December 1985

The Outcome of Antidepressant Use in the Medically Ill

Author Affiliations

From the Departments of Psychiatry (Drs Popkin and Mackenzie and Mr Callies) and Medicine (Drs Popkin and Mackenzie), University of Minnesota Medical School, Minneapolis.

Arch Gen Psychiatry. 1985;42(12):1160-1163. doi:10.1001/archpsyc.1985.01790350034007

• To examine the feasibility of using antidepressant medication to treat major depressive syndromes in the hospitalized medically ill, we reviewed a series of psychiatric consultations meeting the following criteria: (1) the consultant diagnosed a major depressive syndrome, (2) treatment with an antidepressant was advised, (3) the consultee initiated the antidepressant, and (4) hospitalization had been prompted by a major medical illness. The final sample of 50 consultations, representing less than 5% of the cases reviewed, was assessed by retrospective study of entries in the medical record. Judgments regarding response were thus a function of routine clinical observation and care. Drugs were not randomly assigned; rather, the choices represented ongoing clinical usage patterns. Two major points emerge from the data of the study. First, 32% of the trials were terminated due to side effects judged to be unacceptable by the physicians or consultants. Delirium accounted for half of such side effects; cardiotoxicity, however, was not evident. Second, only 40% of patients with medical illnesses, including malignant neoplasm, insulin-dependent diabetes, and epilepsy, responded to treatment. The trials of antidepressants in medical-surgical inpatients did not achieve the pattern of therapeutic responses routinely characterizing comparable interventions in psychiatric patients with primary affective disorder.