title: Anti-depressive therapies after heart transplantation.
abstract: 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.
authors.affiliation: Department of Applied and Psychobehavioural Sciences, University of Pavia, Pavia, Italy. p.fusar@libero.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Fusar-Poli
authors.forename: Marco
authors.initials: M
authors.lastname: Picchioni
authors.forename: Valentina
authors.initials: V
authors.lastname: Martinelli
authors.forename: Sagnik
authors.initials: S
authors.lastname: Bhattacharyya
authors.forename: Mariachiara
authors.initials: M
authors.lastname: Cortesi
authors.forename: Francesco
authors.initials: F
authors.lastname: Barale
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Politi
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D003863:Depression / Q000209:etiology* / Q000628:therapy*; D004565:Electroconvulsive Therapy; D016027:Heart Transplantation / Q000523:psychology*; D006801:Humans; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents