ACLP Best Practice Guidance: Evaluation and Treatment of Depression in Solid Organ Transplant Recipients

We present Academy of Consultation Liaison Psychiatry best practice guidance on depression in solid organ transplant (SOT) recipients, which resulted from the collaboration of Academy of Consultation Liaison Psy-chiatry's transplant psychiatry special interest group and Guidelines and Evidence-Based Medicine Subcommittee. Depression (which in the transplant setting may desig-nate depressive symptoms or depressive disorders) is a frequent problem among SOT recipients. Following a structured literature review and consensus process, the Academy of Consultation Liaison Psychiatry transplant psychiatry special interest group proposes recommenda-tions for practice: all organ transplant recipients should be screened routinely for depression. When applicable, positive screening should prompt communication with the mental health treating provider or a clinical evaluation. If the evaluation leads to a diagnosis of depressive disorder, treatment should be recommended and offered. The recommendation for psychotherapy should consider the physical and cognitive ability of the patient to maximize benefit. The first-line antidepressants of choice are esci-talopram, sertraline, and mirtazapine. Treating depres-sive disorders prior to transplantation is recommended to prevent posttransplant depression. Future research should address the mechanism by which transplant pa-tients develop depressive disorders, the efficacy and feasibility of treatment interventions (both pharmaco-logical and psychotherapeutic, in person and via tele-medicine), and the resources available to transplant patients for mental health care. (Journal of the Academy of Consultation-Liaison Psychiatry 2023; 64:357-370)