Nocturnal enuresis associated with lithium carbonate extended-release tablets in a girl with major depressive disorder: A case report

Abstract

Rationale: Lithium carbonate, a mood stabilizer, is most commonly used for the treatment and prevention of mania and bipolar disorder. Common renal side effects include polyuria and polydipsia. However, when combined with other psychotropic medications that have sedative properties, lithium may increase the risk of nocturnal enuresis.

Patient concerns: A 12-year-old girl experienced recurrent major depressive episodes with psychotic symptoms. Her clinical presentation was complex, including depressed mood, irritability, suicidal ideation or behavior, and partial psychotic features. During treatment, she frequently reported polydipsia, polyuria, and nocturnal enuresis.

Diagnoses: Based on the International Classification of Diseases, 10th Edition, the patient was diagnosed with major depressive disorder with psychotic symptoms (F32.3) and enuresis not due to a physical disorder (F98.0).

Interventions: In addition to receiving antidepressants, antipsychotics, benzodiazepines, and modified electroconvulsive therapy, she was also intermittently treated with lithium carbonate extended-release tablets, with a maximum daily dose of 1.2 g. No pathophysiological abnormalities were identified through imaging examinations in relation to her nocturnal enuresis. After suspecting a link between her enuresis and lithium, her nocturnal enuresis resolved following the discontinuation of lithium carbonate extended-release tablets.

Outcomes: During the 4-month follow-up, the patient remained free of nocturnal enuresis, while her depressive and psychotic symptoms significantly subsided.

Lessons: Psychiatrists should be aware of the possibility of lithium-induced nocturnal enuresis when polyuria and polydipsia emerge during lithium treatment, particularly in children and adolescents receiving concomitant psychotropic medications with sedative properties.

Keywords: adolescent; lithium carbonate extended-release tablet; major depressive disorder; nocturnal enuresis; psychotropics.

Figure 1.

Urological system ultrasonic image and spine bone digital X-ray imaging. No abnormalities were detected. (A) Image of renal structure; (B) image of renal blood stream; (C) bladder image; (D) image of spine bone.