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Introduction: Citalopram is effective for dementia-related
agitation, but little evidence supports its use for dementia with
Lewy bodies. Hyponatremia and other SSRI side effects increase
venous thromboembolism (VTE) risk. SSRI use can directly
(platelet aggregation, venous stasis) or indirectly (obesity,
sedation) cause DVT
Case presentation: An 86-year-old woman functionally declined
with Parkinson�s disease, hypertension, diabetes mellitus,
hyperlipidemia, and osteoporosis presented to the emergency
department with altered mental status, decreased oral intake,
generalized weakness, and left lower leg swelling. Medications
included gliclazide, metformin, valsartan, and atorvastatin,
with no medications for Parkinson�s disease. No history of deep
vein thrombosis (DVT) or pulmonary embolism was noted.
Echocardiogram 5 months prior showed normal systolic function;
ejection fraction, 55%�60%; and Grade 1 diastolic dysfunction.
At presentation, the patient was disoriented and lethargic. Blood
pressure: 104/51 mmHg; random blood glucose: 125 mg/dl; and
sodium: 123 mg/dl. Other parameters were normal, including
adrenal function, with no sign of malignancy or autoimmune
disease. Brain computed tomography showed age-related changes.
Doppler ultrasound revealed DVT in the left lower leg. Four weeks
prior, the selective serotonin reuptake inhibitor (SSRI) citalopram
was started for behavioral changes (agitation, resistance to care,
hallucinations, repetitive vocalizations, and
insomnia), resulting in restlessness and vocal changes (lowvolume
speech). Two days prior, citalopram was discontinued
due to excessive fatigue. The patient was admitted and managed
with hypertonic solution and intravenous heparin, with other
medications held. After 3 days, sodium normalized. The patient
was discharged on oral apixaban (2.5 mg, BID), and all home
medications were resumed except gliclazide. At follow-up, plasma
sodium remained normal.
Conclusions and significance: SSRIs should not be first-line
treatments for behavioral symptoms in Parkinson�s disease with
Lewy body dementia. SSRIs combined with sulfonylurea increase
hyponatremia risk. In older patients with functional decline, VTE
prophylaxis should be initiated prior to SSRIs.
RecentPublications
Mirghani, Hyder, Samar Aljohani, and Afaf Albalawi. "Dementia
and adherence to anti-diabetic medications: a meta-analysis."
Cureus 13.4 (2021).
Afaf Albalawi MD, Flavia Brancusi MHS, Frederic Askin MD,
Robert Ehsanipoor MD, Jiangxia Wang MS, MA, Irina Burd
MD, PhD, Priya Sekar MD, MPH. Placental Characteristics of
Fetuses with Congenital Heart Disease. Placental Characteristics
of Fetuses with Congenital Heart Disease. 2017 Mar; 36(5): 965-
972. Pub Status: Published.
Afaf Albalawi MD1, Asha Marhatta MD2, Johns A. Farens MD1.
(October 2017). Diet-induced Hypercarotenemia: A case report
Poster presented at: 2017 ANNUAL SCIENTIFIC MEETING,
ACP Connecticut Chapter; Southington, CT, USA.
Sapna Raghunathan, MD1, Afaf Albalawi, MD1, Yiannis Apergis,
MD1 and Jonathan Fillmore, MD2, (April 2017). Mifepristone
Prior to Surgery for the Management of ACTH Dependent
Cushing's Syndrome of Unknown Etiology Poster presented at:
99th Annual Meeting of the Endocrine Society;Orlando,FL,USA.
Afaf Albalawi MD and Christina Prather MD. (May 2019). Were
depression meets aggression: The intersection of SSRI use and
Parkinson�s disease Poster presented at American Geriatric Society
2019 Annual Scientific Meeting; Portland, OR,USA
Biography
Afaf Albalawi is a consultant in internal medicine, geriatric and palliative hospice medicine at Tabuk University, Saudi Arabia
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