A Case Study of Depression and Suicidality Following LVAD Implant: A Review

Millions of people in the United States are affected by heart failure each year. The use of the left ventricular assist device (LVAD) has been on the rise for the treatment of heart failure (Tigges-Limmer et al., 2010). The device has been shown to be the most effective when patients adhere well to the mechanical regimen, appointment follow-ups, and adjust to their new life with the device. Tigges-Limmer et al. (2010) noted that outlook is worse for patients receiving the device as destination therapy rather than for temporary treatment. The authors also mentioned that several psychological factors have an impact on how each individual adjusts to life after the device. Although several factors are mentioned, effective coping skills, resilience, and careful attentiveness and social support were said to be the most pertinent (Tigges-Limmer et al., 2010). Since LVAD therapy is a relatively new treatment method for heart failure, there is limited research in regards to psychological aspects of the procedure. Therefore, Tigges-Limmer et al. (2010) sought to examine depression and suicidality within a case study.

The authors observed a patient who was a 69-year-old male with comorbid medical conditions (e.g., ischemic cardiomyopathy, hyperlipidemia, obesity, and insulin-dependent diabetes). At the time of the initial assessment, the patient was bedridden, in the intensive care unit, cooperative, and not intubated. Following assessment and intensive education, he decided that LVAD therapy would be the best course for himself. He was later implanted in June 2006 with no complications post-implant. One year later he suffered from recurrent ventricular tachycardia, so he was implanted with a cardio-defibrillator. Three years post-implant, the patient was doing well regarding circulatory support, but he began to decline in his general condition and needed more medical support. Depression ensued as a result of his decline.

In February 2009, the patient refused to eat, drink, talk, or move. Psychiatric and psychological help was offered by the authors. The patient reported that he was a major in the army, so the authors attributed his resistance to pride in solving his problems alone. Later sessions revealed that he was growing tired of the LVAD; he felt a loss of independence; and felt no sense in living life. He was administered anti-depressants and hypnotics, which were effective in decreasing his depressive symptomology. However, he attempted to commit suicide three times by disconnecting the device’s driveline. He was unable to be transferred to a psychiatric hospital due to a lack of LVAD knowledge. His sessions increased to 3 to 4 sessions weekly, lasting for 30 to 60 minutes. The patient revealed that he had prior psychological issues regarding his being a child refugee during World War II among other distressing events. His alcohol abuse post-implant was also brought to light. With prolonged psychiatric and psychological treatment, his depression lessened again.

The patient’s comorbid illnesses continued to contribute to his psychological despair, although he remained relatively stable over time. He was receiving outpatient psychiatric and psychological treatment after he was discharged from the hospital following a toe amputation. One week after discharge, the patient committed suicide by disconnecting his driveline.

During the discussion by Tigges-Limmer et al. (2010), the authors mentioned that LVAD therapy may be a relief at first, but over time the patients may grow frustrated with the limits of life that come with the device. According to Tigges-Limmer et al. (2010) suicide may be perceived as a method to regain control by the patients. Previous studies have indicated that men 75 years and older have the greatest risk of suicide compared to other age groups. This risk increases with comorbid illnesses, with heart failure being a significant contributor (Tigges-Limmer et al., 2010). The authors made the argument that pre-implant psychological screening is pertinent for the wellbeing of patients. They also noted that psychological support should be offered for this vulnerable population, especially in regard to finding coping skills to adjust to post-implant life.

Although the authors conducted a case study instead of an analysis on several patients, they provided valid arguments in how future care should be oriented towards individuals and their psychological needs in reference to receiving an LVAD. With the limited data on the psychological impact of LVAD therapy during the time of this study, the authors definitely contributed to the gaps in the knowledge of this area of research. In regards to their methodology of treatment, it appears that the therapy and medication treatment was effective in alleviating some of the depressive symptomology, but the suicide risks may have been too high for prevention. For future research, it would be helpful if the authors observed personality coping styles prior to implant and how those coping styles impact adjustment to the device. Another area worth exploring is a breakdown of the specific issues that occur with the device and how those issues can be alleviated through an integrative treatment approach.

Tigges-Limmer, K., Schönbrodt, M., Roefe, D., Arusoglu, L., Morshuis, M., & Gummert, J. F. (2010). Suicide after ventricular assist device implantation. The Journal of Heart and Lung Transplantation, 29(6), 692-694.