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Am Fam Physician. 2009;79(3):online

Author disclosure: Nothing to disclose.

Original Article: Pharmacologic Management of Adult Depression
Issue Date: March 15, 2008
Available at:

to the editor: The article on pharmacologic management of adult depression is a useful review of commonly prescribed medications. However, a discussion of the safety of selective serotonin reuptake inhibitors (SSRIs) must include hyponatremia, a well-recognized and potentially life-threatening side effect of this class of medications. A recent literature review showed an incidence of hyponatremia ranging from 0.5 to –32 percent among those receiving SSRIs.1 Risk factors for the development of hyponatremia include older age, female sex, concomitant use of diuretics, low body weight, and lower baseline serum sodium concentration.1,2 Most cases resolve with discontinuation of the SSRI. Physicians should be aware of this potential complication, particularly in older patients.

Antidepressants are often used to man-age depression in women who are pregnant and lactating without adverse effects; however, physicians should discuss the risks these medications may pose to the developing fetus or breastfed infant with the patient before initiating treatment. When used in late pregnancy, an association has been shown between SSRIs and neonatal withdrawal syndrome and persistent pulmonary hypertension.3,4 The American College of Obstetricians and Gynecologists recommends avoidance of paroxetine (Paxil) in particular, because of an increased risk of congenital malformations.5

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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