Heart Transplant

Mental Health & Psychiatry

A heart transplant is often a life changing surgery. It is common to experience a number of intense emotions--including depression and anxiety. These emotions can also be a side effect of some of your medications. A transplant psychiatrist can evaluate your situation and discuss ways to manage these issues.

As is the case with various other chronic medical problems, heart transplant recipients are at increased risk for the development of significant psychiatric symptoms and diagnosable psychiatric disorders. The development of psychiatric symptoms in transplant patients can represent either:

Mood and anxiety-related disorders are the most common psychiatric problems affecting both pre- and post-transplant patients.  In fact, up to 50% of patients with advanced cardiac disease experience anxiety or depression. Following transplant up 63% of heart recipients develop anxiety and/or depression during the first post-transplant year. Patients with depression may experience sadness, irritability, loss of interest in usually pleasurable activities, changes in appetite, changes in sleep, feeling slowed down, poor memory and concentration, feeling worthless or guilty, and morbid thoughts of death or even suicidal ideation. These symptoms may interfere with a patient’s ability or motivation to adhere to a post-transplant regimen of medications, self-monitoring, exercise, and clinic appointments. Excessive or irrational fears due to anxiety can cause patients to avoid tests, treatments, hospitals, or interfere with their medication taking.

Anxiety is also common in transplant patients. Patients with a history of anxiety often experience an exacerbation of symptoms in the transplant setting. Before surgery patients worry about their health, the outcome of the transplant evaluation and whether they will actually be transplanted. After surgery, patients and families are anxious as to whether the new heart will take and function, whether they will experience complications, medication side effects, or graft rejection and whether they will actually have an improved quality of life. Often, before surgery patients are in denial with regard to the rigors and stressors they will face after-transplant. These issues become reality immediately when they are called in for surgery and during the period surrounding transplantation patients are particularly vulnerable to anxiety. Anxiety symptoms may increase with the stress of the ICU stay, medical complications, sleep deprivation, post-operative complications, graft rejection and/or medication side effects

In addition, cognitive impairment (or a change in the way your brain works and you think) can be experienced by many transplant patients around the time of transplantation, particularly immediately after transplant surgery.  In heart failure, low cardiac output and poor blood flow to the brain can contribute to cognitive impairment, even in the absence of an actual stroke. Cardiac medications can also contribute to cognitive impairments. In the case of patients on ventricular assist devices, micro emboli may be a contributing cause of brain dysfunction.

There is mounting evidence that suggest that the development of psychiatric disorders can affect patient health, as well as physical and psychological outcomes after organ transplantation. Therefore it is imperative that patients, family members and medical staff remain vigilant to signs of psychiatric problems- early diagnosis and treatment is key.

Psychiatric services are available through the Psychosomatic Medicine Service, which is part of the Department of Psychiatry and Behavioral Medicine. Dr. Josť Maldonado is a neuropsychiatrist with specialization on the psychiatric aspects of the transplant process. A consultation or clinical services can be arranged through your cardiologist, nurse coordinator or social worker who can make a referral, or by calling the Department of Psychiatry intake line at 650-498-9111.

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