The Perioperative Effects of Antidepressant among Psychologically Distressed Pre-Operative Patients
Date Issued
2009
Date
2009
Author(s)
Yen, Ting-Shan
Abstract
Background: erioperative period may be one of the most unpleasant experience during one’s life. The incidence of preoperative anxiety and depression were reported to be 60% and 20-40%. In the literature review, higher the preoperative anxiety and depression level are associated with more severe postoperative pain, less postoperative satisfaction, and more mortality rate. Although conventional anxiolytic premedication (such as benzodiazepine and α 2 agonist) may be helpful to ameliorate preoperative anxiety symptoms and attenuate postoperative stress response, most anesthesiologists are uncertain to provide sedative medication because those drugs might compromise intra- and postoperative vital signs and patient safety. Moreover, those drugs show no benefit in reducing postoperative depression and anxiety. Currently, there are no standardized preoperative evaluation and treatment for preoperative psychologically distressed patients. irtazapine is a unique antidepressant with the potential of fast onset. The overall effects of the drug are antidepressant, anxiolytic, and sleep-enhancer. Moreover, it might play a role in eliminating postoperative severe pain.he primary goal of this study is to test that perioperative use of mirtazapine in preoperative psychologically distressed patients can reduce perioperative anxiety and depression level, enhance sleep quality, and to reduce the level of postoperative pain.ethod: his is a single-center, open-labeled, quasi-experimental clinical trail. Patients undergoing major abdominal surgery whose Brief Symptom Rating Scale (BSRS-5) were more than 6 were defined as “preoperative psychologically distressed” cases were invited to the trail. Patients were assigned to treatment group or non-treatment group by their own decision. In the treatment group, patients could take mirtazapine 30 mg (Remeron) every night from preoperative day 1 to post operative day 3 by their own will. There were no other intervention in the non-treatment group. Hospital Anxiety and Depression Scale(HADS) ,Athens Insomnia Scale (AIS), and pain score were accessed in all participants on pre-op day 1, post op day 1 and day 3. The demographic data were summarized by descriptive statistics. HADS, AIS scores, pain scores, and morphine consumptions of each day were compared using paired t test within each of two groups and using two-sample t test between two groups in the univariate analysis. In the multivariate analysis, we used the propensity score method to adjust the self-selection bias in our regression analysis of Remoron’s effects on the outcome variables under study. Marginal regression models were fitted to our correlated longitudinal data using the generalized estimating equations (GEE) method to estimate the population average effects of time-varying Remeron usage on the mean values of HADS, AIS, pain scores, and daily morphine consumptions.esults:39 patients prepared to receive major abdominal surgery from September 2007 to December 2008 were eligible for this study. Among them, 150 patients whose BRBS-5 score ≥ 6 were asked to participate in this study. Only 86 patients agreed to be enrolled in the study: 53 of them chose to be in the treatment group on the day of admission, and the other 33 patients were in the non-treatment group on the day of admission. Yet, 3 and 4 patients in each group could not complete the study due to unplanned post-operative ICU care. ropensity score and multivariate analysis showed that mirtazapine did reduce HADS in 2 days in the peri-op psychologically distressed patients. Mirtazapine can decrease AIS day index, and had a trend to decrease night index also. The effect of mirtazapine had the trend of decreasing the amount of morphine consumption, but did not reach statically significance (p = 0.2).n conclusion, mirtazapine can decrease anxiety and depression score and insomnia score in perioperative psychologically distressed patients. Further studies are required to investigate mirtazapine’s effects on peri-op complication, short and long term outcome of those patients.
Subjects
preoperative anxiety
depression
postoperative pain
premedication
insomnia
antidepressant
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