Antidepressant Prescriptions Among Hospice Patients During Their Final Days

Depression is frequently experienced at the end of life and can increase pain and suffering. Antidepressants can alleviate depression among the terminally ill; however, many patients have difficulty swallowing oral tablets as death approaches and may be at risk for antidepressant discontinuation syndrome (ADS). This study retrospectively examined antidepressant prescription patterns among 227 hospice patients in a residential care home to determine the extent to which patients were prescribed antidepressants during their final month of life and at what time in the dying process patients may have stopped taking their medication. Results revealed that 67 (30%) of the hospice patients at the care home were prescribed one or more antidepressants. The vast majority (96.1%) of patients did not consume their prescribed antidepressant on their day of death. For those who died at the home, most (62.7%) did not receive their medication during their last 3 days whereas about a quarter of patients (23.6%) stopped receiving their medication 4-7 days prior to their death and a smaller percentage (13.9%) went without medication from 8-34 days prior to death. Records revealed that antidepressants were not consumed during patients' final days for a variety of reasons including difficulty swallowing, minimal consciousness, confusion, nausea, and patient refusal. These results suggest that hospice patients may be at risk for ADS, a factor that could add to suffering during patients' final days. Alternative routes of administering antidepressants at the end of life may be helpful in ensuring that patients are not suffering unnecessarily while they are dying.