Antidepressants in the ICU: Healing or Hindering Post-ICU Syndrome?

Introduction: ICU survivors are at risk of developing Post Intensive Care Syndrome (PICS), which can involve new or worsening impairments in physical, cognitive, or mental health that persists beyond discharge. Mitigating risk factors during ICU admission is crucial to prevent the development of PICS. Research has shown continuation of antidepressants (AD) during ICU admission decreases ICU delirium; however, data evaluating AD use prior to ICU admission as it relates to development of PICS is lacking. This study aims to evaluate the association between AD use prior to intubation and diagnosis of a new mental health condition or a psychotropic medication prescribed after ICU admission.


Methods: A retrospective cohort study was conducted utilizing TriNetX, a database from 92 international healthcare organizations. A cohort of adult patients admitted to an ICU and prescribed an AD 6 months prior to ICU admission were identified and propensity-score matched (1:1) to a cohort of adult ICU patients not prescribed an AD. Patients with a prior diagnosis of PTSD were excluded. The primary outcome was a composite of new mental health diagnoses identified by ICD-10 codes for anxiety, mood, psychotic, sleep, and adjustment disorders. Matching was done on the basis of demographic factors and risk factors for PICS.


Results: After matching, 21,514 patients were included in each cohort. At two years post intubation, the primary outcome of new mental health diagnosis occurred more often among patients prescribed an AD prior to ICU admission (47% vs. 39%; p< 0.01; risk ratio [RR], 1.210; [95% CI, (01.183, 1.236)]). Patients in the AD cohort were more likely to have a new psychotropic prescription (88% vs. 60%, p< 0.01) or diagnosis of anxiety disorder (27% vs. 24%, p< 0.01), depression (35% vs. 23%, p< 0.01), and psychotic disorder (5% vs. 4%, p=0.025) .Substance use disorder diagnoses did not differ between groups.


Conclusions: Patients receiving a prescription for an antidepressant prior to ICU admission were more likely to have a new mental health diagnosis after discharge. Findings from this study may assist in identification of patients who are at higher risk of developing PICS. Future research is needed to explore strategies to reduce development of PICS.