Effects of Two Selective Serotonin Reuptake Inhibitor Antidepressants, Sertraline and Escitalopram, on Aldosterone/Renin Ratio in Normotensive Depressed Male Patients

Background: Plasma aldosterone to renin ratio (ARR) is the most popular screening test for primary aldosteronism (PAL). Certain medications are known to cause false-negative or -positive ARRs by affecting renin and aldosterone levels. There are no previously published data on the effects of antidepressants on ARR. Methods: Normotensive, depressed male patients (n = 26) underwent measurement (seated, mid-morning) of plasma aldosterone, direct renin concentration (DRC), renin activity (PRA), electrolytes and creatinine and urinary aldosterone, cortisol, electrolytes, and creatinine at baseline and after 2 and 6 wk treatment with sertraline (n = 14) or escitalopram (n = 12). Results: For both antidepressants, treatment was associated with rises in aldosterone [sertraline: baseline, mean +/- SD, 243 +/- 34; 2 wk, 256 +/- 33; 6 wk, 267 +/- 34 pmol/liter (P < 0.01 by ANOVA); escitalopram, 261 +/- 36, 269 +/- 38, 282 +/- 40 pmol/liter (P < 0.05)], DRC [19.5 +/- 2.2, 33.5 +/- 2.0, 39.0 +/- 2.4 mU/liter (P < 0.001); 24.5 +/- 2.4, 34.0 +/- 2.7, 42.8 +/- 2.4 mU/liter (P < 0.001)], and PRA [2.24 +/- 0.21, 2.58 +/- 0.26, 4.68 +/- 0.42 ng/ml . h (P < 0.001); 4.31 +/- 0.22, 5.57 +/- 0.36, 6.42 +/- 0.53 ng/ml . h (P < 0.001)]. ARR fell significantly whether calculated using DRC [sertraline, 13.7 +/- 2.2, 7.5 +/- 0.7, 6.8 +/- 0.7 (P < 0.001); escitalopram, 11.5 +/- 1.9, 8.0 +/- 1.1, 6.6 +/- 1.0 (P < 0.001)], or PRA [116.6 +/- 15.8, 108.4 +/- 15.6, 60.4 +/- 6.2 (P < 0.001); 61.2 +/- 8.1, 50.0 +/- 7.7, 45.6 +/- 6.0 (P < 0.01)]. Conclusion: Selective serotonin reuptake inhibitor antidepressants can significantly reduce ARR and therefore potentially increase the risk of false-negative results when screening for PAL. Further studies in hypertensive patients, including patients with confirmed PAL, are required. (J Clin EndocrinolMetab 96: 1039-1045, 2011)