Distinguishing End-of-Life Symptoms from Antidepressant Discontinuation Syndrome: Implications for Symptom Management and Medication Use

It is not uncommon for patients to experience distressing symptoms during the final dying process. However, many common symptoms (i.e. agitation, restlessness, fatigue, insomnia) are also recognized symptoms of antidepressant discontinuation syndrome (ADS), a syndrome that occurs when patients abruptly stop taking antidepressants. At the very end of life, patients often lose consciousness and the ability to swallow, raising the question of whether symptoms of distress stem from the natural dying process or disruptions in the antidepressant regimen. Using a retrospective review of hospice patients' medication records during the final week of life, this study set out to determine whether patients who experienced disruptions in their antidepressant regimens exhibited symptoms consistent with ADS. An existing data registry of 535 hospice patients was queried to identify patients receiving antidepressants whose regimens were disrupted in the last week of life and a comparison group of patients whose antidepressant regimens were not disrupted. A third control group was identified of antidepressant-naive patients matched by diagnosis, age, and gender. Symptoms of ADS were assessed indirectly via liquid morphine, haloperidol, and lorazepam use because these medications are used to treat symptoms overlapping with ADS. It was hypothesized that patients experiencing disruptions in their antidepressant regimen would receive higher doses of the 3 medications compared to the other groups. Comparisons of drugs administered 3 days prior vs. post-disruption provided an additional comparison. Insights from this study may help determine whether distressing terminal symptoms might be related to withdrawal and not the natural dying process.