1
|
Lukow PB, Lowther M, Pike AC, Yamamori Y, Chavanne AV, Gormley S, Aylward J, McCloud T, Goble T, Rodriguez-Sanchez J, Tuominen EW, Buehler SK, Kirk P, Robinson OJ. Amygdala activity after subchronic escitalopram administration in healthy volunteers: A pharmaco-functional magnetic resonance imaging study. J Psychopharmacol 2024:2698811241286773. [PMID: 39364684 DOI: 10.1177/02698811241286773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) are used for the treatment of several conditions including anxiety disorders, but the basic neurobiology of serotonin function remains unclear. The amygdala and prefrontal cortex are strongly innervated by serotonergic projections and have been suggested to play an important role in anxiety expression. However, serotonergic function in behaviour and SSRI-mediated neurobiological changes remain incompletely understood. AIMS To investigate the neural correlates of subchronic antidepressant administration. METHODS We investigated whether the 2- to 3-week administration of a highly selective SSRI (escitalopram) would alter brain activation on a task robustly shown to recruit the bilateral amygdala and frontal cortices in a large healthy volunteer sample. Participants performed the task during a functional magnetic resonance imaging acquisition before (n = 96) and after subchronic escitalopram (n = 46, days of administration mean (SD) = 15.7 (2.70)) or placebo (n = 40 days of administration mean (SD) = 16.2 (2.90)) self-administration. RESULTS Compared to placebo, we found an elevation in right amygdala activation to the task after escitalopram administration without significant changes in mood. This effect was not seen in the left amygdala, the dorsomedial region of interest, the subgenual anterior cingulate cortex or the right fusiform area. There were no significant changes in connectivity between the dorsomedial cortex and amygdala or the subgenual anterior cingulate cortex after escitalopram administration. CONCLUSIONS To date, this most highly powered study of subchronic SSRI administration indicates that, contrary to effects often seen in patients with anxiety disorders, subchronic SSRI treatment may increase amygdala activation in healthy controls. This finding highlights important gaps in our understanding of the functional role of serotonin.
Collapse
Affiliation(s)
- Paulina B Lukow
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Millie Lowther
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Alexandra C Pike
- Institute of Cognitive Neuroscience, University College London, London, UK
- Department of Psychology & York Biomedical Research Institute, University of York, York, UK
| | - Yumeya Yamamori
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Alice V Chavanne
- Institute of Cognitive Neuroscience, University College London, London, UK
- Université Paris-Saclay, Institut National de la Santé et de la Recherche Médicale, INSERM U1299 "Trajectoires Développementales Psychiatrie," Ecole Normale Supérieure Paris-Saclay, CNRS UMR 9010, Centre Borelli, Gif-sur-Yvette, France
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Siobhan Gormley
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Jessica Aylward
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Tayla McCloud
- Institute of Cognitive Neuroscience, University College London, London, UK
- UCL Division of Psychiatry, Maple House, London, UK
| | - Talya Goble
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Julia Rodriguez-Sanchez
- Institute of Cognitive Neuroscience, University College London, London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Ella W Tuominen
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Sarah K Buehler
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Peter Kirk
- Institute of Cognitive Neuroscience, University College London, London, UK
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Oliver J Robinson
- Institute of Cognitive Neuroscience, University College London, London, UK
| |
Collapse
|
2
|
Tellone V, Markovic O, Strashimirova M, Sani G, Lenderking WR, Margolis MK, Fallone R, Quarchioni E, Cattaneo A, Comandini A. Impact of trazodone once-a-day on quality of life and functional recovery in adults with major depressive disorder: A prospective, observational study. Brain Behav 2024; 14:e3580. [PMID: 39034363 PMCID: PMC11260556 DOI: 10.1002/brb3.3580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/05/2024] [Accepted: 05/17/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Health-related quality of life (HRQL) is an important goal for patients with major depressive disorder (MDD), but whether antidepressants improve HRQL in these patients is unclear. Here, we describe the real-world effects of trazodone once-a-day (TzOAD) and selective serotonin reuptake inhibitor (SSRI) treatments on HRQL and functioning in adults with MDD. METHODS This 8-week prospective, observational, open-label, multicenter study was conducted in adults with moderate or severe MDD for whom TzOAD or SSRI were prescribed as monotherapy. The primary outcome was life enjoyment and satisfaction assessed via the patient-reported Quality-of-Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF) from baseline to week 8. Secondary outcomes included change in Q-LES-Q-SF from baseline to weeks 1 and 2; severity of depressive symptoms using the Montgomery Åsberg Depression Rating Scale (MADRS) and sleep disturbance via the PROMIS SF-SD 8b questionnaire at weeks 1, 2, and 8; and overall functioning via the Sheehan Disability Scale (SDS), hedonic capacity using the Snaith-Hamilton Pleasure Scale (SHAPS), and cognitive dysfunction using the Perceived Deficits Questionnaire (PDQ-5) at baseline and week 8. RESULTS The study included 208 adults with MDD (mean [SD] age = 50.2 [14.3] years; 68.6% female; 98.4% White). Life enjoyment and satisfaction improved from baseline to week 8 for both treatment groups: Q-LES-Q-SF mean (SD) scores were 27.5 (20.4) for the SSRI group and 39.0 (22.1) for the TzOAD group. Depressive symptoms and sleep disturbances also reduced from baseline to week 8: MADRS (SSRI, -15.7 [8.3]; TzOAD, -21.0 [9.8]); PROMIS SF-SD 8b (SSRI, -9.9 [12.6]; TzOAD, -22.0 [12.6]). Mean change scores in Q-LES-Q-SF, MADRS, and PROMIS SF-SD 8b improved as early as week 1 in both groups. Mean scores also improved from baseline to week 8 on SDS (SSRI, -9.2 [7.4]; TzOAD, -14.3 [7.5]), SHAPS (SSRI, -6.6 [4.3]; TzOAD, -8.3 [4.4]), and PDQ-5 (SSRI, -5.8 [4.5]; TzOAD, -7.7 [5.0]). CONCLUSIONS In adults with MDD who received TzOAD or SSRIs, overall and individual HQRL domains improved rapidly and in parallel with improvements in depressive symptoms, with a slightly greater improvement observed in the TzOAD group.
Collapse
Affiliation(s)
| | - Oto Markovic
- Clinline Services s.r.o.Stredoceský krajCzech Republic
| | | | - Gabriele Sani
- Department of Neuroscience, Section of PsychiatryUniversità Cattolica del Sacro CuoreRomeItaly
- Department of Neuroscience, Sensory Organs and Thorax, UOC Psichiatria Clinica e D'UrgenzaFondazione Policlinico Universitario A Gemelli IRCCSRomeItaly
| | | | | | | | - Elisa Quarchioni
- Pharmacometrics & Clinical SupplyAngelini Pharma S.p.A.RomeItaly
| | | | | |
Collapse
|
3
|
Livermore JJA, Skora LI, Adamatzky K, Garfinkel SN, Critchley HD, Campbell-Meiklejohn D. General and anxiety-linked influences of acute serotonin reuptake inhibition on neural responses associated with attended visceral sensation. Transl Psychiatry 2024; 14:241. [PMID: 38844469 PMCID: PMC11156930 DOI: 10.1038/s41398-024-02971-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024] Open
Abstract
Ordinary sensations from inside the body are important causes and consequences of our affective states and behaviour, yet the roles of neurotransmitters in interoceptive processing have been unclear. With a within-subjects design, this experiment tested the impacts of acute increases of endogenous extracellular serotonin on the neural processing of attended internal sensations and the links of these effects to anxiety using a selective serotonin reuptake inhibitor (SSRI) (20 mg CITALOPRAM) and a PLACEBO. Twenty-one healthy volunteers (fourteen female, mean age 23.9) completed the Visceral Interoceptive Attention (VIA) task while undergoing functional magnetic resonance imaging (fMRI) with each treatment. The VIA task required focused attention on the heart, stomach, or visual sensation. The relative neural interoceptive responses to heart sensation [heart minus visual attention] (heart-IR) and stomach sensation [stomach minus visual attention] (stomach-IR) were compared between treatments. Visual attention subtraction controlled for the general effects of CITALOPRAM on sensory processing. CITALOPRAM was associated with lower interoceptive processing in viscerosensory (the stomach-IR of bilateral posterior insular cortex) and integrative/affective (the stomach-IR and heart-IR of bilateral amygdala) components of interoceptive neural pathways. In anterior insular cortex, CITALOPRAM reductions of heart-IR depended on anxiety levels, removing a previously known association between anxiety and the region's response to attended heart sensation observed with PLACEBO. Preliminary post hoc analysis indicated that CITALOPRAM effects on the stomach-IR of the amygdalae corresponded to acute anxiety changes. This direct evidence of general and anxiety-linked serotonergic influence on neural interoceptive processes advances our understanding of interoception, its regulation, and anxiety.
Collapse
Affiliation(s)
| | - Lina I Skora
- School of Psychology, University of Sussex, Brighton, UK
- Heinrich Heine Universität, Düsseldorf, Germany
- Sussex Centre for Consciousness Science, University of Sussex, Brighton, UK
| | | | - Sarah N Garfinkel
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Hugo D Critchley
- Sussex Centre for Consciousness Science, University of Sussex, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
- Sussex Partnership NHS Foundation Trust, Brighton, UK
| | | |
Collapse
|
4
|
Braun D, Rosenberg AM, Rabaniam E, Haruvi R, Malamud D, Barbara R, Aiznkot T, Levavi-Sivan B, Kawashima T. High-resolution tracking of unconfined zebrafish behavior reveals stimulatory and anxiolytic effects of psilocybin. Mol Psychiatry 2024; 29:1046-1062. [PMID: 38233467 PMCID: PMC11176078 DOI: 10.1038/s41380-023-02391-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024]
Abstract
Serotonergic psychedelics are emerging therapeutics for psychiatric disorders, yet their underlying mechanisms of action in the brain remain largely elusive. Here, we developed a wide-field behavioral tracking system for larval zebrafish and investigated the effects of psilocybin, a psychedelic serotonin receptor agonist. Machine learning analyses of precise body kinematics identified latent behavioral states reflecting spontaneous exploration, visually-driven rapid swimming, and irregular swim patterns following stress exposure. Using this method, we found that acute psilocybin treatment has two behavioral effects: [i] facilitation of spontaneous exploration ("stimulatory") and [ii] prevention of irregular swim patterns following stress exposure ("anxiolytic"). These effects differed from the effect of acute SSRI treatment and were rather similar to the effect of ketamine treatment. Neural activity imaging in the dorsal raphe nucleus suggested that psilocybin inhibits serotonergic neurons by activating local GABAergic neurons, consistent with psychedelic-induced suppression of serotonergic neurons in mammals. These findings pave the way for using larval zebrafish to elucidate neural mechanisms underlying the behavioral effects of serotonergic psychedelics.
Collapse
Affiliation(s)
- Dotan Braun
- Department of Brain Sciences, Weizmann Institute of Science, 234 Herzl Street, Rehovot, Israel
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Ayelet M Rosenberg
- Department of Brain Sciences, Weizmann Institute of Science, 234 Herzl Street, Rehovot, Israel
| | - Elad Rabaniam
- Department of Brain Sciences, Weizmann Institute of Science, 234 Herzl Street, Rehovot, Israel
| | - Ravid Haruvi
- Department of Brain Sciences, Weizmann Institute of Science, 234 Herzl Street, Rehovot, Israel
| | - Dorel Malamud
- Department of Brain Sciences, Weizmann Institute of Science, 234 Herzl Street, Rehovot, Israel
| | - Rani Barbara
- Department of Brain Sciences, Weizmann Institute of Science, 234 Herzl Street, Rehovot, Israel
| | - Tomer Aiznkot
- Department of Animal Sciences, The Robert H. Smith Faculty of Agriculture, Food, and Environment, Hebrew University of Jerusalem, 229 Herzl Street, Rehovot, Israel
| | - Berta Levavi-Sivan
- Department of Animal Sciences, The Robert H. Smith Faculty of Agriculture, Food, and Environment, Hebrew University of Jerusalem, 229 Herzl Street, Rehovot, Israel
| | - Takashi Kawashima
- Department of Brain Sciences, Weizmann Institute of Science, 234 Herzl Street, Rehovot, Israel.
| |
Collapse
|
5
|
Zhou J, Zhou J, Feng L, Feng Y, Xiao L, Chen X, Yang J, Wang G. The associations between depressive symptoms, functional impairment, and quality of life, in patients with major depression: undirected and Bayesian network analyses. Psychol Med 2022; 53:1-13. [PMID: 36349712 PMCID: PMC10600944 DOI: 10.1017/s0033291722003385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 09/29/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Depressive symptoms, functional impairment, and decreased quality of life (QOL) are three important domains of major depressive disorder (MDD). However, the possible causal relationship between these factors has yet to be elucidated. Moreover, it is not known whether certain symptoms of MDD are more impairing than others. The network approach is a promising solution to these shortfalls. METHODS The baseline data of a multicenter prospective project conducted in 11 governances of China were analyzed. In total, 1385 patients with MDD were included. Depressive symptoms, functioning disability, and QOL were evaluated by the 17-item Hamilton Depression Rating Scale (HAMD-17), the Sheehan Disability Scale (SDS), and the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF). The network was estimated through the graphical Least Absolute Shrinkage and Selection Operator (LASSO) technique in combination with the directed acyclic graph. RESULTS Three centrality metrics of the graphical LASSO showed that social life dysfunction, QOL, and late insomnia exhibited the highest strength centrality. The network accuracy and stability were estimated to be robust and stable. The Bayesian network indicated that some depressive symptoms were directly associated with QOL, while other depressive symptoms showed an indirect association with QOL mediated by impaired function. Depressed mood was positioned at the highest level in the model and predicted the activation of functional impairment and anxiety. CONCLUSIONS Functional disability mediated the relationship between depressive symptoms and QOL. Family functionality and suicidal symptoms were directly related to QOL. Depressed mood played the predominant role in activating both anxiety symptom and functional impairment.
Collapse
Affiliation(s)
- Jia Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jingjing Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Lei Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuan Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Le Xiao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xu Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jian Yang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| |
Collapse
|
6
|
Early response to trazodone once-a-day in major depressive disorder: review of the clinical data and putative mechanism for faster onset of action. CNS Spectr 2021; 26:232-242. [PMID: 33731232 DOI: 10.1017/s1092852921000304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Most antidepressants have a delayed onset of action and must be administered for several weeks to generate therapeutic effects. Trazodone is a serotonin antagonist and reuptake inhibitor approved for the treatment of major depressive disorder. The once-a-day (OAD) formulation of trazodone has an improved tolerability profile compared to its conventional formulations. In this study, we systematically reviewed the evidence available for the antidepressant efficacy and early improvement in depressive symptoms with trazodone OAD treatment. METHOD We conducted a PubMed database search for randomized controlled trials published from 2005 to 2020. RESULTS Two studies, a placebo-controlled and an active-comparator (venlafaxine extended-release or XR) study were found. Both the studies demonstrated that trazodone exhibits antidepressant activity at a starting dose of 150 mg/day and results in statistically significant greater reduction in Hamilton Depression Rating Scale (HAM-D17) scores within 1 week of starting treatment compared to placebo or venlafaxine XR (P < .05). Trazodone also resulted in significant early improvement in the HAM-D17 sleep disturbance factor compared to placebo or venlafaxine XR at day 7 (P < .05). This clinical effect is supported by in vitro proprietary data for the affinity of trazodone for different target receptors. Activity at these receptors may underlie trazodone's fast antidepressant action. CONCLUSIONS Trazodone, if properly dosed, can be an effective antidepressant with early onset of action and good tolerability. Future studies designed to specifically evaluate onset and timing of improvement of depressive symptoms remain necessary to confirm and extend these results.
Collapse
|
7
|
O'Driscoll C, Buckman JEJ, Fried EI, Saunders R, Cohen ZD, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Kessler D, Lewis G, Watkins E, Wiles N, Pilling S. The importance of transdiagnostic symptom level assessment to understanding prognosis for depressed adults: analysis of data from six randomised control trials. BMC Med 2021; 19:109. [PMID: 33952286 PMCID: PMC8101158 DOI: 10.1186/s12916-021-01971-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/23/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Depression is commonly perceived as a single underlying disease with a number of potential treatment options. However, patients with major depression differ dramatically in their symptom presentation and comorbidities, e.g. with anxiety disorders. There are also large variations in treatment outcomes and associations of some anxiety comorbidities with poorer prognoses, but limited understanding as to why, and little information to inform the clinical management of depression. There is a need to improve our understanding of depression, incorporating anxiety comorbidity, and consider the association of a wide range of symptoms with treatment outcomes. METHOD Individual patient data from six RCTs of depressed patients (total n = 2858) were used to estimate the differential impact symptoms have on outcomes at three post intervention time points using individual items and sum scores. Symptom networks (graphical Gaussian model) were estimated to explore the functional relations among symptoms of depression and anxiety and compare networks for treatment remitters and those with persistent symptoms to identify potential prognostic indicators. RESULTS Item-level prediction performed similarly to sum scores when predicting outcomes at 3 to 4 months and 6 to 8 months, but outperformed sum scores for 9 to 12 months. Pessimism emerged as the most important predictive symptom (relative to all other symptoms), across these time points. In the network structure at study entry, symptoms clustered into physical symptoms, cognitive symptoms, and anxiety symptoms. Sadness, pessimism, and indecision acted as bridges between communities, with sadness and failure/worthlessness being the most central (i.e. interconnected) symptoms. Connectivity of networks at study entry did not differ for future remitters vs. those with persistent symptoms. CONCLUSION The relative importance of specific symptoms in association with outcomes and the interactions within the network highlight the value of transdiagnostic assessment and formulation of symptoms to both treatment and prognosis. We discuss the potential for complementary statistical approaches to improve our understanding of psychopathology.
Collapse
Affiliation(s)
- C O'Driscoll
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK. ciaran.o'
| | - J E J Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
- iCope - Camden & Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, NW1 0PE, UK.
| | - E I Fried
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - R Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Z D Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - G Ambler
- Statistical Science, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - R J DeRubeis
- School of Arts and Sciences, Department of Psychology, 425 S. University Avenue, Philadelphia, PA, 19104-60185, USA
| | - S Gilbody
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - S D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - T Kendrick
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
| | - D Kessler
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - G Lewis
- Division of Psychiatry, University College London, Maple House, London, W1T 7NF, UK
| | - E Watkins
- Department of Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Perry Road, Exeter, EX4 4QG, UK
| | - N Wiles
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, UK
| | - S Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
| |
Collapse
|
8
|
Guarraci FA, Ali M, Gonzalez CMF, Lucero D, Clemons LW, Davis LK, Henneman EL, Odell SE, Meerts SH. I. Antidepressants and sexual behavior: Weekly ketamine injections increase sexual behavior initially in female and male rats. Pharmacol Biochem Behav 2020; 199:173039. [PMID: 32926881 DOI: 10.1016/j.pbb.2020.173039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 12/28/2022]
Abstract
The present study characterized the effects of weekly ketamine injections on sexual behavior and anxiety in female and male rats, using a dosing protocol that mimics human therapeutic treatment for depression. In Experiment 1A, ketamine (10 mg/kg, i.p.) or saline was injected once per week for four consecutive weeks. The partner preference paradigm was used to measure sexual motivation 30 min after each weekly injection. Briefly, subjects were first given a 10-min test during which they could choose to spend time in the vicinity of a sexually receptive female stimulus or a sexually experienced male stimulus, however physical contact was restricted (no-contact). Immediately after, subjects were given unrestricted access to the stimulus animals (contact). After a washout period, subjects received four additional weekly injections of ketamine or saline, and then were tested for anxiety-like behavior on the elevated plus maze (EPM) after the last injection (Experiment 1B). For Experiment 2, similar procedures were used to test the effects of weekly ketamine injections on sexual motivation (Experiment 2A) and anxiety (Experiment 2B) in male subjects. In female subjects, ketamine increased sexual motivation as measured by greater time spent with the male stimulus, decreased likelihood of leaving after receiving mounts, and shorter return latencies after receiving intromissions, when compared to saline controls. In male subjects, ketamine shortened latency to first mount and first intromission, as well as increased time spent with the female stimulus. Very little anxiety was observed in either group (ketamine or saline) of female or male subjects when tested on the EPM. In conclusion, even after four weeks of ketamine exposure, sexual dysfunction did not emerge in either females or males. In contrast, ketamine increased sexual motivation in both females and males, with an initial robust response. However, as both groups gained sexual experience, the impact of ketamine diminished.
Collapse
Affiliation(s)
- Fay A Guarraci
- Department of Psychology, Southwestern University, Georgetown, TX 78626, USA.
| | - Maryam Ali
- Department of Psychology, Southwestern University, Georgetown, TX 78626, USA
| | | | - Devon Lucero
- Department of Psychology, Southwestern University, Georgetown, TX 78626, USA
| | - Larry W Clemons
- Department of Psychology, Southwestern University, Georgetown, TX 78626, USA
| | - Lourdes K Davis
- Department of Psychology, Southwestern University, Georgetown, TX 78626, USA
| | | | - Shannon E Odell
- Department of Psychology, Southwestern University, Georgetown, TX 78626, USA
| | - Sarah H Meerts
- Neuroscience Program and Department of Psychology, Carleton College, Northfield, MN 55057, USA
| |
Collapse
|
9
|
The Centrality of Depression and Anxiety Symptoms in Major Depressive Disorder Determined Using a Network Analysis. J Affect Disord 2020; 271:19-26. [PMID: 32312693 DOI: 10.1016/j.jad.2020.03.078] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/21/2020] [Accepted: 03/24/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Comorbid anxiety symptoms are highly prevalent and closely linked with poorer treatment outcomes, chronicity, and hospitalization in major depressive disorder (MDD). Our study aimed to estimate the network of depression and anxiety symptoms that was developed based on a sample of MDD patients. METHODS We constructed a network of the 21 Beck Depression Inventory (BDI) symptoms and 21 Beck Anxiety Inventory (BAI) symptoms in 223 patients with MDD who were beginning psychiatric treatment. In addition, each of the depression and anxiety symptoms was considered to be an ordered categorical variable ranging in value from 0 to 3. RESULTS The three depression symptoms including loss of energy, loss of interest, and worthlessness and the seven anxiety symptoms including faintness or lightheadedness, feeling of choking, feeling scared, fear of the worst happening, nervousness, inability to relax, and feeling shaky were identified as the ten most central nodes within a network of depression and anxiety symptoms. The inter-connection between irritability and nervousness was a strong trans-diagnostic edge within the network of depression and anxiety symptoms. LIMITATIONS Because our study was designed in a cross-sectional manner, the networks were estimated undirectionally. CONCLUSIONS Our findings show that depression symptoms are not more central than anxiety symptoms within an estimated network structure of symptoms in patients with MDD. Moreover, the inter-connection between irritability and nervousness may suggests a probable trans-diagnostic association in MDD symptomatology.
Collapse
|
10
|
Efficacy and safety of ketamine in the management of anxiety and anxiety spectrum disorders: a review of the literature. CNS Spectr 2020; 25:331-342. [PMID: 31339086 DOI: 10.1017/s1092852919001238] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Anxiety disorders are among the most prevalent psychiatric conditions. Despite many proven pharmacological and non-pharmacological treatments available, high rates of partial response and low rates of long-term remission remain. Ketamine has been receiving increasing attention as an interventional treatment modality in psychiatry, especially among refractory conditions, including major depressive disorder. There is limited yet growing evidence to support the use of ketamine in anxiety disorders. In this review of the literature, we present case reports, case series, and controlled trials demonstrating proof-of-concept for its potential role in the treatment of anxiety and anxiety spectrum disorders. Its unique mechanism of action, rapid onset, and high rate of response have driven its use in clinical practice. Ketamine is generally well tolerated by patients and has a limited side effect profile; however, the effects of long-term use are unknown. While there is a growing body of research and increasing clinical experience to suggest ketamine may have clinical applications in the treatment of refractory anxiety disorders, further research to determine long-term safety and tolerability is indicated.
Collapse
|
11
|
Estes MK, Freels TG, Prater WT, Lester DB. Systemic oxytocin administration alters mesolimbic dopamine release in mice. Neuroscience 2019; 408:226-238. [DOI: 10.1016/j.neuroscience.2019.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 12/16/2022]
|
12
|
Guarraci FA, Gonzalez CM, Lucero D, Womble PD, Abdel-Rahim H, DeVore J, Kunkel MN, Quadlander E, Stinnett M, Boyette-Davis J. The effects of ketamine on sexual behavior, anxiety, and locomotion in female rats. Pharmacol Biochem Behav 2018; 165:36-44. [DOI: 10.1016/j.pbb.2017.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 12/28/2022]
|
13
|
The centrality of DSM and non-DSM depressive symptoms in Han Chinese women with major depression. J Affect Disord 2018; 227:739-744. [PMID: 29179144 PMCID: PMC5815309 DOI: 10.1016/j.jad.2017.11.032] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 08/24/2017] [Accepted: 11/08/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION We compared DSM-IV criteria for major depression (MD) with clinically selected non-DSM criteria in their ability to represent clinical features of depression. METHOD We conducted network analyses of 19 DSM and non-DSM symptoms of MD assessed at personal interview in 5952 Han Chinese women meeting DSM-IV criteria for recurrent MD. We estimated an Ising model (the state-of-the-art network model for binary data), compared the centrality (interconnectedness) of DSM-IV and non-DSM symptoms, and investigated the community structure (symptoms strongly clustered together). RESULTS The DSM and non-DSM criteria were intermingled within the same symptom network. In both the DSM-IV and non-DSM criteria sets, some symptoms were central (highly interconnected) while others were more peripheral. The mean centrality of the DSM and non-DSM criteria sets did not significantly differ. In at least two cases, non-DSM criteria were more central than symptomatically related DSM criteria: lowered libido vs. sleep and appetite changes, and hopelessness versus worthlessness. The overall network had three sub-clusters reflecting neurovegetative/mood symptoms, cognitive changes and anxiety/irritability. LIMITATIONS The sample were severely ill Han Chinese females limiting generalizability. CONCLUSIONS Consistent with prior historical reviews, our results suggest that the DSM-IV criteria for MD reflect one possible sub-set of a larger pool of plausible depressive symptoms and signs. While the DSM criteria on average perform well, they are not unique and may not be optimal in their ability to describe the depressive syndrome.
Collapse
|
14
|
Selvaraj S, Walker C, Arnone D, Cao B, Faulkner P, Cowen PJ, Roiser JP, Howes O. Effect of Citalopram on Emotion Processing in Humans: A Combined 5-HT 1A [ 11C]CUMI-101 PET and Functional MRI Study. Neuropsychopharmacology 2018; 43:655-664. [PMID: 28776580 PMCID: PMC5693328 DOI: 10.1038/npp.2017.166] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/18/2017] [Accepted: 08/01/2017] [Indexed: 12/21/2022]
Abstract
A subset of patients started on a selective serotonin reuptake inhibitor (SSRI) initially experience increased anxiety, which can lead to early discontinuation before therapeutic effects are manifest. The neural basis of this early SSRI effect is not known. Presynaptic dorsal raphe neuron (DRN) 5-HT1A receptors are known to have a critical role in affect processing. Thus we investigated the effect of acute citalopram on emotional processing and the relationship between DRN 5-HT1A receptor availability and amygdala reactivity. Thirteen (mean age 48±9 years) healthy male subjects received either a saline or citalopram infusion intravenously (10 mg over 30 min) on separate occasions in a single-blind, random order, crossover design. On each occasion, participants underwent a block design face-emotion processing task during fMRI known to activate the amygdala. Ten subjects also completed a positron emission tomography (PET) scan to quantify DRN 5-HT1A availability using [11C]CUMI-101. Citalopram infusion when compared with saline resulted in a significantly increased bilateral amygdala responses to fearful vs neutral faces (left p=0.025; right p=0.038 FWE-corrected). DRN [11C]CUMI-101 availability significantly positively correlated with the effect of citalopram on the left amygdala response to fearful faces (Z=2.51, p=0.027) and right amygdala response to happy faces (Z=2.33, p=0.032). Our findings indicate that the initial effect of SSRI treatment is to alter processing of aversive stimuli and that this is linked to DRN 5-HT1A receptors in line with evidence that 5-HT1A receptors have a role in mediating emotional processing.
Collapse
Affiliation(s)
- Sudhakar Selvaraj
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA,Medical Research Council London Institute of Medical Sciences, Hammersmith Hospital, London, UK,Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Biomedical and Behavioral Sciences Building (BBSB), 1941 East Road, Suite 3208 Houston, TX 77054, USA, Tel: +1 713 486 2500, Fax: +1 713 486 2553, E-mail:
| | - Chris Walker
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Danilo Arnone
- Institute of Psychiatry, King’s College London, Centre for Affective Disorders, London, UK,IoPPN, King’s College London, Institute of Psychiatry, Psychosis Studies, London, UK
| | - Bo Cao
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Paul Faulkner
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Philip J Cowen
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Oliver Howes
- Medical Research Council London Institute of Medical Sciences, Hammersmith Hospital, London, UK,IoPPN, King’s College London, Institute of Psychiatry, Psychosis Studies, London, UK,Institute of Clinical Sciences, Imperial College, Hammersmith Hospital, London, UK
| |
Collapse
|
15
|
Näslund J, Hieronymus F, Emilsson JF, Lisinski A, Nilsson S, Eriksson E. Incidence of early anxiety aggravation in trials of selective serotonin reuptake inhibitors in depression. Acta Psychiatr Scand 2017; 136:343-351. [PMID: 28859218 DOI: 10.1111/acps.12784] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Selective serotonin reuptake inhibitors (SSRIs) may aggravate anxiety and agitation during the first days of treatment but the frequency of such reactions remains unknown. METHOD We analysed patient-level data from placebo-controlled trials of sertraline, paroxetine or citalopram in depressed adults. Somatic anxiety, psychic anxiety and psychomotor agitation as assessed using the Hamilton Depression Rating Scale (HDRS) were analysed in all trials (n = 8262); anxiety-related adverse events were analysed in trials investigating paroxetine and citalopram (n = 5712). RESULTS After one but not two weeks, patients on an SSRI were more likely than those on placebo to report enhanced somatic anxiety (adjusted risk 9.3% vs. 6.7%); likewise, mean rating of somatic anxiety was higher in the SSRI group. In contrast, patients receiving an SSRI were less likely to report aggravation of psychic anxiety (adjusted risk: 7.0% vs. 8.5%) with mean rating of psychic anxiety and agitation being lower in the SSRI group. The adverse event 'nervousness' was more common in patients given an SSRI (5.5% vs. 2.5%). Neither aggravation of HDRS-rated anxiety nor anxiety-related adverse events predicted poor antidepressant response. CONCLUSION Whereas an anxiety-reducing effect of SSRIs is notable already during the first week of treatment, these drugs may also elicit an early increase in anxiety in susceptible subjects that however does not predict a poor subsequent response to treatment.
Collapse
Affiliation(s)
- J Näslund
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - F Hieronymus
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J F Emilsson
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Lisinski
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S Nilsson
- Institute of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - E Eriksson
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
16
|
Esfehani RJ, Kamranian H, Jalalyazdi M. Effect of Fluoxetine Administration on Clinical and Echocardiographic Findings in Patients with Mitral Valve Prolapse and Generalized Anxiety Disorder: Randomized Clinical Trial. Electron Physician 2017; 9:3483-3491. [PMID: 28243397 PMCID: PMC5308485 DOI: 10.19082/3483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 10/06/2016] [Indexed: 01/04/2023] Open
Abstract
Background Mitral valve prolapse (MVP) is accompanied by mental disorders including anxiety, which has similar presentations as MVP. It is hypothesised that treatment of anxiety might reduce the symptoms of MVP. Objective The aim of this study was to assess the clinical and echocardiographic effects of fluoxetine administration in patients with MVP and anxiety. Methods This randomized clinical trial was conducted on patients with documented MVP and generalised anxiety disorder (GAD) who were referred to Mashhad University of Medical Sciences cardiology clinics, Mashhad, Iran in 2015. Subjects were randomly assigned to intervention group who received propranolol and fluoxetine (both at 10 mg/day) and control group who received 10 mg/day propranolol. Assessments included echocardiography and GAD-7 questionnaire and rating of chest pain, that were performed at baseline and then weekly for 4 weeks. Analysis was performed using the Mann-Whitney U test and Two-way Repeated Measures Analysis of Variance (ANOVA). Results Sixty patients (25 male/ 35 female) with a mean age of 22.9 ± 2.5 years were studied in two groups of intervention (n = 30) and control (n = 30). GAD score was significantly higher in the intervention group (17.37 ± 1.61) compared with the control group (14.17 ± 0.83) (p<0.001). No significant difference was observed for changes in left atrium diameter, mitral annular diameter, left ventricular diameter or ejection fraction (p>0.05). Pain severity was reduced significantly more in control group (3.27 ± 1.26) compared to intervention group (2.80 ± 0.85) after treatment (p<0.001). Conclusions This study revealed that the co-administration of fluoxetine and propranolol may not only have no effective in improving echocardiographic changes of MVP but may also aggravate subjective findings of patients with MVP and GAD. Trial registration The trial is registered at the Iranian Clinical Trial Registry (IRCT.ir) with the IRCT identification number IRCT2014102819721N1. Funding This research has been financially supported by Research Council of Sabzevar University of Medical Sciences.
Collapse
Affiliation(s)
- Reza Jafarzadeh Esfehani
- MD-PHD Student, Department of Medical Genetics, Mashhad University of Medical Sciences, Mashhad, Iran; Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Homan Kamranian
- MD. Psychiatrist, Assistant Professor, Department of Psychiatry, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Majid Jalalyazdi
- MD. Cardiologist, Assistant Professor, Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
17
|
D1-like dopamine receptor dysfunction in the lateral habenula nucleus increased anxiety-like behavior in rat. Neuroscience 2017; 340:542-550. [DOI: 10.1016/j.neuroscience.2016.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 10/26/2016] [Accepted: 11/04/2016] [Indexed: 11/22/2022]
|
18
|
A meta-analysis of the efficacy of vortioxetine in patients with major depressive disorder (MDD) and high levels of anxiety symptoms. J Affect Disord 2016; 206:140-150. [PMID: 27474960 DOI: 10.1016/j.jad.2016.07.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/12/2016] [Accepted: 07/06/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Coexisting anxiety is common in major depressive disorder (MDD) and more difficult to treat than depression without anxiety. This analysis assessed the efficacy, safety, and tolerability of vortioxetine in MDD patients with high levels of anxiety (baseline Hamilton Anxiety Rating Scale [HAM-A] total score ≥20). METHODS Efficacy was assessed using an aggregated, study-level meta-analysis of 10 randomized, placebo-controlled, 6/8-week trials of vortioxetine 5-20mg/day in adults (18-75 years), with a study in elderly patients (≥65 years) analyzed separately. Outcome measures included mean differences from placebo in change from baseline to endpoint (Δ) in the Montgomery-Åsberg Depression Rating Scale (MADRS), HAM-A total, and HAM-A subscales. Safety and tolerability were assessed by treatment-emergent adverse events (TEAEs). RESULTS A total of 1497 (48.6%) vortioxetine-treated and 860 (49.1%) placebo-treated patients had baseline HAM-A≥20. There were significant differences from placebo in MADRS (vortioxetine 5mg/day, n=415, Δ-2.68, P=0.005; 10mg/day, n=373, Δ-3.59, P<0.001; 20mg/day, n=207, Δ-4.30, P=0.005) and HAM-A total (5mg/day, n=419, Δ-1.64, P=0.022; 10mg/day, n=373, Δ-2.04, P=0.003; 20mg/day, n=207, Δ-2.19, P=0.027). There were significantly greater improvements versus placebo on the HAM-A psychic subscale for all doses. The most common TEAEs (≥5.0%) were nausea, headache, dizziness, dry mouth, diarrhea, nasopharyngitis, constipation, and vomiting. Incidence of serious TEAEs was 1.3% (placebo) and ≤1.3% (vortioxetine, across doses). LIMITATIONS Study heterogeneity limits this analysis. Patients with baseline HAM-A≥20 were not directly compared to baseline HAM-A<20 or total MDD population. CONCLUSIONS Vortioxetine was efficacious in reducing depressive and anxiety symptoms in patients with MDD and high levels of anxiety.
Collapse
|
19
|
|
20
|
Montoya A, Bruins R, Katzman MA, Blier P. The noradrenergic paradox: implications in the management of depression and anxiety. Neuropsychiatr Dis Treat 2016; 12:541-57. [PMID: 27042068 PMCID: PMC4780187 DOI: 10.2147/ndt.s91311] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Both major depressive disorder and the anxiety disorders are major causes of disability and markedly contribute to a significant global burden of the disease worldwide. In part because of the significant socioeconomic burden associated with these disorders, theories have been developed to specifically build clinical treatment approaches. One such theory, the monoaminergic hypothesis, has led to the development of several generations of selective and nonselective inhibitors of transporters of serotonin and norepinephrine, with the goal of augmenting monoaminergic transmission. These efforts have led to considerable success in the development of antidepressant therapeutics. However, there is a strong correlation between enhanced noradrenergic activity and fear and anxiety. Consequently, some physicians have expressed concerns that the same enhanced noradrenergic activity that alleviates depression could also promote anxiety. The fact that the serotonergic and noradrenergic reuptake inhibitors are successfully used in the treatment of anxiety and panic disorders seems paradoxical. This review was undertaken to determine if any clinical evidence exists to show that serotonergic and noradrenergic reuptake inhibitors can cause anxiety. The PubMed, EMBASE, and Cochrane Library databases were searched, and the results limited to randomized, double-blind, placebo-controlled studies performed in nongeriatric adults and with clear outcome measures were reported. Based on these criteria, a total of 52 studies were examined. Patients in these studies suffered from depression or anxiety disorders (generalized and social anxiety disorders, panic disorder, and posttraumatic stress disorder). The large majority of these studies employed venlafaxine or duloxetine, and the remainder used tri-cyclic antidepressants, atomoxetine, or reboxetine. All the studies reported clinically significant alleviation of depressive and/or anxious symptoms by these therapeutics. In none of these studies was anxiety a treatment-emergent adverse effect. This review argues against the impression that enhanced generalized noradrenergic activity promotes the emergence of anxiety.
Collapse
Affiliation(s)
- Alonso Montoya
- Eli Lilly Canada Inc, University of Ottawa, Ottawa, ON, Canada
| | - Robert Bruins
- Eli Lilly Canada Inc, University of Ottawa, Ottawa, ON, Canada
| | - Martin A Katzman
- START Clinic for the Mood and Anxiety Disorders, Toronto, University of Ottawa, Ottawa, ON, Canada
| | - Pierre Blier
- Mood Disorders Research Unit, Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
21
|
Fried EI, Epskamp S, Nesse RM, Tuerlinckx F, Borsboom D. What are 'good' depression symptoms? Comparing the centrality of DSM and non-DSM symptoms of depression in a network analysis. J Affect Disord 2016; 189:314-20. [PMID: 26458184 DOI: 10.1016/j.jad.2015.09.005] [Citation(s) in RCA: 387] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/20/2015] [Accepted: 09/05/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND The symptoms for Major Depression (MD) defined in the DSM-5 differ markedly from symptoms assessed in common rating scales, and the empirical question about core depression symptoms is unresolved. Here we conceptualize depression as a complex dynamic system of interacting symptoms to examine what symptoms are most central to driving depressive processes. METHODS We constructed a network of 28 depression symptoms assessed via the Inventory of Depressive Symptomatology (IDS-30) in 3,463 depressed outpatients from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. We estimated the centrality of all IDS-30 symptoms, and compared the centrality of DSM and non-DSM symptoms; centrality reflects the connectedness of each symptom with all other symptoms. RESULTS A network with 28 intertwined symptoms emerged, and symptoms differed substantially in their centrality values. Both DSM symptoms (e.g., sad mood) and non-DSM symptoms (e.g., anxiety) were among the most central symptoms, and DSM criteria were not more central than non-DSM symptoms. LIMITATIONS Many subjects enrolled in STAR*D reported comorbid medical and psychiatric conditions which may have affected symptom presentation. CONCLUSION The network perspective neither supports the standard psychometric notion that depression symptoms are equivalent indicators of MD, nor the common assumption that DSM symptoms of depression are of higher clinical relevance than non-DSM depression symptoms. The findings suggest the value of research focusing on especially central symptoms to increase the accuracy of predicting outcomes such as the course of illness, probability of relapse, and treatment response.
Collapse
Affiliation(s)
- Eiko I Fried
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.
| | - Sacha Epskamp
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Francis Tuerlinckx
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Denny Borsboom
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
22
|
Abstract
Psychiatric treatment relies on a solid armamentarium of pharmacologic and nonpharmacologic treatment modalities that perform reasonably well for many patients but leave others in a state of chronic disability or troubled by problematic side effects. Treatment planning in psychiatry remains an art that depends on considerable trial and error. Thus, there is an urgent need for better tools that will provide a means for matching individual patients with the most effective treatments while minimizing the risk of adverse events. This review will consider the current state of the science in predicting treatment outcomes in psychiatry. Genetic and other biomarkers will be considered alongside clinical diagnostic, and family history data. Problems inherent in prediction medicine will also be discussed, along with recent developments that support the hope that psychiatry can do a better job in quickly identifying the best treatments for each patient.
Collapse
Affiliation(s)
- Francis J McMahon
- International Society of Psychiatric Genetics, Brentwood, Tennessee, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Human Genetics Branch, National Institute of Mental Health Intramural Research Program, Bethesda, Maryland, USA
| |
Collapse
|
23
|
Fried EI, Nesse RM. Depression sum-scores don't add up: why analyzing specific depression symptoms is essential. BMC Med 2015; 13:72. [PMID: 25879936 PMCID: PMC4386095 DOI: 10.1186/s12916-015-0325-4] [Citation(s) in RCA: 480] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/13/2015] [Indexed: 02/06/2023] Open
Abstract
Most measures of depression severity are based on the number of reported symptoms, and threshold scores are often used to classify individuals as healthy or depressed. This method--and research results based on it--are valid if depression is a single condition, and all symptoms are equally good severity indicators. Here, we review a host of studies documenting that specific depressive symptoms like sad mood, insomnia, concentration problems, and suicidal ideation are distinct phenomena that differ from each other in important dimensions such as underlying biology, impact on impairment, and risk factors. Furthermore, specific life events predict increases in particular depression symptoms, and there is evidence for direct causal links among symptoms. We suggest that the pervasive use of sum-scores to estimate depression severity has obfuscated crucial insights and contributed to the lack of progress in key research areas such as identifying biomarkers and more efficacious antidepressants. The analysis of individual symptoms and their causal associations offers a way forward. We offer specific suggestions with practical implications for future research.
Collapse
Affiliation(s)
- Eiko I Fried
- University of Leuven, Faculty of Psychology and Educational Sciences, Research Group of Quantitative Psychology and Individual Differences, Tiensestraat 102, 3000, Leuven, Belgium.
| | - Randolph M Nesse
- School of Life Sciences, Arizona State University, Room 351 Life Sciences Building A, Tempe, AZ, 85287-450, USA.
| |
Collapse
|
24
|
McMahon FJ. Prediction of treatment outcomes in psychiatry--where do we stand ? DIALOGUES IN CLINICAL NEUROSCIENCE 2014; 16:455-64. [PMID: 25733951 PMCID: PMC4336916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Psychiatric treatment relies on a solid armamentarium of pharmacologic and nonpharmacologic treatment modalities that perform reasonably well for many patients but leave others in a state of chronic disability or troubled by problematic side effects. Treatment planning in psychiatry remains an art that depends on considerable trial and error. Thus, there is an urgent need for better tools that will provide a means for matching individual patients with the most effective treatments while minimizing the risk of adverse events. This review will consider the current state of the science in predicting treatment outcomes in psychiatry. Genetic and other biomarkers will be considered alongside clinical diagnostic, and family history data. Problems inherent in prediction medicine will also be discussed, along with recent developments that support the hope that psychiatry can do a better job in quickly identifying the best treatments for each patient.
Collapse
Affiliation(s)
- Francis J. McMahon
- International Society of Psychiatric Genetics, Brentwood, Tennessee, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Human Genetics Branch, National Institute of Mental Health Intramural Research Program, Bethesda, Maryland, USA
| |
Collapse
|
25
|
da Conceição Costa DL, Shavitt RG, Castro Cesar RC, Joaquim MA, Borcato S, Valério C, Miguel EC, Diniz JB. Can early improvement be an indicator of treatment response in obsessive-compulsive disorder? Implications for early-treatment decision-making. J Psychiatr Res 2013; 47:1700-7. [PMID: 23948637 DOI: 10.1016/j.jpsychires.2013.07.006] [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: 02/17/2013] [Revised: 07/03/2013] [Accepted: 07/05/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED In major depression, early response to treatment has been strongly associated with final outcome. We aimed to investigate the ability of early improvement (4 weeks) to predict treatment response at 12 weeks in DSM-IV-defined obsessive-compulsive disorder (OCD) patients treated with serotonin reuptake inhibitors (SRI). We conducted an SRI practical trial with 128 subjects. INCLUSION CRITERIA age range 18-65 years-old, baseline Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score ≥ 16, and absence of previous adequate pharmacological treatment. Systematic assessments were performed at baseline, 4 and 12 weeks of treatment. Treatment response at 12 weeks was defined as a 35% or greater reduction in baseline Y-BOCS score. Stepwise logistic regression was used to test the relationship between early improvement and treatment response at 12 weeks, taking into account additional potential predictive factors. Different thresholds of early improvement were tested and their predictive power was calculated. Early improvement, defined as a 20% or greater reduction from baseline Y-BOCS score at 4 weeks, predicted response at 12 weeks with 75.6% sensitivity and 61.9% specificity. According to a logistic regression including demographic and clinical features as explaining variables, early improvement was the best predictor of treatment response (OR = 1.05, p < 0.0001). Only 19.8% of patients who did not improve at 4 weeks were responders after 12 weeks. In contrast, 55.3% of the individuals who showed early improvement were responders at 12 weeks (Pearson Chi-Square = 17.06, p < 0.001). Early improvement predicted OCD treatment response with relatively good sensitivity and specificity, such that its role in early decision-making warrants further investigation in wider samples. TRIAL REGISTRATION clinicaltrials.gov Identifier NCT00680602.
Collapse
|