Treatment of Depression With Duloxetine in Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-Like Episodes.

The mitochondrial cytopathies are a heterogeneous group of diseases characterized by heteroplasmic maternal transmission and selective dysfunction of tissues and organs highly dependent on aerobic respiration (eg, skeletal muscle, cardiac muscle, and brain). Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) is a specific subtype of mitochondrial cytopathy that is commonly associated with mood disturbances in individuals who survive until adulthood. Because of the altered cellular metabolism inherent in MELAS, it is often difficult to determine drug dosing, drug choice, and treatment response in patients with this rare disease.