Depression After Lung Transplantation: Causes and Treatment

Abstract

During the postoperative course of lung transplantation, patients may experience depressive symptoms that negatively influence their ability to cope with the new organ, their adherence to rehabilitation and pharmacologic therapy, and their overall quality of life (QoL). To date, no review has explored the causes of depression following transplantation or the efficacy and safety of therapeutic interventions in this patient group. We conducted a comprehensive 1966-2006 MEDLINE, EMBASE, and PsycINFO search for studies of the causes and treatments of depression in lung transplant recipients. We identified 25 studies of variable methodologic quality. Depression rates are high among candidates for lung transplantation. In the short term, after surgery depressive symptoms remain low with an improvement in QoL, whereas in the long term (>3 years), the decline of functional status is associated with a dramatic increase in such symptomatology. Personality disorders, coping strategies, stressful life events, physical complications, corticosteroid medications, age, gender, and psychosocial support all play a central role in causing depressive states in lung transplant recipients. Serotonin reuptake inhibitors (SSRIs) and new-generation antidepressants (mirtazapine) represent the best therapeutic choices for this group of patients. The risk of serious drug-drug interactions should be carefully monitored by experienced clinicians. Complementary therapies and psychoeducational intervention also help recipients to strengthen their coping strategies, offering further advantages after transplantation. Additional well-conducted randomized controlled trials are needed to clarify the epidemiologic course of depression following lung transplantation and to tailor effective pharmacologic or psychological interventions accordingly.

Onset and risk factors for anxiety and depression during the first 2 years after lung transplantation

“…In particular, MDD risk was substantial, with over one quarter of the sample experiencing it in just the first two years after transplantation. As is typical in cardiothoracic transplant samples,[17,18,72] a large percentage of our patients had pretransplant histories of MDD; MDD is well-known to be a chronic, relapsing disorder. Yet, even in individuals with no pretransplant history, 15%–20% had their first lifetime onset of MDD during the 2-year period posttransplant.…”

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

“…Depression is a readily treatable disorder and many pharmacologic and psychotherapeutic interventions exist(89,90). 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.…”

“…Reviews summarizing these effects have been narrative rather than systematic reviews. With few exceptions(4), they focus on narrow portions of the literature—considering, for example, only certain types of transplantation, or only reports published during brief time periods such as the 12–18 months before the review(22,23,41–46). The reviews note that differences across studies are difficult to reconcile due to variations in study methodology, including the timing and nature of assessments of predictors and outcomes, and the duration of follow-up.…”

Predictors of post‐traumatic psychological growth in the late years after lung transplantation

“…Moreover, lung recipients face life expectancies that are not only shorter than normal for their chronological ages but also lag behind those of other organ recipients . In turn, although some studies considering psychosocial outcomes focus on general pre‐ to post‐transplant improvements with lung transplantation , most such research has focused on adverse post‐transplant outcomes, including somatic, psychological, behavioral, and social functioning problems . Positive consequences of lung transplantation, especially in the long‐term years as transplant‐related morbidities become more common, have received little attention.…”