Chest
Volume 119, Issue 2, February 2001, Pages 547-553
Journal home page for Chest

Clinical Investigations in Critical Care
Epidemiology of Psychiatric Medication Use in Patients Recovering From Critical Illness at a Long-term Acute-Care Facility

https://doi.org/10.1378/chest.119.2.547Get rights and content

Study objectives

To describe the pharmacoepidemiologyof psychotropic medication prescription in patients recovering fromlife-threatening medical and surgical illness.

Design

Retrospective analysis of a random sample of medical records.

Setting

Regional referral center.

Patients

Eighty-nine randomly selected patientstransferred from an ICU to the study facility.

Interventions

None.

Measurements andresults

Patients had been treated at the referring ICU for33 ± 24 days (mean ± SD) and remained at the study hospital for64 ± 52 days. Most of the patients had prolonged respiratoryfailure. Nearly half of the patients (47%) received an antidepressantmedication while at the facility, and 48% received at least one doseof a benzodiazepine on the first day after transfer. In the sample of75 patients not prescribed an antidepressant before transfer, 37% werestarted on therapy with an agent, usually within 3 weeks andpredominantly in the selective serotonin reuptake inhibitor orpsychostimulant class. Younger patients and those evaluated by a mentalhealth specialist were more likely to be prescribed an antidepressant, compared to other patients. Forty percent of patients were stillreceiving at least one dose of a benzodiazepine in a 24-h period aftertheir third week at the facility.

Conclusion

Althoughthe efficacy of antidepressant pharmacotherapy in patients withcomparable severity of medical illness has not been established, asubstantial proportion of patients recovering from critical illness ata specialized facility are prescribed antidepressant medications. Benzodiazepine exposure is frequent after transfer, and the prevalencein patients who remain at the facility minimally decreases overtime.

Section snippets

Materials and Methods

The design was a retrospective cohort study of randomly selectedpatient admissions to a long-term acute-care hospital (Vencor Hospital, Minneapolis, MN). The facility has a census of approximately 50patients and is staffed predominantly by internal medicine physicianswith subspecialty training in pulmonary or renal disease.

Random sampling of medical records from 1995 through 1998 was performedby matching consecutive three-digit numbers from a random number tableto the last three digits of

Results

Two hundred thirty-five records were randomly selected from 989admissions to the facility from 1995 through 1998. Eighty-nine chartswere eligible for abstraction. Ineligible charts (subjects nottransferred directly from an ICU to the study facility or with an ICUstay of < 1 week) included patients with acute and chronic neurologicdisorders, complicated surgical wounds and decubitus ulcers, orthopedicconditions, and long-term dialysis patients with medical illnesses. Thesample was 57% male, with

Discussion

Patients recovering from critical illness must overcome bothphysical and psychological challenges if they are to return to anacceptable level of functioning. It is possible that major depression, adjustment, and anxiety disorders impede progress toward importantgoals such as weaning from mechanical ventilation; however, supportiveevidence for this hypothesis is anecdotal.17 In thisstudy, 37% of patients not previously receiving an antidepressant werestarted on pharmacotherapy usually within the

References (28)

  • WE Narrow et al.

    Use of services by persons with mental and addictive disorders

    Arch Gen Psychiatry

    (1993)
  • JC Nelson

    Safety and tolerability of the new antidepressants

    J Clin Psychiatry

    (1997)
  • JC Nelson et al.

    Treatment of major depression with nortriptyline and paroxetine in patients with ischemic heart disease

    Am J Psychiatry

    (1999)
  • M Von Korff et al.

    Treatment costs, cost-offset, and cost-effectiveness of collaborative management of depression

    Psychosom Med

    (1998)
  • Cited by (24)

    • Psychotropic medication use in former ICU patients with mental health problems: A prospective observational follow-up study

      2020, Journal of Critical Care
      Citation Excerpt :

      One other study followed patients leaving the ICU for a long-term, acute-care facility. In this study group, 47% of the patients used an antidepressant (two-thirds initiated their antidepressant after ICU discharge) in the first few weeks after ICU discharge [26]. In our study group, only one in six patients used antidepressants 1 year after discharge, and only 6.5% of the patients with mental health problems initiated an antidepressant.

    • Risk factors for depression and anxiety in survivors of acute respiratory distress syndrome

      2010, General Hospital Psychiatry
      Citation Excerpt :

      Over 100,000 ARDS survivors per year [1] are at risk for long-term morbidity [7,8] including decreased physical function [8], decreased quality of life [9,10], development of psychiatric disorders [7,11,12] and neurologic injury (i.e., polyneuropathy, encephalopathy, and cognitive sequelae) [7,8]. Psychiatric morbidity such as depression and anxiety are common morbidities of critical illness [10,12--14]. The combination of medications, traumatic stress, pain, inflammation, hypoxemia and brain injury may contribute to psychiatric disorders following critical illness and ICU treatment [13,15,16].

    • Quality of Life, Emotional Abnormalities, and Cognitive Dysfunction in Survivors of Acute Lung Injury/Acute Respiratory Distress Syndrome

      2006, Clinics in Chest Medicine
      Citation Excerpt :

      Little is known regarding the effects of treating depression with antidepressant medications or therapy. A study that assessed antidepressant treatment of depression in patients who had ALI/ARDS 2 months after ICU discharge found 37% of patients were taking antidepressant medications [60]. Although data are accumulating regarding depression after ALI/ARDS, less is known regarding anxiety.

    • Epidemiology of depression and antidepressant therapy after acute respiratory failure

      2006, Psychosomatics
      Citation Excerpt :

      Of all survivors, 49% received antidepressant medications. This is similar to the prevalence (47%) that was previously reported in patients recovering from catastrophic illness at an acute rehabilitation center.31 These data illustrate the widespread use of antidepressants in patients with serious medical illnesses and suggest that additional research on the safety and efficacy of these medications in critically ill patients is needed.

    View all citing articles on Scopus

    Supported by National Heart, Lung, and Blood Institute grants, P50HL50152 and K23HO04073.

    Presented in abstract form at The American Thoracic Society International Conference, San Diego, CA, April 27, 1999.

    View full text