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
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
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
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
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
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
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
Paratz J, Thomas P, Adsett J (2005) Re-admission to intensive care: identification of risk factors. Physiother Res Int 10(3):154–163
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
Slater EJ, Linn MW (1982) Predictors of rehospitalization in a male alcoholic population. Am J Drug Alcohol Abuse 9(2):211–220
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
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
Loosen PT, Dew BW, Prange AJ (1990) Long-term predictors of outcome in abstinent alcoholic men. Am J Psychiatry 147(12):1662–1666
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
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
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
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
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
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
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
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
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
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
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
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
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
BMJ Group (2008) Treating depression in alcohol misuse. Drug Ther Bull 46(2):11–14. doi:10.1136/dtb.2008.01.0003
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
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
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
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
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
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
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
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
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
Kent S, Yellowlees P (1994) Psychiatric and social reasons for frequent rehospitalization. Hosp Community Psychiatry 45(4):347–350
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
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
Green JH (1988) Frequent rehospitalization and noncompliance with treatment. Hosp Community Psychiatry 39(9):963–966
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
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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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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DOI: https://doi.org/10.1007/s11845-015-1304-7