Psychotropic medication use trends in a large pediatric and young adult solid organ transplant population

Abstract

Introduction This study describes psychotropic medication use in a pediatric and young adult solid organ transplant population. Methods We conducted a retrospective review of the lifetime incidence of psychotropic medication use and associated characteristics in patients seen over a 6‐year period at a large pediatric transplant center utilizing univariate and multivariate statistical analyses. Results The lifetime incidence of psychotropic medication use was 36.5% in 393 patients. Transplant psychiatry provided psychopharmacological consultation to 21.9% of patients. Controlling for age and sex, there were significant associations between psychotropic use and thoracic organ disease (heart/lung) (AOR = 2.14; 95% CI: 1.2‐3.8; P = 0.01), White race (P = 0.0002), histories of depressive/mood disorders (AOR = 3.68; 95% CI: 1.8‐7.7; P = 0.0005), attention/learning disorders (AOR = 3.30; 95% CI: 1.6‐6.9; P = 0.001), acute and post‐traumatic stress disorders (AOR = 10.54; 95% CI: 2.6‐42.8; P = 0.001), and experiencing bullying (AOR = 2.16; 95% CI: 1.03‐4.55; P = 0.04). In unadjusted tests, significant associations were found between lifetime psychotropic usage and patient anxiety history (OR = 2.26; 95% CI: 1.5‐3.5; P = 0.0002), end‐of‐life disease progression (OR = 3.04; 95% CI: 1.7‐5.4; P = 0.0002), family psychiatric history (OR = 2.17; 95% CI: 1.4‐3.4; P = 0.0007), and adherence concerns (OR = 2.67; 95% CI: 1.7‐4.1; P < 0.0001). Discussion The lifetime incidence of psychotropic medication use among pediatric and young adult transplant patients is substantial. Patients with thoracic organ disease, end‐of‐life illness, individual/family psychiatric histories, trauma, and bullying histories have particularly high rates. Integrating child psychiatry as part of pediatric transplant teams should be an important consideration for the care of these patients.

Psychological Outcomes and Interventions for Individuals With Congenital Heart Disease: A Scientific Statement From the American Heart Association

“…It is also possible that antidepressant medications may have been prescribed as part of palliative care, given increasing involvement of psychiatry during end-of-life care. 105 The low rate of antidepressant medication use in this British study (<5%) highlights the difference in prescribing patterns between countries. In a similar study from the United States, the rate of documented antidepressant use in adults with congenital heart disease was 18%.…”

Depression in transplantation

“…A significant question remains if depression improves after transplantation. Several authors reported that depression improved posttransplant or was less common posttransplant compared with pretransplant in heart and kidney recipients [23,27,40,46,50]. In liver recipients, however, two studies found that depression worsens after transplantation [43,51].…”

“…Antidepressant use in the first year after kidney transplant was associated with two-fold higher risk of death, 38% higher risk of death-censored graft failure and 61% higher risk of all-cause graft failure in the subsequent year [26]. This is especially concerning considering that the lifetime prevalence of antidepressant use in transplant patients is significant (15% [27]).…”

School and sports participation post‐transplant

“…Mental health issues are also more common in pediatric organ transplant recipients, which can impact cognitive, school, and social functioning. In one single‐center study, over 30% of pediatric and young adult transplant recipients were found to receive psychotropic medications over their lifetimes, illustrating the need for psychiatric involvement in the management of many of these patients 28 …”

“…In one single-center study, over 30% of pediatric and young adult transplant recipients were found to receive psychotropic medications over their lifetimes, illustrating the need for psychiatric involvement in the management of many of these patients. 28 The families, primary care physicians, and schools of pediatric transplant recipients need to be educated about these potential risks, so that they are screened for and addressed with early intervention if needed. Although the utility may differ based on type of organ transplant and specific patient characteristics, some have suggested that formal neuropsychological assessment be included as part of standard post-transplant care (Table 1).…”