Selecting Appropriate Antidepressant Tx for Patients with Chronic Liver Disease, Liver Transplantation
the MPR take:
For patients with chronic liver disease (CLD) or for those who have had orthotopic liver transplantation (OLT), depression can adversely affect patient outcomes. Depressed, cirrhotic patients have been shown to have worse clinical outcomes than cirrhotic patients without depression. Mortality risk for patients with decompensated liver disease being assessed for liver transplantation has been shown to be higher in depressed patients vs. non-depressed patients. A significant number of hepatitis C infected-patients develop neuropsychiatric symptoms; antiviral treatment with interferon-alpha can contribute to depression development as well. Choosing the right antidepressant for these patients can be difficult since clinicians must take into account the patients reduced liver function and concomitant medications. For patients with CLD and hepatitis C, selective serotonin reuptake inhibitors (SSRIs) appear to be the safest class of antidepressants. SSRIs and selective noradrenergic reuptake inhibitors (SNRIs) are commonly used to treat depression in the post-OLT population, however drug selection is important since some SSRIs may interact with immunosuppressive therapy (eg, fluoxetine, paroxetine). Beyond managing decompensated liver disease and immunosupressive regimens, clinicians who treat patients with CLD or OLT should familiarize themselves with the signs and symptoms of depression, be able to distinguish between depression and hepatic encephalopathy, and prescribe effective antidepressive therapy when warranted.
The 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.