The Hidden Risk of Selective Serotonin Reuptake Inhibitors: Preventing Syndrome of Inappropriate Antidiuretic Hormone Secretion in Primary Care

Authors

• Morgan B. McNutt, University of LynchburgFollow

Specialty

Family Medicine

Advisor

Tom Colletti

Abstract

This paper examines SSRI-induced Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), highlighting the pathophysiology, risk factors, presentation, diagnosis, management, and prevention, with emphasis on implications for primary care. Mental health illness affects a large percentage of adults in the United States, and selective serotonin reuptake inhibitors (SSRIs) are common first-line medications. While generally considered safe, these medications can cause a rare complication of hyponatremia called SIADH. Primary care providers prescribe the majority of these medications, highlighting the importance of awareness for this adverse effect. A literature review was conducted using several different databases to identify case reports and systematic reviews relevant to this topic. Although the pathophysiology is not understood, older adults, females, individuals with low body weight or lower baseline serum sodium, and those taking certain medications are at a higher risk. Fluoxetine and escitalopram are associated with a slightly higher risk, while paroxetine carries a lower risk. Symptoms of SIADH typically manifest within the first one to two weeks of initiation. The clinical presentation varies with severity, ranging from fatigue and nausea in mild cases, to seizures and coma when more severe. It is a diagnosis of exclusion, therefore other causes of hyponatremia must be ruled out. Management also depends on severity, and includes discontinuation of the SSRI, fluid restriction, and cautious hypertonic saline administration for severe cases. Other pharmacologic intervention such as salt tablets, tolvaptan, or urea can also be utilized when necessary. Although no consensus exists for routine monitoring of SSRIs, individualized risk assessment, patient education, early detection and timely intervention allow primary care providers to mitigate this adverse effect.

Recommended Citation

McNutt MB. The Hidden Risk of Selective Serotonin Reuptake Inhibitors: Preventing Syndrome of Inappropriate Antidiuretic Hormone Secretion in Primary Care. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).