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Antidepressant Side Effects in the Medically Ill: The Value of Psychiatric Consultation

In this study we evaluated the side effects of antidepressant use in medically ill patients. The authors evaluated fifty-one general hospital inpatients who were later prescribed antidepressant medications by their primary care physicians. These patients' medical records were reviewed one year later for evidence of serious complications. The overall complication rate was 43 percent. When the psychiatrist recommended antidepressant therapy, there was a 30 percent incidence of major complications. When the psychiatrist did not recommend antidepressants, but the patient was treated anyway, the incidence of treatment-limiting side effects was 67 percent. These results suggest that psychiatrists can predict which medically ill patients are at risk for complications. Since most antidepressants are prescribed by non-psychiatrists, an important role for consultants is to identify those patients at high risk for significant complications.