Anti-depressive Therapies After Heart Transplantation

Fusar‐Poli, Paolo; Picchioni, Marco; Martinelli, Valentina; Bhattacharyya, Sagnik; Cortesi, Mariachiara; Barale, Francesco; Politi, Pierluigi

doi:10.1016/j.healun.2006.03.019

Cited by 35 publications

(21 citation statements)

References 93 publications

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“…Although there is concern regarding the level of evidence and the safety of utilizing many interventions—particularly pharmacologic strategies—pre-transplant in individuals with severely compromised organ function(28,39,91,92), there is a large psychosomatic medicine practice-focused literature showing that pharmacologic and psychotherapeutic options can be utilized safely and effectively with transplant recipients who have stable organ function(6,23,44,93–96). Hence, ongoing screening (with treatment) for depression at routine post-transplant follow-up may be warranted, and has also been recommended pre-transplant(4,23,24,95), but with the caveat that we continue to lack the rigorous clinical trial evidence essential to assert that depression screening and treatment are effective. Moreover, any potential harms of screening also merit rigorous study.…”

Section: Discussionmentioning

confidence: 99%

Depression and Anxiety as Risk Factors for Morbidity and Mortality After Organ Transplantation

et al. 2015

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Background Depression and anxiety are common mental health problems in transplant populations. There is mixed evidence concerning whether they increase morbidity and mortality risks post-transplant. If such associations exist, additional risk reduction strategies may be needed. Methods Four bibliographic databases were searched from 1981 through September, 2014 for studies prospectively examining whether depression or anxiety (determined with diagnostic evaluations or standardized symptom scales) affected risk for post-transplant mortality, graft loss, acute graft rejection, chronic rejection, cancer, infection, and rehospitalization. Results Twenty-seven studies (10 heart, total n=1,738; 6 liver, n=1,063; 5 kidney, n=49,515; 4 lung, n=584; 1 pancreas, n=80; 1 mixed recipient sample, n=205) were identified. In each, depression and/or anxiety were typically measured pre- or early post-transplant. Follow-up for outcomes was a median of 5.8 years (range:0.50–18.0). Depression increased the relative risk (RR) of mortality by 65% (RR=1.65, 95% CI:1.34,2.05; 20 studies). Meta-regression indicated that risk was stronger in studies that did (v. did not) control for potential confounders(p=.032). Risk was unaffected by type of transplant or other study characteristics. Depression increased death-censored graft loss risk (RR=1.65, CI:1.21,2.26, 3 studies). Depression was not associated with other morbidities (each morbidity assessed in 1–4 studies). Anxiety did not significantly increase mortality risk (RR=1.39, CI:0.85,2.27, 6 studies) or morbidity risks (assessed in single studies). Conclusions Depression increases risk for post-transplant mortality. Few studies considered morbidities; the depression-graft loss association suggests that linkages with morbidities deserve greater attention. Depression screening and treatment may be warranted, although whether these activities would reduce post-transplant mortality requires study.

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Section: Discussionmentioning

confidence: 99%

Depression and Anxiety as Risk Factors for Morbidity and Mortality After Organ Transplantation

et al. 2015

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“…There is a high incidence of depression after OHT, often requiring regular screening and early intervention to be initiated during work up using validated tools such as the Beck Depression Inventory-II (BDI-II) or Patient Health Questionnaire 9 (PHQ-9) [6, 19, 20]. The BDI-II is a brief validated, easy to use scale which covers all DSM-IV diagnostic criteria for major depressive disorder, and stands as a reliable indicator of symptom severity and suicidal thoughts.…”

Section: Discussionmentioning

confidence: 99%

Pre-transplant depression as a predictor of adherence and morbidities after orthotopic heart transplantation

Delibasic

Mohamedali

Dobrilovic

et al. 2017

J Cardiothorac Surg

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BackgroundPsychosocial factors are useful predictors of adverse outcomes after solid organ transplantation. Although depression is a known predictor of poor outcomes in patients who undergo orthotopic heart transplantation (OHT) and is actively screened for during pre-transplant evaluation, the effects of early identification of this entity on post-transplant outcomes are not clearly understood. The purpose of this study was to evaluate the impact of pre-transplant depression on outcomes after OHT.MethodIn this retrospective study, 51 patients that underwent psychosocial evaluation performed by a social worker prior to the transplant and followed up in our center post-transplant were enrolled. Patients were stratified by the presence/absence of depression during the initial encounter. Primary end-points were overall survival, 1st-year hospitalizations, overall hospitalizations, rejections, and compliance with medications and outpatient appointments.ResultsDepressed patients were 3.5 times more likely to be non-compliant with medications; RR = 3.5, 95% CI (1.2,10.2), p = 0.046 and had higher incidence of first year hospitalizations (4.7 ± 3.1 vs. 2.2 ± 1.9, p = 0.046), shorter time to first hospitalization 25 days (IQR 17–39) vs. 100 days (IQR 37–229), p = 0.001. Patients with depression also had higher overall hospitalizations (8.3 ± 4.4 vs. 4.6 ± 4.2, p = 0.025,) and higher number of admissions for infections (2.8 ± 1.3 vs. 1.5 ± 1.4, p = 0.018) compared to patients without depression. There were no statistically significant differences in total number of rejections or compliance with outpatient appointments. Kaplan-Meier survival analysis did not reveal differences between the two groups (mean 3705 vs. 3764 days, log-rank p = 0.52).ConclusionDepression was a strong predictor of poor medication compliance and higher rates of hospitalization in transplant recipients. No difference in survival between depressed and non-depressed patients after OHT was noted.

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“…Heart transplant patients are at increased risk of developing major depressive disorders because of the high incidence of depression after OHT, and regular screening and early intervention should be initiated in this patient population [41]. The Patient Health Questionnaire 9 (PHQ-9) is a self-administered diagnostic tool for common mental disorders.…”

Section: Discussionmentioning

confidence: 99%

Impact of Identification and Treatment of Depression in Heart Transplant Patients

Okwuosa

Pumphrey

Puthumana

et al. 2014

Cardiovascular Psychiatry and Neurology

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Background. The effects of clinical depression after orthotopic heart transplantation (OHT) are relatively unknown. The purpose of this study was to evaluate the impact of depression on outcomes after OHT. Methods. We performed a single center retrospective review of 102 consecutive patients who underwent OHT at Northwestern Memorial Hospital from June 2005 to October 2009. The diagnosis of depression was obtained from attending physician documentation. The primary endpoints were all-cause mortality (ACM), hospitalizations, and rejection. Results. Of 102 OHT patients, 26 (26%) had depression. Depressed patients were similar in age to nondepressed patients (57.6 years versus 56.9, P = 0.79). There was no statistical difference in survival between groups at 5 years after OHT (P = 0.94). All-cause hospitalizations were higher in depressed versus nondepressed patients (4.3 versus 2.6 hospitalizations P = 0.05). There were no significant differences in hospitalizations between the two groups for the following complications: cardiac (heart failure, edema, arrhythmias, and acute rejection) and infections. There was no significant difference in episodes of 2R and 3R rejection. Conclusion. Early identification and treatment of depression in OHT patients result in outcomes similar to nondepressed patients.

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Anti-depressive Therapies After Heart Transplantation

Cited by 35 publications

References 93 publications

Depression and Anxiety as Risk Factors for Morbidity and Mortality After Organ Transplantation

Depression and Anxiety as Risk Factors for Morbidity and Mortality After Organ Transplantation

Pre-transplant depression as a predictor of adherence and morbidities after orthotopic heart transplantation

Impact of Identification and Treatment of Depression in Heart Transplant Patients

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