Examining Antidepressant Discontinuation Syndrome (ADS) Among Hospice Patients in the Last Week of Life

Abstract

Background

Terminal symptoms at the end-of-life (EOL) can be distressing to hospice patients and to caregivers who often manage symptoms in a home setting. Identifying potential contributors of these symptoms is key to quality patient- and family-centered care. Disruptions in antidepressants can lead to antidepressant discontinuation syndrome (ADS), a condition characterized by unpleasant symptoms such as agitation, restlessness, nausea, and insomnia.

Objectives

Using a retrospective review of hospice patients’ medication records, this study examined whether patients experiencing disruptions in their antidepressant regimen needed additional comfort medication to manage terminal symptoms consistent with ADS.

Methods

An existing data registry of 356 home hospice patients was queried to identify patients who were administered antidepressants whose regimens were disrupted in the last week of life. Patterns of comfort medication administration in these patients were compared to comfort medication usage in patients whose antidepressant regimens were not disrupted and to patients who were not prescribed antidepressants. Symptoms of ADS were assessed by comparing doses of liquid morphine, lorazepam, and haloperidol pre- and post-discontinuation of an antidepressant.

Results

Analyses revealed significant increases in liquid morphine and lorazepam administration among patients who experienced disruptions to their antidepressant regimen, and that the increased overall utilization of these comfort medications was higher than that of control patients whose antidepressants were not disrupted or of those who were not prescribed antidepressants at all. These results warrant further exploration to determine whether distressing EOL symptoms may be indicative of ADS.