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Increased Antidepressant Use after Intensive Care for Aneurysmal Subarachnoid Haemorrhage: A
Ryan Falck-Jones1,2, Johan Olsson3,4, Cecilia Åkerlund3,5
1Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. ryan.falck-jones@ki.se.
Background:
Mood disorders after aneurysmal subarachnoid haemorrhage (aSAH) are common. Meanwhile, mood disorders are also common after intensive care for any reason, and whether aSAH confers an excess risk remains unknown.
Methods:
In this retrospective study, patients with cases of aSAH admitted to intensive care in 2012-2023 were identified in nationwide registers and antidepressant (AD) prescriptions used as a proxy for mood disorders. The primary outcome was incidence of AD therapy in patients who were previously AD-naïve, along with attributable risk factors and impact on sick leave and disability pensions. To investigate the risk of AD treatment in aSAH exceeding what would be expected after intensive care, a control cohort of all patients in the intensive care unit (ICU) nationwide between 2012 and 2018 was identified. Using machine-learning-driven nearest-neighbour propensity score (PS) matching, the relative risk of AD treatment in ICU-treated aSAH cases vs. non-neurovascular ICU cases was calculated.
Results:
In all, 3149 patients with aSAH who were AD-naïve were identified, with a cumulative incidence of AD treatment within 1 year of 25.5% and markers of disease severity being the main risk factors for AD treatment. Patients with aSAH who were treated with ADs used significantly more sick leave and disability pensions than patients with aSAH who were not treated with ADs. After propensity score matching with a general ICU cohort, patients with aSAH still had a risk ratio (RR) of 1.333 [95% confidence interval (CI) 1.241-1.425] of AD treatment within 1 year, indicating an additional impact of aSAH on the development of mood disorders.
Conclusions:
Our results suggest patients with aSAH have a risk of mood disorders exceeding what would be expected after intensive care for non-neurovascular reasons.
