251
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DeLorenzo C, DellaGioia N, Bloch M, Sanacora G, Nabulsi N, Abdallah C, Yang J, Wen R, Mann JJ, Krystal JH, Parsey RV, Carson RE, Esterlis I. In vivo ketamine-induced changes in [¹¹C]ABP688 binding to metabotropic glutamate receptor subtype 5. Biol Psychiatry 2015; 77:266-275. [PMID: 25156701 PMCID: PMC4277907 DOI: 10.1016/j.biopsych.2014.06.024] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/17/2014] [Accepted: 06/23/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND At subanesthetic doses, ketamine, an N-methyl-D-aspartate glutamate receptor antagonist, increases glutamate release. We imaged the acute effect of ketamine on brain metabotropic glutamatergic receptor subtype 5 with a high-affinity positron emission tomography (PET) ligand [(11)C]ABP688 (E)-3-[2-(6-methyl-2-pyridinyl)ethynyl]-2-cyclohexen-1-one-O-(methyl-11C)oxime, a negative allosteric modulator of the metabotropic glutamatergic receptor subtype 5. METHODS Two [(11)C]ABP688 PET scans were performed in 10 healthy nonsmoking human volunteers (34 ± 13 years old); the two PET scans were performed on the same day-before (scan 1) and during intravenous ketamine administration (.23 mg/kg over 1 min, then .58 mg/kg over 1 hour; scan 2). The PET data were acquired for 90 min immediately after [(11)C]ABP688 bolus injection. Input functions were obtained through arterial blood sampling with metabolite analysis. RESULTS A significant reduction in [(11)C]ABP688 volume of distribution was observed in scan 2 relative to scan 1 of 21.3% ± 21.4%, on average, in the anterior cingulate, medial prefrontal cortex, orbital prefrontal cortex, ventral striatum, parietal lobe, dorsal putamen, dorsal caudate, amygdala, and hippocampus. There was a significant increase in measurements of dissociative state after ketamine initiation (p < .05), which resolved after completion of the scan. CONCLUSIONS This study provides first evidence that ketamine administration decreases [(11)C]ABP688 binding in vivo in human subjects. The results suggest that [(11)C]ABP688 binding is sensitive to ketamine-induced effects, although the high individual variation in ketamine response requires further examination.
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Affiliation(s)
- Christine DeLorenzo
- Departments of Psychiatry, Stony Brook University, Stony Brook, New York, New York; Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York, New York.
| | | | - Michael Bloch
- Department of Psychiatry, Diagnostic, Yale University,Department of Child Study Center, Yale University
| | | | | | - Chadi Abdallah
- Department of Psychiatry, Diagnostic, Yale University,Clinical Neuroscience Division, VA National Center for PTSD
| | - Jie Yang
- Department of Preventive Medicine, Stony Brook University
| | - Ruofeng Wen
- Department of Applied Mathematics and Statistics, Stony Brook University
| | | | - John H. Krystal
- Department of Psychiatry, Diagnostic, Yale University,Clinical Neuroscience Division, VA National Center for PTSD
| | - Ramin V. Parsey
- Department of Psychiatry, Stony Brook University,Department of Radiology, Stony Brook University
| | - Richard E. Carson
- Department of Radiology, Biomedical, Yale University,Department of Engineering, Yale University
| | - Irina Esterlis
- Department of Psychiatry, Diagnostic, Yale University,Department of Child Study Center, Yale University
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252
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Liu B, Wang G, Gao D, Gao F, Zhao B, Qiao M, Yang H, Yu Y, Ren F, Yang P, Chen W, Rae CD. Alterations of GABA and glutamate-glutamine levels in premenstrual dysphoric disorder: a 3T proton magnetic resonance spectroscopy study. Psychiatry Res 2015; 231:64-70. [PMID: 25465316 DOI: 10.1016/j.pscychresns.2014.10.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 10/13/2014] [Accepted: 10/27/2014] [Indexed: 12/18/2022]
Abstract
Increasing evidence has suggested that the GABAergic neurotransmitter system is involved in the pathogenesis of premenstrual dysphoric disorder (PMDD). We used proton magnetic resonance spectroscopy ((1)H MRS) to investigate whether PMDD is associated with alterations in brain GABA levels. Levels of glutamate-glutamine (Glx) were also explored. Participants comprised 22 women with PMDD and 22 age-matched healthy controls who underwent 3T (1)H MRS during the late luteal phase of the menstrual cycle. GABA+ and Glx levels were quantified in the anterior cingulate cortex/medial prefrontal cortex (ACC/mPFC) and the left basal ganglia (ltBG). Water-scaled GABA+ concentrations and GABA+/tCr ratios were significantly lower in both the ACC/mPFC and ltBG regions of PMDD women than in healthy controls. Glx/tCr ratios were significantly higher in the ACC/mPFC region of PMDD women than healthy controls. Our preliminary findings provide the first report of abnormal levels of GABA+ and Glx in mood-related brain regions of women with PMDD, indicating that dysregulation of the amino acid neurotransmitter system may be an important neurobiological mechanism in the pathogenesis of PMDD.
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Affiliation(s)
- Bo Liu
- Shandong Medical Imaging Research Institute, Shandong University, No. 324, Jingwu Road, 250021 Jinan, PR China
| | - Guangbin Wang
- Shandong Medical Imaging Research Institute, Shandong University, No. 324, Jingwu Road, 250021 Jinan, PR China
| | - Dongmei Gao
- Basic Medical College, Shandong University of Traditional Chinese Medicine, No. 44, Wenhua Xi Road, 250012 Jinan, PR China
| | - Fei Gao
- Shandong Medical Imaging Research Institute, Shandong University, No. 324, Jingwu Road, 250021 Jinan, PR China
| | - Bin Zhao
- Shandong Medical Imaging Research Institute, Shandong University, No. 324, Jingwu Road, 250021 Jinan, PR China.
| | - Mingqi Qiao
- Basic Medical College, Shandong University of Traditional Chinese Medicine, No. 44, Wenhua Xi Road, 250012 Jinan, PR China
| | - Huan Yang
- Shandong Medical Imaging Research Institute, Shandong University, No. 324, Jingwu Road, 250021 Jinan, PR China
| | - Yanhong Yu
- Basic Medical College, Shandong University of Traditional Chinese Medicine, No. 44, Wenhua Xi Road, 250012 Jinan, PR China
| | - Fuxin Ren
- Shandong Medical Imaging Research Institute, Shandong University, No. 324, Jingwu Road, 250021 Jinan, PR China
| | - Ping Yang
- Philips Healthcare, Shanghai, PR China
| | | | - Caroline D Rae
- Neuroscience Research Australia, Barker Street, Randwick, New South Wales 2031, Australia
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253
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Zanetti MV, Otaduy MC, de Sousa RT, Gattaz WF, Busatto GF, Leite CC, Machado-Vieira R. Bimodal effect of lithium plasma levels on hippocampal glutamate concentrations in bipolar II depression: a pilot study. Int J Neuropsychopharmacol 2015; 18:pyu058. [PMID: 25522399 PMCID: PMC4438538 DOI: 10.1093/ijnp/pyu058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 09/21/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The hippocampus has been highly implicated in the pathophysiology of bipolar disorder (BD). Nevertheless, no study has longitudinally evaluated hippocampal metabolite levels in bipolar depression under treatment with lithium. METHODS Nineteen medication-free BD patients (78.9% treatment-naïve and 73.7% with BD type II) presenting an acute depressive episode and 17 healthy controls were studied. Patients were treated for 6 weeks with lithium in an open-label trial. N-acetyl aspartate (NAA), creatine, choline, myo-Inositol, and glutamate levels were assessed in the left hippocampus before (week 0) and after (week 6) lithium treatment using 3T proton magnetic resonance spectroscopy (1H-MRS). The metabolite concentrations were estimated using internal water as reference and voxel segmentation for partial volume correction. RESULTS At baseline, acutely depressed BD patients and healthy controls exhibited similar hippocampal metabolites concentrations, with no changes after 6 weeks of lithium monotherapy. A significant correlation between antidepressant efficacy and increases in NAA concentration over time was observed. Also, there was a significant positive correlation between the changes in glutamate concentrations over follow-up and plasma lithium levels at endpoint. Mixed effects model analysis revealed a bimodal effect of lithium plasma levels in hippocampal glutamate concentrations: levels of 0.2 to 0.49 mmol/L (n=9) were associated with a decrease in glutamate concentrations, whereas the subgroup of BD subjects with "standard" lithium levels (≥ 0.50 mmol/L; n = 10) showed an overall increase in glutamate concentrations over time. CONCLUSIONS These preliminary results suggest that lithium has a bimodal action in hippocampal glutamate concentration depending on the plasma levels.
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Affiliation(s)
- Marcus V Zanetti
- Mood Disorders Program, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti, de Sousa, Gattaz, and Machado-Vieira); Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil (Drs Zanetti, Gattaz, Busatto, and Machado-Vieira); Laboratory of Psychiatric Neuroimaging, LIM-21, Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti and Busatto); Department of Radiology, University of Sao Paulo, Brazil (Drs Otaduy and Leite); Experimental Therapeutics and Pathophysiology Branch (ETPB), National Institute of Mental Health, NIH, Bethesda, MD (Dr Machado-Vieira).
| | - Maria C Otaduy
- Mood Disorders Program, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti, de Sousa, Gattaz, and Machado-Vieira); Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil (Drs Zanetti, Gattaz, Busatto, and Machado-Vieira); Laboratory of Psychiatric Neuroimaging, LIM-21, Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti and Busatto); Department of Radiology, University of Sao Paulo, Brazil (Drs Otaduy and Leite); Experimental Therapeutics and Pathophysiology Branch (ETPB), National Institute of Mental Health, NIH, Bethesda, MD (Dr Machado-Vieira)
| | - Rafael T de Sousa
- Mood Disorders Program, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti, de Sousa, Gattaz, and Machado-Vieira); Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil (Drs Zanetti, Gattaz, Busatto, and Machado-Vieira); Laboratory of Psychiatric Neuroimaging, LIM-21, Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti and Busatto); Department of Radiology, University of Sao Paulo, Brazil (Drs Otaduy and Leite); Experimental Therapeutics and Pathophysiology Branch (ETPB), National Institute of Mental Health, NIH, Bethesda, MD (Dr Machado-Vieira)
| | - Wagner F Gattaz
- Mood Disorders Program, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti, de Sousa, Gattaz, and Machado-Vieira); Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil (Drs Zanetti, Gattaz, Busatto, and Machado-Vieira); Laboratory of Psychiatric Neuroimaging, LIM-21, Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti and Busatto); Department of Radiology, University of Sao Paulo, Brazil (Drs Otaduy and Leite); Experimental Therapeutics and Pathophysiology Branch (ETPB), National Institute of Mental Health, NIH, Bethesda, MD (Dr Machado-Vieira)
| | - Geraldo F Busatto
- Mood Disorders Program, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti, de Sousa, Gattaz, and Machado-Vieira); Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil (Drs Zanetti, Gattaz, Busatto, and Machado-Vieira); Laboratory of Psychiatric Neuroimaging, LIM-21, Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti and Busatto); Department of Radiology, University of Sao Paulo, Brazil (Drs Otaduy and Leite); Experimental Therapeutics and Pathophysiology Branch (ETPB), National Institute of Mental Health, NIH, Bethesda, MD (Dr Machado-Vieira)
| | - Claudia C Leite
- Mood Disorders Program, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti, de Sousa, Gattaz, and Machado-Vieira); Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil (Drs Zanetti, Gattaz, Busatto, and Machado-Vieira); Laboratory of Psychiatric Neuroimaging, LIM-21, Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti and Busatto); Department of Radiology, University of Sao Paulo, Brazil (Drs Otaduy and Leite); Experimental Therapeutics and Pathophysiology Branch (ETPB), National Institute of Mental Health, NIH, Bethesda, MD (Dr Machado-Vieira)
| | - Rodrigo Machado-Vieira
- Mood Disorders Program, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti, de Sousa, Gattaz, and Machado-Vieira); Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil (Drs Zanetti, Gattaz, Busatto, and Machado-Vieira); Laboratory of Psychiatric Neuroimaging, LIM-21, Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti and Busatto); Department of Radiology, University of Sao Paulo, Brazil (Drs Otaduy and Leite); Experimental Therapeutics and Pathophysiology Branch (ETPB), National Institute of Mental Health, NIH, Bethesda, MD (Dr Machado-Vieira)
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254
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Pehrson AL, Sanchez C. Altered γ-aminobutyric acid neurotransmission in major depressive disorder: a critical review of the supporting evidence and the influence of serotonergic antidepressants. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:603-24. [PMID: 25653499 PMCID: PMC4307650 DOI: 10.2147/dddt.s62912] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Evidence suggesting that central nervous system γ-aminobutyric acid (GABA) concentrations are reduced in patients with major depressive disorder (MDD) has been present since at least 1980, and this idea has recently gained support from more recent magnetic resonance spectroscopy data. These observations have led to the assumption that MDD’s underlying etiology is tied to an overall reduction in GABA-mediated inhibitory neurotransmission. In this paper, we review the mechanisms that govern GABA and glutamate concentrations in the brain, and provide a comprehensive and critical evaluation of the clinical data supporting reduced GABA neurotransmission in MDD. This review includes an evaluation of magnetic resonance spectroscopy data, as well as data on the expression and function of the GABA-synthesizing enzyme glutamic acid decarboxylase, GABA neuron-specific cell markers, such as parvalbumin, calretinin and calbindin, and the GABAA and GABAB receptors in clinical MDD populations. We explore a potential role for glial pathology in MDD-related reductions in GABA concentrations, and evidence of a connection between neurosteroids, GABA neurotransmission, and hormone-related mood disorders. Additionally, we investigate the effects of GABAergic pharmacological agents on mood, and demonstrate that these compounds have complex effects that do not universally support the idea that reduced GABA neurotransmission is at the root of MDD. Finally, we discuss the connections between serotonergic and GABAergic neurotransmission, and show that two serotonin-focused antidepressants – the selective serotonin-reuptake inhibitor fluoxetine and the multimodal antidepressant vortioxetine – modulate GABA neurotransmission in opposing ways, despite both being effective MDD treatments. Altogether, this review demonstrates that there are large gaps in our understanding of the relationship between GABA physiology and MDD, which must be remedied with more data from well-controlled empirical studies. In conclusion, this review suggests that the simplistic notion that MDD is caused by reduced GABA neurotransmission must be discarded in favor of a more nuanced and complex model of the role of inhibitory neurotransmission in MDD.
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Affiliation(s)
- Alan L Pehrson
- External Sourcing and Scientific Excellence, Lundbeck Research USA, Paramus, NJ, USA
| | - Connie Sanchez
- External Sourcing and Scientific Excellence, Lundbeck Research USA, Paramus, NJ, USA
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255
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Neurochemistry of major depression: a study using magnetic resonance spectroscopy. Psychopharmacology (Berl) 2015; 232:501-7. [PMID: 25074444 PMCID: PMC4302231 DOI: 10.1007/s00213-014-3687-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 07/02/2014] [Indexed: 01/07/2023]
Abstract
RATIONALE Magnetic resonance spectroscopy (MRS) is an acceptable non-invasive means of studying brain neurochemistry in depression. Previous studies in depressed patients have focused on measurement of the amino acid neurotransmitters, γ-aminobutyric acid (GABA) and glutamate. OBJECTIVES The aim of this study is to use MRS in conjunction with the ultrashort echo time 'SPECIAL' technique to measure cortical levels of GABA, glutamate and glutathione (GSH) levels in unmedicated patients with major depression. We also examined the effect of 6-week treatment with the selective serotonin re-uptake inhibitor, escitalopram. METHODS We studied patients with DSM-IV major depression and healthy age-matched controls using proton MRS. GABA, glutamate and GSH were measured relative to creatine in a voxel placed in occipital cortex. RESULTS There was no difference in GABA or glutamate levels between depressed participants and controls; however, depressed patients had lower GSH levels. Six-week escitalopram treatment, which resulted in significant clinical responses in some patients, did not alter concentrations of GABA, glutamate or GSH. CONCLUSIONS The sources of variability of GABA and glutamate measures in different studies of depressed patients require further study. Our results suggest that concomitant treatment with selective serotonin re-uptake inhibitors (SSRIs) is unlikely to be an important confounding factor. If lowered GSH levels can be confirmed, they may represent the presence of oxidative stress in some depressed patients.
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256
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Brand SJ, Moller M, Harvey BH. A Review of Biomarkers in Mood and Psychotic Disorders: A Dissection of Clinical vs. Preclinical Correlates. Curr Neuropharmacol 2015; 13:324-68. [PMID: 26411964 PMCID: PMC4812797 DOI: 10.2174/1570159x13666150307004545] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 02/04/2015] [Accepted: 03/06/2015] [Indexed: 11/23/2022] Open
Abstract
Despite significant research efforts aimed at understanding the neurobiological underpinnings of mood (depression, bipolar disorder) and psychotic disorders, the diagnosis and evaluation of treatment of these disorders are still based solely on relatively subjective assessment of symptoms as well as psychometric evaluations. Therefore, biological markers aimed at improving the current classification of psychotic and mood-related disorders, and that will enable patients to be stratified on a biological basis into more homogeneous clinically distinct subgroups, are urgently needed. The attainment of this goal can be facilitated by identifying biomarkers that accurately reflect pathophysiologic processes in these disorders. This review postulates that the field of psychotic and mood disorder research has advanced sufficiently to develop biochemical hypotheses of the etiopathology of the particular illness and to target the same for more effective disease modifying therapy. This implies that a "one-size fits all" paradigm in the treatment of psychotic and mood disorders is not a viable approach, but that a customized regime based on individual biological abnormalities would pave the way forward to more effective treatment. In reviewing the clinical and preclinical literature, this paper discusses the most highly regarded pathophysiologic processes in mood and psychotic disorders, thereby providing a scaffold for the selection of suitable biomarkers for future studies in this field, to develope biomarker panels, as well as to improve diagnosis and to customize treatment regimens for better therapeutic outcomes.
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Affiliation(s)
| | | | - Brian H Harvey
- Division of Pharmacology and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University, Potchefstroom, South Africa.
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257
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Musazzi L, Treccani G, Popoli M. Functional and structural remodeling of glutamate synapses in prefrontal and frontal cortex induced by behavioral stress. Front Psychiatry 2015; 6:60. [PMID: 25964763 PMCID: PMC4410487 DOI: 10.3389/fpsyt.2015.00060] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 04/09/2015] [Indexed: 12/24/2022] Open
Abstract
Increasing evidence has shown that the pathophysiology of neuropsychiatric disorders, including mood disorders, is associated with abnormal function and regulation of the glutamatergic system. Consistently, preclinical studies on stress-based animal models of pathology showed that glucocorticoids and stress exert crucial effects on neuronal excitability and function, especially in cortical and limbic areas. In prefrontal and frontal cortex, acute stress was shown to induce enhancement of glutamate release/transmission dependent on activation of corticosterone receptors. Although the mechanisms whereby stress affects glutamate transmission have not yet been fully understood, it was shown that synaptic, non-genomic action of corticosterone is required to increase the readily releasable pool of glutamate vesicles, but is not sufficient to enhance transmission in prefrontal and frontal cortex. Slower, partly genomic mechanisms are probably necessary for the enhancement of glutamate transmission induced by stress. Combined evidence has suggested that the changes in glutamate release and transmission are responsible for the dendritic remodeling and morphological changes induced by stress and it has been argued that sustained alterations of glutamate transmission may play a key role in the long-term structural/functional changes associated with mood disorders in patients. Intriguingly, modifications of the glutamatergic system induced by stress in the prefrontal cortex seem to be biphasic. Indeed, while the fast response to stress suggests an enhancement in the number of excitatory synapses, synaptic transmission and working memory, long-term adaptive changes - including those consequent to chronic stress - induce opposite effects. Better knowledge of the cellular effectors involved in this biphasic effect of stress may be useful to understand the pathophysiology of stress-related disorders, and open new paths for the development of therapeutic approaches.
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Affiliation(s)
- Laura Musazzi
- Laboratory of Neuropsychopharmacology and Functional Neurogenomics, Dipartimento di Scienze Farmacologiche e Biomolecolari, Center of Excellence on Neurodegenerative Diseases (CEND), Università degli Studi di Milano , Milano , Italy
| | - Giulia Treccani
- Laboratory of Neuropsychopharmacology and Functional Neurogenomics, Dipartimento di Scienze Farmacologiche e Biomolecolari, Center of Excellence on Neurodegenerative Diseases (CEND), Università degli Studi di Milano , Milano , Italy ; Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University , Aarhus , Denmark
| | - Maurizio Popoli
- Laboratory of Neuropsychopharmacology and Functional Neurogenomics, Dipartimento di Scienze Farmacologiche e Biomolecolari, Center of Excellence on Neurodegenerative Diseases (CEND), Università degli Studi di Milano , Milano , Italy
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258
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Drewniany E, Han J, Hancock C, Jones RL, Lim J, Nemat Gorgani N, Sperry JK, Yu HJ, Raffa RB. Rapid-onset antidepressant action of ketamine: potential revolution in understanding and future pharmacologic treatment of depression. J Clin Pharm Ther 2014; 40:125-30. [PMID: 25545040 DOI: 10.1111/jcpt.12238] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 11/09/2014] [Indexed: 12/16/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The current pharmacotherapeutic treatment of major depressive disorder (MDD) generally takes weeks to be effective. As the molecular action of these drugs is immediate, the mechanistic basis for this lag is unclear. A drug that has a more rapid onset of action would be a major therapeutic advance and also be a useful comparator to provide valuable mechanistic insight into the disorder and its treatment. COMMENT Recent evidence suggests that ketamine produces rapid-onset antidepressant action. Important questions are as follows: is it specific or coincidental to other effects; is there a dose-response relationship; and is the mechanism related to that of current antidepressants. NMDA receptor antagonism is unlikely the explanation for ketamine's antidepressant action. WHAT IS NEW AND CONCLUSION It is not an exaggeration to state that the new findings, if validated, might produce a revolution in understanding and treating depressive disorders.
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Affiliation(s)
- E Drewniany
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA, USA
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259
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Naismith SL, Lagopoulos J, Hermens DF, White D, Duffy SL, Robillard R, Scott EM, Hickie IB. Delayed circadian phase is linked to glutamatergic functions in young people with affective disorders: a proton magnetic resonance spectroscopy study. BMC Psychiatry 2014; 14:345. [PMID: 25496061 PMCID: PMC4276104 DOI: 10.1186/s12888-014-0345-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 11/19/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND While the association between affective disorders and sleep and circadian disturbance is well established, little is known about the neurobiology underpinning these relationships. In this study, we sought to determine the relationship between a marker of circadian rhythm and neuronal integrity (N-Acetyl Aspartate, NAA), oxidative stress (glutathione, GSH) and neuronal-glial dysfunction (Glutamate + Glutamine, Glx). METHODS Fifty-three young adults (age range 15-33 years, mean = 21.8, sd = 4.3) with emerging affective disorders were recruited from a specialized tertiary referral service. Participants underwent clinical assessment and actigraphy monitoring, from which sleep midpoint was calculated as a marker of circadian rhythm. Proton magnetic resonance spectroscopy was performed in the anterior cingulate cortex (ACC). The metabolites NAA, GSH and Glx were obtained, and expressed as a ratio to Creatine. RESULTS Neither NAA or GSH were associated with sleep midpoint. However, higher levels of ACC Glx were associated with later sleep midpoints (rho = 0.35, p = 0.013). This relationship appeared to be independent of age and depression severity. CONCLUSIONS This study is the first to demonstrate that delayed circadian phase is related to altered glutamatergic processes. It is aligned with animal research linking circadian rhythms with glutamatergic neurotransmission as well as clinical studies showing changes in glutamate with sleep interventions. Further studies may seek to examine the role of glutamate modulators for circadian misalignment.
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Affiliation(s)
- Sharon L Naismith
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, NSW, 2050, Australia.
| | - Jim Lagopoulos
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, NSW, 2050, Australia.
| | - Daniel F Hermens
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, NSW, 2050, Australia.
| | - Django White
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, NSW, 2050, Australia.
| | - Shantel L Duffy
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, NSW, 2050, Australia.
| | - Rebecca Robillard
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, NSW, 2050, Australia.
| | - Elizabeth M Scott
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, NSW, 2050, Australia.
| | - Ian B Hickie
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, NSW, 2050, Australia.
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260
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Li M, Metzger CD, Li W, Safron A, van Tol MJ, Lord A, Krause AL, Borchardt V, Dou W, Genz A, Heinze HJ, He H, Walter M. Dissociation of glutamate and cortical thickness is restricted to regions subserving trait but not state markers in major depressive disorder. J Affect Disord 2014; 169:91-100. [PMID: 25173431 DOI: 10.1016/j.jad.2014.08.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 06/08/2014] [Accepted: 08/03/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND The anterior cingulate cortex (ACC) plays an important role in the neuropathology of major depressive disorder (MDD). So far, the effect of local cortical alteration on metabolites in multiple subdivisions of ACC has not been studied. We aimed to investigate structural and biochemical changes and their relationship in the pregenual ACC (pgACC), dorsal ACC (dACC) in MDD. METHODS We obtained magnetic resonance spectroscopy (MRS) in two investigated regions for 24 depressed patients and matched controls. In each region, cortical thickness (CTh) was calculated within a template mask based on its MRS voxel. We investigated neurotransmitter concentrations of Glx, N-acetyl aspartate (NAA), and myo-inositol (m-Ins) in two investigated regions, as well as their relationships with CTh in depressed individuals and healthy controls. RESULTS Patients showed significantly lower cortical thickness in dACC compared to controls. Glx in dACC significantly correlated with CTh in healthy controls but not MDD patients, while NAA and CTh in dACC significantly correlated in both groups. A marginal decrease of Glx in pgACC was found in the subgroup of more severely depressive patients, compared to the mildly depressed patients. LIMITATIONS Modest sample size and lack of episodes of depression may limit the generalizability of our findings. CONCLUSION Our results indicate an abolished CTh-MRS relation in dACC-associated with structural decline-but not in pgACC, where acute MRS alterations prevailed. Our study provides the first evidence of a neurochemical basis explaining some of the inter-individual variability in CTh in MDD.
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Affiliation(s)
- Meng Li
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Coraline D Metzger
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany; Center of Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany
| | - Wenjing Li
- State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China; College of Electronic and Control Engineering, Beijing University of Technology, Beijing, China
| | - Adam Safron
- Department of Psychology, Northwestern University, United States
| | - Marie-José van Tol
- Neuroimaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anton Lord
- Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Anna Linda Krause
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Weiqiang Dou
- Biomedical Magnetic Resonance, Otto-von-Guericke University, Magdeburg, Germany
| | - Axel Genz
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; Center of Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany
| | - Huiguang He
- State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China.
| | - Martin Walter
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany; State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China; Leibniz Institute for Neurobiology, Magdeburg, Germany; Center of Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany.
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261
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Zhong S, Wang Y, Zhao G, Xiang Q, Ling X, Liu S, Huang L, Jia Y. Similarities of biochemical abnormalities between major depressive disorder and bipolar depression: a proton magnetic resonance spectroscopy study. J Affect Disord 2014; 168:380-6. [PMID: 25106035 DOI: 10.1016/j.jad.2014.07.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Depression in the context of bipolar disorder (BD) is often misdiagnosed as major depressive disorder (MDD), leading to mistreatments and poor clinical outcomes for many bipolar patients. Previous neuroimaging studies found mixed results on brain structure, and biochemical metabolism of the two disorders. To eliminate the compounding effects of medication, and aging, this study sought to investigate the brain biochemical changes of treatment-naïve, non-late-life patients with MDD and BD in white matter in prefrontal (WMP) lobe, anterior cingulate cortex (ACC) and hippocampus by using proton magnetic resonance spectroscopy ((1)H-MRS). METHODS Three groups of participants were recruited: 26 MDD patients, 20 depressed BD patients, and 13 healthy controls. The multi-voxel (1)H-MRS [repetition time (TR)=1000ms; echo-time (TE)=144ms] was used for the measurement of N-acetylaspartate(NAA), choline containg compounds (Cho), and creatine (Cr) in three brain locations: white matter in prefrontal (WMP) lobe, anterior cingulate cortex (ACC), and hippocampus. Two ratios of NAA/Cr and Cho/Cr as a measure of brain biochemical changes were compared among three experimental groups. RESULTS On the comparison of brain biochemical changes, both MDD patients and BD patients showed many similarities compared to the controls. They both had a significantly lower NAA/Cr ratio in the left WMP lobe. There were no significant differences among three experimental groups for Cho/Cr ratio in the WMP lobe, and for the ratios of NAA/Cr and Cho/Cr in the bilateral ACC and hippocampus. The only difference between MDD and BD patients existed for the NAA/Cr ratio in the right WMP lobe. While MDD patients had a significantly lower NAA/Cr ratio than controls, BD patients showed no such differences. On the comparison of correlation of medical variables and brain biochemical changes, all participants demonstrated no significant correlations. CONCLUSION Reduced NAA/Cr ratio at the left WMP lobe indicated the dysfunction of neuronal viability in deep white matter, in both MDD and BD patients who shared similarities of brain biochemical abnormalities, which might imply an overlap in neuropathology of depression.
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Affiliation(s)
- Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Guoxiang Zhao
- Department of Science and Education, Guangdong Emergency Hospital, Guangzhou 510316, China
| | - Qi Xiang
- Institute of Biomedicine, Jinan University, Guangzhou 510630, China
| | - Xueying Ling
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Sirun Liu
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Li Huang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
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262
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Lin K, Xu G, Lu W, Ouyang H, Dang Y, Lorenzo-Seva U, Guo Y, Bessonov D, Akiskal HS, So KF, Lee TMC. Neuropsychological performance in melancholic, atypical and undifferentiated major depression during depressed and remitted states: a prospective longitudinal study. J Affect Disord 2014; 168:184-91. [PMID: 25061955 DOI: 10.1016/j.jad.2014.06.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 06/05/2014] [Accepted: 06/24/2014] [Indexed: 01/26/2023]
Abstract
BACKGROUND Considerable evidence has demonstrated that melancholic and atypical major depression have distinct biological correlates relative to undifferentiated major depression, but few studies have specifically delineated neuropsychological performance for them. METHOD In a six-week prospective longitudinal study, we simultaneously compared neuropsychological performance among melancholic depression (n=142), atypical depression (n=76), undifferentiated major depression (n=91), and healthy controls (n=200) during a major depressive episode and a clinically remitted state, respectively. We administered neuropsychological tests assessing processing speed, attention, shifting, planning, verbal fluency, visual spatial memory, and verbal working memory to all participants. RESULTS During the depressive state, the three subtypes displayed extensive cognitive impairment, except for attention, when compared with the healthy controls. Melancholic depression significantly differed from atypical depression in processing speed and verbal fluency. In the remitted state, the three subtypes recovered their visual spatial memory and verbal working memory functions to the healthy control level. The recovery of the other domains (processing speed, set shifting, planning, and verbal fluency), however, was different across the subtypes. No predictive relationship existed between neuropsychological performance and the treatment outcome. LIMITATIONS The drop-out rate in the six-week longitudinal study was relatively high. CONCLUSION Our data provide preliminary evidence that during depressed states the three major depressive subtypes display similar cognitive deficits in some domains but differ in such domains as processing speed and verbal fluency. The recovery of the cognitive deficits following clinical remission from depression may be associated with subtypes of major depressive disorder.
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Affiliation(s)
- Kangguang Lin
- Department of Psychiatry, Guangzhou Psychiatric Hospital, 36 Mingxin Road, Fangcun district, Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou 510370, China; Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong; Laboratory of Cognitive Affective Neuroscience, The University of Hong Kong, Hong Kong
| | - Guiyun Xu
- Department of Psychiatry, Guangzhou Psychiatric Hospital, 36 Mingxin Road, Fangcun district, Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou 510370, China.
| | - Weicong Lu
- Department of Psychiatry, Guangzhou Psychiatric Hospital, 36 Mingxin Road, Fangcun district, Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou 510370, China
| | - Huiyi Ouyang
- Department of Psychiatry, Guangzhou Psychiatric Hospital, 36 Mingxin Road, Fangcun district, Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou 510370, China
| | - Yamei Dang
- Department of Psychiatry, Guangzhou Psychiatric Hospital, 36 Mingxin Road, Fangcun district, Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou 510370, China
| | - Urbano Lorenzo-Seva
- Research Centre for Behavioral Assessment, Department of Psychology, Rovira i Virgili University, Tarragona, Spain
| | - Yangbo Guo
- Department of Psychiatry, Guangzhou Psychiatric Hospital, 36 Mingxin Road, Fangcun district, Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou 510370, China
| | - Daniel Bessonov
- International Mood Center, University of California at San Diego, La Jolla, USA
| | - Hagop S Akiskal
- International Mood Center, University of California at San Diego, La Jolla, USA
| | - Kwok-Fai So
- Department of Ophthalmology, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong; GMH Institute of CNS Regeneration, Jinan University, Guangzhou, China
| | - Tatia M C Lee
- Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong; Laboratory of Cognitive Affective Neuroscience, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong; Institute of Clinical Neuropsychology, The University of Hong Kong, Hong Kong.
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263
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Mannie ZN, Filippini N, Williams C, Near J, Mackay CE, Cowen PJ. Structural and functional imaging of the hippocampus in young people at familial risk of depression. Psychol Med 2014; 44:2939-2948. [PMID: 25066547 DOI: 10.1017/s0033291714000580] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Major depression is associated with abnormalities in the function and structure of the hippocampus. However, it is unclear whether these abnormalities might also be present in people 'at risk' of illness. METHOD We studied 62 young people (mean age 18.8 years) at familial risk of depression (FH+) but who had never been depressed themselves. Participants underwent magnetic resonance imaging to assess hippocampal structure and neural responses to a task designed to activate hippocampal memory networks. Magnetic resonance spectroscopy was used to measure levels of a combination of glutamine and glutamate (Glx) in the right hippocampus. A total of 59 matched controls with no history of mood disorder in a first-degree relative underwent the same investigations. RESULTS Hippocampal volume did not differ between FH+ participants and controls; however, relative to controls, during the memory task, FH+ participants showed increased activation in brain regions encompassing the insular cortices, putamen and pallidum as well as the dorsal anterior cingulate cortex (ACC). FH+ participants also had increased hippocampal levels of Glx. CONCLUSIONS Euthymic individuals with a parental history of depression demonstrate increased activation of hippocampal-related neural networks during a memory task, particularly in brain regions involved in processing the salience of stimuli. Changes in the activity of the ACC replicate previous findings in FH+ participants using different psychological tasks; this suggests that task-related abnormalities in the ACC may be a marker of vulnerability to depression. Increased levels of Glx in the hippocampus might also represent a risk biomarker but follow-up studies will be required to test these various possibilities.
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Affiliation(s)
- Z N Mannie
- University Department of Psychiatry,Warneford Hospital, Oxford OX3 7JX,UK
| | - N Filippini
- University Department of Psychiatry,Warneford Hospital, Oxford OX3 7JX,UK
| | - C Williams
- University Department of Psychiatry,Warneford Hospital, Oxford OX3 7JX,UK
| | - J Near
- University Department of Psychiatry,Warneford Hospital, Oxford OX3 7JX,UK
| | - C E Mackay
- University Department of Psychiatry,Warneford Hospital, Oxford OX3 7JX,UK
| | - P J Cowen
- University Department of Psychiatry,Warneford Hospital, Oxford OX3 7JX,UK
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264
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Anti-anhedonic effect of ketamine and its neural correlates in treatment-resistant bipolar depression. Transl Psychiatry 2014; 4:e469. [PMID: 25313512 PMCID: PMC4350513 DOI: 10.1038/tp.2014.105] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 07/14/2014] [Accepted: 08/13/2014] [Indexed: 02/06/2023] Open
Abstract
Anhedonia--which is defined as diminished pleasure from, or interest in, previously rewarding activities-is one of two cardinal symptoms of a major depressive episode. However, evidence suggests that standard treatments for depression do little to alleviate the symptoms of anhedonia and may cause reward blunting. Indeed, no therapeutics are currently approved for the treatment of anhedonia. Notably, over half of patients diagnosed with bipolar disorder experience significant levels of anhedonia during a depressive episode. Recent research into novel and rapid-acting therapeutics for depression, particularly the noncompetitive N-Methyl-D-aspartate receptor antagonist ketamine, has highlighted the role of the glutamatergic system in the treatment of depression; however, it is unknown whether ketamine specifically improves anhedonic symptoms. The present study used a randomized, placebo-controlled, double-blind crossover design to examine whether a single ketamine infusion could reduce anhedonia levels in 36 patients with treatment-resistant bipolar depression. The study also used positron emission tomography imaging in a subset of patients to explore the neurobiological mechanisms underpinning ketamine's anti-anhedonic effects. We found that ketamine rapidly reduced the levels of anhedonia. Furthermore, this reduction occurred independently from reductions in general depressive symptoms. Anti-anhedonic effects were specifically related to increased glucose metabolism in the dorsal anterior cingulate cortex and putamen. Our study emphasizes the importance of the glutamatergic system in treatment-refractory bipolar depression, particularly in the treatment of symptoms such as anhedonia.
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265
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Niciu MJ, Henter ID, Luckenbaugh DA, Zarate CA, Charney DS. Glutamate receptor antagonists as fast-acting therapeutic alternatives for the treatment of depression: ketamine and other compounds. Annu Rev Pharmacol Toxicol 2014; 54:119-39. [PMID: 24392693 DOI: 10.1146/annurev-pharmtox-011613-135950] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The N-methyl-D-aspartate (NMDA) receptor antagonist ketamine has rapid and potent antidepressant effects in treatment-resistant major depressive disorder and bipolar depression. These effects are in direct contrast to the more modest effects seen after weeks of treatment with classic monoaminergic antidepressants. Numerous open-label and case studies similarly validate ketamine's antidepressant properties. These clinical findings have been reverse-translated into preclinical models in an effort to elucidate ketamine's antidepressant mechanism of action, and three important targets have been identified: mammalian target of rapamycin (mTOR), eukaryotic elongation factor 2 (eEF2), and glycogen synthase kinase-3 (GSK-3). Current clinical and preclinical research is focused on (a) prolonging/maintaining ketamine's antidepressant effects, (b) developing more selective NMDA receptor antagonists free of ketamine's adverse effects, and (c) identifying predictor, mediator/moderator, and treatment response biomarkers of ketamine's antidepressant effects.
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Affiliation(s)
- Mark J Niciu
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institutes of Health/National Institute of Mental Health, Bethesda, Maryland 20814-9692;
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266
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Alterations in BDNF (brain derived neurotrophic factor) and GDNF (glial cell line-derived neurotrophic factor) serum levels in bipolar disorder: The role of lithium. J Affect Disord 2014; 166:193-200. [PMID: 25012431 DOI: 10.1016/j.jad.2014.05.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 05/08/2014] [Accepted: 05/09/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Brain-derived neurotrophic factor (BDNF) has been consistently reported to be decreased in mania or depression in bipolar disorders. Evidence suggests that Glial cell line-derived neurotrophic factor (GDNF) has a role in the pathogenesis of mood disorders. Whether GDNF and BDNF act in the same way across different episodes in bipolar disorders is unclear. METHOD BDNF and GDNF serum levels were measured simultaneously by enzyme-linked immunosorbent assay (ELISA) method in 96 patients diagnosed with bipolar disorder according to DSM-IV (37 euthymic, 33 manic, 26 depressed) in comparison to 61 healthy volunteers. SCID- I and SCID-non patient version were used for clinical evaluation of the patients and healthy volunteers respectively. Correlations between the two trophic factor levels, and medication dose, duration and serum levels of lithium or valproate were studied across different episodes of illness. RESULTS Patients had significantly lower BDNF levels during mania and depression compared to euthymic patients and healthy controls. GDNF levels were not distinctive. However GDNF/BDNF ratio was higher in manic state compared to euthymia and healthy controls. Significant negative correlation was observed between BDNF and GDNF levels in euthymic patients. While BDNF levels correlated positively, GDNF levels correlated negatively with lithium levels. Regression analysis confirmed that lithium levels predicted only GDNF levels positively in mania, and negatively in euthymia. LIMITATIONS Small sample size in different episodes and drug-free patients was the limitation of thestudy. CONCLUSION Current data suggests that lithium exerts its therapeutic action by an inverse effect on BDNF and GDNF levels, possibly by up-regulating BDNF and down-regulating GDNF to achieve euthymia.
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267
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Characterisation of the antidepressant properties of nitric oxide synthase inhibitors in the olfactory bulbectomised rat model of depression. Eur Neuropsychopharmacol 2014; 24:1349-61. [PMID: 24931298 DOI: 10.1016/j.euroneuro.2014.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 04/11/2014] [Accepted: 05/09/2014] [Indexed: 02/05/2023]
Abstract
Nitric oxide synthase (NOS) inhibitors possess antidepressant-like properties in preclinical tests and in the current investigation the brain penetrant NOS inhibitor N(ω)-nitro-L-arginine (l-NA) and the preferential inhibitor of neuronal NOS (nNOS) 1-(2-trifluoromethylphenyl) imidazole (TRIM) were assessed in the olfactory bulbectomised (OB) rat, a well-established animal model of depression. Magnetic resonance imaging (MRI) was employed to assess regional brain volumes, blood perfusion and T1 and T2 relaxometry times both with and without drug treatment. l-NA (10 mg/kg, once daily p.o. for 10 days) attenuated OB-related hyperactivity in the "open field" test in a comparable fashion to the tricyclic antidepressant imipramine (20 mg/kg, once daily p.o. for 14 days) indicative of an antidepressant-like response in the model. Treatment with TRIM (50 mg/kg, once daily s.c.) attenuated OB-related hyperactivity following 7 days of treatment when compared to vehicle treated controls. OB is associated with enlarged ventricular volume, increased periventicular perfusion and a decrease in T2 relaxation times in cortical and hippocampal regions, with enhanced perfusion and reduced T2 times attenuated by L-NA treatment. L-NA treatment was also associated with an increase in T1 relaxation times in limbic and cortical regions and found to reduce resting state hippocampal blood perfusion in OB animals. Behavioural observations are consistent with an antidepressant action of NOS inhibitors where associated changes in perfusion and T2 relaxation times may be related to the antidepressant action of L-NA in the model.
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268
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van Tol MJ, Li M, Metzger CD, Hailla N, Horn DI, Li W, Heinze HJ, Bogerts B, Steiner J, He H, Walter M. Local cortical thinning links to resting-state disconnectivity in major depressive disorder. Psychol Med 2014; 44:2053-2065. [PMID: 24176247 DOI: 10.1017/s0033291713002742] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Local structural and metabolic as well as inter-regional connectivity abnormalities have been implicated in the neuropathology of major depressive disorder (MDD). How local tissue properties affect intrinsic functional connectivity is, however, unclear. Using a cross-sectional, multi-modal imaging approach, we investigated the relationship between local cortical tissue abnormalities and intrinsic resting-state functional connectivity (RSFC) in MDD. METHOD A total of 20 MDD in-patients and 20 healthy controls underwent magnetic resonance imaging at 3 T for structural and functional imaging. Whole-brain cortical thickness was calculated and compared between groups. Regions with reduced cortical thickness defined seeds for subsequent whole-brain RSFC analyses. Contributions of structural tissue abnormalities on inter-regional RSFC were explicitly investigated. RESULTS Lower cortical thickness was observed in MDD in the right dorsomedial prefrontal cortex (PFC), superior temporal gyrus/temporal pole, middle-posterior cingulate cortex, and dorsolateral PFC. No differences in local fractional amplitude of low-frequency fluctuations were observed. Lower thickness in patients' dorsomedial PFC further directly and selectively affected its RSFC with the precuneus, which was unaffected by symptom severity. No effects of cortical thickness in other regions showing abnormal thickness were observed to influence functional connectivity. CONCLUSIONS Abnormal cortical thickness in the dorsomedial PFC in MDD patients was observed to selectively and directly affect its intrinsic connectivity with the precuneus in MDD patients independent of depression severity, thereby marking a potential vulnerability for maladaptive mood regulation. Future studies should include an unmedicated sample and replicate findings using independent component analysis to test for morphometric effects on network integrity.
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Affiliation(s)
- M-J van Tol
- NeuroImaging Center,University Medical Center Groningen, University of Groningen,Groningen,The Netherlands
| | - M Li
- Leibniz Institute for Neurobiology, Magdeburg,Germany
| | - C D Metzger
- Leibniz Institute for Neurobiology, Magdeburg,Germany
| | - N Hailla
- Clinical Affective Neuroimaging Laboratory,Center for Behavioral Brain Sciences,Magdeburg,Germany
| | - D I Horn
- Clinical Affective Neuroimaging Laboratory,Center for Behavioral Brain Sciences,Magdeburg,Germany
| | - W Li
- Leibniz Institute for Neurobiology, Magdeburg,Germany
| | - H J Heinze
- Leibniz Institute for Neurobiology, Magdeburg,Germany
| | - B Bogerts
- Department of Psychiatry and Psychotherapy,Otto von Guericke University,Magdeburg,Germany
| | - J Steiner
- Department of Psychiatry and Psychotherapy,Otto von Guericke University,Magdeburg,Germany
| | - H He
- State Key Laboratory of Management and Control for Complex Systems, Institute of Automation,Chinese Academy of Sciences,Beijing,People's Republic of China
| | - M Walter
- Leibniz Institute for Neurobiology, Magdeburg,Germany
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269
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Bustillo JR. Use of proton magnetic resonance spectroscopy in the treatment of psychiatric disorders: a critical update. DIALOGUES IN CLINICAL NEUROSCIENCE 2014. [PMID: 24174904 PMCID: PMC3811104 DOI: 10.31887/dcns.2013.15.3/jbustillo] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Because of the wide availability of hardware as well as of standardized analytic quantification tools, proton magnetic resonance spectroscopy ((1)H-MRS) has become widely used to study psychiatric disorders. (1)H-MRS allows measurement of brain concentrations of more traditional singlet neurometabolites like N-acetylaspartate, choline, and creatine. More recently, quantification of the more complex multiplet spectra for glutamate, glutamine, inositol, and γ-aminobutyric acid have also been implemented. Here we review applications of (1)H-MRS in terms of informing treatment options in schizophrenia, bipolar disorder, and major depressive disorders. We first discuss recent meta-analytic studies reporting the most reliable findings. Then we evaluate the more sparse literature focused on 1H-MRS-detected neurometabolic effects of various treatment approaches in psychiatric populations. Finally we speculate on future developments that may result in translation of these tools to improve the treatment of psychiatric disorders.
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Affiliation(s)
- Juan R Bustillo
- Departments of Psychiatry and Neuroscience, University of New Mexico, Albuquerque, New Mexico, USA
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270
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Strawn JR, Chu WJ, Whitsel RM, Weber WA, Norris MM, Adler CM, Eliassen JC, Phan KL, Strakowski SM, DelBello MP. A pilot study of anterior cingulate cortex neurochemistry in adolescents with generalized anxiety disorder. Neuropsychobiology 2014; 67:224-9. [PMID: 23635944 DOI: 10.1159/000347090] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 02/12/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND/AIMS This study used proton magnetic resonance spectroscopy (¹H MRS) to evaluate the neurochemistry of the anterior cingulate cortex (ACC) in adolescents with generalized anxiety disorder (GAD). METHODS Adolescents with GAD (n = 10) and healthy subjects (n = 10) underwent a ¹H MRS scan at 4 T. Glutamate (Glu), N-acetyl aspartate, creatine (Cr) and myo-inositol concentrations were measured in the ACC and were compared between untreated adolescents with GAD and age- and sex-matched healthy subjects. RESULTS Glu/Cr ratios in the ACC correlated with the severity of both generalized anxiety symptoms on the Pediatric Anxiety Rating Scale and with total anxiety symptom severity as measured by the Hamilton Anxiety Rating Scale, but did not differ between adolescents with GAD and healthy subjects. In addition, no differences in N-acetyl aspartate, Cr, or myo-inositol were detected between groups. CONCLUSION These findings suggest that Glu/Cr in untreated adolescents with GAD may relate to the severity of anxiety symptoms and raise the possibility that dysregulation of Glu within the ACC may be linked to the pathophysiology of pediatric GAD.
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Affiliation(s)
- Jeffrey R Strawn
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA.
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Najjar S, Pearlman DM, Hirsch S, Friedman K, Strange J, Reidy J, Khoukaz M, Ferrell RB, Devinsky O, Najjar A, Zagzag D. Brain biopsy findings link major depressive disorder to neuroinflammation, oxidative stress, and neurovascular dysfunction: a case report. Biol Psychiatry 2014; 75:e23-6. [PMID: 24075735 DOI: 10.1016/j.biopsych.2013.07.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 07/20/2013] [Accepted: 07/24/2013] [Indexed: 12/22/2022]
Affiliation(s)
- Souhel Najjar
- Department of Neurology, New York University School of Medicine; Department of Medicine, Section of Neurology, Staten Island University Hospital, New York, New York.
| | - Daniel M Pearlman
- Department of Neurology, New York University School of Medicine; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
| | - Scott Hirsch
- Department of Neurology, New York University School of Medicine
| | - Kent Friedman
- Department of Radiology, Division of Nuclear Medicine, NYU School of Medicine
| | - John Strange
- Department of Medicine, Section of Neurology, Staten Island University Hospital, New York, New York
| | - Jason Reidy
- Electron Microscopy Laboratory, Beth Israel Medical Center, New York, New York
| | - Maya Khoukaz
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Richard B Ferrell
- Department of Psychiatry, Section of Neuropsychiatry, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Orrin Devinsky
- Department of Neurology, New York University School of Medicine
| | | | - David Zagzag
- Department of Pathology, Division of Neuropathology; Department of Neurosurgery, New York University School of Medicine, New York, New York
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272
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Krystal JH, State MW. Psychiatric disorders: diagnosis to therapy. Cell 2014; 157:201-14. [PMID: 24679536 DOI: 10.1016/j.cell.2014.02.042] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/14/2014] [Accepted: 02/24/2014] [Indexed: 12/13/2022]
Abstract
Recent findings in a range of scientific disciplines are challenging the conventional wisdom regarding the etiology, classification, and treatment of psychiatric disorders. This Review focuses on the current state of the psychiatric diagnostic nosology and recent progress in three areas: genomics, neuroimaging, and therapeutics development. The accelerating pace of novel and unexpected findings is transforming the understanding of mental illness and represents a hopeful sign that the approaches and models that have sustained the field for the past 40 years are yielding to a flood of new data and presaging the emergence of a new and more powerful scientific paradigm.
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Affiliation(s)
- John H Krystal
- Departments of Psychiatry and Neurobiology, Yale University School of Medicine, New Haven, CT 06510, USA; VA National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT 06516, USA.
| | - Matthew W State
- Department of Psychiatry and Langley Porter Psychiatric Institute, University of California, San Francisco, San Francisco, CA 94143, USA.
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273
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Kondo DG, Hellem TL, Shi XF, Sung YH, Prescot AP, Kim TS, Huber RS, Forrest LN, Renshaw PF. A review of MR spectroscopy studies of pediatric bipolar disorder. AJNR Am J Neuroradiol 2014; 35:S64-80. [PMID: 24557702 DOI: 10.3174/ajnr.a3844] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pediatric bipolar disorder is a severe mental illness whose pathophysiology is poorly understood and for which there is an urgent need for improved diagnosis and treatment. MR spectroscopy is a neuroimaging method capable of in vivo measurement of neurochemicals relevant to bipolar disorder neurobiology. MR spectroscopy studies of adult bipolar disorder provide consistent evidence for alterations in the glutamate system and mitochondrial function. In bipolar disorder, these 2 phenomena may be linked because 85% of glucose in the brain is consumed by glutamatergic neurotransmission and the conversion of glutamate to glutamine. The purpose of this article is to review the MR spectroscopic imaging literature in pediatric bipolar disorder, at-risk samples, and severe mood dysregulation, with a focus on the published findings that are relevant to glutamatergic and mitochondrial functioning. Potential directions for future MR spectroscopy studies of the glutamate system and mitochondrial dysfunction in pediatric bipolar disorder are discussed.
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Affiliation(s)
- D G Kondo
- From The Brain Institute (D.G.K., T.L.H., X.F.S., Y.H.S., A.P.P., R.S.H., L.N.F., P.F.R), University of Utah, Salt Lake City, UtahDepartments of Psychiatry (D.G.K., X.F.S., Y.H.S., P.F.R.)
| | - T L Hellem
- From The Brain Institute (D.G.K., T.L.H., X.F.S., Y.H.S., A.P.P., R.S.H., L.N.F., P.F.R), University of Utah, Salt Lake City, Utah
| | - X-F Shi
- From The Brain Institute (D.G.K., T.L.H., X.F.S., Y.H.S., A.P.P., R.S.H., L.N.F., P.F.R), University of Utah, Salt Lake City, UtahDepartments of Psychiatry (D.G.K., X.F.S., Y.H.S., P.F.R.)
| | - Y H Sung
- From The Brain Institute (D.G.K., T.L.H., X.F.S., Y.H.S., A.P.P., R.S.H., L.N.F., P.F.R), University of Utah, Salt Lake City, UtahDepartments of Psychiatry (D.G.K., X.F.S., Y.H.S., P.F.R.)
| | - A P Prescot
- From The Brain Institute (D.G.K., T.L.H., X.F.S., Y.H.S., A.P.P., R.S.H., L.N.F., P.F.R), University of Utah, Salt Lake City, UtahRadiology (A.P.P.), University of Utah School of Medicine, Salt Lake City, Utah
| | - T S Kim
- and Department of Psychiatry (T.S.K.), Catholic University of Korea Graduate School of Medicine, Seoul, Republic of Korea
| | - R S Huber
- From The Brain Institute (D.G.K., T.L.H., X.F.S., Y.H.S., A.P.P., R.S.H., L.N.F., P.F.R), University of Utah, Salt Lake City, Utah
| | - L N Forrest
- From The Brain Institute (D.G.K., T.L.H., X.F.S., Y.H.S., A.P.P., R.S.H., L.N.F., P.F.R), University of Utah, Salt Lake City, Utah
| | - P F Renshaw
- From The Brain Institute (D.G.K., T.L.H., X.F.S., Y.H.S., A.P.P., R.S.H., L.N.F., P.F.R), University of Utah, Salt Lake City, UtahDepartments of Psychiatry (D.G.K., X.F.S., Y.H.S., P.F.R.)Veterans Integrated Service Network 19 Mental Illness Research (P.F.R.), Education and Clinical Center, VA Salt Lake City Health Care System, Salt Lake City, Utah
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274
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Abstract
Molecular imaging is the visualization, characterization, and measurement of biologic processes at the molecular and cellular levels in humans and other living systems. Molecular imaging techniques such as MR spectroscopy and PET have been used to explore the molecular pathophysiology of depression and assess treatment responses. MR spectroscopy is a noninvasive technique that assesses the levels of biochemical metabolites in the brain, while PET uses radioligands injected in the bloodstream that have high binding affinity for target molecules. MR spectroscopy findings suggest a role for glutamate/glutamine and gamma-aminobutyric acid in depression. PET has generally failed to find a correlation between radioligand binding potential and depression severity or treatment response, though it may offer promise in distinguishing responders and nonresponders to treatment. A major challenge for both modalities is that depression is a heterogeneous, multifactorial disorder, while MR spectroscopy and PET are limited to examining a few metabolites or a single radioligand at a time. This difference makes a comprehensive evaluation of neurochemical changes in the brain difficult.
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Affiliation(s)
- T-S Lee
- From the Duke-National University of Singapore Graduate Medical School, Singapore.
| | - S Y Quek
- From the Duke-National University of Singapore Graduate Medical School, Singapore
| | - K R R Krishnan
- From the Duke-National University of Singapore Graduate Medical School, Singapore
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275
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IFN-alpha-induced cortical and subcortical glutamate changes assessed by magnetic resonance spectroscopy. Neuropsychopharmacology 2014; 39:1777-85. [PMID: 24481242 PMCID: PMC4023151 DOI: 10.1038/npp.2014.25] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 01/19/2014] [Accepted: 01/21/2014] [Indexed: 12/16/2022]
Abstract
Cytokine effects on behavior may be related to alterations in glutamate metabolism. We therefore measured glutamate concentrations in brain regions shown to be affected by inflammatory stimuli including the cytokine interferon (IFN)-alpha. IFN-alpha is known to alter neural activity in the dorsal anterior cingulate cortex (dACC) and basal ganglia in association with symptoms of depression and increases in peripheral cytokines including the tumor necrosis factor (TNF) and its soluble receptor. Single-voxel magnetic resonance spectroscopy (MRS) was employed to measure glutamate concentrations normalized to creatine (Glu/Cr) in dACC and basal ganglia of 31 patients with hepatitis C before and after ∼ 1 month of either no treatment (n = 14) or treatment with IFN-alpha (n = 17). Depressive symptoms were measured at each visit using the Inventory of Depressive Symptoms-Clinician Rating (IDS-C) and the Multidimensional Fatigue Inventory. IFN-alpha was associated with a significant increase in Glu/Cr in dACC and left basal ganglia. Increases in dACC Glu/Cr were positively correlated with scores on the IDS-C in the group as a whole, but not in either group alone. Glu/Cr increases in left basal ganglia were correlated with decreased motivation in the group as a whole and in IFN-alpha-treated subjects alone. No Glu/Cr changes were found in the right basal ganglia, and no significant correlations were found between Glu/Cr and the inflammatory markers. IFN-alpha-induced increases in glutamate in dACC and basal ganglia are consistent with MRS findings in bipolar depression and suggest that inflammatory cytokines may contribute to glutamate alterations in patients with mood disorders and increased inflammation.
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276
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Niciu MJ, Luckenbaugh DA, Ionescu DF, Guevara S, Machado-Vieira R, Richards EM, Brutsche NE, Nolan NM, Zarate CA. Clinical predictors of ketamine response in treatment-resistant major depression. J Clin Psychiatry 2014; 75:e417-23. [PMID: 24922494 PMCID: PMC4310499 DOI: 10.4088/jcp.13m08698] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/07/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The N-methyl-D-aspartate receptor antagonist ketamine has rapid antidepressant effects in treatment-resistant major depressive disorder (MDD) and bipolar depression. Clinical predictors may identify those more likely to benefit from ketamine within clinically heterogeneous populations. METHOD Data were analyzed from 4 studies of treatment-resistant inpatients with DSM-IV-TR-diagnosed MDD or bipolar I or II depression. Patients who were currently experiencing a moderate-to-severe major depressive episode were enrolled between November 2004 and March 2013. All subjects received a single subanesthetic (0.5 mg/kg) ketamine infusion over 40 minutes. Patients were analyzed at the 230-minute postinfusion time point (n = 108), at day 1 (n = 82), and at day 7 (n = 71). Univariate Pearson correlations were performed for each variable with percent change from baseline in the 17-item Hamilton Depression Rating Scale (HDRS). Multivariate linear regression was then conducted for statistically significant predictors (P ≤ .05, 2-tailed). RESULTS Higher body mass index correlated with greater HDRS improvement at 230 minutes (standardized β = -0.30, P = .004) and at day 1 (standardized β = -0.37, P = .001), but not at day 7 (standardized β = -0.18, P = .10). Family history of an alcohol use disorder in a first-degree relative was associated with greater HDRS improvement at day 1 (standardized β = -0.27, P = .014) and day 7 (standardized β = -0.41, P < .001). No prior history of suicide attempt(s) was associated with greater improvement only at day 7 (standardized β = 0.28, P = .01). The overall statistical model explained 13%, 23%, and 36% of HDRS percent change variance at 230 minutes, day 1, and day 7, respectively. CONCLUSIONS Despite its post hoc nature, this study identified several clinical correlates of ketamine's rapid and durable antidepressant effects. Further investigation of these relationships is critical for individualized treatment of depression.
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277
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Bogdanova OV, Abdullah O, Kanekar S, Bogdanov VB, Prescot AP, Renshaw PF. Neurochemical alterations in frontal cortex of the rat after one week of hypobaric hypoxia. Behav Brain Res 2014; 263:203-9. [PMID: 24486259 PMCID: PMC4699295 DOI: 10.1016/j.bbr.2014.01.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 01/16/2014] [Accepted: 01/20/2014] [Indexed: 12/16/2022]
Abstract
Residing at high altitude may lead to reduced blood oxygen saturation in the brain and altered metabolism in frontal cortical brain areas, probably due to chronic hypobaric hypoxia. These changes may underlie the increased rates of depression and suicidal behavior that have been associated with life at higher altitudes. To test the hypothesis that hypobaric hypoxia is responsible for development of mood disorders due to alterations in neurochemistry, we assessed depression-like behavior in parallel to levels of brain metabolites in rats housed at simulated altitude. 32 female Sprague Dawley rats were housed either in a hypobaric hypoxia chamber at 10,000 ft of simulated altitude for 1 week or at local conditions (4500 ft of elevation in Salt Lake City, Utah). Depression-like behavior was assessed using the forced swim test (FST) and levels of neurometabolites were estimated by in vivo proton magnetic resonance spectroscopy in the frontal cortex, the striatum and the hippocampus at baseline and after a week of exposure to hypobaric hypoxia. After hypoxia exposure the animals demonstrated increased immobility behavior and shortened latency to immobility in the FST. Elevated ratios of myo-inositol, glutamate, and the sum of myo-inositol and glycine to total creatine were observed in the frontal cortex of hypoxia treated rats. A decrease in the ratio of alanine to total creatine was also noted. This study shows that hypoxia induced alterations in frontal lobe brain metabolites, aggravated depression-like behavior and might be a factor in increased rates of psychiatric disorders observed in populations living at high altitudes.
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Affiliation(s)
- Olena V Bogdanova
- Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City 84108, UT USA.
| | - Osama Abdullah
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Salt Lake City 84112, UT USA
| | - Shami Kanekar
- Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City 84108, UT USA; Psychiatry Department, University of Utah, 383 Colorow Drive, Salt Lake City 84108, UT USA
| | - Volodymyr B Bogdanov
- INRA, Nutrition et Neurobiologie Intégrée and University Bordeaux, Nutrition et Neurobiologie Intégrée, UMR 1286, 146 rue Léo-Saignat, Bordeaux Cedex 33076, France
| | - Andrew P Prescot
- Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City 84108, UT USA; Department of Radiology, University of Utah, 30 North 1900 East, Salt Lake City 84132, UT USA
| | - Perry F Renshaw
- Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City 84108, UT USA; Psychiatry Department, University of Utah, 383 Colorow Drive, Salt Lake City 84108, UT USA; VISN19 MIRECC Salt Lake City UAMC, 500 Foothill Drive, Salt Lake City 84148, UT USA
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278
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Abstract
Monoamine-based treatments for depression have evolved greatly over the past several years, but shortcomings such as suboptimal efficacy, treatment lag, and residual cognitive dysfunction are still significant. Preclinical and clinical studies using compounds directly targeting glutamatergic neurotransmission present new opportunities for antidepressant treatment, with ketamine having a surprisingly rapid and sustained antidepressant effect that is presumably mediated through glutamate-dependent mechanisms. While direct modulation of glutamate transmission for antidepressant and cognition-enhancing actions may be hampered by nonspecific effects, indirect modulation through the serotonin (5-HT) system may be a viable alternative approach. Based on localization and function, 5-HT can modulate glutamate neurotransmission at least through the 5-HT1A, 5-HT1B, 5-HT3, and 5-HT7 receptors, which presents a rational pharmacological opportunity for modulating glutamatergic transmission without the direct use of glutamatergic compounds. Combining one or more of these glutamate-modulating 5-HT targets with 5-HT transporter inhibition may offer new therapeutic opportunities. The multimodal compounds vortioxetine and vilazodone are examples of this approach with diverse mechanisms, and their different clinical effects will provide valuable insights into serotonergic modulation of glutamate transmission for the potential treatment of depression and associated cognitive dysfunction.
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279
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Jun C, Choi Y, Lim SM, Bae S, Hong YS, Kim JE, Lyoo IK. Disturbance of the glutamatergic system in mood disorders. Exp Neurobiol 2014; 23:28-35. [PMID: 24737937 PMCID: PMC3984954 DOI: 10.5607/en.2014.23.1.28] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/24/2014] [Accepted: 02/24/2014] [Indexed: 12/11/2022] Open
Abstract
The role of glutamatergic system in the neurobiology of mood disorders draws increasing attention, as disturbance of this system is consistently implicated in mood disorders including major depressive disorder and bipolar disorder. Thus, the glutamate hypothesis of mood disorders is expected to complement and improve the prevailing monoamine hypothesis, and may indicate novel therapeutic targets. Since the contribution of astrocytes is found to be crucial not only in the modulation of the glutamatergic system but also in the maintenance of brain energy metabolism, alterations in the astrocytic function and neuroenergetic environment are suggested as the potential neurobiological underpinnings of mood disorders. In the present review, the evidence of glutamatergic abnormalities in mood disorders based on postmortem and magnetic resonance spectroscopy (MRS) studies is presented, and disrupted energy metabolism involving astrocytic dysfunction is proposed as the underlying mechanism linking altered energy metabolism, perturbations in the glutamatergic system, and pathogenesis of mood disorders.
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Affiliation(s)
- Chansoo Jun
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 120-750, Korea. ; Ewha Brain Institute, Ewha Womans University, Seoul 120-750, Korea
| | - Yera Choi
- Ewha Brain Institute, Ewha Womans University, Seoul 120-750, Korea. ; Interdisciplinary Program in Neuroscience, Seoul National University College of Natural Sciences, Seoul 151-747, Korea
| | - Soo Mee Lim
- Ewha Brain Institute, Ewha Womans University, Seoul 120-750, Korea. ; Department of Radiology, Ewha Womans University College of Medicine, Seoul 158-710, Korea
| | - Sujin Bae
- Brain Institute and Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah 84112, USA
| | - Young Sun Hong
- Ewha Brain Institute, Ewha Womans University, Seoul 120-750, Korea. ; Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul 158-710, Korea
| | - Jieun E Kim
- Ewha Brain Institute, Ewha Womans University, Seoul 120-750, Korea. ; Department of Brain and Cognitive Sciences, Ewha Womans University Graduate School, Seoul 120-750, Korea
| | - In Kyoon Lyoo
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 120-750, Korea. ; Ewha Brain Institute, Ewha Womans University, Seoul 120-750, Korea
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280
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Treadway MT, Pizzagalli DA. Imaging the pathophysiology of major depressive disorder - from localist models to circuit-based analysis. BIOLOGY OF MOOD & ANXIETY DISORDERS 2014; 4:5. [PMID: 24606595 PMCID: PMC3995947 DOI: 10.1186/2045-5380-4-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/17/2014] [Indexed: 01/18/2023]
Abstract
The neuroimaging literature of Major Depressive Disorder (MDD) has grown substantially over the last several decades, facilitating great advances in the identification of specific brain regions, neurotransmitter systems and networks associated with depressive illness. Despite this progress, fundamental questions remain about the pathophysiology and etiology of MDD. More importantly, this body of work has yet to directly influence clinical practice. It has long been a goal for the fields of clinical psychology and psychiatry to have a means of making objective diagnoses of mental disorders. Frustratingly little movement has been achieved on this front, however, and the 'gold-standard’ of diagnostic validity and reliability remains expert consensus. In light of this challenge, the focus of the current review is to provide a critical summary of key findings from different neuroimaging approaches in MDD research, including structural, functional and neurochemical imaging studies. Following this summary, we discuss some of the current conceptual obstacles to better understanding the pathophysiology of depression, and conclude with recommendations for future neuroimaging research.
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Affiliation(s)
- Michael T Treadway
- Center for Depression Anxiety and Stress Research, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA.
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281
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Taylor MJ, Godlewska B, Near J, Christmas D, Potokar J, Collier J, Klenerman P, Barnes E, Cowen PJ. Effect of interferon-α on cortical glutamate in patients with hepatitis C: a proton magnetic resonance spectroscopy study. Psychol Med 2014; 44:789-95. [PMID: 23659574 PMCID: PMC3758755 DOI: 10.1017/s0033291713001062] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The development of depressive symptomatology is a recognized complication of treatment with the cytokine interferon-α (IFN-α) and has been seen as supporting inflammatory theories of the pathophysiology of major depression. Major depression has been associated with changes in glutamatergic activity and recent formulations of IFN-induced depression have implicated neurotoxic influences that could also lead to changes in glutamate function. The present study used magnetic resonance spectroscopy (MRS) to measure glutamate and its major metabolite glutamine in patients with hepatitis C who received treatment with pegylated IFN-α and ribavirin. METHOD MRS measurements of glutamate and glutamine were taken from a 25 × 20 × 20 mm voxel including the pregenual anterior cingulate cortex in 12 patients before and after 4-6 weeks of treatment with IFN. RESULTS IFN treatment led to an increase in cortical levels of glutamine (p = 0.02) and a significant elevation in the ratio of glutamine to glutamate (p < 0.01). Furthermore, changes in glutamine level correlated significantly with ratings of depression and anxiety at the time of the second scan. CONCLUSIONS We conclude that treatment with IFN-α is associated with MRS-visible changes in glutamatergic metabolism. However, the changes seen differ from those reported in major depression, which suggests that the pathophysiology of IFN-induced depression may be distinct from that of major depression more generally.
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Affiliation(s)
- M J Taylor
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - B Godlewska
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - J Near
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - D Christmas
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, UK
| | - J Potokar
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, UK
| | | | | | - E Barnes
- NIHR Oxford Biomedical Research Centre, UK
| | - P J Cowen
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
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282
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Machado-Vieira R, Soeiro-De-Souza MG, Richards EM, Teixeira AL, Zarate CA. Multiple levels of impaired neural plasticity and cellular resilience in bipolar disorder: developing treatments using an integrated translational approach. World J Biol Psychiatry 2014; 15:84-95. [PMID: 23998912 PMCID: PMC4180367 DOI: 10.3109/15622975.2013.830775] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This paper reviews the neurobiology of bipolar disorder (BD), particularly findings associated with impaired cellular resilience and plasticity. METHODS PubMed/Medline articles and book chapters published over the last 20 years were identified using the following keyword combinations: BD, calcium, cytokines, endoplasmic reticulum (ER), genetics, glucocorticoids, glutamate, imaging, ketamine, lithium, mania, mitochondria, neuroplasticity, neuroprotection, neurotrophic, oxidative stress, plasticity, resilience, and valproate. RESULTS BD is associated with impaired cellular resilience and synaptic dysfunction at multiple levels, associated with impaired cellular resilience and plasticity. These findings were partially prevented or even reversed with the use of mood stabilizers, but longitudinal studies associated with clinical outcome remain scarce. CONCLUSIONS Evidence consistently suggests that BD involves impaired neural plasticity and cellular resilience at multiple levels. This includes the genetic and intra- and intercellular signalling levels, their impact on brain structure and function, as well as the final translation into behaviour/cognitive changes. Future studies are expected to adopt integrated translational approaches using a variety of methods (e.g., microarray approaches, neuroimaging, genetics, electrophysiology, and the new generation of -omics techniques). These studies will likely focus on more precise diagnoses and a personalized medicine paradigm in order to develop better treatments for those who need them most.
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Affiliation(s)
- Rodrigo Machado-Vieira
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, NIH, Bethesda, MD, USA,Laboratory of Neuroscience, LIM27, Institute and Department of Psychiatry, School of Medicine, University of Sao Paulo, SP, Brazil,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of Sao Paulo, SP, Brazil
| | - Marcio G. Soeiro-De-Souza
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, School of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Erica M. Richards
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, NIH, Bethesda, MD, USA
| | - Antonio L. Teixeira
- Neurology Group, Department of Internal Medicine, School of Medicine, UFMG, Belo Horizonte, Brazil
| | - Carlos A. Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, NIH, Bethesda, MD, USA
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283
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Plasma brain derived neurotrophic factor (BDNF) and response to ketamine in treatment-resistant depression. Int J Neuropsychopharmacol 2014; 17:331-6. [PMID: 24103211 PMCID: PMC3992942 DOI: 10.1017/s1461145713001119] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Ketamine produces rapid antidepressant effects in treatment-resistant depression (TRD), but the magnitude of response varies considerably between individual patients. Brain-derived neurotrophic factor (BDNF) has been investigated as a biomarker of treatment response in depression and has been implicated in the mechanism of action of ketamine. We evaluated plasma BDNF and associations with symptoms in 22 patients with TRD enrolled in a randomized controlled trial of ketamine compared to an anaesthetic control (midazolam). Ketamine significantly increased plasma BDNF levels in responders compared to non-responders 240 min post-infusion, and Montgomery-Åsberg Depression Rating Scale (MADRS) scores were negatively correlated with BDNF (r=-0.701, p = 0.008). Plasma BDNF levels at 240 min post-infusion were highly negatively associated with MADRS scores at 240 min (r = -0.897, p=.002), 24 h (r = -0.791, p = 0.038), 48 h (r = -0.944, p = 0.001) and 72 h (r = -0.977, p = 0.010). No associations with BDNF were found for patients receiving midazolam. These data support plasma BDNF as a peripheral biomarker relevant to ketamine antidepressant response.
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284
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Godlewska BR, Yip SW, Near J, Goodwin GM, Cowen PJ. Cortical glutathione levels in young people with bipolar disorder: a pilot study using magnetic resonance spectroscopy. Psychopharmacology (Berl) 2014; 231:327-32. [PMID: 23955702 DOI: 10.1007/s00213-013-3244-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 08/02/2013] [Indexed: 12/15/2022]
Abstract
RATIONALE Glutathione (GSH) is a key scavenger for cellular free radicals, and patients with bipolar disorder may have lowered GSH levels in plasma and in post-mortem brain tissue. OBJECTIVES The objective of the current study was to use magnetic resonance spectroscopy (MRS) to measure cortical GSH levels in young people with bipolar disorder to determine if lowered GSH might be a useful biomarker of vulnerability to the illness. METHODS We studied 13 patients with DSM-IV bipolar disorder and 11 healthy age-matched controls using proton MRS in conjunction with the SPECIAL acquisition technique. Voxels were placed in prefrontal and occipital cortex. All patients were clinically euthymic at the time of study and unmedicated. GSH and other relevant neurometabolites were measured relative to creatinine. RESULTS There was no difference in GSH levels between bipolar participants and controls in either prefrontal or occipital cortex. Similarly, participants showed no difference from controls in other measured cortical metabolites including γ-aminobutyric acid, glutamate and N-acetylaspartate. CONCLUSIONS This pilot study suggests that levels of cortical GSH are unlikely to be a useful trait biomarker of bipolar disorder in young people with a history of relatively mild mood instability at an early stage of illness. Lowered GSH levels may be relevant to bipolar pathophysiology in more severely ill patients, particular those with significant current mood disturbance.
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Affiliation(s)
- Beata R Godlewska
- University Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK
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285
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Abstract
From a neurobiological perspective there is no such thing as bipolar disorder. Rather, it is almost certainly the case that many somewhat similar, but subtly different, pathological conditions produce a disease state that we currently diagnose as bipolarity. This heterogeneity - reflected in the lack of synergy between our current diagnostic schema and our rapidly advancing scientific understanding of the condition - limits attempts to articulate an integrated perspective on bipolar disorder. However, despite these challenges, scientific findings in recent years are beginning to offer a provisional "unified field theory" of the disease. This theory sees bipolar disorder as a suite of related neurodevelopmental conditions with interconnected functional abnormalities that often appear early in life and worsen over time. In addition to accelerated loss of volume in brain areas known to be essential for mood regulation and cognitive function, consistent findings have emerged at a cellular level, providing evidence that bipolar disorder is reliably associated with dysregulation of glial-neuronal interactions. Among these glial elements are microglia - the brain's primary immune elements, which appear to be overactive in the context of bipolarity. Multiple studies now indicate that inflammation is also increased in the periphery of the body in both the depressive and manic phases of the illness, with at least some return to normality in the euthymic state. These findings are consistent with changes in the hypothalamic-pituitary-adrenal axis, which are known to drive inflammatory activation. In summary, the very fact that no single gene, pathway, or brain abnormality is likely to ever account for the condition is itself an extremely important first step in better articulating an integrated perspective on both its ontological status and pathogenesis. Whether this perspective will translate into the discovery of innumerable more homogeneous forms of bipolarity is one of the great questions facing the field and one that is likely to have profound treatment implications, given that fact that such a discovery would greatly increase our ability to individualize - and by extension, enhance - treatment.
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Affiliation(s)
- Vladimir Maletic
- Department of Neuropsychiatry and Behavioral Sciences, University of South Carolina School of Medicine , Columbia, SC , USA
| | - Charles Raison
- Department of Psychiatry, University of Arizona , Tucson, AZ , USA ; Norton School of Family and Consumer Sciences, College of Agriculture and Life Sciences, University of Arizona , Tucson, AZ , USA
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286
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Niciu MJ, Ionescu DF, Richards EM, Zarate CA. Glutamate and its receptors in the pathophysiology and treatment of major depressive disorder. J Neural Transm (Vienna) 2013; 121:907-24. [PMID: 24318540 DOI: 10.1007/s00702-013-1130-x] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 11/25/2013] [Indexed: 12/13/2022]
Abstract
Monoaminergic neurotransmitter (serotonin, norepinephrine and dopamine) mechanisms of disease dominated the research landscape in the pathophysiology and treatment of major depressive disorder (MDD) for more than 50 years and still dominate available treatment options. However, the sum of all brain neurons that use monoamines as their primary neurotransmitter is <20%. In addition, most patients treated with monoaminergic antidepressants are left with significant residual symptoms and psychosocial disability not to mention side effects, e.g., sexual dysfunction. In the past several decades, there has been greater focus on the major excitatory neurotransmitter in the human brain, glutamate, in the pathophysiology and treatment of MDD. Although several preclinical and human magnetic resonance spectroscopy studies had already implicated glutamatergic abnormalities in the human brain, it was rocketed by the discovery that the N-methyl-D-aspartate receptor antagonist ketamine has rapid and potent antidepressant effects in even the most treatment-resistant MDD patients, including those who failed to respond to electroconvulsive therapy and who have active suicidal ideation. In this review, we will first provide a brief introduction to glutamate and its receptors in the mammalian brain. We will then review the clinical evidence for glutamatergic dysfunction in MDD, the discovery and progress-to-date with ketamine as a rapidly acting antidepressant, and other glutamate receptor modulators (including proprietary medications) for treatment-resistant depression. We will finally conclude by offering potential future directions necessary to realize the enormous therapeutic promise of glutamatergic antidepressants.
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Affiliation(s)
- Mark J Niciu
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, 10 Center Drive, Building 10/CRC, Room 7-5545, Bethesda, MD, 20892, USA,
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287
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Snyder HR, Kaiser RH, Whisman MA, Turner AEJ, Guild RM, Munakata Y. Opposite effects of anxiety and depressive symptoms on executive function: the case of selecting among competing options. Cogn Emot 2013; 28:893-902. [PMID: 24295077 DOI: 10.1080/02699931.2013.859568] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
People constantly face the need to choose one option from among many, such as when selecting words to express a thought. Selecting between many options can be difficult for anyone, and can feel overwhelming for individuals with elevated anxiety. The current study demonstrates that anxiety is associated with impaired selection across three different verbal tasks, and tests the specificity of this finding to anxiety. Anxiety and depression frequently co-occur; thus, it might be assumed that they would demonstrate similar associations with selection, although they also have distinct profiles of symptoms, neuroanatomy and neurochemistry. Here, we report for the first time that anxiety and depressive symptoms counter-intuitively have opposite effects on selection among competing options. Specifically, whereas anxiety symptoms are associated with impairments in verbal selection, depressive symptoms are associated with better selection performance. Implications for understanding the mechanisms of anxiety, depression and selection are discussed.
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Affiliation(s)
- Hannah R Snyder
- a Department of Psychology and Neuroscience , University of Colorado Boulder , Boulder , CO , USA
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288
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Ramadan S, Lin A, Stanwell P. Glutamate and glutamine: a review of in vivo MRS in the human brain. NMR IN BIOMEDICINE 2013; 26:1630-46. [PMID: 24123328 PMCID: PMC3849600 DOI: 10.1002/nbm.3045] [Citation(s) in RCA: 182] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 08/08/2013] [Accepted: 09/08/2013] [Indexed: 05/21/2023]
Abstract
Our understanding of the roles that the amino acids glutamate (Glu) and glutamine (Gln) play in the mammalian central nervous system has increased rapidly in recent times. Many conditions are known to exhibit a disturbance in Glu-Gln equilibrium, and the exact relationships between these changed conditions and these amino acids are not fully understood. This has led to increased interest in Glu/Gln quantitation in the human brain in an array of conditions (e.g. mental illness, tumor, neuro-degeneration) as well as in normal brain function. Accordingly, this review has been undertaken to describe the increasing number of in vivo techniques available to study Glu and Gln separately, or pooled as 'Glx'. The present MRS methods used to assess Glu and Gln vary in approach, complexity, and outcome, thus the focus of this review is on a description of MRS acquisition approaches, and an indication of relative utility of each technique rather than brain pathologies associated with Glu and/or Gln perturbation. Consequently, this review focuses particularly on (1) one-dimensional (1)H MRS, (2) two-dimensional (1)H MRS, and (3) one-dimensional (13)C MRS techniques.
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Affiliation(s)
- Saadallah Ramadan
- School of Health Sciences, Faculty of Health, Hunter Building, University of Newcastle, Callaghan NSW 2308, Australia
| | - Alexander Lin
- Alexander Lin: Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 4 Blackfan Street, HIM-820, Boston MA 02115
| | - Peter Stanwell
- School of Health Sciences, Faculty of Health, Hunter Building, University of Newcastle, Callaghan NSW 2308, Australia
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289
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Verma G, Hariharan H, Nagarajan R, Nanga RPR, Delikatny EJ, Albert Thomas M, Poptani H. Implementation of two-dimensional L-COSY at 7 Tesla: an investigation of reproducibility in human brain. J Magn Reson Imaging 2013; 40:1319-27. [PMID: 24273136 DOI: 10.1002/jmri.24510] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/09/2013] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate the utility of two-dimensional (2D) Localized Correlated Spectroscopy (L-COSY) in metabolic profiling of the human brain at 7 Tesla (T). MATERIALS AND METHODS The 2D L-COSY sequence was implemented at 7 T and its reliability was assessed by test-retest studies of a metabolite phantom and a healthy volunteer. L-COSY data were acquired from the occipital lobe of healthy subjects (n = 6; all male; age, 30-72 years) to assess intersubject variability. Additionally, two subjects underwent scans from the parieto-occipital region, basal ganglia, frontal lobe or dorsolateral prefrontal cortex to test the versatility of L-COSY in studying differing anatomy. Integral/volume measurements of L-COSY spectra were used to estimate normalized metabolite-to-creatine concentrations. RESULTS Phantom test-retest studies revealed coefficients of variation (CVs) of 3-20% for most metabolites. Human 2D L-COSY spectra permitted detection of several metabolite resonances from multiple locations and inter-subject variation studies demonstrated CVs of 4-26%. Cross-peaks from gamma-aminobutyric acid (GABA), isoleucine (Ile), lysine (Lys) and Ethanolamine (Eth) were quantified, which are not readily resolvable with conventional one-dimensional (1D) MR spectroscopy. CONCLUSION 2D L-COSY at 7 T demonstrated improved sensitivity in detecting additional metabolites with reliability comparable to established techniques at lower fields, which may aid in the metabolic assessment of diseased states.
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Affiliation(s)
- Gaurav Verma
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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290
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Chitty KM, Lagopoulos J, Lee RSC, Hickie IB, Hermens DF. A systematic review and meta-analysis of proton magnetic resonance spectroscopy and mismatch negativity in bipolar disorder. Eur Neuropsychopharmacol 2013; 23:1348-63. [PMID: 23968965 DOI: 10.1016/j.euroneuro.2013.07.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 07/16/2013] [Accepted: 07/26/2013] [Indexed: 12/15/2022]
Abstract
Aberrant glutamate neurotransmission has been implicated in the pathophysiology of bipolar disorder with accumulating evidence from imaging, post-mortem and pathology studies. Studies investigating in vivo changes to the glutamatergic system have not been as consistent and warrant clarification. Studies utilizing proton-magnetic resonance spectroscopy ((1)H-MRS) have reported increased levels of combined glutamate and glutamine ("Glx"), which have been linked to impairments in N-methyl-d-aspartate (NMDA) receptor function. Similarly, neurophysiological studies utilising mismatch negativity (MMN) as an index of NMDA receptor function, have reported impairments in bipolar disorder. Here, we provide a systematic review of the literature in regards to the concentration of Glx and the magnitude of MMN in bipolar disorder. Separate meta-analyses revealed that bipolar disorder was associated with increased Glx concentration and decreased MMN-both measured frontally. The current findings corroborate previous evidence indicating that bipolar disorder is characterized by a perturbed frontal glutamate system. These observed changes in bipolar disorder might manifest as impairments in neuronal-glial interactions that lead to disrupted neuronal output and ultimately result in the characteristic neurocognitive sequelae associated with this disorder.
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Affiliation(s)
- Kate M Chitty
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, 94 Mallett Street, Camperdown, NSW 2050, Australia.
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291
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Xu J, Dydak U, Harezlak J, Nixon J, Dzemidzic M, Gunn AD, Karne HS, Anand A. Neurochemical abnormalities in unmedicated bipolar depression and mania: a 2D 1H MRS investigation. Psychiatry Res 2013; 213:235-41. [PMID: 23810639 PMCID: PMC3729606 DOI: 10.1016/j.pscychresns.2013.02.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 01/13/2013] [Accepted: 02/22/2013] [Indexed: 12/28/2022]
Abstract
The neurobiology and neurochemistry of bipolar disorder and its different phases are poorly understood. This study investigated metabolite abnormalities in both unmedicated bipolar depression as well as mania using 2D 1H magnetic resonance spectroscopy imaging (MRSI). MRSI data were obtained from 24 unmedicated bipolar disorder (BP) subjects (12 (hypo)manic (BPM)) and 12 depressed (BPD), and 20 closely matched healthy controls. 2D 1H MRSI data were collected from a 15-mm axial slice placed along the anterior commissure-posterior commissure (AC-PC) line to measure brain metabolites bilaterally in the thalamus and also the anterior and posterior cingulate cortex (ACC and PCC). Brain Lac/Cr levels were significantly increased in the BP group as a whole compared to healthy controls. Glutamate abnormalities varied across bipolar state as well as brain region: significantly increased Glx/Cr values were found in the left thalamus in BPD, but BPM had decreased Glu/Cr and Glx/Cr levels in the PCC when compared to healthy controls and decreased Glu/Cr levels even when compared to the BPD subjects group. The findings of the study point to state-related abnormalities of oxidative and glutamate metabolism in bipolar disorder.
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Affiliation(s)
- Jun Xu
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine
- School of Health Sciences, Purdue University
| | - Ulrike Dydak
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine
- School of Health Sciences, Purdue University
| | | | | | - Mario Dzemidzic
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine
- Department of Neurology, Indiana University School of Medicine
| | - Abigail D. Gunn
- Department of Psychiatry, Indiana University School of Medicine
| | - Harish S Karne
- Department of Psychiatry, Indiana University School of Medicine
| | - Amit Anand
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine
- Department of Psychiatry, Indiana University School of Medicine
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292
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Chitty KM, Lagopoulos J, Hickie IB, Hermens DF. Risky alcohol use in young persons with emerging bipolar disorder is associated with increased oxidative stress. J Affect Disord 2013; 150:1238-41. [PMID: 23838389 DOI: 10.1016/j.jad.2013.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 06/04/2013] [Accepted: 06/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Alcohol misuse is highly prevalent in bipolar disorder (BD) and has been associated with increased formation of reactive oxygen species in the CNS. Proton magnetic resonance spectroscopy ((1)H-MRS) is an in vivo tissue-based imaging modality that allows the investigation of changes in the brains primary antioxidant, glutathione (GSH), as a result of alcohol use in this population. METHODS Thirty-three patients with BD and 17 controls aged 18-30 years were recruited. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) and underwent (1)H-MRS. Levels of GSH in the anterior cingulate cortex (ACC) were determined. ANOVA was conducted to determine differences between high and low risk drinking bipolar participants and controls. RESULTS ANOVA with all groups revealed a significant difference in GSH between bipolar high and low risk drinkers, with those in the high-risk group displaying reduced GSH levels. A significant negative correlation was found between total AUDIT score and GSH in bipolar (R=-0.478, p=0.005) which remained significant when controlling for age and medication status. LIMITATIONS Our participant sample consisted of a heterogeneous group of patients, most of whom were medicated at time of testing. CONCLUSIONS Young people with emerging BD who drink at risky levels display reduced levels of ACC-GSH. Increased oxidative stress and its resulting neurotoxic effects may be especially detrimental in an emerging bipolar sample where the illness trajectory is unclear and the brain is still undergoing significant development.
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Affiliation(s)
- Kate M Chitty
- Clinical Research Unit, Brain and Mind Research Institute, The University of Sydney, Sydney, NSW 2050, Australia.
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293
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Abstract
Major depression is characterized by low mood, a reduced ability to experience pleasure and frequent cognitive, physiological and high anxiety symptoms. It is also the leading cause of years lost due to disability worldwide in women and men, reflecting a lifelong trajectory of recurring episodes, increasing severity and progressive treatment resistance. Yet, antidepressant drugs at best treat only one out of every two patients and have not fundamentally changed since their discovery by chance >50 yr ago. This status quo may reflect an exaggerated emphasis on a categorical disease classification that was not intended for biological research and on oversimplified gene-to-disease models for complex illnesses. Indeed, genetic, molecular and cellular findings in major depression suggest shared risk and continuous pathological changes with other brain-related disorders. So, an alternative is that pathological findings in major depression reflect changes in vulnerable brain-related biological modules, each with their own aetiological factors, pathogenic mechanisms and biological/environment moderators. In this model, pathological entities have low specificity for major depression and instead co-occur, combine and interact within individual subjects across disorders, contributing to the expression of biological endophenotypes and potentially clinical symptom dimensions. Here, we discuss current limitations in depression research, review concepts of gene-to-disease biological scales and summarize human post-mortem brain findings related to pyramidal neurons, γ-amino butyric acid neurons, astrocytes and oligodendrocytes, as prototypical brain circuit biological modules. Finally we discuss nested aetiological factors and implications for dimensional pathology. Evidence suggests that a focus on local cell circuits may provide an appropriate integration point and a critical link between underlying molecular mechanisms and neural network dysfunction in major depression.
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294
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Differential levels of brain amino acids in rat models presenting learned helplessness or non-learned helplessness. Psychopharmacology (Berl) 2013; 229:63-71. [PMID: 23568578 DOI: 10.1007/s00213-013-3080-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/21/2013] [Indexed: 01/09/2023]
Abstract
RATIONALE Glutamatergic and γ-aminobutyric acid (GABA)ergic abnormalities have recently been proposed to contribute to depression. The learned helplessness (LH) paradigm produces a reliable animal model of depression that expresses a deficit in escape behavior (LH model); an alternative phenotype that does not exhibit LH is a model of resilience to depression (non-LH model). OBJECTIVES We measured the contents of amino acids in the brain to investigate the mechanisms involved in the pathology of depression. METHODS LH and non-LH models were subjected to inescapable electric footshocks at random intervals following a conditioned avoidance test to determine acquirement of predicted escape deficits. Tissue amino acid contents in eight brain regions were measured via high-performance liquid chromatography. RESULTS The non-LH model showed increased GABA levels in the dentate gyrus and nucleus accumbens and increased glutamine levels in the dentate gyrus and the orbitofrontal cortex. The LH model had reduced glutamine levels in the medial prefrontal cortex. Changes in the ratios of GABA, glutamine, and glutamate were detected in the non-LH model, but not in the LH model. Reductions in threonine levels occurred in the medial prefrontal cortex in both models, whereas elevated alanine levels were detected in the medial prefrontal cortex in non-LH animals. CONCLUSIONS The present study demonstrates region-specific compensatory elevations in GABA levels in the dentate gyrus and nucleus accumbens of non-LH animals, supporting the implication of the GABAergic system in the recovery of depression.
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295
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Seese RR, Chen LY, Cox CD, Schulz D, Babayan AH, Bunney WE, Henn FA, Gall CM, Lynch G. Synaptic abnormalities in the infralimbic cortex of a model of congenital depression. J Neurosci 2013; 33:13441-8. [PMID: 23946402 PMCID: PMC3742930 DOI: 10.1523/jneurosci.2434-13.2013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 07/07/2013] [Accepted: 07/13/2013] [Indexed: 01/17/2023] Open
Abstract
Multiple lines of evidence suggest that disturbances in excitatory transmission contribute to depression. Whether these defects involve the number, size, or composition of glutamatergic contacts is unclear. This study used recently introduced procedures for fluorescence deconvolution tomography in a well-studied rat model of congenital depression to characterize excitatory synapses in layer I of infralimbic cortex, a region involved in mood disorders, and of primary somatosensory cortex. Three groups were studied: (1) rats bred for learned helplessness (cLH); (2) rats resistant to learned helplessness (cNLH); and (3) control Sprague Dawley rats. In fields within infralimbic cortex, cLH rats had the same numerical density of synapses, immunolabeled for either the postsynaptic density (PSD) marker PSD95 or the presynaptic protein synaptophysin, as controls. However, PSD95 immunolabeling intensities were substantially lower in cLH rats, as were numerical densities of synapse-sized clusters of the AMPA receptor subunit GluA1. Similar but less pronounced differences (comparable numerical densities but reduced immunolabeling intensity for PSD95) were found in the somatosensory cortex. In contrast, non-helpless rats had 25% more PSDs than either cLH or control rats without any increase in synaptophysin-labeled terminal frequency. Compared with controls, both cLH and cNLH rats had fewer GABAergic contacts. These results indicate that congenital tendencies that increase or decrease depression-like behavior differentially affect excitatory synapses.
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Affiliation(s)
| | | | | | - Daniela Schulz
- Brookhaven National Laboratory, Upton, New York 11973, and
| | | | | | - Fritz A. Henn
- Brookhaven National Laboratory, Upton, New York 11973, and
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York 11724
| | - Christine M. Gall
- Departments of Anatomy and Neurobiology
- Neurobiology and Behavior, University of California, Irvine, California 92697
| | - Gary Lynch
- Departments of Anatomy and Neurobiology
- Psychiatry and Human Behavior, and
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296
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Metzger CD, Walter M, Graf H, Abler B. SSRI-related modulation of sexual functioning is predicted by pre-treatment resting state functional connectivity in healthy men. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:935-947. [PMID: 23771550 DOI: 10.1007/s10508-013-0103-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 11/20/2012] [Accepted: 12/21/2012] [Indexed: 06/02/2023]
Abstract
Sexual dysfunction related to treatment with selective serotonin reuptake inhibitors (SSRIs) is a common reason for discontinuation of otherwise effective antidepressant treatment regimens. Thus, identification of subjects at risk for this side effect remains a crucial challenge. After demonstrating task-related neural correlates of impaired sexual functioning under treatment with the SSRI paroxetine (Abler et al., 2011), we studied (1) if resting state brain function before treatment predicts subsequent development of treatment-related modulation of sexual function, and (2) which neural circuits relate to different aspects of the impairment. Effects of paroxetine and bupropion administration over 1 week on subjective sexual functioning were investigated in 17 healthy male volunteers in a placebo-controlled, randomized cross-over design using the Massachusetts General Hospital Sexual Function Questionnaire. Data from a 10 min eyes-closed resting state scan were used to analyze functional connectivity under placebo in previously identified brain regions, focussing on the sublenticular extended amygdala (SLEA), dopaminergic midbrain, and anterior cingulate cortex. Resting state functional connectivities of the pregenual anterior cingulate cortex (pgACC), midbrain, and insula to the SLEA sufficiently predicted the development of subjective SSRI-related decreased sexual functioning and distinguished vulnerable from resilient subjects. Furthermore, connectivity with the midbrain particularly predicted orgasm-related deficits, while connectivity with pgACC predicted sexual satisfaction. Linking SSRI-related subjective sexual functioning to pre-treatment resting state connectivities in cortico-subcortical network of sexual processing, we demonstrated the potential of novel, non-invasive and passive brain imaging techniques to guide therapeutic decisions and adjust treatment protocols in psychiatric disorders and sexual medicine.
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Affiliation(s)
- Coraline D Metzger
- Department of Psychiatry and Psychotherapy, Centre for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany
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297
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Zhang J, Abdallah CG, Chen Y, Huang T, Huang Q, Xu C, Xiao Y, Liu Y, Ding Y, Wu R. Behavioral deficits, abnormal corticosterone, and reduced prefrontal metabolites of adolescent rats subject to early life stress. Neurosci Lett 2013; 545:132-7. [PMID: 23643993 PMCID: PMC3699722 DOI: 10.1016/j.neulet.2013.04.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/11/2013] [Accepted: 04/23/2013] [Indexed: 02/05/2023]
Abstract
The present study investigated the effect of early life stress in adolescent rats on brain metabolites, serum corticosterone, and depressive-like behavior. A group of rats was subject to early life stress from postnatal day (PND) 1 to 14. A matched control group was studied. Behavioral tests, serum corticosterone and high-resolution proton magnetic resonance spectroscopy were conducted between PND 30 and 40. In this study, adolescent rats exposed to early life stress demonstrated depressive-like behavior and increased serum corticosterone during adolescence. They also showed reduced glutamate, glutamine, and N-acetylaspartate (NAA) levels in the prefrontal cortex. A reduced myo-inositol level, consistent with astroglial deficits, was observed but was not statistically significant. Together, these findings characterize the effect of early life stress on adolescent animals and underscore the long-lasting and detrimental effects of childhood adversities.
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Affiliation(s)
- Jie Zhang
- Mental Health Center, Shantou University Medical College, Shantou, Guangdong, P. R. China
- Department of Radiology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P. R. China
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Chadi G. Abdallah
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Clinical Neuroscience Division, National Center for PTSD, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Yaowen Chen
- Central Laboratory of Shantou University, Shantou, Guangdong, P. R. China
| | - Tianhua Huang
- Research Center for Reproductive Medicine, Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Qingjun Huang
- Mental Health Center, Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Chongtao Xu
- Mental Health Center, Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Yeyu Xiao
- Department of Radiology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Yuzhen Liu
- Department of E.N.T, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Yan Ding
- Department of Radiology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Renhua Wu
- Department of Radiology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P. R. China
- Corresponding author: Renhua Wu, MD, PhD. Address: Dongxia North Road, Department of Radiology, 2nd Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, P.R China. Tel: +86-754-8891-5674; fax: +86-754-8891-5674. (R.H Wu)
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298
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Zarate CA, Mathews DC, Furey ML. Human biomarkers of rapid antidepressant effects. Biol Psychiatry 2013; 73:1142-55. [PMID: 23374639 PMCID: PMC3672383 DOI: 10.1016/j.biopsych.2012.11.031] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 11/13/2012] [Accepted: 11/30/2012] [Indexed: 10/27/2022]
Abstract
Mood disorders such as major depressive disorder and bipolar disorder--and their consequent effects on the individual and society--are among the most disabling and costly of all medical illnesses. Although a number of antidepressant treatments are available in clinical practice, many patients still undergo multiple and lengthy medication trials before experiencing relief of symptoms. Therefore a tremendous need exists to improve current treatment options and to facilitate more rapid, successful treatment in patients suffering from the deleterious neurobiological effects of ongoing depression. Toward that end, ongoing research is exploring the identification of biomarkers that might be involved in prevention, diagnosis, treatment response, severity, or prognosis of depression. Biomarkers evaluating treatment response will be the focus of this review, given the importance of providing relief to patients in a more expedient and systematic manner. A novel approach to developing such biomarkers of response would incorporate interventions with a rapid onset of action--such as sleep deprivation or intravenous drugs (e.g., ketamine or scopolamine). This alternative translational model for new treatments in psychiatry would facilitate shorter studies, improve feasibility, and increase higher compound throughput testing for these devastating disorders.
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Affiliation(s)
- Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA.
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299
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Musazzi L, Treccani G, Mallei A, Popoli M. The action of antidepressants on the glutamate system: regulation of glutamate release and glutamate receptors. Biol Psychiatry 2013; 73:1180-8. [PMID: 23273725 DOI: 10.1016/j.biopsych.2012.11.009] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 11/13/2012] [Accepted: 11/13/2012] [Indexed: 01/09/2023]
Abstract
Recent compelling evidence has suggested that the glutamate system is a primary mediator of psychiatric pathology and also a target for rapid-acting antidepressants. Clinical research in mood and anxiety disorders has shown alterations in levels, clearance, and metabolism of glutamate and consistent volumetric changes in brain areas where glutamate neurons predominate. In parallel, preclinical studies with rodent stress and depression models have found dendritic remodeling and synaptic spines reduction in corresponding areas, suggesting these as major factors in psychopathology. Enhancement of glutamate release/transmission, in turn induced by stress/glucocorticoids, seems crucial for structural/functional changes. Understanding mechanisms of maladaptive plasticity may allow identification of new targets for drugs and therapies. Interestingly, traditional monoaminergic-based antidepressants have been repeatedly shown to interfere with glutamate system function, starting with modulation of N-methyl-D-aspartate (NMDA) receptors. Subsequently, it has been shown that antidepressants reduce glutamate release and synaptic transmission; in particular, it was found antidepressants prevent the acute stress-induced enhancement of glutamate release. Additional studies have shown that antidepressants may partly reverse the maladaptive changes in synapses/circuitry in stress and depression models. Finally, a number of studies over the years have shown that these drugs regulate glutamate receptors, reducing the function of NMDA receptors, potentiating the function of α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptors, and, more recently, exerting variable effects on different subtypes of metabotropic glutamate receptors. The development of NMDA receptor antagonists has opened new avenues for glutamatergic, rapid acting, antidepressants, while additional targets in the glutamate synapse await development of new compounds for better, faster antidepressant action.
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Affiliation(s)
- Laura Musazzi
- Laboratory of Neuropsychopharmacology and Functional Neurogenomics-Dipartimento di Scienze Farmacologiche e Biomolecolari and Center of Excellence on Neurodegenerative Diseases-CEND, Università degli Studi di Milano, Milano, Italy
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Sylvia LG, Peters AT, Deckersbach T, Nierenberg AA. Nutrient-based therapies for bipolar disorder: a systematic review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2013; 82:10-9. [PMID: 23147067 DOI: 10.1159/000341309] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 06/22/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pharmacotherapy is the first line of treatment for bipolar disorder, but many patients continue to experience persistent subthreshold symptoms. Alternative adjunct treatments, including nutritional therapies, may have the potential to alleviate residual symptoms and improve the outcomes of standard pharmacotherapy. The aim of this paper is to critically review the current clinical evidence and mechanisms of action of nutrient-based therapies alone or in combination with commonly used pharmacotherapies for mania and bipolar depression. METHODS We conducted a Medline search for clinical trials conducted with humans, published in English from 1960 to 2012 using nutritional supplements such as n-3, chromium, inositol, choline, magnesium, folate and tryptophan alone or in combination with pharmacotherapies for the treatment of bipolar disorder. RESULTS Preliminary data yields conflicting but mainly positive evidence for the use of n-3 fatty acids and chromium in the treatment of bipolar depression. Limited evidence found that inositol may be helpful for bipolar depression, but larger sample sizes are needed. Preliminary randomized, controlled trials suggest that choline, magnesium, folate and tryptophan may be beneficial for reducing symptoms of mania. CONCLUSIONS Given the potential public health impact of identifying adjunct treatments that improve psychiatric as well as physical health outcomes, nutritional treatments appear promising for the management of bipolar disorder but require further study.
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Affiliation(s)
- Louisa G Sylvia
- Bipolar Clinic and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA.
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