Paradoxical Depression in Renal Transplant Recipients

Paradoxical depression occurs despite a completely successful transplantation without tissue rejection or other medical complications. In this study, the occurrence of paradoxical depression was retrospectively investigated among 1139 Japanese successful renal transplant recipients January 1997 through September 2006. Among the 1139 recipients, 103 visited the Department of Psychiatry after renal transplantation, including 40 with depressive symptoms and 15 with a physical problem considered to have nonparadoxical depression. The other 25 recipients were considered to have paradoxical depression; that is, more than half of the 40 recipients with depressive symptoms had paradoxical depression. There were no significant differences in the clinical characteristics, including average age at the time of renal transplantation, rate of living-donor transplantation, rate of ABO incompatibility, method of dialysis (hemodialysis or peritoneal dialysis), duration of dialysis, and time interval between the renal transplantation and the initial visit to the Department of Psychiatry among the 2 groups. These results suggested that there was another risk factor or interactions between factors. Of the 25 recipients, 6 had relationship problems, 6 had social-rehabilitation problems, and 13 had mentioned no clear psychological problems. These psychological factors might in fact be related to the loss of an imagined past. Additional consecutive prospective studies are needed—a challenging prospect for consultation liaison psychiatrists in the field of transplantation.