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Abstract

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