Antidepressants in Critical Illness

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Key points in Critical Care Medicine:

Antidepressants in critical illness

“Adapted from Oxford Textbook of Critical Care-Oxford University Press 2016”

  • Selective serotonin reuptake inhibitors (SSRIs), Serotonin Norepinephrine reuptake inhibitors (SNRIs), Bupropion and Mirtazapine are typically the first-line agents for the treatment of depression in the intensive care unit (ICU) setting given their safety and tolerability.
  • Serotonin syndrome is a significant risk in overdose of most antidepressants and can also be seen in the setting of combining more than one antidepressant.
  • Stimulants can be used safely and effectively to treat apathy, loss of appetite, and low energy in ICU patients.
  • Antidepressants should typically be continued during ICU stays (except in the presence of delirium), as abrupt cessation may produce withdrawal phenomenon.
  • Current evidence does not recommend prophylactic initiation of antidepressants following trauma.

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