Preoperative Depression Symptom Severity and Its Impact on Adherence to Preoperative Beta-Blocker Therapy

Abstract

Objective 1) To test the association among depression symptoms, distressed personality-type, and preoperative beta-blocker non-adherence. 2) To estimate the prevalence of untreated major depression in this population. Design Prospective Observational Study Setting A Veterans hospital Patients 120 subjects on outpatient beta-blocker therapy presenting for surgery. Interventions The Patient Health Questionnaire (PHQ)-9, the D-Scale-14 (DS14), and Modified Morisky Scale (MMS) questionnaires. Measurements and Main Results Of 99 participants who presented for surgery, the incidence of preoperative non-adherence was 14.1% (95% CI 7–21%), consistent with prior research. Non-adherence was 9.5% among those with no depression, 27.8% among those with mild depression, and 28.6% among those with moderate to severe depression (Cochrane-Armitage test for trend p=0.03). Distressed personality-type was found in 35% of the cohort (95% CI 26–45%) and was not associated with beta-blocker non-adherence (Fisher’s exact p=0.24). Among participants with symptoms of Major Depressive Disorder (N=25, 25.3%), over half (N=14, 56%) had no indication of depression listed at their most recent primary care visit. Conclusions Patients with symptoms of depression on chronic beta-blocker therapy are prone to medication non-adherence on the day of surgery. The majority of surgical patients with symptoms of major depression lack a diagnosis of depression. Preoperative depression screening may thus 1) identify a population at increased risk of beta-blocker withdrawal and 2) identify patients who may benefit from anesthesiologist-initiated referral for this treatable condition.

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“…The PHQ-9 is completed by the patients and scored by the clinician. The questions pertain to nine items: little interest or pleasure in doing things, feeling low, trouble falling asleep, feeling tired, poor appetite, feeling bad about oneself, trouble concentrating on things, moving or speaking slowly, and suicidal or self-harming thoughts [ 16 , 17 ].…”

Ambulatory Medical Follow-Up in the Year After Surgery and Subsequent Survival in a National Cohort of Veterans Health Administration Surgical Patients

“…System-level interventions directed toward improving care coordination of surgical patients so that observations and assessments made by perioperative care providers can be integrated into the larger care of the patient deserve further study. Possible interventions could include, for example, initiatives to screen surgical patients for a range of modifiable health risk factors including smoking, 4 hypertension, 8–10 diabetes, and mental health disorders such as depression 33 that affect the perioperative course but that may not have been fully addressed by primary care providers or that have remained poorly controlled due to patterns of patient nonadherence or treatment resistance that emerge during the perioperative period. 34 Such a shift in practice standards among perioperative clinicians thereby might contribute to the prevention of preventable morbidity distant in time from the surgical care episode.…”

Rebound Phenomenon – Important and Ubiquitous in Pharmacotherapy

“…5. Rebound syndromes have been reported after a sudden withdrawal of various drugs used in cardiology, starting from heparin rebound and beta blocker (BB) rebound (14,(17)(18)(19)(20)(21)(22)(23)(24)(25).…”