- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Part 2.1 Respiratory drugs
- Part 2.2 Cardiovascular drugs
- Part 2.3 Gastrointestinal drugs
- Part 2.4 Nervous system drugs
- Chapter 42 Sedatives and anti-anxiety agents in critical illness
- Chapter 43 Analgesics in critical illness
- Chapter 44 Antidepressants in critical illness
- Chapter 45 Antiseizure agents in critical illness
- Chapter 46 Inhalational anaesthetic agents in critical illness
- Chapter 47 Muscle relaxants in critical illness
- Chapter 48 Neuroprotective agents in critical illness
- Part 2.5 Hormonal drugs
- Part 2.6 Haematological drugs
- Part 2.7 Antimicrobial and immunological drugs
- Part 2.8 Fluids and diuretics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 193) Antidepressants in critical illness
- Chapter:
- (p. 193) Antidepressants in critical illness
- Author(s):
Scott R. Beach
and Theodore A. Stern
- DOI:
- 10.1093/med/9780199600830.003.0044
Selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and atypical antidepressants are considered first-line agents for depression in the intensive care unit (ICU) setting, and are preferred over older antidepressants due to their more benign side effect profile and tolerability. This chapter reviews the literature on the use of antidepressants in the ICU. Common side effects of SSRIs include insomnia and gastrointestinal discomfort, while citalopram may uniquely cause prolongation of the QTc interval. All SSRIs carry a risk for the development of serotonin syndrome following overdose. SNRIs are similar to SSRIs in their side effect profile, although they are more likely to cause hypertension. Mirtazapine is strongly associated with sedation and weight gain. Stimulants may also be used to treat depression in the medically ill, and can be particularly effective in treating apathy, low energy, and loss of appetite. Monotherapy is typically the initial treatment strategy and low doses are generally recommended in the ICU setting. Efficacy may not be apparent for up to 8 weeks. Patients who have been taking an antidepressant prior to their arrival in the ICU should continue on the medication so as to prevent discontinuation syndrome. Delirium may warrant cessation of the antidepressant and potentially dangerous medication interactions also need to be evaluated. At present, there is no evidence to suggest that an antidepressant should be initiated after a significant physical or emotional trauma.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Part 2.1 Respiratory drugs
- Part 2.2 Cardiovascular drugs
- Part 2.3 Gastrointestinal drugs
- Part 2.4 Nervous system drugs
- Chapter 42 Sedatives and anti-anxiety agents in critical illness
- Chapter 43 Analgesics in critical illness
- Chapter 44 Antidepressants in critical illness
- Chapter 45 Antiseizure agents in critical illness
- Chapter 46 Inhalational anaesthetic agents in critical illness
- Chapter 47 Muscle relaxants in critical illness
- Chapter 48 Neuroprotective agents in critical illness
- Part 2.5 Hormonal drugs
- Part 2.6 Haematological drugs
- Part 2.7 Antimicrobial and immunological drugs
- Part 2.8 Fluids and diuretics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care