Egyptian College of Critical Care Physicians

Advancing Critical Care Medicine in Egypt

Antidepressants in Critical Illness

“Adapted from Oxford Textbook of Critical Care-Oxford University Press 2016”

Selective serotonin reuptake inhibitors (SSRIs), Serotonin Norepinephrine reuptake inhibitors (SNRIs), Bupropion and Mirtazapine are typically the first-line agents for the treatment of depression in the intensive care unit (ICU) setting given their safety and tolerability.
Serotonin syndrome is a significant risk in overdose of most antidepressants and can also be seen in the setting of combining more than one antidepressant.
Stimulants can be used safely and effectively to treat apathy, loss of appetite, and low energy in ICU patients.
Antidepressants should typically be continued during ICU stays (except in the presence of delirium), as abrupt cessation may produce withdrawal phenomenon.
Current evidence does not recommend prophylactic initiation of antidepressants following trauma.

“Adapted from Oxford Textbook of Critical Care-Oxford University Press 2016”

The intensive care unit (ICU) environment exposes staff to stressful and emotionally-demanding situations, which places them at high risk for burnout.
Risk factors for Burnout can be found at both individual and organization levels.
Consequences of low morale and burnout include personal distress for clinicians, poor quality of care for patients, and highly health care costs for organizations and society.
Staff engagement is emerging as the antithesis of burnout.
We need to promote a wider recognition among ICU staff regrading risks of burnout and the consequences for both them and the patients in their care.

Potential phases of Burnout

The need to prove oneself: often occurring in highly motivated and ambitious individuals.
Working harder: high personal expectations emerge as further work commitments are undertaken.
Neglecting personal needs: no time or energy is reserved for activities or relationships outside the workplace.
Displacement of conflict: The individual is unable to identify the cause for their difficulties.
Revision of values: isolation from family and friends with a solely job- related value system.
Denial: cynicism, aggression, and intolerance of others emerge, leading to isolation.
Behavioral changes become more apparent to others: e.g conflict.
Depersonalization: loss of appreciation for self and self- worth. Cannot appreciate further success.
Inner emptiness: may seek an activity to full the void such as eating, drugs, etc.
Depression: typical affective, cognitive and somatic features are present.