tacrolimus and Depressive-Disorder

The prevalence of psychiatric disorders in dialyzed patients is estimated around 5-20% of the cases. This explains the high use of antidepressant drugs in these patients. We present the case of a 68-year-old woman with a history of renal failure, with chronic hemodialysis and a depressive syndrome in treatment with Mirtazapine. In November 2008, the patient received a renal graft. An immunosuppressant treatment was started with Basiliximab, Tacrolimus, Mycophenolate Mofetil, and corticosteroids. The patient did not present renal immediate renal function. Four days after the transplant, the treatment with Mirtazapine was re-applied, with an asymptomatic hypotension after 2 hours, and without surgical complications. Tacrolimus blood levels were higher than 15 ng/ml. In our opinion, hypotension was a consequence of the interaction Mirtazapine-Tacrolimus in a patient without immediate renal function. This situation has not been described in the literature before, and hypotension could have had negative consequences in the evolution of the graft.

Topics: Aged; Antidepressive Agents, Tricyclic; Blood Pressure; Depressive Disorder; Drug Interactions; Female; Humans; Hypotension; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Mianserin; Mirtazapine; Tacrolimus

Elevation of baseline intracellular calcium levels was observed in platelets or lymphoblasts of patients with bipolar affective disorders suggesting an altered intracellular Ca(2+) homeostasis in the pathophysiology of mood disorders. The role of supraspinal endoplasmic ryanodine receptors (RyRs), which allow mobilization of intracellular Ca(2+) stores, in the modulation of depressive states was, then, investigated. Ryanodine and FK506 reduced the immobility time in the mouse forced swimming test showing an antidepressant-like profile comparable with that produced by amitriptyline and clomipramine. We generated types 1, 2, and 3 RyR knockdown mice by using selective antisense oligonucleotides (aODN) to investigate the role of each RyR isoform. A gene-specific cerebral RyR protein level reduction in knockdown animals was demonstrated by immunoblotting, immunoprecipitation, and immunohistochemical experiments. Repeated intracerebroventricular administration of aODNs complementary to the sequence of the types 1, 2, or 3 RyR produced an antidepressant-like response in the forced swimming test. The aODN-induced reduction of immobility time was temporary and reversible and did not impair motor coordination, spontaneous mobility, and exploratory activity. These findings identify cerebral RyRs as critical targets underlying depressive states and should facilitate the comprehension of the pathophysiology of mood disorders and help developing of new therapeutical strategies.

Topics: Animals; Antidepressive Agents, Tricyclic; Brain; Brain Chemistry; Calcium Signaling; Depressive Disorder; Down-Regulation; Immunosuppressive Agents; Male; Mice; Motor Activity; Oligonucleotides, Antisense; Ryanodine; Ryanodine Receptor Calcium Release Channel; Tacrolimus

Neuropsychiatric complications are an important source of morbidity following orthotopic liver transplantation. Etiology of liver disease and type of immunosuppression are possible related factors. The aim of this study was to describe the prevalence of neuropsychiatric complications after liver transplantation, the role of immunosuppression, and the association between these and specific liver diseases such as hepatitis C. One hundred twenty-eight patients with liver transplants were studied. Tacrolimus was the primary immunosuppressant in 101 patients and cyclosporine in 27 patients. Seventy-five complications in 49 patients (38.2%) were reported. In 43 patients, the etiology was associated with immunosuppression: 36 on tacrolimus and 7 on cyclosporine (P = 0.34). Seventeen and four-tenths percent of patients with hepatitis C and 4.6% of patients without hepatitis C developed depression (P = 0.02). There is no difference between types of primary immunosuppression and neuropsychiatric complications. There is a significantly greater incidence of depression in patients transplanted for hepatitis C.

Topics: Adult; Aged; Cyclosporine; Depressive Disorder; Female; Hepatitis C, Chronic; Humans; Immunocompromised Host; Immunosuppressive Agents; Incidence; Liver Diseases; Liver Transplantation; Male; Medical Records; Middle Aged; Postoperative Complications; Retrospective Studies; Tacrolimus; Tennessee

Topics: Adolescent; Antidepressive Agents, Second-Generation; Depressive Disorder; Drug Administration Schedule; Drug Interactions; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Paroxetine; Piperazines; Tacrolimus; Triazoles