افسردگی اساسی و استفاده از الکتروشوک درمانی (ECT) در بیماران پیوند ریه

The purpose of this study is to describe the potential risks and benefits of electroconvulsive therapy (ECT) for treatment of depression in lung transplant recipients. The authors performed a record review of depressed patients who underwent lung transplantation at Johns Hopkins Hospital and evaluated their treatment, including ECT. In 9 years, 131 lung transplants were performed, and four patients had been diagnosed with major depression. Of those, two were candidates for ECT, and one received it. This patient’s depression did abate with ECT. ECT, an effective treatment for depression, remains a treatment method of choice for depression in the posttransplant population.

Chronic lung disease remains the fourth leading cause of death.1 It is estimated that in approximately 20 years, it will become the third leading cause of death, surpassing stroke. As a result of the increasing number of those suffering from chronic lung disease, the number of patients requiring lung transplantation has also substantially increased.2 Lung transplantation has been shown to dramatically improve the physical status and quality of life of severely ill patients.3 Past research has focused on psychiatric manifestations after organ transplantation and has indicated that large numbers of patients suffer from various forms of psychiatric illness, including major depression, during the posttransplant period.4 Attempts made to assess the population of pretransplant patients found that 50% of candidates for lung transplantation had a diagnosable psychiatric disorder.5 Singer et al.6 assessed personality profiles of lung transplant candidates and noted that somatic, anxiety, and affective symptoms are often present in this patient population. Given this fact, and in light of the large impact that chronic lung disease has on our population, it behooves the psychiatric field to assess this patient population for psychiatric care. For example, Thoren7 has reported a high comorbidity between asthma and anxiety disorders, and others8,9 have reported the link between chronic obstructive pulmonary disease and affective disorders. Yet other reports have attempted to describe the psychological impact of such illness on the lives of patients. For example, Coffman10 assessed the psychodynamic aspects of pulmonary disease on patients. Although affective disorders have been noted in patients with chronic lung disease, including in those requiring transplantation, it is unclear whether screening techniques are currently used to detect comorbid affective conditions in daily practice. In addition, the treatment of such cases is often felt to be problematic. When a patient with debilitating chronic lung disease presents with major depression, physicians remain uncertain about which course of treatment is most beneficial. Both pre- and posttransplant patients are prescribed numerous medications for their illnesses, making the addition of psychiatric medications more difficult, since these may increase the risk of serious drug interactions. ECT remains an alternative and effective treatment for major depression. While Rabheru11 found that ECT remains a safe and effective treatment in medically ill populations, concern exists that this treatment is too dangerous and controversial for patients suffering either from the effects of incapacitating lung disease or the sequelae of lung transplantation. The purpose of this article is to present a case history of depression diagnosed in a lung transplant patient at a large academic center and to review the adequacy and safety of treatment methods used, which included ECT.