factors for the development of lithium-induced polyuria.  Br J Psychiatry. 2003;  182 319-323
    CrossrefPubMedGoogle Scholar
  • 20 Siegel AJ, Baldessarini RJ, Klepser MB, MacDonald JC. Primary and drug-induced disorders of water homeostasis in psychiatric patients: principles of diagnosis and management.  Harv Rev Psychiatry. 1998;  6 190-200
    PubMedGoogle Scholar
  • 21 Siegler EL, Tamres D, Berlin JA, Allen-Taylor L, Strom BL. Risk factors for the development of hyponatremia in psychiatric inpatients.  Arch Intern Med. 1995;  155 953-957
    CrossrefPubMedGoogle Scholar
  • 22 Spigset O, Hedenmalm K. Hyponatraemia and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) induced by psychotropic drugs.  Drug Saf. 1995;  12 209-225
    PubMedGoogle Scholar
  • 23 Tatsumi M, Groshan K, Blakely RD, Richelson E. Pharmacological profile of antidepressants and related compounds at human monoamine transporters.  Eur J Pharmacol. 1997;  340 249-258
    CrossrefPubMedGoogle Scholar
  • 24 Tonini M, Candura SM. 5-HT4 receptor agonists and bladder disorders.  Trends Pharmacol Sci. 1996;  17 314-316
    PubMedGoogle Scholar
  • 25 Vestergaard P, Amdisen A, Schou M. Clinically significant side effects of lithium treatment. A survey of 237 patients in long-term treatment.  Acta Psychiatr Scand. 1980;  62 193-200
    PubMedGoogle Scholar
  • 26 Vestergaard P, Poulstrup I, Schou M. Prospective studies on a lithium cohort. 3. Tremor, weight gain, diarrhea, psychological complaints.  Acta Psychiatr Scand. 1988;  78 434-441
    PubMedGoogle Scholar
  • 27 Vieweg WV, David JJ, Rowe WT, Peach MJ, Veldhuis JD, Kaiser DL. et al . Psychogenic polydipsia and water intoxication–concepts that have failed.  Biol Psychiatry. 1985;  20 1308-1320
    CrossrefPubMedGoogle Scholar
  • 28 Votolato NA, Stern S, Caputo RM. Serotonergic antidepressants and urinary incontinence.  Int Urogynecol J Pelvic Floor Dysfunct. 2000;  11 386-388
    CrossrefPubMedGoogle Scholar
  • 29 Yoshimura R, Ueda N, Shinkai K, Nakamura J. Two cases of bipolar disorder successfully stabilized for five years with a low dose of risperidone and lithium.  Pharmacopsychiatry. 2006;  39 233-234
    Article in Thieme ConnectPubMedGoogle Scholar

Correspondence

Prof. Dr. A. C. G. Egberts

Utrecht University

Faculty of Science

Utrecht Institute for Pharmaceutical Sciences

Division of Pharmacoepidemiology & Pharmacotherapy

PO Box 80 082

3508 TB Utrecht

The Netherlands

Phone: +31/30/253 73 24

Fax: +31/30/253 91 66

Email: a.c.g.egberts@uu.nl

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