A man went to the hospital with a life threatening condition after doing things more than a million Americans do every day – taking antidepressants and drinking.
The unnamed patient had been taking the popular antidepressant escitalopram – better known in the US by the brand name Lexapro.
He was an occasional drinker and one day, after consuming ‘substantial’ amounts of alcohol, he developed muscle pain, trembles and passed out.
Doctors theorized his Lexapro had caused his muscles to break down spontaneously – leaking bits of damaged tissue into his blood, blocking up his kidneys and putting him into the life-threatening kidney failure.
The patient had a history of bipolar disorder and mild alcohol use. The doctors didn’t specify how much he had drank before coming to the emergency department, but called it ‘substantial’
In rare situations – a breakdown of muscle tissue can lead to kidney failure. Some case reports have linked this condition to antidepressants
Researchers aren’t sure how antidepressants could cause this rapid muscular break down, but one theory is that it causes prolonged muscle contractions, leading to cellular damage.
The case, which occurred in Romania in 2023, was revealed in the American Journal of Case Reports said.
‘The findings underscore the necessity for rigorous and ongoing renal function monitoring for individuals undergoing long-term treatment with psychiatric medications, regardless of dosage levels,’ the study authors said.
Roughly 43 million Americans were taking antidepressants in 2018, the most recent data available from the CDC national trends.
The most commonly prescribed kind of antidepressants are selective serotonin reuptake inhibitors (SSRIs)- drugs which increase the amount of serotonin, a neurotransmitter that controls mood, sleep and sex drive.
Over 70 percent of Americans using antidepressants take SSRIs, according to research from Rush University.
Popular brands include Zoloft, Prozac and Lexapro. Lexapro’s official FDA label advises against drinking alcohol while taking the drug.
In the case of the Romanian patient, he had been using different types of psychiatric medication to treat his bipolar disorder for at least five years.
His current cocktail included Lexapro and anti-seizure drugs and alcohol.
When he came to the Emergency Clinical County Hospital in Bucharest, Romania, the man had diarrhea, muscle aches, tremor and high blood pressure for two days and had passed out after drinking ‘substantial’ amounts of alcohol.
They found out that he had rhabdomyolysis, a rare condition where the muscle cells rapidly break down and leak material into the blood stream – blocking the kidneys and putting someone into kidney failure.
He likely passed out from the alcohol use because his kidneys had already stopped working – so his body wasn’t able to filter out the effects from his blood efficiently.
It’s not that the condition was caused by alcohol, the doctors wrote, but the alcohol likely exacerbated the condition.
After the doctors took him off Lexapro and gave him fluids via an IV, he stabilized.
But when they put him back on the drug his condition started to return – making the doctors theorize that the SSRI had caused the rare condition in the first case.
Doctors aren’t sure how common this is, or how SSRI’s might cause it. They have noted it in a few other cases, including a teenager in Norway in 2023, a 25-year-old woman in New York in 2016 and a 13-year-old boy in New York in 2018.
Lexapro is one of a popular class of antidepressants that act on the neurotransmitter serotonin. Similar medications include Zoloft and Prozac
It could be that taking selective serotonin reuptake inhibitors, which increase the amount of the neurotransmitter in your system in hopes of boosting your mood, could also cause your muscles to contract.
Researchers from Norway suggested that its possible these drugs cause your muscles to contract, or tense, for a prolonged period of time, causing them to break down and leak their contents into blood.
In other cases, this leaky-muscle cell syndrome occurs when someone’s muscles get injured or are put on bed rest for too long.
This syndrome is just one of many things that can cause your kidneys to fail.
More commonly, conditions like diabetes, high blood pressure, heart disease, or a long history of taking drugs that can damage the kidneys, like over the counter pain relievers, lead to the condition.
All told roughly 750,000 Americans to go into kidney failure each year.
Your kidneys are responsible for filtering toxins out of your body. So when they slow or stop working, you get sick with nausea, vomiting, fatigue, confusion, swelling and muscle cramps.
Eventually, if left untreated, this can lead to death.
The scientists who published the case study wrote that this rare condition should be something that doctors consider when prescribing their patients SSRI’s – and should take note if they have a family history of kidney disease or alcohol use.
