Depression After Lung Transplantation: Causes and Treatment |
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Authors: | P Fusar-Poli M Lazzaretti M Ceruti R Hobson K Petrouska M Cortesi E Pozzi P Politi |
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Institution: | (1) Department of Applied and Psychobehavioural Health Sciences, University of Pavia, via Bassi 21, 27100 Pavia, Italy;(2) Department of Pulmonary Medicine, University of Pavia and IRCCS Policlinico San Matteo, Pavia, Italy;(3) Barts and The London School of Medicine, London, UK;(4) Department of Child Neurology and Psychiatry, University of Pavia, Pavia, Italy |
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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. |
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Keywords: | Lung transplantation Quality of life Depression Antidepressants |
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