Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation

Abstract

SummaryBackgroundThe scale of depression in patients with chronic liver disease (CLD) and those who have received orthotopic liver transplantation (OLT) is poorly characterised. Clinicians are uncertain of how best to manage depression within these patients.AimsTo review the literature evaluating both the prevalence and impact of depression in patients with CLD and post‐OLT, and to assess the safety and efficacy of antidepressant use within this context.MethodsA PubMed search using the phrases ‘chronic liver disease’, ‘cirrhosis’, ‘liver transplantation’, ‘depression’, ‘antidepressant’ and the names of specific causes of liver disease and individual antidepressants.ResultsOver 30% of cirrhotic patients have depressive features, and they experience worse clinical outcomes than nondepressed cirrhotic patients. CLD patients with chronic hepatitis C are particularly prone to depression, partly related to the use of interferon therapy. OLT patients with depression have higher mortality rates than nondepressed patients; appropriate antidepressant use reverses this effect. Selective serotonin reuptake inhibitors (SSRIs) and selective noradrenaline reuptake inhibitors (SNRIs) are effective and generally safe in both CLD and OLT patients.ConclusionsDepression is much more prevalent in CLD or OLT patients than is generally recognised, and it adversely affects clinical outcomes. The reasons for this relationship are complex and multifactorial. Antidepressants are effective in both CLD and post‐OLT, although lower doses or a reduced dosing frequency may be required to minimise side effects, e.g. exacerbation of hepatic encephalopathy. Further research is needed to establish optimal management of depression in these patients, including the potential role of nonpharmacological treatments.

Vitamin D supplementation reduces depressive symptoms in patients with chronic liver disease

“…This finding is in line with those of others, with one in every three CLD patients presenting with depressive symptoms [10]. Eighty percent of the cohort also had inadequate vitamin D levels, further reinforcing previous studies reporting vitamin D deficiency in these patients [2].…”

“…Co-morbid depression often affects patients with CLD, with a reported prevalence of approximately 30% [9,10]. Standard antidepressant therapy, however, is not always feasible.…”

Depression and Anxiety as Risk Factors for Morbidity and Mortality After Organ Transplantation

“…Depression is a readily treatable disorder and many pharmacologic and psychotherapeutic interventions exist(89,90). Although there is concern regarding the level of evidence and the safety of utilizing many interventions—particularly pharmacologic strategies—pre-transplant in individuals with severely compromised organ function(28,39,91,92), there is a large psychosomatic medicine practice-focused literature showing that pharmacologic and psychotherapeutic options can be utilized safely and effectively with transplant recipients who have stable organ function(6,23,44,93–96). Hence, ongoing screening (with treatment) for depression at routine post-transplant follow-up may be warranted, and has also been recommended pre-transplant(4,23,24,95), but with the caveat that we continue to lack the rigorous clinical trial evidence essential to assert that depression screening and treatment are effective.…”

Influence of Depression on Recovery After Major Noncardiac Surgery

“…Alongside it, integrated collaborative care should be enhanced in surgery (as recommended by the World Health Organization 44 and already effectively performed in other nonsurgical specialties) 45,46 to manage mental health issues with brief effective psychotherapy 47,48 or pharmaceutical treatment. 49 CONCLUSION Surgeons should not overlook the importance of depression in their patients; it has medical, economic, and social consequences. Attention to the early identification and treatment of psychological distress in patients undergoing hepatectomy must be enhanced among surgeons, as must cooperation between surgeons and mental health professionals.…”