Hypoglycemic episodes in a case of Prementrual Dysphoric Disorder on sertraline (original) (raw)
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American Journal of Physiology Endocrinology and Metabolism, 2008
Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed for patients with co-morbid diabetes and depression. Clinical case studies in diabetic patients, however, suggest that SSRI therapy may exacerbate hypoglycemia. We hypothesized that SSRIs might increase the risk of hypoglycemia by impairing hormonal counterregulatory responses (CRR). We evaluated the effect of the SSRI sertraline on hormonal CRRs to single or recurrent hypoglycemia in non-diabetic rats. Since there are time dependenteffects of SSRIs on serotonin neurotransmission that correspond with therapeutic action, we evaluated the effect of 6 or 20d sertraline treatment on hypoglycemia CRRs. We found that 6d sertraline (SERT) treatment specifically enhanced the epinephrine response to a single bout of hypoglycemia vs. vehicle-(VEH) treated rats (t.120; VEH, 2,573+448 vs. SERT, 4,202+545, pg/ml; p<0.05). In response to recurrent hypoglycemia, VEHtreated rats exhibited the expected impairment in epinephrine secretion (t.60; 678+73, pg/ml) vs. VEH-treated rats experiencing first time hypoglycemia (t.60; 2,081+436, pg/ml; p<0.01). SERT treatment prevented the impaired epinephrine response in recurrent hypoglycemic rats (t.60; 1,794+276, pgl/ml). In 20d SERT-treated rats, epinephrine, norepinephrine and glucagon CRRs were all significantly elevated above VEH-treated controls in response to hypoglycemia. Similar to 6d sertraline treatment, 20d sertraline treatment rescued the impaired epinephrine response in recurrent hypoglycemic rats. Our data demonstrate that neither 6 nor 20d sertraline treatment impaired hormonal CRRs to hypoglycemia in non-diabetic rats. Instead, sertraline treatment resulted in an enhancement of hypoglycemia CRRs and prevented the impaired adrenomedullary response normally observed in recurrent hypoglycemic rats.
Running Head: Sertraline enhances hormonal responses to hypoglycemia Corresponding author
2013
Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed for patients with co-morbid diabetes and depression. Clinical case studies in diabetic patients, however, suggest that SSRI therapy may exacerbate hypoglycemia. We hypothesized that SSRIs might increase the risk of hypoglycemia by impairing hormonal counterregulatory responses (CRR). We evaluated the effect of the SSRI sertraline on hormonal CRRs to single or recurrent hypoglycemia in non-diabetic rats. Since there are time dependenteffects of SSRIs on serotonin neurotransmission that correspond with therapeutic action, we evaluated the effect of 6 or 20d sertraline treatment on hypoglycemia CRRs. We found that 6d sertraline (SERT) treatment specifically enhanced the epinephrine response to a single bout of hypoglycemia vs. vehicle- (VEH) treated rats (t.120; VEH, 2,573+448 vs. SERT, 4,202+545, pg/ml; p<0.05). In response to recurrent hypoglycemia, VEHtreated rats exhibited the expected impairment in epinephrin...
Hypoglycemia associated with fluoxetine treatment in a patient with type 1 diabetes
World Journal of Clinical Cases, 2013
We report on a patient with type 1 diabetes mellitus who presented with recurrent episodes of hypoglycemia and a marked reduction in her daily insulin requirements after introduction of fluoxetine. This 25-yearold Caucasian woman had been followed up at the outpatient clinic for type 1 diabetes mellitus and prepregnancy care. She used a continuous subcutaneous insulin infusion with lispro and her daily insulin dose was 0.5 IU/kg per day. She had no chronic diabetic complications or hypoglycemia unawareness. Fluoxetine at a daily dose of 20 mg had been started because of depressive symptoms and within one week, she presented recurrent hypoglycemic episodes that prompted a progressive reduction in the insulin dose down to 0.3 IU/kg per day. The reduced insulin requirements continued during the period of fluoxetine treatment while glycated hemoglobin remained stable. She had no concurrent additional cause to explain the reduced insulin requirements. After fluoxetine was stopped, insulin re-quirements progressively increased and returned to the patient´s usual dose.
Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 2011
In this study, we aimed to investigate the possible effects of sertraline on blood glucose and lipid levels as risk factors for cardiovascular disease in depressive patients. Eight male and twelve female depressive patients, diagnosed according to DSM-IV criteria, were included in this study. The subjects aged 19-50 years, did not smoke, and had normal body mass index (BMI), homeostasis model assessment-estimated insulin resistance (HOMA-IR) values, blood pressure, blood glucose, insulin and lipid levels. Sertraline therapy (50 mg/day) was started. Patients with diabetes mellitus, heart disease, pregnancy, and those taking other drugs were excluded from the study. Blood glucose, insulin, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), and triglyceride values were measured in patients before, and at the 4(th), 8(th) and 12(th) weeks after treatment with sertraline. Moreover, HbA1C levels were measured at the beginning and at the end of the t...
Drug Safety, 2007
Objectives Depression is common in patients with diabetes, and the use of antidepressants may impair glycaemic control. We assessed the association between antidepressant use and hyper-and hypoglycaemia. Methods Based on spontaneous reports listed in the World Health Organization (WHO) Adverse Drug Reaction Database, a case-control study was conducted. The study base consisted of all adverse drug reactions (ADRs) ascribed to antidepressants, antipsychotics and benzodiazepines between 1969 and 2005. Cases were defined as reported ADRs classified as hyper-or hypoglycaemia and separated in different study populations. All other reports were considered as controls. Exposure to antidepressants was the primary determinant investigated. Benzodiazepines and antipsychotics were chosen as reference groups. Potential confounding factors, namely, age, gender, use of antidiabetic medication, use of hyper-or hypoglycaemiainducing comedication and reporting year, were determined on the index date. Multivariate logistic regression was used to evaluate the strength of the association, which was expressed as reporting odds ratios (RORs) with 95% confidence intervals (95% CI). Results Overall, the use of antidepressants was associated with hyperglycaemia [ROR 1.52 (95% CI: 1.20-1.93)] and of hypoglycaemia [ROR 1.84 (95% CI: 1.40-2.42)]. The association with hyperglycaemia was most pronounced for antidepressants with affinity for the 5-HT 2c receptor, histamine-1 receptor and norepinephrinic (NE) reuptake transporter. The association with hypoglycaemia was most pronounced for antidepressants with affinity for the serotonin reuptake transporter. Conclusion The results of this study strengthen the findings in individual case reports that the use of antidepressants is associated with disturbances in glucose homeostasis.
Acute effect of different antidepressants on glycemia in diabetic and non-diabetic rats
Brazilian Journal of Medical and Biological Research, 2001
Diabetic patients have a 20% higher risk of depression than the general population. Treatment with antidepressant drugs can directly interfere with blood glucose levels or may interact with hypoglycemic agents. The treatment of depression in diabetic patients must take into account variations of glycemic levels at different times and a comparison of the available antidepressant agents is important. In the present study we evaluated the interference of antidepressants with blood glucose levels of diabetic and non-diabetic rats. In a first experiment, male adult Wistar rats were fasted for 12 h. Imipramine (5 mg/kg), moclobemide (30 mg/kg), clonazepam (0.25 mg/kg), fluoxetine (20 mg/kg) sertraline (30 mg/kg) or vehicle was administered. After 30 min, fasting glycemia was measured. An oral glucose overload of 1 ml of a 50% glucose solution was given to rats and blood glucose was determined after 30, 60 and 90 min. Imipramine and clonazepam did not change fasting or overload glycemia. Fluoxetine and moclobemide increased blood glucose at different times after the glucose overload. Sertraline neutralized the increase of glycemia induced by oral glucose overload. In the second experiment, non-diabetic and streptozotocininduced diabetic rats were fasted, and the same procedures were followed for estimation of glucose tolerance 30 min after glucose overload. Again, sertraline neutralized the increase in glycemia after glucose overload both in diabetic and non-diabetic rats. These data raise the question of whether sertraline is the best choice for prolonged use for diabetic individuals, because of its antihyperglycemic effects. Clonazepam would be useful in cases with potential risk of hypoglycemia. Correspondence H.M.T. Barros Divisão de Farmacologia FFFCMPA Rua Sarmento Leite, 245 90050-170 Porto Alegre, RS Brasil Fax: +55-51-224-8822 E-mail: helenbar@fffcmpa.tche.br R. Gomez is the recipient of a CAPES fellowship. H.M.T. Barros is the recipient of a CNPq Scientific Productivity grant.
INDIAN DRUGS, 2016
The present study was planned to study the influence of sertraline on hypoglycemic effect of orally administered pioglitazone and rosiglitazone in healthy rabbits. In the beginning of experiment, the rabbit were fasted for 18 hours with distilled water ad libitum. The blood was withdrawn from the marginal ear vein of pioglitazone (10 mg/kg, p.o.) treated rabbits and rosiglitazone (720 μg/kg, p.o.) treated rabbits at different time intervals at 0 h, 1, 2, 4, 8, 12, 18, 24 h before and after administration of sertraline (18 mg/ kg, p.o). The blood glucose was estimated by GOD-POD enzymatic kit method using semi-autoanalyzer and data were expressed in mg/dl. The results shown that sertraline increases the onset, peak effect and duration action of pioglitazone and rosiglitazone in healthy rabbits during concomitant administration of these drugs. In conclusion the dose and frequency of administration of sertraline with pioglitazone or rosiglitazone should be adjusted while administrating...
Hyponatremia as a complication of selective serotonin reuptake inhibitors
Journal of the American Academy of …, 2008
Purpose: To review the literature on hyponatremia as a complication of selective serotonin reuptake inhibitors (SSRIs) in the elderly; to summarize the prevalence, clinical findings, treatment modalities, and likely pathophysiological mechanisms related to the problem. Data sources: All published articles that could be located since Food and Drug Administration approval of this class of medications in 1987, using MEDLINE, CINAHL, and PsychInfo databases and a case study. Conclusions: Hyponatremia is a potentially serious complication of the use of SSRIs and is statistically more prevalent in the elderly and in females. Few clinical guidelines exist for managing this potential reaction. No evidence-based guidelines could be located.