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Antidepressant use and hyperactive delirium at the end of life: retrospective study
  1. Naomi Gleadle1,
  2. Angus Cook2,
  3. Claire E Johnson3 and
  4. Grace Walpole1
  1. 1Supportive and Palliative Care Service, Eastern Health, Melbourne, Victoria, Australia
  2. 2School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
  3. 3Australian Health Services Research Institute, University of Wollongong Faculty of Business, Wollongong, New South Wales, Australia
  1. Correspondence to Dr Naomi Gleadle, Supportive and Palliative Care Service, Eastern Health, Melbourne, VIC 3132, Australia; naomigleadle{at}live.com

Abstract

Objectives Little is known about the adverse effects associated with antidepressant use in palliative care inpatients imminently approaching death. This study investigates the relationship between antidepressant use and hyperactive delirium in this population.

Methods This is a retrospective medical record review of patients who died in a metropolitan palliative care unit in Victoria, Australia, during 2019. Generalised estimating equations were used to estimate the association between antidepressant use and presence of hyperactive delirium in the final 2 weeks of life.

Results Of the 501 adult patients who died in the 12-month period, 113 (22.55%) were on at least one antidepressant at the time of admission. Any antidepressant use in the last 14 days of life was significantly associated with the diagnosis of hyperactive delirium (OR 1.48; 95% CI 1.30, 1.68). Patients prescribed antidepressants also experienced longer durations of delirium (3.89 days; SD 4.23) compared with those not taking any antidepressant (2.99 days; SD 3.70) in the final 2 weeks of life.

Conclusion Antidepressant use or discontinuation is significantly associated with hyperactive delirium within 14 days of death. Although the causes of delirium are multifactorial and complex, antidepressant use is a potentially modifiable risk factor.

  • End of life care
  • Terminal care
  • Delirium

http://dx.doi.org/10.1136/spcare-2023-004417

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    Footnotes

    • Presented at NG presented the aspects of this research at the ANZSPM Conference at Canberra, Australia, on 3 September 2022 (Gleadle N, Cook A, Johnson C et al. Antidepressant discontinuation and hyperactive delirium at the end of life [abstract]. Presented at: ANZSPM 2022 Biennial Conference; 2–4 September 2022; Canberra, Australia).

    • Contributors Substantial contributions to the conception and design of the work, and the acquisition, analysis and interpretation of data completed by NG, AC, CEJ and GW. Drafting and critical revision of the work completed by NG, AC, CEJ and GW. Final approval of the work completed by NG, AC, CEJ and GW. Agreement to be accountable for all aspects of the work by authors NG, AC, CEJ and GW.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.