Anti-depressive therapies after heart transplantation

TY - JOUR

T1 - Anti-depressive therapies after heart transplantation

AU - Fusar-Poli, P

AU - Picchioni, M

AU - Martinelli, V

AU - Bhattacharyya, S

AU - Cortesi, M

AU - Barale, F

AU - Politi, P

PY - 2006/7

Y1 - 2006/7

N2 - Objective: Despite an improved quality of life, about 33% of heart transplant recipients will develop depressive symptoms post-operatively. To date, no review has explored the efficacy and safety of pharmacologic or psychologic interventions in this patient group. Methods: We conducted a comprehensive MEDLINE, EMBASE, PSYCINFO search for studies of the treatment of depression in heart transplant recipients. Results: We identified 34 studies of variable methodologic quality. Selective serotonin re-uptake inhibitors (SSRIs), particularly citalopram and new-generation anti-depressants (mirtazapine), seem to represent the best therapeutic choices for this population. Tricyclic anti-depressants (TCAs), and electroconvulsive therapy (ECT) should be reserved for severe depression unresponsive to other treatments, whereas monoamine oxidase inhibitors (MAOIs) should be avoided. St John's wort, an alternative herbal drug, has been associated with life-threatening immunosuppression. Psychologic therapy offers further advantages after heart transplantation. Conclusions: Further well-conducted, randomized, controlled trials are needed to clarify the efficacy and the safety of pharmacologic (SSRIs and atypical anti-depressants) and psychologic interventions in the management of depression after heart transplantation.

AB - Objective: Despite an improved quality of life, about 33% of heart transplant recipients will develop depressive symptoms post-operatively. To date, no review has explored the efficacy and safety of pharmacologic or psychologic interventions in this patient group. Methods: We conducted a comprehensive MEDLINE, EMBASE, PSYCINFO search for studies of the treatment of depression in heart transplant recipients. Results: We identified 34 studies of variable methodologic quality. Selective serotonin re-uptake inhibitors (SSRIs), particularly citalopram and new-generation anti-depressants (mirtazapine), seem to represent the best therapeutic choices for this population. Tricyclic anti-depressants (TCAs), and electroconvulsive therapy (ECT) should be reserved for severe depression unresponsive to other treatments, whereas monoamine oxidase inhibitors (MAOIs) should be avoided. St John's wort, an alternative herbal drug, has been associated with life-threatening immunosuppression. Psychologic therapy offers further advantages after heart transplantation. Conclusions: Further well-conducted, randomized, controlled trials are needed to clarify the efficacy and the safety of pharmacologic (SSRIs and atypical anti-depressants) and psychologic interventions in the management of depression after heart transplantation.

U2 - 10.1016/j.healun.2006.03.019

DO - 10.1016/j.healun.2006.03.019

M3 - Literature review

VL - 25

SP - 785

EP - 793

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

IS - 7

M1 - N/A

ER -