27th National Clinical Education Symposium Presentation Abstracts
29 APRIL 2025, MONDAY
13:00-14:00 POSTER PRESENTATION SESSION-2
Hypoglycemia Induced by SSRI Use
Ayça Nur Örün1, Şuheda Tapan Çelikkaleli1
-
Show more (Affiliations)
1. Department of Psychiatry, Van Yüzüncü Yıl University, Van, Turkey
DOI: 10.5080/kes27.abs136 Page 162
OBJECTIVE:Selective serotonin reuptake inhibitors (SSRIs) have been associated with hypoglycemia, though this adverse effect remains underrecognized. In this case report, we present a patient with empty sella syndrome who experienced worsening hypoglycemic episodes following sertraline initiation, which resolved after switching to vortioxetine. CASE (The patient consent must be provided and specified with appropriate terms.):A 42-year-old female with recurrent depressive episodes first sought psychiatric treatment 15 years ago. Between 2015 and 2020, she was intermittently treated with escitalopram, trazodone, mirtazapine, and reboxetine, leading to remission and eventual medication discontinuation. In 2019, she was diagnosed with partial empty sella syndrome and underwent three ventriculoperitoneal shunt surgeries over five years. She was on acetazolamide, acarbose, and levothyroxine sodium. She experienced occasional hypoglycemic episodes with dizziness and headaches but was not under continuous psychiatric follow-up. In 2022, she was prescribed escitalopram 10 mg for worsening depression but discontinued it due to suspected worsening of hypoglycemia, with glucose levels dropping to 40 mg/dL. Several months later, she presented with persistent symptoms, and sertraline 50 mg was initiated. Shortly after, she developed frequent and severe hypoglycemic episodes, with glucose levels dropping to 38 mg/dL. Due to suspected SSRI-induced hypoglycemia, sertraline was discontinued, and vortioxetine 10 mg was introduced. Subsequent glucose levels normalized to 78 mg/dL, and follow-ups showed stable glucose levels without further hypoglycemia. Informed consent was obtained. DISCUSSION:SSRIs, particularly those with strong serotonin reuptake affinity like sertraline and fluoxetine, may exacerbate hypoglycemia through mechanisms such as increased insulin secretion, impaired counterregulatory hormone response, and suppressed hepatic gluconeogenesis. While this effect is well-documented in diabetic patients, cases in non-diabetic individuals remain rare and poorly understood. Clinicians should consider SSRI-induced hypoglycemia in patients with recurrent unexplained episodes, especially those with metabolic or endocrine disorders.