The characteristics of patients given antidepressants while recovering from critical illness

Abstract

Antidepressants are occasionally given to recovering intensive care (ICU) patients, either while in ICU, or shortly afterwards on the ward. However there is little research on what characterizes these patients or their longer term psychological recovery. As part of a larger rehabilitation study data were collected on the characteristics of ICU patients receiving antidepressants while in hospital and their progress up to 6 months post ICU. Recovering ICU patients were approached once it was clear the patient was expected to survive to 6 months. A record was made of antidepressant medication and depression was assessed using the Hospital Anxiety and Depression Scale (HAD). Psychological recovery was assessed at 2 and 6 months post ICU using the HAD1 and the Fear questionnaire2 to record panic attacks/phobias and physical recovery was similarly recorded using the SF-36. Seventy-six patients completed the HAD at 2 weeks, 2 months and 6 months post ICU. All the patients had been intubated and had had an ICU stay ≥48 h, 18 had received antidepressants either in the ICU or shortly afterwards on the ward for a clinical diagnosis of depression. Patients receiving antidepressants were much more likely to have had a longer ICU stay and a longer hospital stay (see Table 12). The fear questionnaire scores were not related directly to the length of ICU stay. The questionnaire allows the examination of which particular areas patients are having difficulty with. Patients receiving antidepressants were becoming panicky travelling alone, being alone in a busy street or far from home, and going shopping alone. The data suggest that the use of antidepressants at times may be inappropriate. The difficulty of establishing the diagnosis of depression in ICU may mean that only soft clinical criteria are used. This is more likely to occur in longer stay patients. Passivity due to a learned helplessness state may be diagnosed as depression while patients are intubated. This would fit with these patients having difficulty performing activities alone. Alternatively a subdued anxiety state may be similarly being misdiagnosed as depression.