Association of Sertrailine and Escitalopram With Antidepressant Induced Hyponatremia Among Coronary Artery Disease Patients at a Tertiary Care Hospital of Rawalpindi

Abstract

Objective: To determine the association of sertraline and escitalopram with antidepressant-induced hyponatremia among coronary artery disease patients.

Study Design: Cross-sectional analytical study
Place and Duration of Study: This study was conducted at the Armed Forces Institute of Mental Health Rawalpindi December 16 till March 15, 2026.

Methods: This study was conducted including 220 patients with coronary artery disease receiving sertraline or escitalopram. Demographic variables included age, gender, and socioeconomic status. Clinical variables included
type and duration of coronary artery disease, comorbidities such as hypertension and diabetes, and concurrent medications.

Results: The mean age was 61.4 ± 10.8 years, and hyponatremia was observed in 26.4% of patients. Hyponatremia was more frequent with escitalopram compared to sertraline (65.5% vs 34.5%, p = 0.003). Patients with hyponatremia had lower serum sodium (131.1 ± 3.1 vs 139.2 ± 2.8 mEq/L; p <0.001) and higher creatinine levels (2.0 ± 0.9 vs 1.4 ± 0.6 mg/dL; p <0.001). Heart failure, diuretic use, high-dose SSRI therapy, and polypharmacy were significantly associated with hyponatremia (p <0.05).

Conclusion: Antidepressant-induced hyponatremia is significantly associated with escitalopram use and multiple clinical risk factors in coronary artery disease patients. Regular monitoring and careful drug selection are essential to reduce complications.