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Depression and alcohol withdrawal syndrome: is antidepressant therapy associated with lower rates of hospital readmission?

Abstract

Background

Alcohol withdrawal syndrome (AWS) is a frequent cause of admission to acute care hospitals and many of these patients have a history of depression.

Aim

Our objective was to determine if antidepressant use in patients with a history of depression is associated with lower rates of hospital readmission for AWS.

Methods

A retrospective study was performed of patients admitted with AWS between January 1, 2006 and December 31, 2008 to an academic tertiary referral hospital.

Results

Three hundred and twenty-two patients were admitted with AWS during the study period. One hundred and sixty-one patients (50 %) had no history of depression, 111 patients (34 %) had a history of depression and antidepressant use, and 50 patients (16 %) had a history of depression and no antidepressant use. There was no significant difference in the number of hospitalizations for AWS between these three groups. Patients with a history of depression on antidepressant medication were more likely to be retired or work disabled compared to the other two groups (p < 0.05). The antidepressant class most commonly used was SSRI (63 %).

Conclusion

Our study highlights the high frequency of depression and antidepressant use in patients admitted with AWS to an acute care hospital. As alcohol withdrawal is associated with increased morbidity and mortality and depression is common in those with alcohol use disorder, further research is necessary to clarify the optimal treatment of comorbid depression and alcohol use disorder in reducing these revolving door admissions.

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References

  1. 1.

    Larson SA, Burton MC, Kashiwagi DT, Hugo ZP, Cha SS, Lapid MI (2012) Multiple admissions for alcohol withdrawal. J Hosp Med 7(8):617–621. doi:10.1002/jhm.1953

    Article  PubMed  Google Scholar 

  2. 2.

    Coventry PA, Gemmell I, Todd CJ (2011) Psychosocial risk factors for hospital readmission in COPD patients on early discharge services: a cohort study. BMC Pulm Med 11:49. doi:10.1186/1471-2466-11-49

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Levine JB, Covino NA, Slack WV, Safran C, Safran DB, Boro JE et al (1996) Psychological predictors of subsequent medical care among patients hospitalized with cardiac disease. J Cardiopulm Rehabil 16(2):109–116

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Song EK, Lennie TA, Moser DK (2009) Depressive symptoms increase risk of rehospitalisation in heart failure patients with preserved systolic function. J Clin Nurs 18(13):1871–1877. doi:10.1111/j.1365-2702.2008.02722.x

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Ottenbacher KJ, Graham JE, Ottenbacher AJ, Lee J, Al Snih S, Karmarkar A et al (2012) Hospital readmission in persons with stroke following postacute inpatient rehabilitation. J Gerontol A Biol Sci Med Sci 67(8):875–881. doi:10.1093/gerona/glr247

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Mudge AM, Kasper K, Clair A, Redfern H, Bell JJ, Barras MA et al (2011) Recurrent readmissions in medical patients: a prospective study. J Hosp Med 6(2):61–67. doi:10.1002/jhm.811

    Article  PubMed  Google Scholar 

  7. 7.

    Paratz J, Thomas P, Adsett J (2005) Re-admission to intensive care: identification of risk factors. Physiother Res Int 10(3):154–163

    Article  PubMed  Google Scholar 

  8. 8.

    Lin CH, Chen YS, Lin KS (2007) Factors affecting time to rehospitalization for patients with major depressive disorder. Psychiatry Clin Neurosci 61(3):249–254. doi:10.1111/j.1440-1819.2007.01662.x

    Article  PubMed  Google Scholar 

  9. 9.

    Slater EJ, Linn MW (1982) Predictors of rehospitalization in a male alcoholic population. Am J Drug Alcohol Abuse 9(2):211–220

    Article  PubMed  Google Scholar 

  10. 10.

    Moos RH, Moos BS (1995) Stay in residential facilities and mental health care as predictors of readmission for patients with substance use disorders. Psychiatr Serv 46(1):66–72

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Greenfield SF, Weiss RD, Muenz LR, Vagge LM, Kelly JF, Bello LR et al (1998) The effect of depression on return to drinking: a prospective study. Arch Gen Psychiatry 55(3):259–265

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Loosen PT, Dew BW, Prange AJ (1990) Long-term predictors of outcome in abstinent alcoholic men. Am J Psychiatry 147(12):1662–1666

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Gamble SA, Conner KR, Talbot NL, Yu Q, Tu XM, Connors GJ (2010) Effects of pretreatment and posttreatment depressive symptoms on alcohol consumption following treatment in Project MATCH. J Stud Alcohol Drugs 71(1):71–77

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Suter M, Strik W, Moggi F (2011) Depressive symptoms as a predictor of alcohol relapse after residential treatment programs for alcohol use disorder. J Subst Abuse Treat 41(3):225–232. doi:10.1016/j.jsat.2011.03.005

    Article  PubMed  Google Scholar 

  15. 15.

    Oslin DW (2005) Treatment of late-life depression complicated by alcohol dependence. Am J Geriatr Psychiatry 13(6):491–500. doi:10.1176/appi.ajgp.13.6.491

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Clark BJ, Keniston A, Douglas IS, Beresford T, Macht M, Williams A et al (2013) Healthcare utilization in medical intensive care unit survivors with alcohol withdrawal. Alcohol Clin Exp Res 37(9):1536–1543. doi:10.1111/acer.12124

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Campos J, Roca L, Gude F, Gonzalez-Quintela A (2011) Long-term mortality of patients admitted to the hospital with alcohol withdrawal syndrome. Alcohol Clin Exp Res 35(6):1180–1186. doi:10.1111/j.1530-0277.2011.01451.x

    Article  PubMed  Google Scholar 

  18. 18.

    Monte R, Rabunal R, Casariego E, Lopez-Agreda H, Mateos A, Pertega S (2010) Analysis of the factors determining survival of alcoholic withdrawal syndrome patients in a general hospital. Alcohol Alcohol 45(2):151–158. doi:10.1093/alcalc/agp087

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    O’Brien JM Jr, Lu B, Ali NA, Martin GS, Aberegg SK, Marsh CB et al (2007) Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among adult intensive care unit patients. Crit Care Med 35(2):345–350. doi:10.1097/01.CCM.0000254340.91644.B2

    Article  PubMed  Google Scholar 

  20. 20.

    Monras M, Mondon S, Ortega L, Gual A (2005) Alcoholism in the general hospital: 4 years mortality and hospitalization. Med Clin (Barc) 125(12):441–447

    Article  Google Scholar 

  21. 21.

    Hecksel KA, Bostwick JM, Jaeger TM, Cha SS (2008) Inappropriate use of symptom-triggered therapy for alcohol withdrawal in the general hospital. Mayo Clin Proc 83(3):274–279. doi:10.4065/83.3.274

    Article  PubMed  Google Scholar 

  22. 22.

    Torrens M, Fonseca F, Mateu G, Farre M (2005) Efficacy of antidepressants in substance use disorders with and without comorbid depression. A systematic review and meta-analysis. Drug Alcohol Depend 78(1):1–22. doi:10.1016/j.drugalcdep.2004.09.004

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Mason BJ, Kocsis JH, Ritvo EC, Cutler RB (1996) A double-blind, placebo-controlled trial of desipramine for primary alcohol dependence stratified on the presence or absence of major depression. JAMA 275(10):761–767

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Nunes EV, McGrath PJ, Quitkin FM, Stewart JP, Harrison W, Tricamo E et al (1993) Imipramine treatment of alcoholism with comorbid depression. Am J Psychiatry 150(6):963–965

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    McGrath PJ, Nunes EV, Stewart JW, Goldman D, Agosti V, Ocepek-Welikson K et al (1996) Imipramine treatment of alcoholics with primary depression: a placebo-controlled clinical trial. Arch Gen Psychiatry 53(3):232–240

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    BMJ Group (2008) Treating depression in alcohol misuse. Drug Ther Bull 46(2):11–14. doi:10.1136/dtb.2008.01.0003

    Article  Google Scholar 

  27. 27.

    Ekers D, Richards D, Gilbody S (2008) A meta-analysis of randomized trials of behavioural treatment of depression. Psychol Med 38(5):611–623. doi:10.1017/S0033291707001614

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Moak DH, Anton RF, Latham PK, Voronin KE, Waid RL, Durazo-Arvizu R (2003) Sertraline and cognitive behavioral therapy for depressed alcoholics: results of a placebo-controlled trial. J Clin Psychopharmacol 23(6):553–562. doi:10.1097/01.jcp.0000095346.32154.41

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Hobbs JD, Kushner MG, Lee SS, Reardon SM, Maurer EW (2011) Meta-analysis of supplemental treatment for depressive and anxiety disorders in patients being treated for alcohol dependence. Am J Addict. 20(4):319–329. doi:10.1111/j.1521-0391.2011.00140.x

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Watkins KE, Hunter SB, Burnam MA, Pincus HA, Nicholson G (2005) Review of treatment recommendations for persons with a co-occurring affective or anxiety and substance use disorder. Psychiatr Serv 56(8):913–926. doi:10.1176/appi.ps.56.8.913

    Article  PubMed  Google Scholar 

  31. 31.

    Brown RA, Evans DM, Miller IW, Burgess ES, Mueller TI (1997) Cognitive-behavioral treatment for depression in alcoholism. J Consult Clin Psychol 65(5):715–726

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Brown RA, Ramsey SE, Kahler CW, Palm KM, Monti PM, Abrams D et al (2011) A randomized controlled trial of cognitive-behavioral treatment for depression versus relaxation training for alcohol-dependent individuals with elevated depressive symptoms. J Stud Alcohol Drugs 72(2):286–296

    Article  PubMed  PubMed Central  Google Scholar 

  33. 33.

    DiMatteo MR, Lepper HS, Croghan TW (2000) Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 160(14):2101–2107

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Grenard JL, Munjas BA, Adams JL, Suttorp M, Maglione M, McGlynn EA et al (2011) Depression and medication adherence in the treatment of chronic diseases in the United States: a meta-analysis. J Gen Intern Med 26(10):1175–1182. doi:10.1007/s11606-011-1704-y

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Lejoyeux M, Lehert P (2011) Alcohol-use disorders and depression: results from individual patient data meta-analysis of the acamprosate-controlled studies. Alcohol Alcohol 46(1):61–67. doi:10.1093/alcalc/agq077

    Article  PubMed  Google Scholar 

  36. 36.

    Kent S, Yellowlees P (1994) Psychiatric and social reasons for frequent rehospitalization. Hosp Community Psychiatry 45(4):347–350

    CAS  PubMed  Google Scholar 

  37. 37.

    Haywood TW, Kravitz HM, Grossman LS, Cavanaugh JL Jr, Davis JM, Lewis DA (1995) Predicting the “revolving door” phenomenon among patients with schizophrenic, schizoaffective, and affective disorders. Am J Psychiatry 152(6):856–861

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    Sullivan G, Wells KB, Morgenstern H, Leake B (1995) Identifying modifiable risk factors for rehospitalization: a case-control study of seriously mentally ill persons in Mississippi. Am J Psychiatry 152(12):1749–1756

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Green JH (1988) Frequent rehospitalization and noncompliance with treatment. Hosp Community Psychiatry 39(9):963–966

    CAS  PubMed  Google Scholar 

  40. 40.

    Jeon-Slaughter H (2012) Economic factors in of patients’ nonadherence to antidepressant treatment. Soc Psychiatry Psychiatr Epidemiol 47(12):1985–1998. doi:10.1007/s00127-012-0497-6

    Article  PubMed  Google Scholar 

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Conflict of interest

Drs. Kimberly Schoonover, M. Caroline Burton, Scott Larson, and Maria Lapid in addition to Mr. Stephen Cha report no conflict of interest.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Correspondence to K. Schoonover.

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Schoonover, K., Burton, M.C., Larson, S.A. et al. Depression and alcohol withdrawal syndrome: is antidepressant therapy associated with lower rates of hospital readmission?. Ir J Med Sci 185, 573–579 (2016). https://doi.org/10.1007/s11845-015-1304-7

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Keywords

  • Alcohol withdrawal syndrome
  • Depression
  • Antidepressant medication
  • Hospital readmission