It is common to experience a number of intense emotions during a transplant — 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, 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:
Reactivation of a preexisting mental health problem
The development of a new disorder, either as a reaction of the illness process (and transplant, or due to side effects to medications.
Mood and anxiety-related disorders are the most common psychiatric problems, affecting both pre- and post-transplant patients.
Patients with depression may experience:
Loss of interest in usually pleasurable activities
Changes in appetite
Changes in sleep
Feeling slowed down
Poor memory and concentration
Feeling worthless or guilty
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 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 organ 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
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.
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.
Dr. José 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.
Robert Negrin, MD, Director of Stanford's Blood and Marrow Transplant program on why he left biochemistry to become a hematologist.
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