New-Onset Antidepressant Use After Cardiothoracic Intensive Care is Associated with Increased Long-Term Mortality

Background: Survival after cardiothoracic intensive care has improved, yet long-term psychological and physical morbidities remain common. Depression is frequent after intensive care, and initiation of antidepressant therapy may serve as a proxy for clinically significant psychological distress. We investigated the incidence, associated factors, and outcomes related to new-onset antidepressant use among cardiothoracic ICU survivors in Sweden. Methods: Nationwide, population-based cohort study using linked Swedish registers. We included 27,006 patients who survived ≥ 90 days after their first cardiothoracic ICU admission (2010–2017) and were naïve to antidepressants during the preceding 6 months. The primary outcome was new-onset SSRI use within 12 months after discharge. Multivariable logistic regression identified associated factors, and Cox models assessed long-term mortality. Results: Overall, 2,051 patients (7.6%) initiated SSRI therapy within one year. Factors associated with new-onset antidepressant use included psychiatric comorbidity, substance abuse, higher somatic comorbidity (CCI > 1), and ICU length of stay > 7 days, while male sex was associated with lower odds. New-onset SSRI use was independently associated with higher long-term mortality (adjusted HR 1.9; 95% CI 1.4–2.6). Patients prescribed SSRIs also had fewer care days alive and at home within 90 days after ICU discharge (DAH90), indicating delayed recovery or greater post-ICU morbidity. Conclusions: New-onset SSRI use after cardiothoracic critical illness was associated with markers of higher mortality and fewer early days at home. These findings underscore the importance of addressing mental health in post-ICU care.