Depression After ICU Stay is Common, Makes Recovery More Difficult
Depressive symptoms are common among ICU survivors and makes recovery much more difficult. Unfortunately, many physicians tend to focus, understandably, on physical recovery and fail to address mental health after hospitalization. However, depression can be long-lasting, even after discharge, and can drastically affect quality of life and the ability to independently perform important daily tasks such as shopping and preparing food.
The most recent study of depression after an intensive care stay comes from researchers at the Johns Hopkins University School of Medicine. Study leader O. Joseph Bienvenu MD PhD, an associate professor of psychiatry and behavioral scientists, and colleagues assessed 186 survivors of a potentially deadly syndrome known as acute lung injury, a condition characterized by hypoxemia (decreased oxygen concentration) and reduced lung compliance. ALI is most often seen as part of a systemic inflammatory process, particularly systemic sepsis (severe blood stream infection).
The average age of the patients was 49 years old – people who should be in the prime of their lives but became disabled and unable to return to work after discharge from the intensive care unit. The researchers surveyed their levels of depression and their ability to independently perform tasks of daily life at three, six, 12 and 24 months after their illness.
Forty percent of the patients developed depressive symptoms in the first two years after discharge even though they had not previously experienced them. Sixty-six percent experienced new physical impairments. The depressive symptoms frequently preceded the physical impairments, not the other way around as might be expected.
The research team said the findings may be applicable to patients with other types of disease or injury who spend time in hospital intensive care units hooked up to ventilators that breathe for them.
Standard ICU care for patients with acute lung injury often includes deep sedation and mechanical ventilation. A separate study from Johns Hopkins, published in the May 2009 issue of Critical Care Medicine finds that the benzodiazepine used for sedation is associated with depressive symptoms for at least 6 months after hospitalization.
"High doses of benzodiazepines alone may somehow cause depressive symptoms," Dr. Bienvenu suggested. He pointed out that benzodiazepines are also associated with worse posttraumatic stress disorder (PTSD) scores after ICU stays.
Another factor that could increase the risk of post-discharge depression is hypoglycemia, or low blood sugar. Glucose values less than 45 mg/dL can be due to continuous venovenous hemofiltration, decrease in nutrition without adjustment for insulin, and sepsis. Depression is also known to be related to long stretches of inactivity and the severity of the illness.
“Depression can make recovery much more difficult. Identifying depressive symptoms early — and treating them — could make a real difference in how patients fare physically in the long term,” said Dr. Bienvenu.
Dr. Dale M. Needham MD PhD, an associate professor of pulmonary and critical care medicine and physical medicine and rehabilitation at Johns Hopkins, notes that collaboration between all specialists involved in a patients ICU stay is important to assess both the physical and mental health of a patient, but is often missed. “Patients are burdened for a very long time after their hospital stays. We need to figure out what we can do to help these previously productive people get back their lives.”
An estimated 190,000 Americans suffer from acute lung injury each year and more than 74,000, almost 40 percent, will die while in hospital.
Bienvenu OJ et al. Depressive Symptoms and Impaired Physical Function after Acute Lung Injury: a 2-Year Longitudinal Study. Am. J. Respir. Crit. Care Med. 2011.
Bienvenu OJ et al. Are intensive care factors associated with depressive symptoms 6 mnths after acute lung injury? Crit Care Med. 2009;37:1702-1707.
Bienvenu OJ et al. Intensive care unit hypoglycemia predicts depression during early recovery from acute lung injury. Crit Care Med. 2008 Oct;36(10):2726-33.