Rationalising antidepressants in palliative care

Follow the principles of rationalising psychotropics when rationalising antidepressants in palliative care.

If an antidepressant is needed in patients with palliative care needs, continue it for as long as indicated. However, consider slowly reducing the dose over the last weeks of life to decrease the risk of symptoms from abrupt discontinuation (eg nausea, hyperarousal, insomnia, delirium) when the patient can no longer swallow. This is particularly important for patients taking high doses of paroxetine, venlafaxine, desvenlafaxine or duloxetine, which are more likely to cause severe withdrawal effects. For information on withdrawing antidepressant therapy, see the Psychotropic guidelines.

For some patients with anxiety, it may be appropriate to switch to a sublingual or subcutaneous benzodiazepine for the last days of life.