Case of Fluoxetine-induced Enuresis in a Female Patient

Ms. K is a 19-year-old Caucasian female with no prior psychiatric diagnoses who presented to outpatient clinic with chief complaint of depressed mood. She reports depressed mood, low energy, low motivation, low self-esteem, anhedonia, and loss of appetite for past 2 months. She reports sleeping only 4 hours per night and denies daytime naps. She was diagnosed with major depressive disorder according to Diagnostic and Statistical Manual of Mental Disorder, 5 edition in our outpatient clinic. She denies suicidal thought, homicidal thoughts, or plan. She denies hopelessness, worthlessness, and recurrent thoughts of death. She denies history of mania, psychosis, PTSD, eating disorder or OCD. She works as a server at a local restaurant. She denies tobacco, alcohol use and other illicit substance use. She doesn’t have history of inpatient hospitalization, suicide attempt or homicide attempt. She had not tried psychotropics in the past. She doesn’t have any medical illness and not on any current medications. She has history of nocturnal enuresis at age 6 improved and remitted with minimizing fluid intake before bedtime and enuresis alarm. She was started on fluoxetine 10mg daily for 7 days and increase to 20mg daily for depression. She came for follow up 4 weeks later. She reported significant improvement in her mood, energy, interest, and sleep. She has been sleeping 8 hours per night. During the follow up she denied depressed and other depressive symptoms. She reported onset of nocturnal enuresis 1 weeks after start of fluoxetine. She is reporting nocturnal enuresis 4 times a week. fluoxetine 20mg daily was decreased to 10mg daily however enuresis persisted. After discussing with patient, we decided to discontinue fluoxetine and start escitalopram 10mg daily for depression. 4 days later, patient reported that nocturnal enuresis resolved completely. Patient reached remission of her depressive symptoms on escitalopram 10mg daily. Case reports describing SSRI induced incontinence with paroxetine, sertraline have been published. Escitalopram is extremely selective for serotonergic transport proteins when compared with other antidepressant such as sertraline, fluoxetine, paroxetine, and fluvoxamine. Clinicians should keep in mind the possibility that enuresis may possible be either precipitated or exacerbated by SSRI. In this poster, we discuss fluoxetine induced enuresis, possible mechanism and bladder pathophysiology