Options when anti-depressants cannot be used in conventional ways. Clinical case and review of literature

Das, Aparna; Obiozor, Crystal C.; Elwadhi, Deeksha; Fuller, Michael

doi:10.1016/j.pmip.2019.01.002

Cited by 3 publications

(2 citation statements)

References 45 publications

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“…30 However, antidepressants are not easily accessible in buccal, rectal, inhalation, and intravenous routes. 31,32 The FDA has approved some antidepressants in alternate routes, including mirtazapine and selegiline orally disintegrating tablets, selegiline transdermal patch, esketamine nasal spray, and fluoxetine liquid. 31 A number of antidepressants that were administered to patients in this study (ie, escitalopram, fluoextine, paroxetine, sertraline) are available in liquid formulation, 39 yet only 1 patient in this study was prescribed liquid antidepressant because they were on a feeding tube, and their antidepressant was discontinued 6 days prior to death when their feeding tube was disconnected.…”

Section: Discussionmentioning

confidence: 99%

“…29 Patients' prescriptions are oftentimes adjusted to non-oral routes during the final dying process when they can no longer consume medications orally and medications that are deemed non-essential are discontinued. 30 Many antidepressants do not come in alternative forms suitable for the actively dying 31,32 ; therefore, hospice patients prescribed antidepressants may be at risk for ADS when their medication is discontinued or disrupted.…”

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confidence: 99%

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Antidepressant Use During Hospice Patients’ Final Months on Routine Home Care

Crampton

Weisse

2022

Am J Hosp Palliat Care

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Background: Antidepressants can be used to manage symptoms at the end of life, but the dying process can impact their use. Objectives: To examine the use of antidepressants during hospice patients’ final months of home care. Methods: A retrospective case records review of 227 hospice patients in their last three months of care in a residential setting. Chart reviews were conducted of medication logs, hospice staff notes, and caregiver narratives to examine antidepressant use including types of medications prescribed and factors associated with medication maintenance. Results: Thirty percent of patients were prescribed at least 1 antidepressant for symptoms including depression, anxiety, pain, disturbances in sleep, and poor appetite. The majority (96.1%) of patients were not administered their antidepressant on the day of death, and more than half (61.8%) did not receive their antidepressant during their last 3 days of life. A quarter (25.5%) of patients on antidepressants did not receive medication 4-7 days prior to death while some (12.7%) went without their antidepressant for 8 or more days. Antidepressant use was discontinued by hospice staff or caregivers due to a variety of reasons including difficulty swallowing, minimal consciousness, confusion, nausea, or patient refusal. Conclusions: Antidepressants are prescribed to manage multiple symptoms at the end of life, but use is often disrupted during patients' final days. Tapering and other prescription adjustments may be warranted to avoid risk of antidepressant discontinuation syndrome (ADS).

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Antidepressant Use During Hospice Patients’ Final Months on Routine Home Care

Crampton

Weisse

2022

Am J Hosp Palliat Care

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Depression and Anxiety Disorders

2021

The Maudsley Prescribing Guidelines in Psychiatry

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Depression is widely recognised as a major public health problem around the world. The basic principles of prescribing are described in this chapter, along with a summary of NICE guidance. This chapter concentrates on the use of antidepressants and offers advice on drug choice, dosing, switching strategies and sequencing of treatments. Management of treatment‐resistant depression has been informed by the STAR*D programme. The 2019 PANDA trial results support the prescription of selective serotonin reuptake inhibitor antidepressants in a wider group of participants than previously thought, including those with mild to moderate symptoms who do not meet diagnostic criteria for depression or generalised anxiety disorder. Over the last two decades, ketamine, an uncompetitive N‐Methyl‐D‐Aspartate receptor antagonist and dissociative anaesthetic, has emerged as a novel and effective rapid‐acting antidepressant. Psychotic depression is an under‐identified disorder and may have a life‐time risk of up to 1%.

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