Depression is the most prevalent psychiatric disorder in transplant recipients and may lead to noncompliance and negative outcomes without psychosocial and pharmacologic interventions. The pharmacologic treatment of depression in this patient population is complicated by complex immunosuppressant drug regimens and multiple potential drug interactions that can adversely affect the newly transplanted organs. This review provides a brief overview of the currently available antidepressant medications and highlights the clinically important features each class of agents in transplant recipients. Newer agents selective serotonin reuptake inhibitors, venlafaxine, bupropion, nefazodone, and mirtazapine are discussed as well as tricyclic antidepressants and monoamine oxidase inhibitors. A brief discussion of St. John's wort and its impact on posttransplant drug therapy is also included.
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References
1.
JowseySGTaylorMLSchneeklothTDClarkMM. Psychosocial challenges in transplantation. J Psych Practice.2001;7:404–414.
DeshieldsTLMcDonoughEMMannenRKMillerLW. Psychological and cognitive status before and after heart transplantation. Gen Hosp Psych.1996;18(suppl 6):S62–S69.
4.
DewMARothLHSchulbergHC. Prevalence and predictors of depression and anxiety-related disorders during the year after heart transplantation. Gen Hosp Psych.1996;18 (suppl 6):S48–S61.
5.
KuhnWFMyersBBrennanAF. Psychopathology in heart transplant candidates. J Heart Transplant.1998;7:223–226.
6.
TrzepaczPTMaueFRCoffmanGVan ThielDH. Neuropsychiatric assessment of liver transplantation candidates: Delirium and other psychiatric disorders. Int J Psychiatry Med.1986;16:101–111.
7.
DewMAKormosRLDimartiniAF. Prevalence and risk of depression and anxiety-related disorders during the first three years after heart transplantation. Psychosomatics.2001;42:300–313.
8.
WilliamsJWMulrowCDChiquetteE. A systematic review of newer pharmacotherapies for depression in adults: Evidence report summary: Clinical guideline, part 2. Ann Intern Med.2000;132:743–756.
9.
GelenbergAJChesenCl. How fast are antidepressant?J Clin Psychiatry.2000;61:712–721.
10.
AlvarezWPickworthKK. Safety of antidepressant drugs in the patient with cardiac disease: A review of literature. Pharmacotherapy.2003;23:754–771.
11.
HirschfeldRA. Management of sexual side effects of antidepressant therapy. J Clin Psychiatry.1999;60(suppl 14):27–30.
12.
SegravesRT. Antidepressant-induced sexual dysfunction. J Clin Psychiatry.1998;59(suppl 4):48–54.
FavaMJudgeRHoogSL. Fluoxetine versus sertraline and paroxetine in major depressive disorder: Changes in weight with long-term treatment. J Clin Psychiatry.2000; 61:863–867.
15.
MilneRJGoaKL. Citalopram: A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depressive illness. Drugs.1991;41:450–477.
16.
ZajeckaJTracyKAMitchellS. Discontinuation symptoms after treatment with serotonin reuptake inhibitors: A literature review. Psychiatry.1997;58:291–297.
17.
KoseljMBrenAKandusAKovacD. Drug interactions between cyclosporine and rifampicin, erythromycin, and azoles in kidney recipients with opportunistic infections. Transplant Proc.1994;26:2823–2824.
18.
SketrisISMethotMENicolDBelitskyPKnowMG. Effect of calcium-channel blockers on cyclosporine clearance and use in renal transplant patients. Ann Pharmacother.1994;28:1227–1231.
19.
StrouseTBFairbanksLASkotzkoCEFawzyFI. Fluoxetine and cyclosporine in organ transplantion: Failure to detect significant drug interactions or adverse clinical events in depressed organ recipients. Psychosomatics.1996;37:23–30.
20.
MarkowitzJSGillHSHuntNMMonroeRRDe VaneCL. Lack of antidepressant-cyclosporine pharmacokinetic interactions. J Clin Psychopharmacol. February 1998;18:91–93.
21.
PreskornShAldermanJGreenblattDJHorstWD. Sertraline does not inhibit cytochrome P450 3A-mediated drug metabolism in vivo. Psychopharmacol Bull.1997;33:659–665.
22.
RichelsonE. Pharmacokinetic drug interactions of new antidepressants: A review of the effects on the metabolism of other drugs. Mayo Clinic Proc.1997;72:835–847.
23.
SchweizerEWeiseCClaryC. Placebo-controlled trial of venlafaxine for the treatment of major depression. J Clin Psychopharmacol.1991;11:233–236.
24.
ThaseME. Effects of venlafaxine on blood pressure: A meta-analysis of original data from 3744 depressed patients. J Clin Psychiatry.1998;59:502–508.
25.
VercauterenSVBosmansJLElseviersMM. A meta-analysis and morphological review of cyclosporine-induced nephrotoxicity in auto-immune diseases. Kidney Int.1998;54:536–545.
26.
KhanAFabreLFRudolphR. Venlafaxine in depressed outpatients. Psychopharmacol Bull.1991; 27:141–144.
DavidsonJ. Seizures and bupropion: A review. J Clin Psychiatry.1989;50:256–261.
30.
TrzepaczPGuptaBDiMartiniA. Issues in pharmacologic organ transplantation. In: TrzepaczPDiMartiniA, eds. The Transplant Patient: Biologic, Psychiatric, and Ethical Issues in Organ Transplantation.Cambridge, Mass: Cambridge University Press; 2000:196.
31.
EllingrodVLPerryPJ. Nefazodone: A new antidepressant. Am J Health-Syst Pharm.1995;52:2799–2812.
32.
FawcettJMarcusRNAntonSF. Response of anxiety and agitation symptoms during nefazodone treatment of major depression. J Clin Psychiatry.1995;56(suppl 6):37–42.
33.
GillinJCRapaportMErmanMK. A comparison of nefazodone and fluoxetine on mood and on objective, subjective, and clinician rated measures of sleep in depressed patients: A double-blind, 8-week clinical trial. J Clin Psychiatry.1997;58:185–192.
34.
Aranda-MichelJKoehlerABejaranoPA. Nefazodone-induced liver failure: Report of three cases. Ann Intern Med.1999;130:285–288.
35.
SchraderGDRoberts-ThompsonJC. Adverse effect of nefazodone: Hepatitis. Med J Aust.1999;170:452.
36.
GelenbergA. Liver failure with nefazodone. Biol Ther Psychiatr.1999;22:34.
Helms-SmithKMCurtisSLHattonRC. Apparent interaction between nafazodone and cyclosporine [letter]. Ann Intern Med.1996;125:424.
39.
CampoJVSmithCPerelJM. Tacrolimus toxic reaction associated with the use of nefazodone: Paroxetine as an alternative. Arch Gen Psychiatr.1998;55:1050–1052.
40.
WrightDHLakeKDBruhnPSEmeryRW. Nefazodone and cyclosporine drug-drug interaction. J Heart Lung Transplant.1999;18:913–915.
41.
GartonT. Nefazodone and CYP450 3A4 interactions with cyclosporine and tacrolimus [letter]. Transplantation.2002; 74:745.
Prozac(R), fluoxetine [product information].Indianapolis, Ind: Eli Lilly and Company; 1999.
50.
Hypericum Depression Trial Group.Effect of Hypericum perforatum (St. John's Wort) in major depressive disorder: A randomized controlled trial. JAMA.2002;287:1807–1814.
51.
RobyCAAndersonGDKantorEDryerDABursteinAH. St. John's wort. Effect on CYP3A4 activity. Clin Pharmacol Ther.2000;67:451–457.
52.
JohneABrockmollerJBauerSMaurerALangheinrichMRootsI. Pharmacokinetic interaction of digoxin with an herbal extract from St. John's wort (hypericum perforatum). Clin Pharmacol Ther.1999;66:338–345.
53.
JohneASchmiderJBrockmollerJ. Decreased plasma levels of amitriptyline and its metabolites on comedication with an extract from St. John's wort (Hypericum perforatum). J Clin Psychopharmacol.2002;22:46–54.
54.
DurrDStiegerBKullak-UblickGA. St. John's wort induces intestinal P-glycoprotein/MDR1 and intestinal and hepatic CYP3A4. Clin Pharmacol Ther.2000;68:598–604.
55.
HebertMF. Contribution of hepatic and intestinal metabolism and P-glycoprotein to cyclosporine and tacrolimus oral drug delivery. Adv Drug Deliv Rev.1997;27:201–214.
56.
RuschitzkaFMeierPJTurinaMLuscherTFNollG. Acute heart transplant rejection due to Saint John's wort. Lancet.2000;355:548–549.
57.
BolleyRZulkeCKammerlMFischerederMKramerBK. Tacrolimus-induced nephrotoxicity unmasked by induction of the CYP3A4 system with St. John's wort [letter]. Transplantation.2002;73:1009.
58.
BreidenbachTHoffmannMWBeckerTHSchlittHKlempnauerJ. Drug interaction of St. John's wort with cyclosporine [letter]. Lancet.2000;355:1912.
59.
MandelbaumAPertzbornFMartin-FacklamMWieselM. Unexplained decrease of cyclosporine trough levels in a compliant renal transplant patient. Nephrol Dial Transplant.2000; 15:1473–1474.
60.
MaiIStoemerEBauerSKrugerHBuddeKRootsI. Impact of St. John's wort treatment on the pharmacokinetics of tacrolimus and mycophenolic acid in renal transplant patients. Nephrol Dial Transplant.2003;18:819–822.
61.
BauerSStormerEJohneA. Alterations in cyclosporine: A pharmacokinetics and metabolism during treatment with St. John's wort in renal transplant patients. Br J Clin Pharmacol.2002;55:203–211.
