Current concepts of the mechanisms of action of antidepressant drugs

Neurophysiological evidence for tricyclic antidepressant-induced decreased beta-adrenergic responsiveness in the rat hippocampus

A study was made in rats of the effects of chronic treatment with the tricyclic antidepressant agent imipramine on the increase in the population spike amplitude produced by the beta-adrenergic receptor agonist isoproterenol in the 'in vitro' slice preparation of the hippocampus. A significant reduction of 39% and 44% of the population spike increase was observed at 5 X 10(-7) M and 1 X 10(-6) M isoproterenol respectively in rats treated for 28 days with 10 mg/kg i.p. imipramine.

Reduced metabolism and turnover rates of rat brain dopamine, norepinephrine and serotonin by chronic desipramine and zimelidine treatments

As part of of an ongoing effort to compare changes in whole body turnover of catecholamines and serotonin in man with those induced by antidepressants in the rat brain, we have evaluated the chronic effects of desipramine (DMI) and zimelidine (ZMI) on brain catecholamines and serotonin in the rat. The amines and metabolites measured include norepinephrine (NE), dopamine (DA) and their metabolites, 3-methoxy-4-hydroxyphenylglycol (MHPG), 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA). Three brain areas were analysed; the hypothalamus, caudate nucleus and frontal cortex. Chronic DMI and ZMI reduced hypothalamic MHPG and caudate nucleus DA metabolites, in particular HVA. Both drugs reduced NE and DA turnover rates (estimated after alpha-methyl-p-tyrosine injection) and the rate of MHPG formation in the hypothalamus (estimated after pargyline treatment). They did not change NE turnover rate, but reduced DA turnover rate and rate of HVA formation in the caudate nucleus. Chronic DMI but not ZMI reduced DOPAC rate of formation in the caudate nucleus. Apparently changes in DA turnover and metabolism produced by these antidepressants are better related to changes in HVA than DOPAC concentrations. Similar to their influence on hypothalamic and caudate nucleus catecholamines, both chronic DMI and ZMI produced changes in serotonin concentration in the caudate nucleus and frontal cortex serotonin that suggest a reduction in its turnover rate and metabolism. The reduction in NE turnover in hypothalamus is consistent with the effects of chronic DMI and ZMI on whole body NE turnover observed in man.(ABSTRACT TRUNCATED AT 250 WORDS)

Biochemical effects and drug levels in rats after long-term treatment with the specific 5-HT-uptake inhibitor, citalopram

The effects in rats of long-term administration of the potent, specific 5-HT uptake inhibitor citalopram have been investigated. Citalopram hydrobromide (MW = 405) was given in the diet, 99 or 25 mumol/kg daily, for 13 days or orally, 49 mumol/kg twice a day, for 14 days. High plasma and brain levels of citalopram were found during the treatment period, whereas negligible amounts were found 24 h after withdrawal. The 5-HT uptake mechanism in blood platelets was completely blocked, since levels of whole blood 5-HT during and shortly (2 days) after treatment were decreased by 75-90%. The drug load after the two highest doses in terms of plasma drug levels was the same as in depressed patients treated with citalopram. Receptor binding technique ex vivo was applied to different brain parts to measure receptor parameters for several neurotransmitters. All data were evaluated by Eadie- Hoffstee analysis. No changes were seen in Bmax and Kd for beta-receptors (3H-dihydroalprenolol) in frontal cortex, occipital + temporal cortex, whole cortex and limbic structures, 5-HT2 receptors (3H-spiroperidol) in frontal and whole cortex, alpha 1-receptors (3H-prazosin) in "rest of brain" and DA D-2 receptors (3H-spiroperidol) in corpus striatum and limbic structures. The uptake mechanism for 5-HT as well as the inhibitory effect of citalopram on this uptake remained unaffected in brain synaptosomes derived from control and from citalopram (99 mumol/kg)-treated rats. Thus long-term treatment with citalopram does not induce changes in neurotransmitter receptors as seen with most tricyclic as well as newer " atypical " antidepressants.(ABSTRACT TRUNCATED AT 250 WORDS)

Some effects of chronic antidepressant treatments on rat brain monoaminergic systems

A range of established and putative antidepressant therapies were studied for the effect of their long-term administration on two facets of presynaptic monoaminergic functioning in rat brain, namely NE, DA, and 5-HT turnover and alpha 2-adrenoceptor sensitivity. Unless stated otherwise drugs (10 mg/kg) were injected i.p. twice daily for 14 days. ECT (100 mA for 1 s) was applied once daily for 10 days. Changes in turnover were indirectly assessed by measuring levels of metabolites. Brain levels of MHPG-SO4 were unchanged by chronic amitriptyline, imipramine, nisoxetine (20 mg/kg), nortriptyline, salbutamol (5 mg/kg), and ECT. Amitriptyline elicited a slight, but significant, increase in brain DOPAC content. Brain levels of 5-HIAA were increased by amitriptyline, imipramine, salbutamol, and ECT. An overall view of the results indicates that no common pattern of change was elicited by the range of antidepressant therapies studied. Central alpha 2-adrenoceptor sensitivity was assessed by investigating the effect of various therapies on the ability of clonidine (25 mg/kg i.p.) to decrease rat brain MHPG-SO4 content. The clonidine-induced fall was attenuated by desipramine, imipramine, and ECT. Amitriptyline, iprindole, mianserin, nisoxetine, nortriptyline, Org 6582 (10 mg/kg once daily), pargyline (25 mg/kg once daily), salbutamol, and trazodone were ineffective. The following chronic antidepressant therapies were investigated for their effect on rat frontal cortex 3H-clonidine binding: amitriptyline, desipramine, imipramine, iprindole, mianserin, nisoxetine, nortriptyline, pargyline, salbutamol, and ECT. CHronic, but not acute, pargyline decreased 3H-clonidine binding and this was due to a diminished number of binding sites. The induction of subsensitive presynaptic alpha 2-adrenoceptors in rat brain is not a property common to all forms of antidepressant therapies. Hence it cannot be the fundamental mode of action of antidepressants. No correlation exists between the changes in rat cortical 3H-clonidine binding and the observed changes in the sensitivity of central presynaptic alpha 2-adrenoceptors.

The antidepressant agents desipramine, fluoxetine, fluvoxamine and norzimelidine inhibit uptake of [3H]noradrenaline and [3H]5-hydroxytryptamine in slices of human and rat cortical brain tissue

The stability of uptake of [3H]noradrenaline and [3H]5-hydroxytryptamine in rat neocortical brain slices, prepared up to 4-5 h after decapitation, was established. Subsequently, monoamine uptake inhibition by 4 antidepressant agents: desipramine, fluoxetine, fluvoxamine and norzimelidine was compared in human post-mortem neocortical brain slices vs rat neocortical brain slices. In both species, desipramine exhibited considerable selectivity for noradrenaline uptake, while fluoxetine, fluvoxamine and norzimelidine showed varying degrees of selectivity for 5-hydroxytryptamine uptake. These results support the use of rat brain as a model for the study of neurochemical correlates of depression and antidepressant drug action.

Functional supersensitivity of CNS alpha 1-adrenoceptors following chronic antidepressant treatment

Chronic but not acute administration (21 days) of desipramine (10 mg/kg), amitriptyline (10 mg/kg) or iprindole (5 mg/kg) enhanced the stimulatory effect of the alpha 1-adrenergic agonist phenylephrine on the acoustic startle reflex when phenylephrine was infused into the subarachnoid space of the spinal cord. Comparable supersensitivity to phenylephrine also occurred 1 week after selective depletion of norepinephrine in the spinal cord via intrathecal administration of 6-hydroxydopamine. Behavioral supersensitivity to phenylephrine was associated with an increase in the number of 3H-prazosin binding sites following denervation but not following chronic antidepressant treatments. The results indicate that chronic antidepressant treatments may enhance functional alpha 1-adrenergic transmission through mechanisms different than those following denervation.

Serotonin receptor changes after chronic antidepressant treatments: ligand binding, electrophysiological, and behavioral studies

Early biochemical research on antidepressant treatments provided evidence that the treatments alter catecholaminergic and serotonergic activity. The mechanisms of action proposed by the resulting biogenic amine hypotheses of affective disorders, however, are not consistent with the delayed onset of therapeutic effects of antidepressant treatments nor with the acute effects of more recently developed antidepressant drugs. Recent investigation of chronic antidepressant treatments using ligand binding, electrophysiological, and behavioral techniques have attempted to identify subgroups of receptors that might be affected uniquely and specifically by chronic antidepressant treatments. Such receptor changes have been suggested to form a basis for the mechanism of action of antidepressants. At the present time, however, the data produced by ligand binding experiments and electrophysiological experiments investigating serotonergic functioning do not fit together. In addition, interpretational problems and internal contradictions exist within each of the three bodies of data when straightforward hypotheses regarding a serotonergic role in antidepressant treatment are formulated. In order to clarify the serotonergic role in antidepressant drug and ECS effects the functional significance of observed changes in putative serotonergic receptors must be discovered. Unfortunately, putative receptors identified by ligand binding cannot be directly compared to those identified by electrophysiological techniques, because these two methods require the disassembly of the organism in mutually incompatible ways. In order to prove that either or both techniques do in fact identify functional serotonin receptors, investigators need to proceed both more microscopically and also more globally. Further anatomical and physiological studies are necessary to locate putative receptors and to demonstrate their place in existing serotonergic networks. Further behavioral studies must be done to relate alterations in receptor characteristics to the functioning of the intact organism.

Solubilization and assay of [3H]imipramine binding sites from human platelets

[3H]Imipramine binding sites were characterized on outdated (72-96 h) human platelets. The binding site profile was very similar to that previously described for fresh platelets and for CNS membrane preparations. [3H]Imipramine binding sites are believed to represent the recognition site for the 5-hydroxytryptamine uptake system. In order to further investigate this molecular relationship, we solubilized [3H]imipramine binding sites using 1% digitonin and characterised them using a polyethylene glycol precipitation assay. Solubilization did not alter the pharmacological specificity or affinity of the [3H]imipramine binding site and recovery of sites was very high. It was concluded that the solubilization procedure left the binding site remarkably intact. The ready availability of platelets and the convenience of the binding assay makes this system amenable for further purification steps.

Guanosine triphosphate activation of brain adenylate cyclase: enhancement by long-term antidepressant treatment

Activation of adenylate cyclase by a stable guanosine 5'-triphosphate analog was augmented in brain membrane preparations from rats treated on a long-term basis with tricyclic antidepressants or electroconvulsive shock. These treatments may facilitate cyclase activation by promoting the interaction of the regulatory and catalytic subunits of the enzyme. This finding suggests a possible mechanism for the changes in sensitivity to various neurotransmitters seen after antidepressant administration.

Chronic antidepressant therapy and associated changes in central monoaminergic receptor functioning

Acutely administered antidepressants possess a multiplicity of pharmacological actions. However, the fact that agents possessing similar pharmacological actions are devoid of antidepressant activity, together with the lack of correlation between doses required for acute pharmacological effects and clinical efficacy, suggest that the mechanism(s) of action of antidepressants cannot be directly attributed to the acute pharmacological properties of the drugs. The lag phase in onset of clinical effectiveness emphasizes the importance of adaptive changes following chronic antidepressant administration. A rapidly accelerating trend in attempting to delineate the precise molecular mechanisms of action of antidepressants is the shift in emphasis following chronic antidepressant therapies from alterations in uptake, storage, synthesis and release of neurotransmitters to adaptive changes in receptor functioning. These adaptations occur both pre- and postsynaptically. Examples of the former are alpha 2 and DA presynaptic receptors, both being down-regulated by certain forms of chronic antidepressant therapy. The fact that the NE-coupled adenylate cyclase system in rat brain slices is down-regulated by tricyclics, atypical antidepressants, MAO inhibitors and ECT emphasizes the importance of the system. Electrophysiological and behavioral studies point to the up-regulation of central alpha 1 and 5-HT receptor functioning following long-term antidepressant therapy. In contrast to the beta-adrenoceptor, these findings cannot be correlated with data from radioligand binding studies. In general central alpha 1-adrenoceptor binding remains unaltered. This is also true for 5-HT1 binding whereas cortical 5-HT2 binding is both increased and decreased depending on the type of antidepressant therapy being investigated. The relationship of these adaptive changes to the clinical efficacy of antidepressants in man is not clear since there is generally a lack of good models for studying human central receptor functioning. A review of current data from animal studies would tend to disfavour the view that all forms of antidepressant therapy possess a common mechanism of action. Perhaps multiple intervention sites exist. The introduction and evaluation of agents possessing a specificity of pharmacological action will undoubtedly aid psychotherapeutic research. The knowledge that peptides and 'classical' neurotransmitters can co-exist in the same neurone will undoubtedly generate studies of the significance and importance of the co-transmitter function of peptides in the mechanisms of action of antidepressant therapies.

The effect of desipramine upon central adrenergic function in depressed patients

Eleven drug free patients meeting Research Diagnostic Criteria for Major Depressive Disorder have been treated with desipramine and given a clonidine infusion after 0, 1 and 3 weeks of treatment. The sedative and hypotensive effects of clonidine were significantly inhibited after three weeks of treatment with desipramine: a similar interaction was seen after one week of treatment although this just failed to reach statistical significance. The growth hormone (GH) response to clonidine was initially impaired, but increased significantly after one week of treatment. A significant reduction in the GH response occurred during the second and third weeks of treatment with desipramine. This last finding is interpreted as evidence of adaptive change of alpha 2 adrenoceptors: the other changes can be explained by the known ability of desipramine to block the re-uptake of noradrenaline.

Pharmacological comparison of the potential antidepressant UP 614-04 with viloxazine and imipramine; behavioral studies

1. Several behavioral tests were used to compare the pharmacological activity of the potential antidepressant UP 614-04 with those of viloxazine and imipramine. 2. Orally-administered UP 614-04, like viloxazine, reduced locomotor activity in mice, and, like viloxazine and imipramine, it antagonized the hypothermia or ptosis induced by reserpine or tetrabenazine and the hypothermia induced by a high dose of apomorphine. 3. UP 614-04 antagonized oxotremorine-induced hypothermia, and to a lesser extent, oxotremorine-induced tremors, indicating that it possesses some CNS anticholinergic activity. 4. Both imipramine and viloxazine were more potent than UP 614-04 in potentiating yohimbine toxicity in mice. 5. Orally-administered UP 614-04 potentiated d-amphetamine-induced stereotypy to a greater extent than viloxazine, but to a lesser extent than imipramine. 6. Intraperitoneally-injected UP 614-04 was much more potent than viloxazine in increasing tryptamine convulsive potential in rats, indicating that it might exert an inhibitory action on monoamine oxidase. 7. These results indicate that UP 614-04 has a behavioral profile that is consistent with an antidepressant action, but that it differs from imipramine and viloxazine.