Hurricane said:
I'm doing a rotation in the ICU and my attending said that "since I'm the psych person" he wants me to look up the treatment for "acute depression" since many unit patients seem to be depressed. (The issue came up becaue we have a lady now who is tearful about having to be on the trach.) But isn't depression by definition not acute?
Related question: I never rotation on psych consults. Is there an SSRI that's usually used to start people on while in the hospital?
Thanks
I'd recommend that the attending ask for a formal psychiatry consult. Crying in the hospital is most often not depression. Patients go through perfectly normal periods of sadness and grief when confronted with major illness, that no SSRI will help.
See:
Boland RJ, Diaz S, Lamdan RM, Ramchandani D, McCartney JR.
Overdiagnosis of depression in the general hospital.
Gen Hosp Psychiatry. 1996 Jan;18(1):28-35.
Green RL, McAllister TW, Bernat JL.
A study of crying in medically and surgically hospitalized patients.
Am J Psychiatry. 1987 Apr;144(4):442-7.
Non-psychiatrists often see SSRIs as benign, "so what's the harm in starting one." My standard answers:
1) Increased risk of delirium in the medically ill patient
2) Increased risk of bleeding due to decreased platelet aggregation 2ndary to increased serotonin saturation of platelet receptors.
3) Pathologizing or minimizing the pt's very real feelings by suggesting they're abnormal and that a pill will take them away.
Which, when weighed against no benefit in the absence of an actual neurovegetative depression, should be prohibitive.
That being said, if I do make a dx of major depression, I'll usually start out with citalopram since a) reduced risk of p450 interactions with other medications for the medically ill patient, and b) it's generic.