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
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
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
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
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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