Cardiology Division, Soroka University Medical Center, Beer-Sheva 8410501, Israel.
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel.
Int J Mol Sci. 2023 Jul 10;24(14):11270. doi: 10.3390/ijms241411270.
Depression is a common and devastating mental illness associated with increased morbidity and mortality, partially due to elevated rates of suicidal attempts and death. Select patients with end-stage heart failure on a waiting-list for a donor heart undergo left ventricular assist device (LVAD) implantation. The LVAD provides a circulatory flow of oxygenated blood to the body, mimicking heart functionality by operating on a mechanical technique. LVAD improves functional capacity and survivability among patients with end-stage heart failure. However, accumulating data suggests that LVAD recipients suffer from an increased incidence of depression and suicide attempts. There is scarce knowledge regarding the pathological mechanism and appropriate treatment approach for depressed LVAD patients. This article summarizes the current evidence on the association between LVAD implantation and occurrence of depression, suggesting possible pathological mechanisms underlying the device-associated depression and reviewing the current treatment strategies. The summarized data underscores the need for a rigorous pre-(LVAD)-implantation psychiatric evaluation, continued post-implantation mental health assessment, and administration of antidepressant treatment as necessary.
抑郁症是一种常见且严重的精神疾病，与发病率和死亡率升高有关，部分原因是自杀企图和死亡的发生率升高。一些等待心脏供体的终末期心力衰竭患者在等待名单上接受左心室辅助装置（LVAD）植入。LVAD 将含氧血液循环输送到全身，通过机械技术运行来模拟心脏功能。LVAD 提高了终末期心力衰竭患者的功能能力和存活率。然而，越来越多的数据表明，LVAD 接受者的抑郁和自杀企图发生率增加。对于患有抑郁症的 LVAD 患者，关于病理机制和适当治疗方法的知识很少。本文总结了 LVAD 植入与抑郁症发生之间的关联的现有证据，提出了与设备相关的抑郁症的可能病理机制，并回顾了目前的治疗策略。总结的数据强调了在植入（LVAD）前进行严格的精神评估、在植入后继续进行心理健康评估以及必要时进行抗抑郁治疗的必要性。
