Anti-depressive therapies after heart transplantation.
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.
Fusar-Poli
Paolo
P
Department of Applied and Psychobehavioural Sciences, University of Pavia, Pavia, Italy. p.fusar@libero.it
Picchioni
Marco
M
Martinelli
Valentina
V
Bhattacharyya
Sagnik
S
Cortesi
Mariachiara
M
Barale
Francesco
F
Politi
Pierluigi
P
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
D000928:Antidepressive Agents