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Urinary incontinence is involuntary leakage of urine. It is not life-threatening but adversely affects the quality of life (1). The patient usually complains about frequent or periodic urinary incontinence in small amount or just leakage. Here we report a case of urinary incontinence induced with sertraline and resolved after sertraline was discontinued.
Case: A 38 year-old married female patient presented to our clinic with complaints such as boredom, avolution, and depression. In her history, there was no psychiatric treatment or treatment with any other medications. On her psychological examination, she was cooperative, oriented, replying to questions brieşy and properly. Her affect was depressive. The patient was diagnosed with depressive disorder and prescribed sertraline 50mg/day. She was suggested to come to the clinic for follow up after 3 weeks, however she came back a week later complaining of urinary incontinence. Without any pressure feeling, she developed urinary incontinence which negatively affected her daily activities. Her medication was changed to şuoxetine 20mg/day from sertraline 50mg/day. Her urinary incontinence complaint disappeared 2 days after. On the follow-up the patient did not have any urinary incontinence. We presented a case report of urinary incontinence, which developed after starting sertraline. In the literature, there are case reports about sertraline induced urinary incontinence and switching to şuoxetine (1,2). Despite extensive research, the mechanism of enuresis has not been clarified in detail. Continence is maintained by alpha-adrenergically mediated constriction of the bladder sphincter (3). Sertraline has alpha-adrenergic blockage, which may partially explain urinary incontinence in our case. Enuresis is usually underdiagnosed because of clinicians do not ascertain about it or the masking of this side effect by multiple drugs such as antimuscarinic or noradrenergic agents (3). Fluoxetine may be a choice in sertraline induced urinary incontinence cases in the treatment of depression and anxiety disorders. Larger case series are needed on this issue.
References:
1. Votolato NA, Stern S, Caputo RM: Serotonergic antidepressants and urinary incontinence Int Urogynecol J Pelvic Floor Dysfunct 2000;11:p 386–8.
2. Maalouf Fadi T, Gilbert Andrew R. Sertraline-Induced Enuresis in a Prepubertal Child Resolves after Switching to Fluoxetine. J Child Adolesc Psychopharmacol 2010;20:161
3. Andersson KE: Advances in the pharmacological control of the bladder. Exp Physiol 1999;84:195–213 Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S179