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Olatunji TL, Siebert F, Adetunji AE, Harvey BH, Gericke J, Hamman JH, Van der Kooy F. Sceletium tortuosum: A review on its phytochemistry, pharmacokinetics, biological, pre-clinical and clinical activities. JOURNAL OF ETHNOPHARMACOLOGY 2022; 287:114711. [PMID: 34758918 DOI: 10.1016/j.jep.2021.114711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Sceletium tortuosum (L.) N.E.Br., the most sought after and widely researched species in the genus Sceletium is a succulent forb endemic to South Africa. Traditionally, this medicinal plant is mainly masticated or smoked and used for the relief of toothache, abdominal pain, as a mood-elevator, analgesic, hypnotic, anxiolytic, thirst and hunger suppressant, and for its intoxicating/euphoric effects. Sceletium tortuosum is currently of widespread scientific interest due to its clinical potential in treating anxiety and depression, relieving stress in healthy individuals, and enhancing cognitive functions. These pharmacological actions are attributed to its phytochemical constituents referred to as mesembrine-type alkaloids. AIM OF THE REVIEW The aim of this review was to comprehensively summarize and critically evaluate recent research advances on the phytochemistry, pharmacokinetics, biological, pre-clinical and clinical activities of the medicinal plant S. tortuosum. Additionally, current ongoing research and future perspectives are also discussed. METHODS All relevant scientific articles, books, MSc and Ph.D. dissertations on botany, behavioral pharmacology, traditional uses, and phytochemistry of S. tortuosum were retrieved from different databases (including Science Direct, PubMed, Google Scholar, Scopus and Web of Science). For pharmacokinetics and pharmacological effects of S. tortuosum, the focus fell on relevant publications published between 2009 and 2021. RESULTS Twenty-five alkaloids belonging to four structural classes viz: mesembrine, Sceletium A4, joubertiamine, and tortuosamine, have been identified from S. tortuosum, of which the mesembrine class is predominant. The crude extracts and commercially available standardized extracts of S. tortuosum have displayed a wide spectrum of biological activities (e.g. antimalarial, anti-oxidant, neuromodulatory, immunomodulatory, anti-HIV, neuroprotection) in in vitro or in vivo studies. While the plant has been studied in clinical populations, this has only been in healthy subjects, so that further study in pathological states remains to be done. Nevertheless, the aforementioned studies have demonstrated that S. tortuosum has potential for enhancing cognitive function and managing anxiety and depression. CONCLUSION As an important South African medicinal plant, S. tortuosum has garnered many research advances on its phytochemistry and biological activities over the last decade. These scientific studies have shown that S. tortuosum has various bioactivities. The findings have further established the link between the phytochemistry and pharmacological application, and support the traditional use of S. tortuosum in the indigenous medicine of South Africa.
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Affiliation(s)
- T L Olatunji
- Unit for Environmental Sciences and Management, North-West University, Potchefstroom, South Africa
| | - F Siebert
- Unit for Environmental Sciences and Management, North-West University, Potchefstroom, South Africa
| | - A E Adetunji
- School of Life Sciences, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - B H Harvey
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa; SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, South Africa
| | - J Gericke
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
| | - J H Hamman
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
| | - F Van der Kooy
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa.
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152
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Alexander L, Young AH. Recent advances in the psychopharmacology of major depressive disorder. BJPSYCH ADVANCES 2022. [DOI: 10.1192/bja.2022.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
This review highlights some of the recent advances in the psychopharmacology of major depressive disorder (MDD). We synthesise evidence on emerging pharmacological therapies targeting the serotonergic system, before exploring several novel treatment targets: the glutamatergic system, the GABAergic system and inflammation. When describing new treatment avenues, we examine the evidence base and how far these new treatments are from routine practice.
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153
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Fuenmayor A, Cournos F. Addressing depressive disorders among people with HIV. TOPICS IN ANTIVIRAL MEDICINE 2022; 30:454-463. [PMID: 36346702 PMCID: PMC9306689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Depressive disorders are the most common psychiatric disorders among people with HIV. Depressive disorders cause great suffering and disability and, among people with HIV, are associated with numerous negative HIV outcomes, including nonadherence to antiretroviral medication and increased morbidity and mortality. This article is focused on the detection, differential diagnosis, and management of depressive disorders among adults in HIV primary care settings in the United States. Because of the siloed nature of HIV primary health care and behavioral health care in the United States, this paper is geared toward clinicians who are not behavioral health specialists and who are working in HIV care settings that have limited access to behavioral health services and still seek to treat depressive disorders. In clinical settings that are fortunate enough to have well-integrated behavioral health services, HIV primary care clinicians may be able to depend on this specialist workforce, but these settings tend to be the exception and not the rule.
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Affiliation(s)
- Andres Fuenmayor
- Send correspondence to Andres Fuenmayor, MD, Herbert Pardes Building, 1051 Riverside Dr, New York, NY, 10032, or email
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Wu X, Dai B, Yan F, Chen Y, Xu Y, Xia Q, Zhang X. Serum Cortisol, Nesfatin-1, and IL-1β: Potential Diagnostic Biomarkers in Elderly Patients with Treatment-Resistant Depression. Clin Interv Aging 2022; 17:567-576. [PMID: 35480963 PMCID: PMC9038158 DOI: 10.2147/cia.s361459] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/18/2022] [Indexed: 12/02/2022] Open
Abstract
Aim Treatment-resistant depression (TRD) affects approximately 30% of patients with major depressive disorder (MDD), especially elderly patients. As individuals with TRD are at an increased risk of committing suicide and pose a higher risk of relapse, early diagnostic biomarkers of TRD and a better understanding of the resistance mechanism are highly needed. This study aimed to determine whether serum cortisol, nesfatin-1, and pro-inflammatory cytokines can be used as biomarkers for the diagnosis of elderly patients with TRD. Methods Thirty elderly patients with TRD were selected as the TRD group. Thirty elderly patients with MDD who were effectively treated with conventional antidepressants were selected as the non-TRD group. The baseline levels of serum cortisol, nesfatin-1, and pro-inflammatory cytokines were measured and compared, and their diagnostic values were evaluated using the receiver operating characteristic (ROC) curve method for discriminating patients with TRD from those without TRD. Results Serum cortisol, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) levels were significantly higher in the non-TRD and TRD groups than in the control group. Moreover, serum cortisol, CRP, TNF-α, and IL-6 levels in the TRD group were significantly lower than those in the non-TRD group. Furthermore, serum nesfatin-1 levels in the non-TRD group were significantly lower than those in the control and TRD groups, while the serum IL-1β levels in the non-TRD group were significantly higher than those in the control and TRD groups. Additionally, an ROC analysis revealed an area under the curve (AUC) of 0.929 for the combination of nesfatin-1 and IL-1β and an AUC of 0.956 for the combination of cortisol, nesfatin-1, and IL-1β in discriminating elderly patients with TRD from those without non-TRD. Conclusion Serum cortisol, nesfatin-1, and IL-1β may be potential diagnostic biomarkers for discriminating elderly patients with TRD from those without TRD.
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Affiliation(s)
- Xiaoping Wu
- Department of Geriatric Psychology, Hefei Fourth People’s Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Department of Medical Education and Research, Anhui Mental Health Center, Hefei, People’s Republic of China
| | - Biao Dai
- Department of Medical Education and Research, Anhui Mental Health Center, Hefei, People’s Republic of China
- Department of Pharmacy, Hefei Fourth People’s Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
| | - Fanfan Yan
- Department of Geriatric Psychology, Hefei Fourth People’s Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Department of Medical Education and Research, Anhui Mental Health Center, Hefei, People’s Republic of China
| | - Yang Chen
- Department of Medical Education and Research, Anhui Mental Health Center, Hefei, People’s Republic of China
- Modified Electroconvulsive Therapy Room, Hefei Fourth People’s Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, 230032, People’s Republic of China
| | - Yayun Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People’s Republic of China
| | - Qingrong Xia
- Department of Medical Education and Research, Anhui Mental Health Center, Hefei, People’s Republic of China
- Department of Science and Education, Hefei Fourth People’s Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
| | - Xulai Zhang
- Department of Geriatric Psychology, Hefei Fourth People’s Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Department of Medical Education and Research, Anhui Mental Health Center, Hefei, People’s Republic of China
- Correspondence: Xulai Zhang, Department of Geriatric Psychology, Hefei Fourth People’s Hospital, Affiliated Psychological Hospital of Anhui Medical University, No. 316 Huangshan Road, Hefei, 230032, People’s Republic of China, Tel +86 551 63616022, Fax +86 551 63616022, Email
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155
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Zamani M, Wilhelm T, Furst AL. Perspective-Electrochemical Sensors for Neurotransmitters and Psychiatrics: Steps toward Physiological Mental Health Monitoring. JOURNAL OF THE ELECTROCHEMICAL SOCIETY 2022; 169:047513. [PMID: 37577452 PMCID: PMC10421614 DOI: 10.1149/1945-7111/ac5e42] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Therapeutic monitoring of neurotransmitters (NTs) and psychiatric medications is essential for the diagnosis and treatment of mental illness. However, in-vivo monitoring of NTs in humans as well as continuous physiological monitoring of psychiatrics have yet to be realized. In pursuit of this goal, there has been a plethora of work to develop electrochemical sensors for both in-vivo NT monitoring as well as in-vitro detection of psychiatric medications. We review these sensors here while discussing next steps needed to achieve concurrent, continuous physiological monitoring of NTs and psychiatric medications as part of a closed-loop feedback system that guides medication administration.
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Affiliation(s)
- Marjon Zamani
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts—02139, United States of America
| | - Tatum Wilhelm
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts—02139, United States of America
| | - Ariel L. Furst
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts—02139, United States of America
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The Influence of Research Follow-Up during COVID-19 Pandemic on Mental Distress and Resilience: A Multicenter Cohort Study of Treatment-Resistant Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063738. [PMID: 35329424 PMCID: PMC8950889 DOI: 10.3390/ijerph19063738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 02/01/2023]
Abstract
Background: During the COVID-19 outbreak, patients with mental disorders have faced more negative psychological consequences than the public. For people with treatment-resistant depression (TRD), it is unclear whether research engagement would protect them from the deterioration of their symptoms. The study aimed to examine if chronic depressive patients would have improved resilience and mental distress levels after follow-up interviews during an observation period under COVID-19. Methods: The study was nested within a three-year prospective cohort study. A two-group comparison design was conducted, i.e., the follow-up group with regular research interviews every three months after baseline assessment and the control group with one assessment-only interview. The two groups were compared with demographics, psychosocial, and suicide information. Results: Baseline assessments were not significantly different in sociodemographic variables, suicide risks, mental distress, and resilience between groups. Significant differences were detected in resilient coping and mental distress levels (p < 0.05). The follow-up group (n = 46) experienced a higher level of resilient coping (37% vs. 25%) and lower level of mental distress (47.8% vs. 64.7%) than the control group (n = 68). Conclusions: Findings highlight under universal government strategy against COVID-19, TRD patients receiving regular research follow-ups exhibited better resilience and less mental distress than those without regular support from healthcare providers.
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157
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Meade E, Hehir S, Rowan N, Garvey M. Mycotherapy: Potential of Fungal Bioactives for the Treatment of Mental Health Disorders and Morbidities of Chronic Pain. J Fungi (Basel) 2022; 8:jof8030290. [PMID: 35330292 PMCID: PMC8954642 DOI: 10.3390/jof8030290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/05/2023] Open
Abstract
Mushrooms have been used as traditional medicine for millennia, fungi are the main natural source of psychedelic compounds. There is now increasing interest in using fungal active compounds such as psychedelics for alleviating symptoms of mental health disorders including major depressive disorder, anxiety, and addiction. The anxiolytic, antidepressant and anti-addictive effect of these compounds has raised awareness stimulating neuropharmacological investigations. Micro-dosing or acute dosing with psychedelics including Lysergic acid diethylamide (LSD) and psilocybin may offer patients treatment options which are unmet by current therapeutic options. Studies suggest that either dosing regimen produces a rapid and long-lasting effect on the patient post administration with a good safety profile. Psychedelics can also modulate immune systems including pro-inflammatory cytokines suggesting a potential in the treatment of auto-immune and other chronic pain conditions. This literature review aims to explore recent evidence relating to the application of fungal bioactives in treating chronic mental health and chronic pain morbidities.
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Affiliation(s)
- Elaine Meade
- Department of Life Science, Sligo Institute of Technology, F91 YW50 Sligo, Ireland; (E.M.); (S.H.)
| | - Sarah Hehir
- Department of Life Science, Sligo Institute of Technology, F91 YW50 Sligo, Ireland; (E.M.); (S.H.)
- Centre for Precision Engineering, Materials and Manufacturing Research (PEM), Institute of Technology, F91 YW50 Sligo, Ireland
| | - Neil Rowan
- Bioscience Research Institute, Technical University Shannon Midlands Midwest, N37 HD68 Athlone, Ireland;
| | - Mary Garvey
- Department of Life Science, Sligo Institute of Technology, F91 YW50 Sligo, Ireland; (E.M.); (S.H.)
- Centre for Precision Engineering, Materials and Manufacturing Research (PEM), Institute of Technology, F91 YW50 Sligo, Ireland
- Correspondence: ; Tel.: +353-071-9305529
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158
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Gillain B, Degraeve G, Dreesen T, De Bruecker G, Buntinx E, Beke D, Kestens C, Valassopoulou E, Verhelst F, Peeters E, Pype S, De Vos C, Strens D, Vandersmissen I. Real-World Treatment Patterns, Outcomes, Resource Utilization and Costs in Treatment-Resistant Major Depressive Disorder: PATTERN, a Retrospective Cohort Study in Belgium. PHARMACOECONOMICS - OPEN 2022; 6:293-302. [PMID: 34782984 PMCID: PMC8864045 DOI: 10.1007/s41669-021-00306-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Treatment-resistant depression (TRD), a subgroup of major depressive disorder (MDD) that does not adequately respond to treatment, has a substantial impact on the quality of life of patients and is associated with higher medical and mental health care costs. This study aimed to report real-world treatment patterns, outcomes, resource utilization, and costs in the management of TRD by psychiatrists in Belgium. METHODS We conducted a retrospective, non-interventional cohort study of patients ≥ 18 years, with diagnosed MDD who are treatment-resistant, defined as not responding to two different antidepressant treatments in the current moderate to severe major depressive episode (MDE). Data obtained from medical records of patients included patient health state (MDE, response, remission, and recovery) and resource use (number of consultations and emergency room visits, non-drug and drug interventions, and hospitalizations). RESULTS One hundred and twenty-five patients were enrolled in nine sites, with an average observation period of 34 months. During the MDE, 89.7% of patients were treated with selective serotonin reuptake inhibitors, 63.2% with serotonin-norepinephrine reuptake inhibitors, and 60.8% with anti-psychotics. Twenty-four percent of patients did not respond to any treatment; 76% responded, of whom 61% experienced a relapse; 28% of patients reached recovery, of whom 31.4% experienced recurrence. The average yearly direct cost of a TRD patient is €9012, mainly driven by hospitalization in the MDE. The observed absenteeism relates to a high indirect cost, representing 70% of the total MDE cost. CONCLUSION TRD is associated with a high unmet need and economic burden for patients and society, with highest costs in the MDE health state driven by absenteeism.
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Affiliation(s)
- B Gillain
- Clinique Saint Pierre, Ottignies, Belgium
| | - G Degraeve
- Psychiatric Center Guislain, Ghent, Belgium
- Private Practice, Maldegem, Belgium
- AZ Alma, Eeklo, Belgium
| | - T Dreesen
- Mentona Centre for Psychiatry and Psychotherapy, Bilzen, Belgium
| | | | - E Buntinx
- Medical Center Anima, Alken, Belgium
| | - D Beke
- Psychiatric Center Menen, Menen, Belgium
| | - C Kestens
- Centre Hospitalier Régional de Huy, Huy, Belgium
| | | | - F Verhelst
- Grand Hôpital de Charleroi, Charleroi, Belgium
| | - E Peeters
- Department Medical Affairs, Janssen-Cilag NV, Beerse, Belgium
| | - S Pype
- Department Medical Affairs, Janssen-Cilag NV, Beerse, Belgium
| | - C De Vos
- Department Market Access, Janssen-Cilag NV, Antwerpseweg 15-17, 2340, Beerse, Belgium
| | - D Strens
- Realidad bvba, Grimbergen, Belgium
| | - I Vandersmissen
- Department Market Access, Janssen-Cilag NV, Antwerpseweg 15-17, 2340, Beerse, Belgium.
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Millis RM, Arcaro J, Palacios A, Millis GL. Electroencephalographic Signature of Negative Self Perceptions in Medical Students. Cureus 2022; 14:e22675. [PMID: 35242485 PMCID: PMC8883328 DOI: 10.7759/cureus.22675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/05/2022] Open
Abstract
Frontal alpha asymmetry (fAA) is purported to be a neurophysiological marker for anxiety and depression. Higher left frontal alpha EEG voltage is associated with lower left and higher right frontal cerebral cortical activation, indicative of right-sided fAA. This pilot study tests the hypothesis that greater left-sided frontal alpha voltage is associated with negative thoughts about oneself. A group of eight healthy 28-41-year-old right-handed male medical students were subjected to an extensive interactive self-report inventory (ISI) evaluating perceptions of their psychosocial interactions. Quantitative EEG (qEEG) was performed with eyes closed. Computations of fAA and related parameters were based on measurements in the alpha bandwidth (8-13 Hz) at the left frontal F7 and right frontal F8 scalp electrodes. fAA was the percent difference between mean voltages at F8 minus that at F7. Significance of associations between fAA and the ISI scores was determined by Pearson’s product-moment correlation coefficient, at P≤0.05. “Depressed” scores were positively correlated with right-sided fAA (P=0.01). “Relaxed” (P=0.05), “regulated” (P=0.02), “cooperative” (P=0.05) and “dependent scores” (P=0.004) were negatively correlated with right-sided fAA. These findings imply that right-sided fAA may be associated with more perceptions of “depressed” psychosocial interactions involving negative thoughts about oneself, as well as, more reliance on others (“dependence” score), less sharing (“cooperative” ISI score), less trust (“regulated” ISI score) and less initiative (“relaxed” ISI score). These results support the hypothesis that right-sided fAA may identify individuals with a predilection for negative thoughts about themselves and other negatively-valenced perceptions of their psychosocial interactions.
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160
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Deo N, Redpath G. Serotonin Receptor and Transporter Endocytosis Is an Important Factor in the Cellular Basis of Depression and Anxiety. Front Cell Neurosci 2022; 15:804592. [PMID: 35280519 PMCID: PMC8912961 DOI: 10.3389/fncel.2021.804592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Depression and anxiety are common, debilitating psychiatric conditions affecting millions of people throughout the world. Current treatments revolve around selective serotonin reuptake inhibitors (SSRIs), yet these drugs are only moderately effective at relieving depression. Moreover, up to 30% of sufferers are SSRI non-responders. Endocytosis, the process by which plasma membrane and extracellular constituents are internalized into the cell, plays a central role in the regulation of serotonin (5-hydroxytryptophan, 5-HT) signaling, SSRI function and depression and anxiety pathogenesis. Despite their therapeutic potential, surprisingly little is known about the endocytosis of the serotonin receptors (5-HT receptors) or the serotonin transporter (SERT). A subset of 5-HT receptors are endocytosed by clathrin-mediated endocytosis following serotonin binding, while for the majority of 5-HT receptors the endocytic regulation is not known. SERT internalizes serotonin from the extracellular space into the cell to limit the availability of serotonin for receptor binding and signaling. Endocytosis of SERT reduces serotonin uptake, facilitating serotonin signaling. SSRIs predominantly inhibit SERT, preventing serotonin uptake to enhance 5-HT receptor signaling, while hallucinogenic compounds directly activate specific 5-HT receptors, altering their interaction with endocytic adaptor proteins to induce alternate signaling outcomes. Further, multiple polymorphisms and transcriptional/proteomic alterations have been linked to depression, anxiety, and SSRI non-response. In this review, we detail the endocytic regulation of 5-HT receptors and SERT and outline how SSRIs and hallucinogenic compounds modulate serotonin signaling through endocytosis. Finally, we will examine the deregulated proteomes in depression and anxiety and link these with 5-HT receptor and SERT endocytosis. Ultimately, in attempting to integrate the current studies on the cellular biology of depression and anxiety, we propose that endocytosis is an important factor in the cellular basis of depression and anxiety. We will highlight how a thorough understanding 5-HT receptor and SERT endocytosis is integral to understanding the biological basis of depression and anxiety, and to facilitate the development of a next generation of specific, efficacious antidepressant treatments.
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Affiliation(s)
- Nikita Deo
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Gregory Redpath
- European Molecular Biology Lab (EMBL) Australia Node in Single Molecule Science, School of Medical Sciences and the Australian Research Council (ARC) Centre of Excellence in Advanced Molecular Imaging, University of New South Wales, Sydney, NSW, Australia
- *Correspondence: Gregory Redpath
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Scotton E, Antqueviezc B, Vasconcelos M, Dalpiaz G, Paul Géa L, Ferraz Goularte J, Colombo R, Ribeiro Rosa A. Is (R)-ketamine a Potential Therapeutic Agent for Treatment-Resistant Depression with Less Detrimental Side Effects? A Review of Molecular Mechanisms Underlying Ketamine and its Enantiomers. Biochem Pharmacol 2022; 198:114963. [PMID: 35182519 DOI: 10.1016/j.bcp.2022.114963] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/18/2022]
Abstract
Approximately one-third of individuals with major depressive disorder are resistant to conventional antidepressants (i.e., monoamine-based therapies), and, even among respondents, a proper therapeutic effect may require weeks of treatment. Ketamine, a racemic mixture of the two enantiomers, (R)-ketamine and (S)-ketamine, is an N-methyl-d-aspartate receptor (NMDAR) antagonist and has been shown to have rapid-acting antidepressant properties in patients with treatment-resistant depression (TRD). Although (R)-ketamine has a lower affinity for NMDAR, it presents greater potency and longer-lasting antidepressant properties, with no major side effects, than racemic ketamine or (S)-ketamine in preclinical findings. Thereby, ketamine and its enantiomers have not only an antagonistic effect on NMDAR but also a strong synaptogenic-modulatory effect, which is impaired in TRD pathophysiology. In this review, we summarize the current evidence regarding the modulation of neurotransmission, neuroplasticity, and neural network activity as putative mechanisms of these rapid-acting antidepressants, highlighting differences on intracellular signaling pathways of synaptic proteins such as mammalian target of rapamycin (mTOR), extracellular signal-regulated kinase (ERK) and brain-derived neurotrophic factor (BDNF). In addition, we discuss probable mechanisms involved in the side effects of ketamine and its enantiomers.
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Affiliation(s)
- Ellen Scotton
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Department of Pharmacology, Programa de Pós-Graduação em Farmacologia e Terapêutica, UFRGS, Porto Alegre, RS, Brazil.
| | - Bárbara Antqueviezc
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Mailton Vasconcelos
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Instituto de Psicologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Giovana Dalpiaz
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Luiza Paul Géa
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Jéferson Ferraz Goularte
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Rafael Colombo
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Programa de Pós-Graduação em Biotecnologia, Universidade de Caxias do Sul (UCS), Caxias do Sul, RS, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade de Caxias do Sul (UCS), Caxias do Sul, RS, Brazil.
| | - Adriane Ribeiro Rosa
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Department of Pharmacology, Programa de Pós-Graduação em Farmacologia e Terapêutica, UFRGS, Porto Alegre, RS, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
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Jiang J, Ju J, Luo L, Song Z, Liao H, Yang X, Wei S, Wang D, Zhu W, Chang J, Ma J, Hu H, Yu J, Wang H, Hou ST, Li S, Li H, Li N. Salmon Calcitonin Exerts an Antidepressant Effect by Activating Amylin Receptors. Front Pharmacol 2022; 13:826055. [PMID: 35237169 PMCID: PMC8883047 DOI: 10.3389/fphar.2022.826055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
Depressive disorder is defined as a psychiatric disease characterized by the core symptoms of anhedonia and learned helplessness. Currently, the treatment of depression still calls for medications with high effectiveness, rapid action, and few side effects, although many drugs, including fluoxetine and ketamine, have been approved for clinical usage by the Food and Drug Administration (FDA). In this study, we focused on calcitonin as an amylin receptor polypeptide, of which the antidepressant effect has not been reported, even if calcitonin gene-related peptides have been previously demonstrated to improve depressive-like behaviors in rodents. Here, the antidepressant potential of salmon calcitonin (sCT) was first evaluated in a chronic restraint stress (CRS) mouse model of depression. We observed that the immobility duration in CRS mice was significantly increased during the tail suspension test and forced swimming test. Furthermore, a single administration of sCT was found to successfully rescue depressive-like behaviors in CRS mice. Lastly, AC187 as a potent amylin receptor antagonist was applied to investigate the roles of amylin receptors in depression. We found that AC187 significantly eliminated the antidepressant effects of sCT. Taken together, our data revealed that sCT could ameliorate a depressive-like phenotype probably via the amylin signaling pathway. sCT should be considered as a potential therapeutic candidate for depressive disorder in the future.
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Affiliation(s)
- Jian Jiang
- Tomas Lindahl Nobel Laureate Laboratory, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Jun Ju
- Tomas Lindahl Nobel Laureate Laboratory, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Liang Luo
- Department of Critical Care Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Ze Song
- Oncology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Huanquan Liao
- The Clinical Neuroscience Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xiuyan Yang
- Tomas Lindahl Nobel Laureate Laboratory, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Shoupeng Wei
- Tomas Lindahl Nobel Laureate Laboratory, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Dilong Wang
- Tomas Lindahl Nobel Laureate Laboratory, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Wenhui Zhu
- Tomas Lindahl Nobel Laureate Laboratory, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Jinlong Chang
- Tomas Lindahl Nobel Laureate Laboratory, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Junzhe Ma
- Tomas Lindahl Nobel Laureate Laboratory, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
- China-UK Institute for Frontier Science, Shenzhen, China
| | - Hao Hu
- Wolfson Institute for Biomedical Research, Division of Medicine, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Jiezhong Yu
- The Fourth People’s Hospital of Datong City, Datong, China
| | - Huiqing Wang
- The Fifth People’s Hospital of Datong City, Datong, China
| | - Sheng-Tao Hou
- Brain Research Centre and Department of Biology, School of Life Sciences, Southern University of Science and Technology, Shenzhen, China
| | - Shupeng Li
- State Key Laboratory of Oncogenomics, School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen, China
- *Correspondence: Shupeng Li, ; Huiliang Li, ; Ningning Li,
| | - Huiliang Li
- Wolfson Institute for Biomedical Research, Division of Medicine, Faculty of Medical Sciences, University College London, London, United Kingdom
- *Correspondence: Shupeng Li, ; Huiliang Li, ; Ningning Li,
| | - Ningning Li
- Tomas Lindahl Nobel Laureate Laboratory, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
- China-UK Institute for Frontier Science, Shenzhen, China
- *Correspondence: Shupeng Li, ; Huiliang Li, ; Ningning Li,
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163
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Bujarski KA, Song Y, Xie T, Leeds Z, Kolankiewicz SI, Wozniak GH, Guillory S, Aronson JP, Chang L, Jobst BC. Modulation of Emotion Perception via Amygdala Stimulation in Humans. Front Neurosci 2022; 15:795318. [PMID: 35221888 PMCID: PMC8864965 DOI: 10.3389/fnins.2021.795318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/28/2021] [Indexed: 12/20/2022] Open
Abstract
Background Multiple lines of evidence show that the human amygdala is part of a neural network important for perception of emotion from environmental stimuli, including for processing of intrinsic attractiveness/“goodness” or averseness/“badness,” i.e., affective valence. Objective/Hypothesis With this in mind, we investigated the effect of electrical brain stimulation of the human amygdala on perception of affective valence of images taken from the International Affective Picture Set (IAPS). Methods Using intracranial electrodes in patients with epilepsy, we first obtained event-related potentials (ERPs) in eight patients as they viewed IAPS images of varying affective valence. Next, in a further cohort of 10 patients (five female and five male), we measured the effect of 50 Hz electrical stimulation of the left amygdala on perception of affective valence from IAPS images. Results We recorded distinct ERPs from the left amygdala and found significant differences in the responses between positively and negatively valenced stimuli (p = 0.002), and between neutral and negatively valenced stimuli (p = 0.017) 300–500 ms after stimulus onset. Next, we found that amygdala stimulation did not significantly affect how patients perceived valence for neutral images (p = 0.58), whereas stimulation induced patients to report both positively (p = 0.05) and negatively (< 0.01) valenced images as more neutral. Conclusion These results render further evidence that the left amygdala participates in a neural network for perception of emotion from environmental stimuli. These findings support the idea that electrical stimulation disrupts this network and leads to partial disruption of perception of emotion. Harnessing this effect may have clinical implications in treatment of certain neuropsychiatric disorders using deep brain stimulation (DBS) and neuromodulation.
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Affiliation(s)
- Krzysztof A. Bujarski
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- *Correspondence: Krzysztof A. Bujarski,
| | - Yinchen Song
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Tiankang Xie
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
- Department of Quantitative Biomedical Sciences, Dartmouth College, Lebanon, NH, United States
| | - Zachary Leeds
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Sophia I. Kolankiewicz
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Gabriella H. Wozniak
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Sean Guillory
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - Joshua P. Aronson
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Luke Chang
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - Barbara C. Jobst
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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164
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Heerlein K, De Giorgi S, Degraeve G, Frodl T, Hagedoorn W, Oliveira-Maia AJ, Otte C, Perez Sola V, Rathod S, Rosso G, Sierra P, Vita A, Morrens J, Rive B, Mulhern Haughey S, Kambarov Y, Young AH. Real-world evidence from a European cohort study of patients with treatment resistant depression: Healthcare resource utilization. J Affect Disord 2022; 298:442-450. [PMID: 34742998 DOI: 10.1016/j.jad.2021.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Treatment resistant depression (TRD) is diagnosed when patients experiencing a major depressive episode fail to respond to ≥2 treatments. Along with substantial indirect costs, patients with TRD have higher healthcare resource utilization (HCRU) than other patients with depression. However, research on the economic impact of this HCRU, and differences according to response to treatment, is lacking. METHODS This multicenter, observational study documented HCRU among patients with TRD in European clinical practice initiating new antidepressant treatments. Data regarding access to outpatient consultations and other healthcare resources for the first 6 months, collected using a questionnaire, were analyzed qualitatively according to response and remission status. The economic impact of HCRU, estimated using European costing data, was analyzed quantitatively. RESULTS Among 411 patients, average HCRU was higher in non-responders, attending five times more general practitioner (GP) consultations and spending longer in hospital (1.7 versus 1.1 days) than responders. Greater differences were observed according to remission status, with non-remitters attending seven times more GP consultations and spending approximately three times longer in hospital (1.7 versus 0.6 days) than remitters. Consequently, the estimated economic impacts of non-responders and non-remitters were significantly greater than those of responders and remitters, respectively. LIMITATIONS Key limitations are small cohort size, absence of control groups and generalizability to different healthcare systems. CONCLUSION Patients with TRD, particularly those not achieving remission, have considerable HCRU, with associated economic impact. The costs of unmet TRD treatment needs are thus substantial, and treatment success is fundamental to reduce individual needs and societal costs.
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Affiliation(s)
| | - S De Giorgi
- Department of Mental Health ASL Lecce, Lecce, Italy
| | - G Degraeve
- AZ Alma General Hospital, Eeklo, Belgium; PC Dr Guislain Hospital, Ghent, Belgium
| | - T Frodl
- Department of Psychiatry and Psychotherapy, Univeritätsklinikum Magdeburg, Otto von Guericke Universität Magdeburg, Magdeburg, Germany
| | - W Hagedoorn
- Practice for Psychiatry and Psychotherapy, Heerde, the Netherlands
| | - A J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal; NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | - C Otte
- Charité Universitätsmedizin, Berlin, Germany
| | - V Perez Sola
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona IMIM Hospital del Mar Medical Research Institute, Univ Autonoma de Barcelona, CIBERSAM, Barcelona, Spain
| | - S Rathod
- Research Department, Southern Health NHS Foundation Trust, Tom Rudd Unit, Southampton, United Kingdom
| | - G Rosso
- Department of Neurosciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - P Sierra
- University and Polytechnic Hospital La Fe, University of Valencia, Valencia, Spain
| | - A Vita
- Department of Mental Health and Addiction Services, Spedali Civili Hospital and University of Brescia, Brescia, Italy
| | | | - B Rive
- Janssen EMEA, Paris, France
| | | | | | - A H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom
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165
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Brain Research Bulletin Special Issue: Brain–body communication in health and diseases Brain–spleen axis in health and diseases: a review and future perspective. Brain Res Bull 2022; 182:130-140. [DOI: 10.1016/j.brainresbull.2022.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 02/06/2023]
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166
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Yuen J, Rusheen AE, Price JB, Barath AS, Shin H, Kouzani AZ, Berk M, Blaha CD, Lee KH, Oh Y. Biomarkers for Deep Brain Stimulation in Animal Models of Depression. Neuromodulation 2022; 25:161-170. [PMID: 35125135 PMCID: PMC8655028 DOI: 10.1111/ner.13483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/20/2021] [Accepted: 05/11/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Despite recent advances in depression treatment, many patients still do not respond to serial conventional therapies and are considered "treatment resistant." Deep brain stimulation (DBS) has therapeutic potential in this context. This comprehensive review of recent studies of DBS for depression in animal models identifies potential biomarkers for improving therapeutic efficacy and predictability of conventional DBS to aid future development of closed-loop control of DBS systems. MATERIALS AND METHODS A systematic search was performed in Pubmed, EMBASE, and Cochrane Review using relevant keywords. Overall, 56 animal studies satisfied the inclusion criteria. RESULTS Outcomes were divided into biochemical/physiological, electrophysiological, and behavioral categories. Promising biomarkers include biochemical assays (in particular, microdialysis and electrochemical measurements), which provide real-time results in awake animals. Electrophysiological tests, showing changes at both the target site and downstream structures, also revealed characteristic changes at several anatomic targets (such as the medial prefrontal cortex and locus coeruleus). However, the substantial range of models and DBS targets limits the ability to draw generalizable conclusions in animal behavioral models. CONCLUSIONS Overall, DBS is a promising therapeutic modality for treatment-resistant depression. Different outcomes have been used to assess its efficacy in animal studies. From the review, electrophysiological and biochemical markers appear to offer the greatest potential as biomarkers for depression. However, to develop closed-loop DBS for depression, additional preclinical and clinical studies with a focus on identifying reliable, safe, and effective biomarkers are warranted.
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Affiliation(s)
- Jason Yuen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA,Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong VIC 3216, Australia
| | - Aaron E. Rusheen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA,Medical Scientist Training Program, Mayo Clinic, Rochester, MN 55905, USA
| | - J. Blair Price
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Hojin Shin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA,Department of Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Abbas Z. Kouzani
- School of Engineering, Deakin University, Geelong VIC 3216, Australia
| | - Michael Berk
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong VIC 3216, Australia
| | - Charles D. Blaha
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Kendall H. Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA,Department of Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Yoonbae Oh
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA,Department of Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
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167
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Akanuma SI, Han M, Murayama Y, Kubo Y, Hosoya KI. Differences in Cerebral Distribution between Imipramine and Paroxetine via Membrane Transporters at the Rat Blood-Brain Barrier. Pharm Res 2022; 39:223-237. [PMID: 35112227 DOI: 10.1007/s11095-022-03179-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/24/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The present study aimed to elucidate the transport properties of imipramine and paroxetine, which are the antidepressants, across the blood-brain barrier (BBB) in rats. METHODS In vivo influx and efflux transport of imipramine and paroxetine across the BBB were tested using integration plot analysis and a combination of brain efflux index and brain slice uptake studies, respectively. Conditionally immortalized rat brain capillary endothelial cells, TR-BBB13 cells, were utilized to characterize imipramine and paroxetine transport at the BBB in vitro. RESULTS The in vivo influx clearance of [3H]imipramine and [3H]paroxetine in rats was determined to be 0.322 mL/(min·g brain) and 0.313 mL/(min·g brain), respectively. The efflux clearance of [3H]imipramine and [3H]paroxetine was 0.380 mL/(min·g brain) and 0.126 mL/(min·g brain), respectively. These results suggest that the net flux of paroxetine, but not imipramine, at the BBB in vivo was dominated by transport to the brain from the circulating blood. The uptake of imipramine and paroxetine by TR-BBB13 cells exhibited time- and temperature-dependence and one-saturable kinetics with a Km of 37.6 μM and 89.2 μM, respectively. In vitro uptake analyses of extracellular ion dependency and the effect of substrates/inhibitors for organic cation transporters and transport systems revealed minor contributions to known transporters and transport systems and the difference in transport properties in the BBB between imipramine and paroxetine. CONCLUSIONS Our study showed the comprehensive outcomes of imipramine and paroxetine transport at the BBB, implying that molecular mechanism(s) distinct from previously reported transporters and transport systems are involved in the transport.
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Affiliation(s)
- Shin-Ichi Akanuma
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Myeongrae Han
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Yuka Murayama
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Yoshiyuki Kubo
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Ken-Ichi Hosoya
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
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168
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Treatment-Resistant Depression in Poland—Epidemiology and Treatment. J Clin Med 2022; 11:jcm11030480. [PMID: 35159935 PMCID: PMC8837165 DOI: 10.3390/jcm11030480] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders worldwide. Although several antidepressant drugs have been developed, up to 30% of patients fail to achieve remission, and acute remission rates decrease with the number of treatment steps required. The aim of the current project was to estimate and describe the population of treatment-resistant depression (TRD) patients in outpatient clinics in Poland. (2) Methods: The project involved a representative sample of psychiatrists working in outpatient clinics, chosen through a process of quota random sampling. The doctors completed two questionnaires on a consecutive series of patients with MDD, which captured the patients’ demographics, comorbidities, and medical histories. TRD was defined as no improvement seen after a minimum of two different antidepressant drug therapies applied in sufficient doses for a minimum of 4 weeks each. The data were weighted and extrapolated to the population of TRD outpatients in Poland. (3) Results: A total of 76 psychiatrists described 1781 MDD patients, out of which 396 fulfilled the criteria of TRD. The TRD patients constituted 25.2% of all MDD patients, which led to the number of TRD outpatients in Poland being estimated at 34,800. The demographics, comorbidities, medical histories, and histories of treatment of Polish TRD patients were described. In our sample of the TRD population (mean age: 45.6 ± 13.1 years; female: 64%), the patients had experienced 2.1 ± 1.6 depressive episodes (including the current one), and the mean duration of the current episode was 4.8 ± 4.4 months. In terms of treatment strategies, most patients (around 70%) received monotherapy during the first three therapies, while combination antidepressant drugs (ADs) were applied more often from the fourth line of treatment. The use of additional medications and augmentation was reported in only up to one third of the TRD patients. During all of the treatment steps, patients most often received a selective serotonin reuptake inhibitor (SSRI) and a serotonin norepinephrine reuptake inhibitor (SNRI). (4) Conclusions: TRD is a serious problem, affecting approximately one fourth of all depressive patients and nearly 35,000 Poles.
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169
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Serum Mature BDNF Level Is Associated with Remission Following ECT in Treatment-Resistant Depression. Brain Sci 2022; 12:brainsci12020126. [PMID: 35203890 PMCID: PMC8870188 DOI: 10.3390/brainsci12020126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/07/2022] [Accepted: 01/16/2022] [Indexed: 11/16/2022] Open
Abstract
The search for a biological marker predicting the future failure or success of electroconvulsive therapy (ECT) remains highly challenging for patients with treatment-resistant depression. Evidence suggests that Brain-Derived Neurotrophic Factor (BDNF), a protein known to be involved in brain plasticity mechanisms, can play a key role in both the clinical efficacy of ECT and the pathophysiology of depressive disorders. We hypothesized that mature BDNF (mBDNF), an isoform of BDNF involved in the neural plasticity and survival of neural networks, might be a good candidate for predicting the efficacy of ECT. Total BDNF (tBDNF) and mBDNF levels were measured in 23 patients with severe treatment-resistant depression before (baseline) they received a course of ECT. More precisely, tBDNF and mBDNF measured before ECT were compared between patients who achieved the criteria of remission after the ECT course (remitters, n = 7) and those who did not (non-remitters, n = 16). We found that at baseline, future remitters displayed significantly higher mBDNF levels than future non-remitters (p = 0.04). No differences were observed regarding tBDNF levels at baseline. The multiple logistic regression model controlled for age and sex revealed that having a higher baseline mBDNF level was significantly associated with future remission after ECT sessions (odd ratio = 1.38; 95% confidence interval = 1.07–2.02, p = 0.04). Despite the limitations of the study, current findings provide additional elements regarding the major role of BDNF and especially the mBDNF isoform in the clinical response to ECT in major depression.
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170
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Martin SA, Tully PJ, Kahokehr AA, Jay A, Wittert GA. The bidirectional association between depression and lower urinary tract symptoms (LUTS) in men: A systematic review and meta-analysis of observational studies. Neurourol Urodyn 2022; 41:552-561. [PMID: 35019156 DOI: 10.1002/nau.24868] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Recent evidence from observational studies suggests a bidirectional association between lower urinary tract symptoms (LUTS) and depression in men. We sought to systematically quantify the effect of the presence of LUTS on depression symptoms, compared to those without LUTS, in adult males, and vice versa. METHODS Electronic databases (MEDLINE, PsycINFO, SCOPUS, Embase) were examined for articles in English before March 2021. Observational studies of men aged over 18 years; reporting an association between LUTS and depression; including a validated scale for LUTS and depression symptoms were eligible for study inclusion. RESULTS Seventeen studies out of 1787 records identified 163 466 men with reported depression symptoms by LUTS status, while 10 studies reported 72 363 men with LUTS by depression symptoms. Pooled estimates showed a strong effect of LUTS presence on depression risk (OR: 2.89, 95% CI: 2.50-3.33), with a high degree of heterogeneity among the examined studies (I2 = 83%; τ2 = 0,06; p < 0.001). Subgroup analyses demonstrated differences by study region (Q value:13.7, df:4, p = 0.003), setting (7.8(2), p = 0.020), design (7.2(1), p = 0.003), quality (6.2(1), p = 0.013), and LUTS measure (40.9(3), p < 0.001). Pooled estimates also showed a strong effect of depression presence on LUTS risk in men (OR: 3.13, 95% CI: 2.72-3.60), with only moderate heterogeneity between studies (I2 = 58%; τ2 = 0,02; p = 0.001). CONCLUSIONS The strong relationship observed between LUTS and depression implies shared risk factors that cannot be solely attributed to the prostate. This has immediate implications for future studies and the assessment and management of patients with either condition.
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Affiliation(s)
- Sean A Martin
- Freemasons Centre for Male Health & Wellbeing, University of Adelaide, Adelaide, South Australia, Australia
| | - Phillip J Tully
- Freemasons Centre for Male Health & Wellbeing, University of Adelaide, Adelaide, South Australia, Australia.,School of Psychology, University of New England, Armidale, New South Wales, Australia
| | - Arman A Kahokehr
- Lyell McEwin Health Service, SA Health, Elizabeth Vale, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Department of Urology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Alex Jay
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health & Wellbeing, University of Adelaide, Adelaide, South Australia, Australia
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171
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Floden L, Hudgens S, Jamieson C, Popova V, Drevets WC, Cooper K, Singh J. Evaluation of Individual Items of the Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS) in Adults with Treatment-Resistant Depression Treated with Esketamine Nasal Spray Combined with a New Oral Antidepressant. CNS Drugs 2022; 36:649-658. [PMID: 35441931 PMCID: PMC9166828 DOI: 10.1007/s40263-022-00916-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to determine which symptoms measured by the Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS) improve in those treated with esketamine nasal spray in combination with oral antidepressant (AD) compared with those treated with placebo plus AD for adult patients with treatment-resistant depression (TRD). These results complement the interpretation of PHQ-9 and MADRS total scores. METHODS The TRANSFORM 2 study evaluated the efficacy and safety of esketamine nasal spray in combination with AD. This post-hoc analysis used PHQ-9 and MADRS data to evaluate symptom changes. The total scores change and proportions of individual item change scores on the PHQ-9 and MADRS were evaluated at days 15 and 28; analysis of variance was used to test differences on total scores. Generalized estimation equations of logistic regression models were used to estimate the likelihood of improvement on instrument items. RESULTS The mean total score reduction of the PHQ-9, indicating improvement, was greater in the esketamine plus AD arm compared with placebo plus AD at day 15 (- 1.8; p = 0.045) and day 28 (- 2.8; p = 0.006). Proportions of those who improved (≥ 1 point on a 4-point scale and ≥ 2 points on a 7-point scale for the PHQ-9 and MADRS, respectively) was greater in the esketamine plus AD group compared with the placebo plus AD group across all items. The odds of improving for those in the esketamine plus AD group compared with the placebo plus AD group were over two times greater on the PHQ-9 items: "Little interest/pleasure in things" (OR 2.252, 95% CI 1.165-4.355); "Feeling down, depressed, or hopeless" (OR 2.767, 95% CI 1.400-5.470); and "Feeling tired or having little energy" (OR 2.171, 95% CI 1.153-4.087). The mean reduction in total scores on the MADRS, indicating improvement, was numerically greater at day 15 (- 2.0; p = 0.189) and statistically significantly greater at day 28 (- 4.4; p = 0.017) in the esketamine plus AD arm compared with placebo plus AD. The odds of improving for those in the esketamine plus AD group compared with the placebo plus AD group were over two times greater on the MADRS items measuring "Apparent sadness" (OR 2.007, 95% CI 1.096-3.674); and "Inability to feel" (OR 2.099, 95% CI 1.180-3.735). CONCLUSION Improvement in mean total scores in those treated with esketamine plus AD compared with placebo plus AD are important results to confirm efficacy. The odds of improving in those treated with esketamine plus AD was at least two times greater than with placebo plus AD on three patient- and two clinician-reported individual symptoms of TRD. These findings provide patient-relevant quantification of the esketamine plus AD treatment benefit, adding understanding as to which symptoms are most improved with treatment. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02418585; first posted 16 April 2015.
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Affiliation(s)
- Lysbeth Floden
- Clinical Outcomes Solutions, 1820 E River RD, Suite 220, Tucson, AZ, 85718, USA.
| | - Stacie Hudgens
- Clinical Outcomes Solutions, 1820 E River RD, Suite 220, Tucson, AZ 85718 USA
| | | | - Vanina Popova
- Janssen Research and Development LLC, Beerse, Belgium
| | | | | | - Jaskaran Singh
- Janssen Research and Development LLC, San Diego, CA USA ,Present Address: Neurocrine Biosciences, San Diego, CA USA
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172
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Hollis F, Pope BS, Gorman-Sandler E, Wood SK. Neuroinflammation and Mitochondrial Dysfunction Link Social Stress to Depression. Curr Top Behav Neurosci 2022; 54:59-93. [PMID: 35184261 DOI: 10.1007/7854_2021_300] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Major depressive disorder is a debilitating mental illness and a leading cause of global disease burden. While many etiological factors have been identified, social stress is a highly prevalent causative factor for the onset of depression. Unfortunately, rates of depression continue to increase around the world, and the recent COVID-19 pandemic has further exacerbated this mental health crisis. Though several therapeutic strategies are available, nearly 50% of patients who receive treatment never reach remission. The exact mechanisms by which social stress exposure promotes the development of depression are unclear, making it challenging to develop novel and more effective therapeutics. However, accumulating evidence points to a role for stress-induced neuroinflammation, particularly in treatment-resistant patients. Moreover, recent evidence has expanded the concept of the pathogenesis of depression to mitochondrial dysfunction, suggesting that the combined effects of social stress on mitochondria and inflammation may synergize to facilitate stress-related depression. In this chapter, we review evidence for neuroinflammation and mitochondrial dysfunction in the pathogenesis of social stress-induced depression and discuss these in the context of novel therapeutic targets for the treatment of depression.
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Affiliation(s)
- Fiona Hollis
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Brittany S Pope
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
- Department of Exercise Science, University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Erin Gorman-Sandler
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Susan K Wood
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA.
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173
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Marseille E, Bertozzi S, Kahn JG. The economics of psychedelic-assisted therapies: A research agenda. Front Psychiatry 2022; 13:1025726. [PMID: 36545038 PMCID: PMC9760680 DOI: 10.3389/fpsyt.2022.1025726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022] Open
Abstract
After a long hiatus, psychiatry is undergoing a resurgence of interest in psychedelic drugs as therapy for a wide range of mental health disorders Accumulating clinical evidence suggests substantial potential for psychedelics used in a therapeutic context, as treatment for, among other disorders, depression, post-traumatic stress disorder (PTSD), and addictions to tobacco, opioids and alcohol. As soon as 2024, powerful new therapeutic modalities could become available for individuals with mental health problems refractory to traditional therapies. Yet research has lagged on economic considerations, such as costs and cost-effectiveness, the economic effects of widespread implementation, pricing, and economic appraisal's methodological considerations relevant to psychedelic therapies. These issues are critical if psychedelic therapies are to become widely accessible. We describe six types of economic analyses and their rationale for decisions and planning including the needs of health care payers. We also outline desirable features of this research, including scientific rigor, long horizons, equity, and a global view.
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Affiliation(s)
- Elliot Marseille
- Global Initiative for Psychedelic Science Economics (GIPSE), University of California, Berkeley, Berkeley, CA, United States.,Center for Global Health Delivery Diplomacy and Economics, University of California, San Francisco, San Francisco, CA, United States
| | - Stefano Bertozzi
- Global Initiative for Psychedelic Science Economics (GIPSE), University of California, Berkeley, Berkeley, CA, United States.,Center for Global Health Delivery Diplomacy and Economics, University of California, San Francisco, San Francisco, CA, United States.,School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - James G Kahn
- Global Initiative for Psychedelic Science Economics (GIPSE), University of California, Berkeley, Berkeley, CA, United States.,Center for Global Health Delivery Diplomacy and Economics, University of California, San Francisco, San Francisco, CA, United States.,School of Medicine, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States
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174
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Ceolin G, Rockenbach G, Confortin SC, d’Orsi E, Moreira JD. Association between the consumption of omega-3-rich fish and depressive symptoms in older adults living in a middle-income country: EpiFloripa Aging cohort study. CAD SAUDE PUBLICA 2022; 38:e00011422. [DOI: 10.1590/0102-311xen011422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/13/2022] [Indexed: 11/27/2022] Open
Abstract
This study aimed to verify the association between the consumption of omega-3-rich (n-3) fish and depressive symptoms in older adults living in Southern Brazil. This is a cross-sectional analysis with data from the second wave of the EpiFloripa Aging cohort study (2013/2014) including 1,130 individuals aged 60 years or older. The presence of depressive symptoms was measured by the 15-items Geriatric Depression Scale (GDS-15), and the consumption of n-3-rich fish by a question of weekly frequency. The minimum set of variables for adjustment was defined using directed acyclic graph (DAG). Poisson regression with robust error variance was applied (adjusted by Model 1: demographic and socioeconomic variables, Model 2: added behavioral variables, Model 3: added health variables). We identified the prevalence of depressive symptoms in 19% of older adults and 51.8% reported eating n-3-rich fish once a week. Models 1 and 3 showed an inverse association between n-3-rich fish and depressive symptoms. However, the association was reduced when behavioral factors (leisure-time physical activity) were included in Model 2. These findings suggest that n-3-rich fish intake tends to be associated with depressive symptoms in older adults. However, other factors, such as physical exercise, are as pivotal as n-3 fatty acids in preventing the development of depressive symptoms.
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175
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Yosaee S, Clark CCT, Keshtkaran Z, Ashourpour M, Keshani P, Soltani S. Zinc in depression: From development to treatment: A comparative/ dose response meta-analysis of observational studies and randomized controlled trials. Gen Hosp Psychiatry 2022; 74:110-117. [PMID: 32829928 DOI: 10.1016/j.genhosppsych.2020.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/01/2020] [Accepted: 08/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND A previous meta-analysis suggested that zinc status may be linked to depression status. However, it remains unclear whether zinc status can predict the risk of depression development, or whether the monotherapy of zinc is superior to the combination of zinc supplementation and antidepressant medications in the treatment of depression. Therefore, this meta-analysis aimed to clarify the impact of zinc status and supplementation on depression development and status across all available evidence. METHODS PubMed, EMBASE, Scopus, and ISI web of science were searched, up to 14 May 2020, for relevant publications. Pooled relative risks (RRs) with 95% confidence intervals (CI) in observational studies, and mean and standard deviation (SD) for the change in depression score in RCTs were calculated using a random-effects model. RESULTS The meta-analysis of RCTs indicated that zinc supplementation significantly lowered depressive symptom scores of depressed patients [weighted mean difference (WMD = -4.15 point; 95% CI: -6.56, -1.75 point; P < 0.01)], and the improvement in depression status occurred only when zinc supplementation was prescribed as a monotherapy. The cohort studies showed that the highest level of zinc intake was associated with a 28% reduced risk of depression (RR: 0.66; 95% CI: 0.50, 0.82; I2 = 13.90). Dose-response analyses revealed a significant non-linear effect of baseline mood status on depression score. CONCLUSION Current evidence from observational studies and RCT's supports the potential benefits zinc to reduce the risk of, and alleviate, depression. However, further trials are needed to confirm the beneficial effect of zinc as a monotherapy versus adjunctive therapies.
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Affiliation(s)
- Somaye Yosaee
- Department of Nutrition Sciences, School of Health, Larestan University of Medical Sciences, Larestan, Iran; Emam Reza Teaching Hospital, Larestan University of Medical Sciences, Larestan, Iran
| | - Cain C T Clark
- Faculty Research Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry CV1 5FB, UK
| | - Zahra Keshtkaran
- Nursing Department, Community based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahkameh Ashourpour
- Department of Nutrition Sciences, School of Health, Larestan University of Medical Sciences, Larestan, Iran; Emam Reza Teaching Hospital, Larestan University of Medical Sciences, Larestan, Iran
| | - Parisa Keshani
- Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sepideh Soltani
- Department of Nutrition, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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176
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Ramasubramanian V, Mathumathi S, Rajendhiran G, Bijulakshmi P, Kannan M. A comparative study of the effect of electroconvulsive therapy and transcranial direct current stimulation in the treatment of persons suffering from treatment-resistant depression. Ind Psychiatry J 2022; 31:68-73. [PMID: 35800872 PMCID: PMC9255613 DOI: 10.4103/ipj.ipj_217_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 07/04/2021] [Accepted: 10/11/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND About 20%-30% of persons with major depression are said to have treatment-resistant depression (TRD) when they do not respond to antidepressants. These people continue to suffer in life and have poor quality of life. Although electroconvulsive therapy (ECT) is the most successful option in treating TRD, many people refuse ECT due to various reasons (stigma, the cost involved, and medical complications). Various studies combine treatment options such as psychotherapy, repetitive trans magnetic stimulation, ketamine, and transcranial direct current stimulation (tDCS) in an attempt to reduce symptoms for those people suffering from TRD. This study aims to compare the effectiveness of ECT and tDCS in TRD. SUBJECTS AND METHODS A total of 90 persons suffering from TRD were selected for the study. 46 persons received 6 ECTs and 44 persons received 10 sessions of tDCS. Treatment response was measured using baseline and postassessment scores of Hamilton depression rating scale and clinical global impression. The scores were used to determine the effectiveness of ECT in comparison to tDCS in TRD. STATISTICAL ANALYSIS The mean ± standard deviation was analyzed and paired t-test was used to find the significance of treatment outcome in a group at a 95% confidence interval. RESULTS ECT was found to be more effective than tDCS in the reduction of depressive symptoms. tDCS showed a significant reduction in depressive symptoms (P < 0.001). ECT has yet again been proven to be effective in the treatment of TRD. CONCLUSION AND DISCUSSION tDCS is effective in reducing depressive symptoms in persons suffering from TRD. However, ECT is superior in decreasing depressive symptoms in TRD when compared to tDCS.
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Affiliation(s)
- Vikhram Ramasubramanian
- Department of Psychiatry, Ahana Hospitals, Madurai, Tamil Nadu, India.,M.S. Chellamuthu Trust and Research Foundation, Madurai, Tamil Nadu, India
| | - S Mathumathi
- Department of Psychiatry, Ahana Hospitals, Madurai, Tamil Nadu, India
| | - Gopi Rajendhiran
- Department of Psychiatry, Ahana Hospitals, Madurai, Tamil Nadu, India
| | - P Bijulakshmi
- Department of Psychiatry, Ahana Hospitals, Madurai, Tamil Nadu, India
| | - M Kannan
- M.S. Chellamuthu Trust and Research Foundation, Madurai, Tamil Nadu, India
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177
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Di Vincenzo JD, Lipsitz O, Rodrigues NB, Jones BDM, Gill H, Lee Y, Lui LMW, Teopiz KM, Ho R, Lin K, Nasri F, McIntyre RS, Rosenblat JD. Frequency analysis of symptomatic worsening following ketamine infusions for treatment resistant depression in a real-world sample: Results from the canadian rapid treatment center of excellence. Psychiatry Res 2022; 307:114321. [PMID: 34890909 DOI: 10.1016/j.psychres.2021.114321] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
Antidepressants are associated with symptomatic worsening in a subgroup of patients. Replicated evidence has demonstrated rapid and robust antidepressant effects with intravenous (IV) ketamine in treatment resistant depression (TRD); however, the risk of ketamine worsening depressive symptoms in a subgroup of patients remains unknown. Herein we report a retrospective analysis on the rates of symptomatic worsening during an acute course of IV ketamine in individuals with unipolar (n = 142) and bipolar (n = 22) TRD. Adults (N = 164; mean age = 45.97) with TRD underwent four sub-anesthetic infusions (0.5-0.75 mg/kg over 40 min) of IV ketamine over two weeks, and were assessed with the Quick Inventory for Depression Symptomatology-Self Report-16 (QIDS-SR16) at baseline and after each infusion. The primary outcome was the proportion of patients experiencing clinically significant worsening of depressive symptoms (≥20% increase on the QIDS-SR16) at each time point relative to baseline. Secondary analyses explored trends in the results. The frequency of clinically significant worsening fluctuated between 1.83% to 5.49%, with no identifiable trend across time. Zero individuals with bipolar TRD reported symptomatic worsening. Limitations include the single-centered, uncontrolled, retrospective nature of this study. Rates of symptomatic worsening associated with IV ketamine therapy for TRD appear to be very low and similar to conventional antidepressants.
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Affiliation(s)
- Joshua D Di Vincenzo
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Medical Sciences Building, 1 King's College Cir Room 4207, M5S 1A8, Toronto, ON, Canada
| | - Orly Lipsitz
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Nelson B Rodrigues
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Brett D M Jones
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, M5T 1R8, Toronto, ON, Canada
| | - Hartej Gill
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Yena Lee
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Leanna M W Lui
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kayla M Teopiz
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Roger Ho
- Department of Psychological Medicine, National University Health System, Singapore, Singapore; Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Kangguang Lin
- Department of Affective Disorders, The Affiliated Brain Hospital of Guangzhou Medical University
| | - Flora Nasri
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, M5T 1R8, Toronto, ON, Canada.
| | - Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, M5T 1R8, Toronto, ON, Canada
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178
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Liu P, Zhang SS, Liang Y, Gao ZJ, Gao W, Dong BH. Efficacy and Safety of Esketamine Combined with Antidepressants for Treatment-Resistant Depression: A Meta-Analysis. Neuropsychiatr Dis Treat 2022; 18:2855-2865. [PMID: 36514492 PMCID: PMC9741854 DOI: 10.2147/ndt.s388764] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of esketamine + antidepressant in treatment-resistant depression. METHODS We searched PubMed, Web of Science, Embase, CNKI, and Wanfang databases to obtain published information on esketamine + antidepressant from inception to July 2022. We searched for randomized controlled studies on the treatment of depression with a double-blind induction phase. Outcome indicators included changes in Montgomery-Asberg Depression Rating Scale (MADRS) scores before and after treatment, effective response rate, remission rate, and changes in self-rating depression scale (SDS). We analyzed data using Review Manager 5.4 and assessed the quality of evidence using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) analysis. RESULTS A total of seven articles were included, including 701 patients in the esketamine + antidepressant group and 551 in the placebo group. Meta-analysis results showed that esketamine + antidepressant could improve the MADRS score in patients with treatment-resistant depression (MD = -2.68, 95% CI -3.98 to -1.37, P < 0.0001), SDS (MD = -2.9, 95% CI -4.01 to -1.79, P < 0.00001), response rate at the end of the double-blind induction period (RR = 1.28, 95% CI 1.12 to 1.46, P = 0.0002), remission rate at the end of the double-blind induction period (RR = 1.39, 95% CI 1.18 to 1.63, P < 0.0001), Five-Dimensional Health Scale (EQ-5D-5L) (MD = 0.05, 95% CI 0.02 to 0.08, P = 0.00009), Visual Analogue Scale of Health Status (EQ-VAS) (MD = 5.54, 95% CI 2.37 to 8.71, P = 0.0006). CONCLUSION Esketamine + antidepressant has an obvious curative effect in treatment-resistant depression and can rapidly improve depression in patients, quality of life and satisfaction, but minor adverse reactions can occur.
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Affiliation(s)
- Peng Liu
- Department of Anesthesiology, Xi'an Honghui Hospital, Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.,Xi'an Medical University, Xi'an, People's Republic of China
| | - Shan-Shan Zhang
- Department of Anesthesiology, Xi'an Honghui Hospital, Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.,Xi'an Medical University, Xi'an, People's Republic of China
| | - Yun Liang
- Department of Anesthesiology, Xi'an Honghui Hospital, Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.,Xi'an Medical University, Xi'an, People's Republic of China
| | - Zi-Jun Gao
- Department of Anesthesiology, Xi'an Honghui Hospital, Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Wei Gao
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Bu-Huai Dong
- Department of Anesthesiology, Xi'an Honghui Hospital, Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
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179
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An S, Fousek J, Kiss ZHT, Cortese F, van der Wijk G, McAusland LB, Ramasubbu R, Jirsa VK, Protzner AB. High-resolution Virtual Brain Modeling Personalizes Deep Brain Stimulation for Treatment-Resistant Depression: Spatiotemporal Response Characteristics Following Stimulation of Neural Fiber Pathways. Neuroimage 2021; 249:118848. [PMID: 34954330 DOI: 10.1016/j.neuroimage.2021.118848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/25/2021] [Accepted: 12/21/2021] [Indexed: 02/07/2023] Open
Abstract
Over the past 15 years, deep brain stimulation (DBS) has been actively investigated as a groundbreaking therapy for patients with treatment-resistant depression (TRD); nevertheless, outcomes have varied from patient to patient, with an average response rate of ∼50%. The engagement of specific fiber tracts at the stimulation site has been hypothesized to be an important factor in determining outcomes, however, the resulting individual network effects at the whole-brain scale remain largely unknown. Here we provide a computational framework that can explore each individual's brain response characteristics elicited by selective stimulation of fiber tracts. We use a novel personalized in-silico approach, the Virtual Big Brain, which makes use of high-resolution virtual brain models at a mm-scale and explicitly reconstructs more than 100 000 fiber tracts for each individual. Each fiber tract is active and can be selectively stimulated. Simulation results demonstrate distinct stimulus-induced event-related potentials as a function of stimulation location, parametrized by the contact positions of the electrodes implanted in each patient, even though validation against empirical patient data reveals some limitations (i.e., the need for individual parameter adjustment, and differential accuracy across stimulation locations). This study provides evidence for the capacity of personalized high-resolution virtual brain models to investigate individual network effects in DBS for patients with TRD and opens up novel avenues in the personalized optimization of brain stimulation.
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Affiliation(s)
- Sora An
- Department of Communication Disorders, Ewha Womans University, 03760, Seoul, Republic of Korea.
| | - Jan Fousek
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, 13005, Marseille, France
| | - Zelma H T Kiss
- Hotchkiss Brain Institute, University of Calgary, T2N 1N4, Calgary, Alberta, Canada; Mathison Centre for Mental Health, University of Calgary, T2N 1N4, Calgary, Alberta, Canada; Department of Clinical Neurosciences and Psychiatry, Cumming School of Medicine, University of Calgary, T2N 1N4, Calgary, Alberta, Canada
| | - Filomeno Cortese
- Hotchkiss Brain Institute, University of Calgary, T2N 1N4, Calgary, Alberta, Canada; Seaman Family MR Centre, Foothills Medical Centre, University of Calgary, T2N 1N4, Calgary, Alberta, Canada
| | - Gwen van der Wijk
- Department of Psychology, University of Calgary, T2N 1N4, Calgary, Alberta, Canada
| | - Laina Beth McAusland
- Department of Clinical Neurosciences and Psychiatry, Cumming School of Medicine, University of Calgary, T2N 1N4, Calgary, Alberta, Canada
| | - Rajamannar Ramasubbu
- Hotchkiss Brain Institute, University of Calgary, T2N 1N4, Calgary, Alberta, Canada; Mathison Centre for Mental Health, University of Calgary, T2N 1N4, Calgary, Alberta, Canada; Department of Clinical Neurosciences and Psychiatry, Cumming School of Medicine, University of Calgary, T2N 1N4, Calgary, Alberta, Canada
| | - Viktor K Jirsa
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, 13005, Marseille, France.
| | - Andrea B Protzner
- Hotchkiss Brain Institute, University of Calgary, T2N 1N4, Calgary, Alberta, Canada; Mathison Centre for Mental Health, University of Calgary, T2N 1N4, Calgary, Alberta, Canada; Department of Psychology, University of Calgary, T2N 1N4, Calgary, Alberta, Canada.
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180
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Brusov OS, Karpova NS, Oleichik IV, Faktor MI, Sizov SV. [The decrease in procoagulant activity of blood during combined therapy with antidepressants and antipsychotics in patients with endogenous mental disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:55-60. [PMID: 34932286 DOI: 10.17116/jnevro202112111155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare the changes in thrombodynamics indices in two groups of patients with endogenous mental disorders before and after combined treatment with antipsychotics and antidepressants (AD + group) and those who did not receive antidepressants (AD-group). MATERIAL AND METHODS The study included 110 patients, aged from 16 to 60 years (median age [Q1; Q3] 29 years [22; 35]), admitted for inpatient treatment at the clinic of Mental Health Research Center with the following mental disorders: schizophrenia with attack-like/attack-progressive/continuous type of course (F20.00-2), schizotypal disorder with affective fluctuations (F21.3-4), affective disorder (F 31.1-5; F 32.0-3; F 33.0-3). The thrombodynamics test (TD) was carried out on a T-2 thrombodynamics device according to the manufacturer's instructions (Hemacore LLC, Moscow, Russia). RESULTS In patients with endogenous mental disorders after combined therapy with antidepressants and antipsychotics, a statistically significant decrease in the procoagulant activity of plasma and procoagulant spontaneous clots is observed, which indicates a decrease in the severity of systemic, immune inflammation. In patients with endogenous mental disorders after antipsychotic therapy without the addition of antidepressants, for most thrombodynamic parameters, there is no statistically significant decrease in procoagulant plasma activity and spontaneous clots formation. It indicates the persistence of acute systemic, immune inflammation in this group. CONCLUSION The statistically significant positive change in plasma and platelet hemostasis may testify that combined treatment with antipsychotics and antidepressants in patients with endogenous mental disorders may be a biological, pathogenetic link that promotes augmentation (extended action) of antipsychotic therapy.
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Affiliation(s)
- O S Brusov
- Mental Health Research Center, Moscow, Russia
| | - N S Karpova
- Mental Health Research Center, Moscow, Russia
| | | | - M I Faktor
- Mental Health Research Center, Moscow, Russia
| | - S V Sizov
- Mental Health Research Center, Moscow, Russia
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Wang JY, Zhang Y, Chen Y, Wang Y, Li SY, Wang YF, Zhang ZX, Zhang J, Rong P. Mechanisms underlying antidepressant effect of transcutaneous auricular vagus nerve stimulation on CUMS model rats based on hippocampal α7nAchR/NF-κB signal pathway. J Neuroinflammation 2021; 18:291. [PMID: 34920740 PMCID: PMC8680337 DOI: 10.1186/s12974-021-02341-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 12/03/2021] [Indexed: 01/15/2023] Open
Abstract
Background Stress-induced neuroinflammation was considered to play a critical role in the pathogenesis of depression. Transcutaneous auricular vagus nerve stimulation (taVNS) is a relatively non-invasive alternative treatment for patients suffering from major depressive disorder. The anti-inflammatory signal of vagus nerve is mediated by α7 nicotinic acetylcholine receptor (α7nAchR), and the hippocampus, the region with the most distribution of α7nAchR, regulates emotions. Here, we investigated the role of α7nAchR mediating hippocampal neuroinflammation in taVNS antidepressant effect though homozygous α7nAChR (−/−) gene knockout and α7nAchR antagonist (methyllycaconitine, MLA). Methods There were control, model, taVNS, α7nAChR(−/−) + taVNS, hippocampus (Hi) MLA + taVNS and Hi saline + taVNS groups. We used the chronic unpredicted mild stress (CUMS) method to establish depressive model rats for 42 days, excepting control group. After the successful modeling, except the control and model, the rats in the other groups were given taVNS, which was applied through an electroacupuncture apparatus at the auricular concha (2/15 Hz, 2 mA, 30 min/days) for 21 days. Behavioral tests were conducted at baseline, after modeling and after taVNS intervention, including sucrose preference test (SPT), open field test (OFT) and forced swimming test (FST). These tests are widely used to evaluate depression-like behavior in rats. The samples were taken after experiment, the expressions of α7nAchR, NF-κB p65, IL-1β and the morphology of microglia were detected. Results Depression-like behavior and hippocampal neuroinflammation in CUMS model rats were manifested by down-regulated expression of α7nAchR, up-regulated expression of NF-κB p65 and IL-1β, and the morphology of microglia was in amoebic-like activated state. TaVNS could significantly reverse the above-mentioned phenomena, but had rare improvement effect for α7nAChR(−/−) rats and Hi MLA rats. Conclusion The antidepressant effect of taVNS is related to hippocampal α7nAchR/NF-κB signal pathway.
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Affiliation(s)
- Jun-Ying Wang
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Dongcheng District, No.16 Dongzhimen Nan Xiao Street, Beijing, 100700, China
| | - Yue Zhang
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Dongcheng District, No.16 Dongzhimen Nan Xiao Street, Beijing, 100700, China
| | - Yu Chen
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Dongcheng District, No.16 Dongzhimen Nan Xiao Street, Beijing, 100700, China
| | - Yu Wang
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Dongcheng District, No.16 Dongzhimen Nan Xiao Street, Beijing, 100700, China
| | - Shao-Yuan Li
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Dongcheng District, No.16 Dongzhimen Nan Xiao Street, Beijing, 100700, China
| | - Yi-Fei Wang
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Dongcheng District, No.16 Dongzhimen Nan Xiao Street, Beijing, 100700, China
| | - Zi-Xuan Zhang
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Dongcheng District, No.16 Dongzhimen Nan Xiao Street, Beijing, 100700, China
| | - Jinling Zhang
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Dongcheng District, No.16 Dongzhimen Nan Xiao Street, Beijing, 100700, China
| | - Peijing Rong
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Dongcheng District, No.16 Dongzhimen Nan Xiao Street, Beijing, 100700, China.
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Sakai Y, Chen C, Toyomaki A, Hashimoto N, Kitagawa K, Inoue T, Sato A, Makihara K, Kameyama R, Wakatsuki Y, Udo N, Shirakawa R, Yokota T, Nakagawa S, Kusumi I. A Brief, Individualized Exercise Program at Intensities Below the Ventilatory Threshold Exerts Therapeutic Effects for Depression: A Pilot Study. Front Behav Neurosci 2021; 15:787688. [PMID: 34880736 PMCID: PMC8648260 DOI: 10.3389/fnbeh.2021.787688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 12/03/2022] Open
Abstract
Due to the fact that existing pharmacological treatments for depression are not ideal, effort has been devoted to the development of complementary, alternative therapies such as physical exercise. The antidepressant effect of exercise is well documented. However, current recommendations and prescriptions of exercise may be too demanding for depressed patients, as some complain about the design of exercise programs and depression is associated with reduced motivation and capacity to exercise. Therefore, appropriately designed, patient-friendly exercise programs may prove critical for the long-term maintenance and therapeutic effects of exercise. In this pilot study, we developed an exercise program based on patients’ individual level of ventilatory threshold (VT), a submaximal index of aerobic capacity measured by Cardiopulmonary Exercise Testing (CPX). Compared to traditional measures, CPX provides more trustable indices of aerobic capacity and more homogenous exercise prescriptions. The main episode of the program consisted of 15–25 min of cycling twice a week at an intensity that approached but never went higher than subjects’ VT (considered low to moderate in intensity). We found that in patients diagnosed with major depressive disorder or persistent depressive disorder (n = 8), the program resulted in a significant reduction in depressive symptoms at week 8, which was maintained at week 16. Meanwhile, patients’ social functioning, quality of life, and cognitive functions improved. Although we used a single arm, non-randomized design, our results suggest that even a brief, low to moderate intensity exercise program may exert therapeutic effects for depression and CPX may be a useful tool for exercise prescriptions.
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Affiliation(s)
- Yuri Sakai
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Chong Chen
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Atsuhito Toyomaki
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kan Kitagawa
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takao Inoue
- Department of Health Sciences, Hokkaido University Graduate School of Health Sciences, Sapporo, Japan
| | - Asumi Sato
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Keisuke Makihara
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Rie Kameyama
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yumi Wakatsuki
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Niki Udo
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryosuke Shirakawa
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashi Yokota
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shin Nakagawa
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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183
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Degerlund Maldi K, Asellus P, Myléus A, Norström F. Cost-utility analysis of esketamine and electroconvulsive therapy in adults with treatment-resistant depression. BMC Psychiatry 2021; 21:610. [PMID: 34876085 PMCID: PMC8650406 DOI: 10.1186/s12888-021-03601-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/11/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) has long been used for treating individuals with treatment-resistant depression (TRD). Esketamine has recently emerged as a new treatment for TRD due to its rapid antidepressant effects. To further inform the decision regarding choice of treatment, this paper aims to evaluate whether ECT or esketamine is the more cost-effective option. METHODS The cost-effectiveness was derived as cost per quality-adjusted life-year (QALY) using a Markov model from a societal and life-time perspective. The incremental cost-effectiveness ratio (ICER) was calculated. Health states included different depression and remission states and death. Data to populate the model was derived from randomised controlled trials and other research. Various sensitivity analyses were carried out to test the robustness of the model. RESULTS The base case scenario shows that ECT is cost-effective compared to esketamine and yields more QALYs at a lower cost. The sensitivity analysis shows that ECT is cost-effective in all scenarios and ECT dominates esketamine in 12 scenarios. CONCLUSIONS This study found that, from a cost-effectiveness point of view, ECT should be the first-hand option for individuals with TRD, when other first line treatments have failed. Considering the lack of economic evaluation of ECT and esketamine, this study is of great value to decision makers.
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Affiliation(s)
- Kinza Degerlund Maldi
- Department of Epidemiology and Global Health, Umeå University, SE-901 87 Umeå, Sweden
| | - Peter Asellus
- Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
| | - Anna Myléus
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, SE-901 87 Umeå, Sweden
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184
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Chen MH, Wu HJ, Li CT, Lin WC, Tsai SJ, Hong CJ, Tu PC, Bai YM, Mao WC, Su TP. Is one or two infusions better in the first week of low-dose ketamine treatment for medication-resistant depression? A post hoc pooled analysis of randomized placebo-controlled and open-label trials. J Psychiatr Res 2021; 144:448-454. [PMID: 34752941 DOI: 10.1016/j.jpsychires.2021.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Whether a second ketamine infusion in the first week improves the antidepressant, antisuicidal, and anti-inflammatory effects of the first low-dose ketamine infusion remains unclear. METHODS A total of 78 patients with medication-resistant depression were allocated to receive two ketamine infusions (n = 30; days 1 and 4), a single ketamine infusion (n = 24; only day 1), or normal saline placebo infusion (n = 24; only day 1). The Montgomery-Asberg Depression Scale (MADRS) and 17-item Hamilton Rating Scale for Depression (HDRS) were administered before and at 40 min, 240 min, day 2, day 4, day 5, and day 7 after infusion. Serum concentrations of interleukin (IL)-2 and tumor necrosis factor (TNF)-α were assessed. RESULTS Two ketamine infusions improved the overall depressive symptoms (p < 0.001) and melancholic symptoms (p < 0.001) than a single ketamine or placebo infusion. The antisuicidal effect did not differ between the ketamine treatment groups. Two ketamine infusions increased TNF-α levels compared with a single ketamine or placebo infusion (p = 0.015). A single ketamine infusion improved the TNF-α-to-IL-2 ratio, an index of average anti-inflammatory effect, than two ketamine infusions or a single placebo infusion (p = 0.027). DISCUSSION Repeated low-dose ketamine infusions improved the antidepressant effect, but not the antisuicidal effect, compared with a single infusion. However, repeated ketamine infusions may exert a lesser anti-inflammatory effect than a single infusion.
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Affiliation(s)
- Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Hui-Ju Wu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Chen Lin
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chen-Jee Hong
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pei-Chi Tu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Chung Mao
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan.
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185
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Sajjadian M, Lam RW, Milev R, Rotzinger S, Frey BN, Soares CN, Parikh SV, Foster JA, Turecki G, Müller DJ, Strother SC, Farzan F, Kennedy SH, Uher R. Machine learning in the prediction of depression treatment outcomes: a systematic review and meta-analysis. Psychol Med 2021; 51:2742-2751. [PMID: 35575607 DOI: 10.1017/s0033291721003871] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Multiple treatments are effective for major depressive disorder (MDD), but the outcomes of each treatment vary broadly among individuals. Accurate prediction of outcomes is needed to help select a treatment that is likely to work for a given person. We aim to examine the performance of machine learning methods in delivering replicable predictions of treatment outcomes. METHODS Of 7732 non-duplicate records identified through literature search, we retained 59 eligible reports and extracted data on sample, treatment, predictors, machine learning method, and treatment outcome prediction. A minimum sample size of 100 and an adequate validation method were used to identify adequate-quality studies. The effects of study features on prediction accuracy were tested with mixed-effects models. Fifty-four of the studies provided accuracy estimates or other estimates that allowed calculation of balanced accuracy of predicting outcomes of treatment. RESULTS Eight adequate-quality studies reported a mean accuracy of 0.63 [95% confidence interval (CI) 0.56-0.71], which was significantly lower than a mean accuracy of 0.75 (95% CI 0.72-0.78) in the other 46 studies. Among the adequate-quality studies, accuracies were higher when predicting treatment resistance (0.69) and lower when predicting remission (0.60) or response (0.56). The choice of machine learning method, feature selection, and the ratio of features to individuals were not associated with reported accuracy. CONCLUSIONS The negative relationship between study quality and prediction accuracy, combined with a lack of independent replication, invites caution when evaluating the potential of machine learning applications for personalizing the treatment of depression.
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Affiliation(s)
- Mehri Sajjadian
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Roumen Milev
- Department of Psychiatry and Psychology, Queen's University, Providence Care Hospital, Kingston, ON, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jane A Foster
- Department of Psychiatry & Behavioural Neurosciences, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Gustavo Turecki
- Department of Psychiatry, Douglas Institute, McGill University, Montreal, QC, Canada
| | - Daniel J Müller
- Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Stephen C Strother
- Baycrest and Department of Medical Biophysics, Rotman Research Center, University of Toronto, Toronto, ON, Canada
| | - Faranak Farzan
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University Health Network, Toronto, ON, Canada
- Krembil Research Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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186
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Ramos-da-Silva L, Carlson PT, Silva-Costa LC, Martins-de-Souza D, de Almeida V. Molecular Mechanisms Associated with Antidepressant Treatment on Major Depression. Complex Psychiatry 2021; 7:49-59. [PMID: 35813936 PMCID: PMC8739385 DOI: 10.1159/000518098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/23/2021] [Indexed: 11/25/2023] Open
Abstract
Major depressive disorder (MDD) is a complex and multifactorial psychiatric disorder that causes serious health, social, and economic concerns worldwide. The main treatment of the symptoms is through antidepressant (AD) drugs. However, not all patients respond properly to these drugs. Omic sciences are widely used to analyze not only biomarkers for the AD response but also their molecular mechanism. In this review, we aimed to focus on omics data to better understand the molecular mechanisms involving AD effects on MDD. We consistently found, from preclinical to clinical data, that glutamatergic transmission, immune/inflammatory processes, energy metabolism, oxidative stress, and lipid metabolism were associated with traditional and potential new ADs. Despite efforts of studies investigating biomarkers of response to ADs, which could contribute to personalized treatment, there is no biomarker panel available for clinical application. From clinical genomic studies, we found that the main findings contribute to the development of pharmacogenomic tests for AD efficacy for each patient. Several studies pointed at DRD2, PXDNL, CACNA1E, and CACNA2D1 genes as potential targets for MDD treatment and the efficacy and rapid-antidepressant effect of ketamine. Finally, more in-depth studies of the molecular targets pointed here are needed to determine the clinical relevance and provide further evidence for precision MDD treatment.
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Affiliation(s)
- Lívia Ramos-da-Silva
- Department of Biochemistry and Tissue Biology, Laboratory of Neuroproteomics, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Pamela T. Carlson
- Department of Biochemistry and Tissue Biology, Laboratory of Neuroproteomics, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Licia C. Silva-Costa
- Department of Biochemistry and Tissue Biology, Laboratory of Neuroproteomics, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Daniel Martins-de-Souza
- Department of Biochemistry and Tissue Biology, Laboratory of Neuroproteomics, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
- Experimental Medicine Research Cluster (EMRC), University of Campinas, Campinas, Brazil
- D'Or Institute for Research and Education (IDOR), São Paulo, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria, Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
| | - Valéria de Almeida
- Department of Biochemistry and Tissue Biology, Laboratory of Neuroproteomics, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
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187
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Lee D, Minko T. Nanotherapeutics for Nose-to-Brain Drug Delivery: An Approach to Bypass the Blood Brain Barrier. Pharmaceutics 2021; 13:pharmaceutics13122049. [PMID: 34959331 PMCID: PMC8704573 DOI: 10.3390/pharmaceutics13122049] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 02/01/2023] Open
Abstract
Treatment of neurodegenerative diseases or other central nervous system (CNS) disorders has always been a significant challenge. The nature of the blood-brain barrier (BBB) limits the penetration of therapeutic molecules to the brain after oral or parenteral administration, which, in combination with hepatic metabolism and drug elimination and inactivation during its journey in the systemic circulation, decreases the efficacy of the treatment, requires high drug doses and often induces adverse side effects. Nose-to-brain drug delivery allows the direct transport of therapeutic molecules by bypassing the BBB and increases drug concentration in the brain. The present review describes mechanisms of nose-to-brain drug delivery and discusses recent advances in this area with especial emphasis on nanotechnology-based approaches.
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Affiliation(s)
- David Lee
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA;
| | - Tamara Minko
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA;
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA
- Environmental and Occupational Health Science Institute, Rutgers, The State University of New Jersey, 170 Frelinghuysen Road, Piscataway, NJ 08854, USA
- Correspondence: ; Tel.: +1-848-445-6348
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188
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Wu CS, Hsu LY, Pan YJ, Wang SH. Associations Between Antidepressant Use and Advanced Diabetes Outcomes in Patients with Depression and Diabetes Mellitus. J Clin Endocrinol Metab 2021; 106:e5136-e5146. [PMID: 34259856 DOI: 10.1210/clinem/dgab443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Comorbid depression in patients with diabetes deteriorates the prognosis. Antidepressants might attenuate the adverse effects of depression; however, they are associated with cardiometabolic adverse effects. OBJECTIVE This study aimed to explore the association between antidepressant treatment and advanced diabetic complications and mortality among patients with depression and diabetes mellitus. METHODS We conducted a nationwide retrospective cohort study of 36 276 patients with depression and newly treated diabetes mellitus using Taiwan's universal health insurance database. Antidepressant treatment patterns within a 6-month window were classified into none, poor, partial, and regular use, and we accounted for time-dependent variables in the Cox proportional hazards regression analysis with adjustment for time-dependent comorbidity and concomitant use of medications. Different classes of antidepressants were compared. Macro- and microvascular complications, as well as all-cause mortality, were the main outcomes. Benzodiazepines were chosen as negative control exposure. RESULTS Compared with poor use of antidepressants, regular use was associated with a 0.92-fold decreased risk of macrovascular complications and a 0.86-fold decreased risk of all-cause mortality but not associated with microvascular complications. Regular use of selective serotonin reuptake inhibitors was associated with a 0.83- and 0.75-fold decreased risk of macrovascular complications and all-cause mortality, respectively. Regular use of tricyclic or tetracyclic antidepressants was associated with a 0.78-fold decreased risk of all-cause mortality. Regular use of benzodiazepine showed no association with diabetic outcomes. CONCLUSION Regular antidepressant use was associated with lower risk of advanced diabetic complications compared with poor adherence. Clinicians should emphasize antidepressant treatment adherence among patients with depression and diabetes mellitus.
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Affiliation(s)
- Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, 100, Taiwan
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, 350, Taiwan
| | - Le-Yin Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, 100, Taiwan
| | - Yi-Jiun Pan
- School of Medicine, China Medical University, Taichung, 404, Taiwan
| | - Shi-Heng Wang
- Department of Occupational Safety and Health, China Medical University, Taichung, 406, Taiwan
- Department of Public Health, China Medical University, Taichung, 406, Taiwan
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Ponton E, Turecki G, Nagy C. Sex Differences in the Behavioral, Molecular, and Structural Effects of Ketamine Treatment in Depression. Int J Neuropsychopharmacol 2021; 25:75-84. [PMID: 34894233 PMCID: PMC8756094 DOI: 10.1093/ijnp/pyab082] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/08/2021] [Accepted: 11/15/2021] [Indexed: 12/14/2022] Open
Abstract
Major depressive disorder (MDD) is a common psychiatric illness that manifests in sex-influenced ways. Men and women may experience depression differently and also respond to various antidepressant treatments in sex-influenced ways. Ketamine, which is now being used as a rapid-acting antidepressant, is likely the same. To date, the majority of studies investigating treatment outcomes in MDD do not disaggregate the findings in males and females, and this is also true for ketamine. This review aims to highlight that gap by exploring pre-clinical data-at a behavioral, molecular, and structural level-and recent clinical trials. Sex hormones, particularly estrogen and progesterone, influence the response at all levels examined, and sex is therefore a critical factor to examine when looking at ketamine response. Taken together, the data show females are more sensitive to ketamine than males, and it might be possible to monitor the phase of the menstrual cycle to mitigate some risks associated with the use of ketamine for females with MDD. Based on the studies reviewed in this article, we suggest that ketamine should be administered adhering to sex-specific considerations.
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Affiliation(s)
- Ethan Ponton
- Department of Anatomy and Cell Biology, McGill University, Montreal, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Corina Nagy
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- Correspondence: Corina Nagy, PhD, 6875 LaSalle Blvd, Verdun, Québec, Canada H4H 1R3 ()
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Song Y, Li J, Li H, Cai M, Miao D. The role of ventral tegmental area orexinergic afferents in depressive-like behavior in a chronic unpredictable mild stress (CUMS) mouse model. Biochem Biophys Res Commun 2021; 579:22-28. [PMID: 34583191 DOI: 10.1016/j.bbrc.2021.09.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
Orexin has been implicated in comorbid diseases of depression, making it a promising target for anti-depression treatment. Although orexin neurons exhibit abnormal activity in depression, the neurocircuit mechanism of orexin remains unclear. As one of the important downstream factors of orexin neurons, the ventral tegmental area (VTA) is considered crucial to the mechanism of depression. However, the role of VTA orexinergic afferents in depression remains unclear. In this study, we applied a combination of opto/chemogenetic and neuropharmacology methods to investigate whether the VTA orexinergic afferents participate in the pathogenesis of depression in a chronic unpredictable mild stress (CUMS) mouse model. We found that c-Fos expression in these VTA-projecting orexin neurons specifically decreased in CUMS-treated mice. Optogenetic and chemogenetic activation of orexin terminals in the VTA significantly reversed depressive behavior. Microinjection of orexin-A, but not orexin-B, into the VTA significantly improved depressive-like behavior. Our study provided direct evidence that the VTA orexinergic afferents participate in the mechanism of depression, and the orexin-1 receptor plays a major role.
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Affiliation(s)
- Yunyun Song
- Department of Medical Psychology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jiannan Li
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Huiming Li
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Min Cai
- Department of Psychiatry, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Danmin Miao
- Department of Medical Psychology, The Fourth Military Medical University, Xi'an, Shaanxi, China.
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191
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Olatunji TL, Siebert F, Adetunji AE, Harvey BH, Gericke J, Hamman JH, Van der Kooy F. Sceletium tortuosum: A review on its phytochemistry, pharmacokinetics, biological and clinical activities. JOURNAL OF ETHNOPHARMACOLOGY 2021; 280:114476. [PMID: 34333104 DOI: 10.1016/j.jep.2021.114476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Sceletium tortuosum (L.) N.E.Br, the most sought after and widely researched species in the genus Sceletium is a succulent forb endemic to South Africa. Traditionally, this medicinal plant is mainly masticated or smoked and used for the relief of toothache, abdominal pain, and as a mood-elevator, analgesic, hypnotic, anxiolytic, thirst and hunger suppressant, and for its intoxicating/euphoric effects. Sceletium tortuosum is currently of widespread scientific interest due to its clinical potential in treating anxiety and depression, relieving stress in healthy individuals, and enhancing cognitive functions. These pharmacological actions are attributed to its phytochemical constituents referred to as mesembrine-type alkaloids. AIM OF THE REVIEW The aim of this review was to comprehensively summarize and critically evaluate recent research advances on the phytochemistry, pharmacokinetics, biological and clinical activities of the medicinal plant S. tortuosum. Additionally, current ongoing research and future perspectives are also discussed. METHODS All relevant scientific articles, books, MSc and Ph.D. dissertations on botany, behavioral pharmacology, traditional uses, and phytochemistry of S. tortuosum were retrieved from different databases (including Science Direct, PubMed, Google Scholar, Scopus and Web of Science). For pharmacokinetics and pharmacological effects of S. tortuosum, the focus fell on relevant publications published between 2009 and 2021. RESULTS Twenty-five alkaloids belonging to four structural classes viz: mesembrine, Sceletium A4, joubertiamine, and tortuosamine, have been identified from S. tortuosum, of which the mesembrine class is predominant. The crude extracts and commercially available standardized extracts of S. tortuosum have displayed a wide spectrum of biological activities (e.g. antimalarial, anti-oxidant, immunomodulatory, anti-HIV, neuroprotection, enhancement of cognitive function) in in vitro or in vivo studies. This plant has not yet been studied in a clinical population, but has potential for enhancing cognitive function, and managing anxiety and depression. CONCLUSION As an important South African medicinal plant, S. tortuosum has garnered many research advances on its phytochemistry and biological activities over the last decade. These scientific studies have shown that S. tortuosum has various bioactivities. The findings have further established the link between the phytochemistry and pharmacological application, and support the traditional use of S. tortuosum in the indigenous medicine of South Africa.
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Affiliation(s)
- T L Olatunji
- Unit for Environmental Sciences and Management, North-West University, Potchefstroom, South Africa.
| | - F Siebert
- Unit for Environmental Sciences and Management, North-West University, Potchefstroom, South Africa.
| | - A E Adetunji
- School of Life Sciences, University of KwaZulu-Natal, Durban 4001, South Africa.
| | - B H Harvey
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa; SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; Department of Pharmacology, School of Pharmacy, North-West University, Potchefstroom Campus, 2520, South Africa.
| | - J Gericke
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa; Department of Pharmacology, School of Pharmacy, North-West University, Potchefstroom Campus, 2520, South Africa.
| | - J H Hamman
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa.
| | - F Van der Kooy
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa.
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192
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Zangani C, Giordano B, Stein H, Bonora S, D'Agostino A, Ostinelli EG. Efficacy of amisulpride for depressive symptoms in individuals with mental disorders: A systematic review and meta-analysis. Hum Psychopharmacol 2021; 36:e2801. [PMID: 34727399 PMCID: PMC8596405 DOI: 10.1002/hup.2801] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Depressive symptoms occur in several psychiatric disorders, often in the absence of a formal diagnosis of depression. We aimed to evaluate the efficacy and the tolerability of amisulpride, both alone and as augmentation therapy, in the treatment of depressive symptoms in individuals with any major psychiatric disorder. METHODS We searched PubMed, Embase, PsycINFO, GreyLit, OpenGrey and ProQuest up to March 2020 for randomised controlled trials focussing on the treatment of an acute depressive episode in any major psychiatric disorder. A random-effect meta-analysis was performed to synthesize the findings on depressive symptoms (primary outcome), response rate and tolerability. RESULTS We retrieved 11 studies including 2065 patients with a diagnosis of dysthymia (eight studies), major depression (one study) or schizophrenia (two studies). Amisulpride 50 mg/day was associated with a larger reduction of depressive symptoms compared to placebo (standardised mean difference [SMD] = -0.70, CI 95% -0.92, -0.49; I2 = 0.0%), and was found to be comparable to selective serotonin reuptake inhibitors (SSRIs; SMD = -0.08, CI 95% -0.23, 0.06, I2 = 0.0%), amineptine, imipramine and amitriptyline in the treatment of dysthymia (three studies, not pooled). In individuals with schizophrenia, amisulpride administered at higher doses (>400 mg/day) was comparable to olanzapine and risperidone (two studies, not pooled). In terms of tolerability, amisulpride was superior to placebo for dysthymia (odds ratio [OR] = 3.94, CI 95% 1.07, 14.48; I2 = 0.0) and comparable with SSRIs (OR = 0.94, CI 95% 0.55, 1.62; I2 = 0.0%). CONCLUSION Treatment with amisulpride could be a valid choice for selected individuals with dysthymia or depressive symptoms in the context of schizophrenia. More studies on the efficacy and tolerability of amisulpride are needed to draw firm conclusions on its potential benefits in other psychiatric disorders.
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Affiliation(s)
- Caroline Zangani
- Oxford Health NHS Foundation Trust, Warneford HospitalOxfordUK,Department of PsychiatryUniversity of OxfordOxfordUK,Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research CentreOxfordUK,Department of Health SciencesUniversity of MilanMilanItaly
| | | | | | - Stefano Bonora
- Department of Health SciencesUniversity of MilanMilanItaly
| | | | - Edoardo Giuseppe Ostinelli
- Oxford Health NHS Foundation Trust, Warneford HospitalOxfordUK,Department of PsychiatryUniversity of OxfordOxfordUK,Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research CentreOxfordUK
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193
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Pisanu C, Vitali E, Meloni A, Congiu D, Severino G, Ardau R, Chillotti C, Trabucchi L, Bortolomasi M, Gennarelli M, Minelli A, Squassina A. Investigating the Role of Leukocyte Telomere Length in Treatment-Resistant Depression and in Response to Electroconvulsive Therapy. J Pers Med 2021; 11:jpm11111100. [PMID: 34834452 PMCID: PMC8622097 DOI: 10.3390/jpm11111100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022] Open
Abstract
Psychiatric disorders seem to be characterized by premature cell senescence. However, controversial results have also been reported. In addition, the relationship between accelerated aging and treatment-resistance has scarcely been investigated. In the current study, we measured leukocyte telomere length (LTL) in 148 patients with treatment-resistant depression (TRD, 125 with major depressive disorder, MDD, and 23 with bipolar disorder, BD) treated with electroconvulsive therapy (ECT) and analyzed whether LTL was associated with different response profiles. We also compared LTL between patients with TRD and 335 non-psychiatric controls. For 107 patients for which genome-wide association data were available, we evaluated whether a significant overlap among genetic variants or genes associated with LTL and with response to ECT could be observed. LTL was negatively correlated with age (Spearman’s correlation coefficient = −0.25, p < 0.0001) and significantly shorter in patients with treatment-resistant MDD (Quade’s F = 35.18, p < 0.0001) or BD (Quade’s F = 20.84, p < 0.0001) compared to controls. Conversely, baseline LTL was not associated with response to ECT or remission. We did not detect any significant overlap between genetic variants or genes associated with LTL and response to ECT. Our results support previous findings suggesting premature cell senescence in patients with severe psychiatric disorders and suggest that LTL could not be a predictive biomarker of response to ECT.
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Affiliation(s)
- Claudia Pisanu
- Department of Biomedical Science, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Cagliari, Italy; (C.P.); (A.M.); (D.C.); (G.S.)
| | - Erika Vitali
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (E.V.); (M.G.); (A.M.)
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Anna Meloni
- Department of Biomedical Science, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Cagliari, Italy; (C.P.); (A.M.); (D.C.); (G.S.)
| | - Donatella Congiu
- Department of Biomedical Science, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Cagliari, Italy; (C.P.); (A.M.); (D.C.); (G.S.)
| | - Giovanni Severino
- Department of Biomedical Science, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Cagliari, Italy; (C.P.); (A.M.); (D.C.); (G.S.)
| | - Raffaella Ardau
- Unit of Clinical Pharmacology, University Hospital Agency of Cagliari, 09123 Cagliari, Italy; (R.A.); (C.C.)
| | - Caterina Chillotti
- Unit of Clinical Pharmacology, University Hospital Agency of Cagliari, 09123 Cagliari, Italy; (R.A.); (C.C.)
| | - Luigi Trabucchi
- Psychiatric Hospital “Villa Santa Chiara”, 37142 Verona, Italy; (L.T.); (M.B.)
| | - Marco Bortolomasi
- Psychiatric Hospital “Villa Santa Chiara”, 37142 Verona, Italy; (L.T.); (M.B.)
| | - Massimo Gennarelli
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (E.V.); (M.G.); (A.M.)
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Alessandra Minelli
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (E.V.); (M.G.); (A.M.)
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Alessio Squassina
- Department of Biomedical Science, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Cagliari, Italy; (C.P.); (A.M.); (D.C.); (G.S.)
- Correspondence: ; Tel.: +39-070-675-4323
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194
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Lee MF, Eather R, Best T. Plant-based dietary quality and depressive symptoms in Australian vegans and vegetarians: a cross-sectional study. BMJ Nutr Prev Health 2021; 4:479-486. [PMID: 35028517 PMCID: PMC8718860 DOI: 10.1136/bmjnph-2021-000332] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/30/2021] [Indexed: 12/11/2022] Open
Abstract
Plant-based dietary patterns (vegan and vegetarian) are often considered 'healthy' and have been associated with broad health benefits, including decreased risk of obesity and ill health (cardiovascular disease, blood glucose and type II diabetes). However, the association between plant-based diets and mood disorders such as depression remains largely equivocal. This cross-sectional study of 219 adults aged 18-44 (M=31.22, SD=7.40) explored the associations between an estimate of overall plant-based diet quality and depression in vegans (n=165) and vegetarians (n=54). Overall plant-based diet quality was associated with depressive symptoms in vegans and vegetarians F(1, 215)=13.71, p<0.001 accounting for 6% of the variation in depressive symptoms. For those without depression, higher diet quality was protective against depressive symptoms F(1, 125)=6.49, p=0.012. Conversely, for those with depression no association with diet quality was found F(1, 89)=0.01, p=0.963. These findings suggest that a high-quality plant-based diet may be protective against depressive symptoms in vegans and vegetarians. In line with emerging research between food and mental health, higher-quality dietary patterns are associated with a reduced risk of depressive symptoms. Given the rapidly increasing rate of vegan and vegetarian food products within Australia, understanding the potential mechanisms of effects through which a plant-based diet may influence depressive symptoms is required.
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Affiliation(s)
- Megan Frances Lee
- Faculty of Society and Design, Bond University, Robina, Queensland, Australia
| | - Ryan Eather
- School of Health, Medical and Applied Sciences, NeuroHealth Lab, Appleton Institute, Central Queensland University, Brisbane, Queensland, Australia
| | - Talitha Best
- School of Health, Medical and Applied Sciences, NeuroHealth Lab, Appleton Institute, Central Queensland University, Brisbane, Queensland, Australia
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195
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Della Vecchia S, Marchese M, Santorelli FM, Sicca F. Kir4.1 Dysfunction in the Pathophysiology of Depression: A Systematic Review. Cells 2021; 10:2628. [PMID: 34685608 PMCID: PMC8534194 DOI: 10.3390/cells10102628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 12/17/2022] Open
Abstract
A serotonergic dysfunction has been largely postulated as the main cause of depression, mainly due to its effective response to drugs that increase the serotonergic tone, still currently the first therapeutic line in this mood disorder. However, other dysfunctional pathomechanisms are likely involved in the disorder, and this may in part explain why some individuals with depression are resistant to serotonergic therapies. Among these, emerging evidence suggests a role for the astrocytic inward rectifier potassium channel 4.1 (Kir4.1) as an important modulator of neuronal excitability and glutamate metabolism. To discuss the relationship between Kir4.1 dysfunction and depression, a systematic review was performed according to the PRISMA statement. Searches were conducted across PubMed, Scopus, and Web of Science by two independent reviewers. Twelve studies met the inclusion criteria, analyzing Kir4.1 relationships with depression, through in vitro, in vivo, and post-mortem investigations. Increasing, yet not conclusive, evidence suggests a potential pathogenic role for Kir4.1 upregulation in depression. However, the actual contribution in the diverse subtypes of the disorder and in the comorbid conditions, for example, the epilepsy-depression comorbidity, remain elusive. Further studies are needed to better define the clinical phenotype associated with Kir4.1 dysfunction in humans and the molecular mechanisms by which it contributes to depression and implications for future treatments.
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Affiliation(s)
- Stefania Della Vecchia
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, 56128 Pisa, Italy;
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Maria Marchese
- Department of Molecular Medicine, IRCCS Stella Maris Foundation, Via dei Giacinti 2, 56128 Pisa, Italy;
| | - Filippo Maria Santorelli
- Department of Molecular Medicine, IRCCS Stella Maris Foundation, Via dei Giacinti 2, 56128 Pisa, Italy;
| | - Federico Sicca
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, 56128 Pisa, Italy;
- Child Neuropsychiatric Unit, USL Centro Toscana, 59100 Prato, Italy
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196
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Sex-based changes in rat brain serotonin and behavior in a model of altitude-related vulnerability to treatment-resistant depression. Psychopharmacology (Berl) 2021; 238:2867-2881. [PMID: 34159421 DOI: 10.1007/s00213-021-05902-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/08/2021] [Indexed: 01/03/2023]
Abstract
RATIONALE Rates of depression and suicide increase with altitude. In our animal model, rats housed at moderate altitude vs. at sea level exhibit increased depressive symptoms in the forced swim test (FST) and lack of response to selective serotonin reuptake inhibitors (SSRIs). Depression and SSRI resistance are linked to disrupted serotonergic function, and hypobaric hypoxia may reduce the oxygen-dependent synthesis of serotonin. We therefore tested brain serotonin in rats housed at altitude. METHODS Sprague-Dawley rats were housed at altitude (4,500 ft, 10,000 ft) vs. sea level for 7-36 days. Brain serotonin was measured by ELISA, or behavior evaluated in the FST, sucrose preference (SPT), or open-field tests (OFT). RESULTS After 2 weeks at 4,500 ft or 10,000ft vs. sea level, serotonin levels decreased significantly at altitude in the female prefrontal cortex, striatum, hippocampus, and brainstem, but increased with altitude in the male hippocampus and brainstem. Female brain serotonin decreased from 7 to 36 days at 4,500 ft, but males did not vary. At 2 weeks and 24 days, females at altitude exhibit lower brain serotonin and increased depressive symptoms in the FST and SPT, with motor behavior unaltered. In males, serotonin, passive coping in the FST and OFT immobility increased with altitude at 2 weeks, but not at 24 days. Male SPT behavior did not change with altitude. CONCLUSIONS Females may be more vulnerable to depressive symptoms at altitude, while males may be resilient. Chronic hypoxic stress at altitudes as low as 4,500 ft may cause a brain serotonin imbalance to worsen vulnerability to depression and SSRI resistance, and potentially worsen suicide risk.
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197
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A partial least squares and artificial neural network study for a series of arylpiperazines as antidepressant agents. J Mol Model 2021; 27:297. [PMID: 34558019 DOI: 10.1007/s00894-021-04906-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
Depression affects more than 300 million people around the world and can lead to suicide. About 30% of patients on treatment for depression drop out of therapy due to side effects or to latency time associated to therapeutic effects. 5-HT receptor, known as serotonin, is considered the key in depression treatment. Arylpiperazine compounds are responsible for several pharmacological effects and are considered as ligands in serotonin receptors, such as the subtype 5-HT2a. Here, in silico studies were developed using partial least squares (PLSs) and artificial neural networks (ANNs) to design new arylpiperazine compounds that could interact with the 5-HT2a receptor. First, molecular and electronic descriptors were calculated and posteriorly selected from correlation matrixes and genetic algorithm (GA). Then, the selected descriptors were used to construct PLS and ANN models that showed to be robust and predictive. Lastly, new arylpiperazine compounds were designed and their biological activity values were predicted by both PLS and ANN models. It is worth to highlight compounds G5 and G7 (predicted by the PLS model) and G3 and G15 (predicted by the ANN model), whose predicted pIC50 values were as high as the three highest values from the arylpiperazine original set studied here. Therefore, it can be asserted that the two models (PLS and ANN) proposed in this work are promising for the prediction of the biological activity of new arylpiperazine compounds and may significantly contribute to the design of new drugs for the treatment of depression.
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198
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Yu WS, Kwon SH, Agadagba SK, Chan LLH, Wong KH, Lim LW. Neuroprotective Effects and Therapeutic Potential of Transcorneal Electrical Stimulation for Depression. Cells 2021; 10:cells10092492. [PMID: 34572141 PMCID: PMC8466154 DOI: 10.3390/cells10092492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/29/2021] [Accepted: 09/17/2021] [Indexed: 12/22/2022] Open
Abstract
Transcorneal electrical stimulation (TES) has emerged as a non-invasive neuromodulation approach that exerts neuroprotection via diverse mechanisms, including neurotrophic, neuroplastic, anti-inflammatory, anti-apoptotic, anti-glutamatergic, and vasodilation mechanisms. Although current studies of TES have mainly focused on its applications in ophthalmology, several lines of evidence point towards its putative use in treating depression. Apart from stimulating visual-related structures and promoting visual restoration, TES has also been shown to activate brain regions that are involved in mood alterations and can induce antidepressant-like behaviour in animals. The beneficial effects of TES in depression were further supported by its shared mechanisms with FDA-approved antidepressant treatments, including its neuroprotective properties against apoptosis and inflammation, and its ability to enhance the neurotrophic expression. This article critically reviews the current findings on the neuroprotective effects of TES and provides evidence to support our hypothesis that TES possesses antidepressant effects.
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Affiliation(s)
- Wing-Shan Yu
- Neuromodulation Laboratory, School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (W.-S.Y.); (S.-H.K.); (K.-H.W.)
| | - So-Hyun Kwon
- Neuromodulation Laboratory, School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (W.-S.Y.); (S.-H.K.); (K.-H.W.)
| | - Stephen Kugbere Agadagba
- Department of Electrical Engineering, City University of Hong Kong, Hong Kong, China; (S.K.A.); (L.-L.-H.C.)
| | - Leanne-Lai-Hang Chan
- Department of Electrical Engineering, City University of Hong Kong, Hong Kong, China; (S.K.A.); (L.-L.-H.C.)
| | - Kah-Hui Wong
- Neuromodulation Laboratory, School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (W.-S.Y.); (S.-H.K.); (K.-H.W.)
- Department of Anatomy, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Lee-Wei Lim
- Neuromodulation Laboratory, School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (W.-S.Y.); (S.-H.K.); (K.-H.W.)
- Correspondence:
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199
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Yeung SSH, Ho YS, Chang RCC. The role of meningeal populations of type II innate lymphoid cells in modulating neuroinflammation in neurodegenerative diseases. Exp Mol Med 2021; 53:1251-1267. [PMID: 34489558 PMCID: PMC8492689 DOI: 10.1038/s12276-021-00660-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 02/08/2023] Open
Abstract
Recent research into meningeal lymphatics has revealed a never-before appreciated role of type II innate lymphoid cells (ILC2s) in modulating neuroinflammation in the central nervous system (CNS). To date, the role of ILC2-mediated inflammation in the periphery has been well studied. However, the exact distribution of ILC2s in the CNS and therefore their putative role in modulating neuroinflammation in neurodegenerative diseases such as Alzheimer's disease (AD), multiple sclerosis (MS), Parkinson's disease (PD), and major depressive disorder (MDD) remain highly elusive. Here, we review the current evidence of ILC2-mediated modulation of neuroinflammatory cues (i.e., IL-33, IL-25, IL-5, IL-13, IL-10, TNFα, and CXCL16-CXCR6) within the CNS, highlight the distribution of ILC2s in both the periphery and CNS, and discuss some challenges associated with cell type-specific targeting that are important for therapeutics. A comprehensive understanding of the roles of ILC2s in mediating and responding to inflammatory cues may provide valuable insight into potential therapeutic strategies for many dementia-related disorders.
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Affiliation(s)
- Sherry Sin-Hang Yeung
- grid.194645.b0000000121742757Laboratory of Neurodegenerative Diseases, School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR China
| | - Yuen-Shan Ho
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR China
| | - Raymond Chuen-Chung Chang
- grid.194645.b0000000121742757Laboratory of Neurodegenerative Diseases, School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR China ,grid.194645.b0000000121742757State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR China
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Zhdanava M, Karkare S, Pilon D, Joshi K, Rossi C, Morrison L, Sheehan J, Lefebvre P, Lopena O, Citrome L. Prevalence of Pre-existing Conditions Relevant for Adverse Events and Potential Drug-Drug Interactions Associated with Augmentation Therapies Among Patients with Treatment-Resistant Depression. Adv Ther 2021; 38:4900-4916. [PMID: 34368919 PMCID: PMC8408057 DOI: 10.1007/s12325-021-01862-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/13/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Pre-existing conditions relevant for adverse events (AE) and the potential for drug-drug interactions (DDIs) may limit safe pharmacotherapeutic augmentation options for patients with major depressive disorder (MDD). This concern may be heightened among patients with treatment-resistant depression (TRD), who often have comorbid medical disorders. METHODS Adults with MDD and ≥ 1 antidepressant claim within the first observed major depressive episode were identified in the MarketScan® Databases. Those initiating a new regimen after two regimens at adequate dose and duration were considered to have TRD. The index date was defined at TRD onset or on a random antidepressant claim among patients with non-TRD MDD. Pre-existing conditions 12 months pre-index and potential DDIs 3 months pre/post-index associated with specific non-antidepressant augmentation therapies, including atypical antipsychotics (APs), buspirone, psychostimulants, anticonvulsants, thyroid hormone, and lithium were compared between 1:1 matched TRD and non-TRD MDD cohorts. RESULTS Overall, 3414 patients with TRD and non-TRD MDD (mean age 39.7 years, 69% female) were matched. Relative to non-TRD MDD, patients with TRD had 33% higher likelihood of ≥ 1 pre-existing condition relevant for AEs listed in product labels of non-antidepressant augmentation therapies (p < 0.001). Patients with TRD vs. non-TRD MDD had 12.9 and 6.4 times higher likelihood of ≥ 2 and ≥ 3 DDIs, respectively, based on their medication regimen (all p < 0.001). CONCLUSION Pre-existing conditions relevant for listed AEs and potential DDIs limit safe augmentation options in MDD, particularly among patients with TRD. Payer prior authorization policies requiring several augmentation therapy trials to access novel treatments may complicate clinical management of this population.
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Affiliation(s)
- Maryia Zhdanava
- Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC, H3B 0G7, Canada.
| | - Swapna Karkare
- Real-World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Dominic Pilon
- Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - Kruti Joshi
- Real-World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Carmine Rossi
- Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - Laura Morrison
- Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - John Sheehan
- Real-World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Patrick Lefebvre
- Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - Oliver Lopena
- Real-World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
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