The Outcome of Antidepressant Use in the Medically Ill

doi:10.1001/archpsyc.1985.01790350034007

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Vol. 42 No. 12, December 1985

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The Outcome of Antidepressant Use in the Medically Ill

Michael K. Popkin, MD; Allan L. Callies; Thomas B. Mackenzie, MD

Arch Gen Psychiatry. 1985;42(12):1160-1163.

Abstract

• To examine the feasibility of using antidepressant medicationto treat major depressive syndromes in the hospitalized medicallyill, we reviewed a series of psychiatric consultations meetingthe following criteria: (1) the consultant diagnosed a majordepressive syndrome, (2) treatment with an antidepressant wasadvised, (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 than5% of the cases reviewed, was assessed by retrospective studyof entries in the medical record. Judgments regarding responsewere thus a function of routine clinical observation and care.Drugs were not randomly assigned; rather, the choices representedongoing clinical usage patterns. Two major points emerge fromthe data of the study. First, 32% of the trials were terminateddue to side effects judged to be unacceptable by the physiciansor consultants. Delirium accounted for half of such side effects;cardiotoxicity, however, was not evident. Second, only 40% ofpatients with medical illnesses, including malignant neoplasm,insulin-dependent diabetes, and epilepsy, responded to treatment.The trials of antidepressants in medical-surgical inpatientsdid not achieve the pattern of therapeutic responses routinelycharacterizing comparable interventions in psychiatric patientswith primary affective disorder.

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.

Footnotes

Accepted for publication Jan 29, 1984.

Reprint requests to Box 345, Mayo Building, University Hospitals,420 Delaware St SE, Minneapolis, MN 55455 (Dr Popkin).

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