Antidepressant Discontinuation Syndrome Among Hospice Patients in a Residential Care Home Setting

Depression and anxiety are common experiences at the end of life, and antidepressants are oftentimes prescribed to manage these symptoms. Unfortunately, antidepressant use can be disrupted during the final dying process for a variety of reasons, leaving patients vulnerable to antidepressant discontinuation syndrome (ADS). Symptoms of ADS include increased arousal and restlessness, and therefore may not be identified as ADS because these are common symptoms at the end of life. Whether ADS occurs among hospice patients whose antidepressant is discontinued is not known. The aim of this study was to examine whether hospice patients whose antidepressants were disrupted experienced symptoms of ADS. Due to the fact that administration of haloperidol is often used to alleviate symptoms of agitation among terminally ill patients, this study used haloperidol administration as an indirect measure of patients’ symptoms of ADS. Both scheduled and PRN haloperidol administrations were identified from hospice patients’ medication records from local, community-run residential care homes (RCHs). It was hypothesized that patients whose antidepressants were disrupted (N = 14) would be more likely to receive haloperidol compared to patients whose antidepressants were not disrupted (N = 14) or matched controls who were not prescribed antidepressants (N = 14). Results did not reveal differences in haloperidol administration among groups. A lack of differences may have been due to the small sample size or due to variations in antidepressants’ half-life between the experimental and antidepressant control group.