Antidepressant use associated with increased mortality among critically ill patients?

Researchers at Beth Israel Deaconess Medical Center, in Boston, and the Massachusetts Institute of Technology in Cambridge, have found that critically ill patients were more likely to die if they were taking the most commonly prescribed antidepressants when they were admitted to the intensive care unit (ICU).

The researchers conducted a using the of 10,568 patients to look at in-hospital mortality and mortality a year after being admitted to the ICU.

"We found that mortality was higher overall for patients taking antidepressants prior to admission to the ICU and remained significantly higher a year later," said Katherine. M. Berg, MD, one of the physicians involved in the study. "We also found that certain subgroups of patients, particularly patients admitted for , appeared to be at even greater risk."

The study results will be presented at the ATS 2012 International Conference in San Francisco.

Of the 10,568 patient records studied, 1,876 patients were taking either a (SSRI) or a serotonin and norepinephrine reuptake inhibitor (SNRI) prior to admission to an ICU. They were compared to patients admitted to an ICU who were not on one of these medications. After adjusting for age, gender, ICD-9 diagnosis, and co-morbidities, the researchers found that patients on SSRI/SNRI's prior to admission to the ICU were 73 percent more likely to die in the hospital (p<0.001), and that the increase in risk persisted at one year.

Among patient groups, risk was highest among patients with and those who had undergone . For both of these patient groups, the risk of dying in the hospital was more than double if they were taking one of these antidepressants prior to admission (OR 2.41; p<.0020 and 2.08; p<0.001, respectively).

Not all patient groups demonstrated that patients on SSRI/SNRI's were more likely to die. There was, for example, no increase in mortality among patients admitted with sepsis.

Both classes of antidepressants, which work by increasing the levels of neurotransmitters in the brain, are generally thought to have fewer side effects than previous generations of antidepressants. Recent studies, however, have found that SSRIs may increase a patient's risk of bleeding, dizziness, falls and stroke.

"Major depression is a common disorder affecting more than 16 percent of adults in the United States, and SSRI's are the most commonly prescribed medication class for this disease," added Dr. Berg. "The benefits of SSRI's for the treatment of depression are well documented. Due to the practical limitations of clinical trials, however, the long-term risks are unknown."

The researchers acknowledged that this study shows an association, but that the preadmission SSRI/SNRI use may not have been the cause of the increased mortality. The authors attempted to control for other factors that could lead to increased mortality, but were unable to control for some potentially important ones such as smoking and depression itself.

The authors stressed that these results require validation by similar studies utilizing other ICU databases. They stated, however, that this information highlights the need for alternative ways to monitor for potential adverse effects of medications, and the role that large clinical databases may play in this line of investigation.

More information: "Pre-Admission Use Of Selective Serotonin Reuptake Inhibitors Is Associated With ICU Mortality" (Session C24, Tuesday, May 22, 2012, Room 309, Moscone Center; Abstract 31998).

add to favorites email to friend print save as pdf

Related Stories

Health insurance status linked to mortality risk in PA ICUs

May 17, 2010

Adult patients without health insurance admitted to intensive care units (ICUs) in Pennsylvania hospitals are at a 21 percent increased risk of death compared to similar patients with private insurance, according to researchers ...

Heart attack not a death sentence

Jul 18, 2008

Survivors of cardiac arrest who received intensive care can expect long-term quality of life at reasonable expense to the health care system. Research published today in BioMed Central's open access journal Critical Care is the ...

Recommended for you

Supercomputers link proteins to drug side effects

19 hours ago

New medications created by pharmaceutical companies have helped millions of Americans alleviate pain and suffering from their medical conditions. However, the drug creation process often misses many side ...

No added benefit proven for umeclidinium/vilanterol in COPD

Oct 20, 2014

The drug combination umeclidinium/vilanterol (trade name Anoro) has been approved since May 2014 for adults with chronic obstructive pulmonary disease (COPD). In an early benefit assessment pursuant to the Act on the Reform ...

User comments