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In the
ICU, use of Benzodiazepines, other factors
may predict severity of Post-Stay Depression
Newswise — Psychiatrists and critical care
specialists at Johns Hopkins have begun to
tease out what there is about a stay in an
intensive care unit (ICU) that leads so many
patients to report depression after they go
home.
In a study reported online in Critical Care
Medicine, the Hopkins researchers say
several factors predicted symptoms of
depression six months after hospitalization
among very sick ICU patients, including a
high level of organ failure and being given
relatively high doses of a benzodiazepine
sedative.
“The hope is that as we learn more about the
effect of variations in ICU care, we’ll be
able to predict which patients are most
susceptible to depression, prevent some
depression by changing ICU practices, and
make sure patients receive adequate mental
health monitoring after discharge,” says O.
Joseph Bienvenu, M.D., Ph.D., an associate
professor in the Department of Psychiatry at
the Johns Hopkins University School of
Medicine.
Bienvenu says doctors have long theorized
that a health problem devastating enough to
send someone to an ICU might well trigger
depression, but because only some patients
become depressed, he and his colleagues
wondered whether the root causes might be
more complex.
“Historically, the only goal for critical
care physicians, understandably, was to keep
people alive, but now there is interest in
longer-term outcomes, such as patients’
mental health and well-being,” says Bienvenu.
“So we asked ourselves, could certain
aspects of critical illness and ICU care
swing patients toward depression?”
To test the idea, Bienvenu and other Johns
Hopkins researchers evaluated patients
recently admitted to one of 13 ICUs located
at four teaching hospitals in Baltimore,
Md., including four ICUs at The Johns
Hopkins Hospital.
Each of the patients was treated for acute
lung injury (ALI), a respiratory distress
syndrome that’s considered an archetype of
critical illness.
Patients with ALI typically require invasive
interventions in the ICU, including use of
ventilators. Though better care has greatly
reduced mortality rates, ALI still kills
about 40 percent of those affected.
Bienvenu and his colleagues followed 160
patients who had survived at least six
months after their ALI diagnosis.
The researchers took note of a variety of
features of each patient’s status and care
while in the ICU, such as severity of organ
failure, their blood sugar levels and other
lab work, and the amount and type of
sedative they received.
At six months after ALI diagnosis, the
researchers administered a questionnaire to
patients that measured depressive symptoms
ranging from none to possible or probable
clinical depression.
Of the 160, 26 percent scored above the
threshold for possible depression. Compared
to other ALI survivors, the depressed
patients were more likely to have suffered
greater severity of organ failure and to
have received 75 mg or more of a
benzodiazepine sedative daily.
Bienvenu says that because more severe organ
failure may lead to a longer physical
recovery period after ICU discharge,
patients’ depression may be explained, in
part, by a slow recovery.
However, he and his colleagues aren’t sure
how to explain the association between
depression and ICU benzodiazepine dose.
One possibility could be that the amount of
this drug received reflects how agitated
patients were in the ICU, with very
distressed individuals getting higher doses.
However, because this relationship hasn’t
been seen with other types of sedatives
commonly prescribed in the ICU, it’s
possible that high doses of benzodiazepine
alone may somehow cause depressive symptoms.
“This is clearly a question that needs
further study,” says Bienvenu.
Other Hopkins researchers who participated
in this study include David W. Dowdy, M.D.,
Ph.D. (now in the Department of Medicine at
the University of California, San
Francisco), Victor D. Dinglas, B.S., Pedro
A. Mendez-Tellez, M.D., Jonathan Sevransky,
M.D., Carl Shanholtz, M.D., and Dale M.
Needham, M.D., Ph.D.
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