Failure of chronic lithium treatment to block tricyclic antidepressant-induced 5-HT supersensitivity

Role of central serotonin and noradrenaline interactions in the antidepressants' action: Electrophysiological and neurochemical evidence

The development of antidepressant drugs, in the last 6 decades, has been associated with theories based on a deficiency of serotonin (5-HT) and/or noradrenaline (NA) systems. Although the pathophysiology of major depression (MD) is not fully understood, numerous investigations have suggested that treatments with various classes of antidepressant drugs may lead to an enhanced 5-HT and/or adapted NA neurotransmissions. In this review, particular morpho-physiological aspects of these systems are first considered. Second, principal features of central 5-HT/NA interactions are examined. In this regard, the effects of the acute and sustained antidepressant administrations on these systems are discussed. Finally, future directions including novel therapeutic strategies are proposed.

Long-term antidepressant treatments result in a tonic activation of forebrain 5-HT1A receptors

We report here the first direct functional evidence of an increase in the tonic activation of postsynaptic 5-HT1A receptors by antidepressant treatments. Because 5-HT1A receptor activation hyperpolarizes and inhibits CA3 pyramidal neurons in the dorsal hippocampus, we determined, using in vivo extracellular recording, whether the selective 5-HT1A receptor antagonist WAY 100635 could disinhibit these neurons. Unexpectedly, no disinhibition could be detected in controls. However, after long-term treatment with the tricyclic antidepressant imipramine, the selective 5-HT reuptake inhibitor paroxetine, the reversible monoamine oxidase-A inhibitor befloxatone, the alpha2-adrenergic antagonist mirtazapine, or the 5-HT1A receptor agonist gepirone or multiple electroconvulsive shock (ECS) administration, WAY 100635 markedly increased (60-200%) the firing activity of CA3 pyramidal neurons. Such a disinhibition was absent in rats treated with the nonantidepressant drug chlorpromazine, in rats receiving only one ECS, or in rats receiving multiple ECSs in combination with an intrahippocampal pertussis toxin treatment to inactivate Gi/o-coupled 5-HT1A receptors. These data indicate that such antidepressant treatments, acting on entirely different primary targets, might alleviate depression by enhancing the tonic activation of forebrain postsynaptic 5-HT1A receptors.

The serotonergic and noradrenergic systems of the hippocampus: their interactions and the effects of antidepressant treatments

Previous reviews have well illustrated how antidepressant treatments can differentially alter several neurotransmitter systems in various brain areas. This review focuses on the effects of distinct classes of antidepressant treatments on the serotonergic and the noradrenergic systems of the hippocampus, which is one of the brain limbic areas thought to be relevant in depression: it illustrates the complexity of action of these treatments in a single brain area. First, the basic elements (receptors, second messengers, ion channels, ...) of the serotonergic and noradrenergic systems of the hippocampus are revisited and compared. Second, the extensive interactions occurring between the serotonergic and the noradrenergic systems of the brain are described. Finally, issues concerning the short- and long-term effects of antidepressant treatments on these systems are broadly discussed. Although there are some contradictions, the bulk of data suggests that antidepressant treatments work in the hippocampus by increasing and decreasing, respectively, serotonergic and noradrenergic neurotransmission. This hypothesis is discussed in the context of the purported function of the hippocampus in the formation of memory traces and emotion-related behaviors.

Alterations in responses to LSD in humans associated with chronic administration of tricyclic antidepressants, monoamine oxidase inhibitors or lithium

This study sought to investigate possible interactions between antidepressant agents and lysergic acid diethylamide (LSD) in humans through the use of retrospective questionnaires. Ten subjects were identified who used LSD during chronic (3 weeks or longer) periods of antidepressant administration. These subjects were asked to describe the phenomenological effects of self-administered hallucinogens prior to and during antidepressant treatment; a structured, standardized questionnaire was used to evaluate LSD experiences. Chronic tricyclic antidepressant administration was associated with subjective increases in physical, hallucinatory and psychological responses to LSD. Similarly, subjects receiving lithium chronically also reported increases in their responses to LSD. In contrast, subjects who had been chronically taking an monoamine oxidase (MAO) inhibitor reported subjective decreases in the effects of LSD. This is similar to a previous report by our group of a decreased response to LSD in individuals who were chronically taking serotonin-selective antidepressants. These altered responses to LSD most likely involve differential changes in central serotonin and dopamine receptor systems and are consistent with other recent data suggesting that the clinical efficacy of different classes of antidepressants may not necessarily rely on a common mechanism of action in the brain.

Use-dependent effects of acute and chronic treatment with imipramine and buspirone on excitatory synaptic transmission in the rat hippocampus in vivo

The effects of acute and long-term treatment with imipramine and buspirone on the responses of rat hippocampal neurones to low and high frequency electrical stimulation were compared. Whereas acute treatment with imipramine (10 mg/kg, i.p.) had no effect on synaptic responses to low frequency stimulation, chronic treatment for 14 days significantly reduced the amplitude of the field excitatory postsynaptic potential. Both acute and chronic imipramine treatment markedly reduced the amplitude of the nerve volley and excitatory postsynaptic potential evoked at high frequency stimulation rates in a use-dependent manner. Buspirone (0.5-3 mg/kg, i.p.) produced a significant reduction of the excitatory postsynaptic potential at high frequencies. This was enhanced after repeated administration of a dose of 0.5 mg/kg for 14 days. We previously reported a similar effect of buspirone at low frequency stimulation. Both compounds therefore share the ability to exert strong depressant effects on transmission in the hippocampus especially after chronic treatment.

Psychoactive drugs and human sexual behavior: the role of serotonergic activity

A wide range of both prescription and nonprescription drugs has been reported to affect human sexual functioning. While the sexual side effects resulting from drug use have often been attributed to adrenergic, anticholinergic or dopaminergic activity, the present review considers the potential role of serotonin. Based on animal studies, serotonin has been shown to either facilitate or inhibit sexual activity depending on which serotonin receptor subtype is activated. However, few studies have been done in the human that assess the effects of drugs that bind selectively to serotonin receptors. Consequently, little is known about the role of serotonin in human sexual functioning. In this review, a wide range of drugs that affect both brain serotonergic systems and human sexual behavior is examined in an effort to determine the possible role of serotonin in human sexual behavior. A review of the literature is consistent with the hypothesis that the 5-HT1A and the 5-HT2 receptor subtypes play a facilitatory role in human sexual behavior. The evidence suggests that drugs that act as agonists on these receptor sites enhance sexual functioning in the human, while those that act as antagonists inhibit sexual functioning.

Imipramine alters beta-adrenergic, but not serotonergic, mediated responses in rat hippocampal pyramidal cells

Imipramine, a tricyclic antidepressant, acts acutely to block the reuptake of serotonin (5-HT) and norepinephrine (NE). However, imipramine's action as an antidepressant takes several weeks to develop. This study investigated acute and chronic effects of imipramine on intracellularly-recorded responses mediated by 5-HT and beta-adrenergic receptors on pyramidal cells from area CA1 of rat hippocampal slices maintained in vitro. Addition of 10 microM imipramine in the perfusion medium sinistrally shifted the 5-HT1A concentration-response curve for membrane hyperpolarization and the 5-HT concentration-response curve for the reduction in the amplitude of the slow afterhyperpolarization (AHP) elicited by a train of action potentials. After two weeks of treatment with imipramine (10 mg/kg daily i.p. injections or s.c. osmotic mini-pumps) the responses to 5-HT were not altered. In contrast the concentration-response curve for the beta-adrenergic mediated reduction in AHP amplitude was significantly altered; there was a reduction in Emax and a log unit dextral shift in EC50. There was no change in the concentration-response curve for the beta-adrenergic mediated depolarization. These data are in agreement with previous biochemical results reporting a decrease in beta-adrenergic receptor mediated stimulation in adenylyl cyclase and down-regulation of beta-receptor in cortex and hippocampus. These findings suggest that a consequence of long-term imipramine treatment is a decrease in the augmentation of cell excitation normally produced by beta-adrenergic receptor stimulation.

Effects of long-term administration of antidepressants and neuroleptics on receptors in the central nervous system

1. A review of the effects of long-term administration of antidepressants and neuroleptics on receptors in the central nervous system is presented. 2. The effects of antidepressants on adenylate cyclase activity and on receptor binding in brain tissue are discussed. Effects on a variety of receptor types are considered. 3. The utilization of electrophysiological, behavioral, and neurochemical studies to assess receptor function after chronic antidepressant administration is discussed, as is the use of peripheral receptor estimations in clinical studies. 4. Animal studies on the actions of chronic administration of neuroleptics on pre- and postsynaptic dopamine receptors are reviewed. Effects of these drugs on dopamine receptors in humans are considered from the following perspectives: postmortem and in vivo binding studies in schizophrenia, tardive dyskinesia, and central versus peripheral receptor estimation.

Autoradiographic quantification of serotonin1A receptors in rat brain following antidepressant drug treatment

There is growing evidence that the serotonergic (5-HT) system is involved in the pathogenesis and treatment of major depression. The 5-HT receptor subtype involved in the enhancing effect of antidepressant treatments, however, has not been identified. The present study was undertaken to quantify 5-HT1A sites in the rat brain by autoradiography and membrane binding, using the selective ligand [3H]8-hydroxy-N,N-dipropyl-2-aminotetralin (8-OH-DPAT), following long-term antidepressant treatment. Following a 21-day treatment with amitriptyline (10 mg/kg/day), there was a significant increase of [3H]8-OH-DPAT binding measured by autoradiography in the dorsal hippocampus, but there was no change in the nucleus raphe dorsalis; whole brain membrane binding revealed an increase in the number of binding sites, with no change in the affinity for [3H]8-OH-DPAT. Conversely, fluoxetine (10 mg/kg/day), a selective blocker of 5-HT reuptake, and gepirone (10 mg/kg/day), a 5-HT1A agonist, both administered for 21 days, significantly reduced [3H]8-OH-DPAT binding measured by autoradiography in the nucleus raphe dorsalis without altering hippocampal binding sites. The control active treatment with diazepam (2 mg/kg/day) did not alter [3H]8-OH-DPAT binding in the hippocampus or in the nucleus raphe dorsalis. All groups were compared to a 21-day vehicle-treated control group. These results are fully consistent with previous electrophysiological and behavioral studies and suggest that alterations of 5-HT1A receptors might underlie the enhancement of 5-HT neurotransmission by antidepressant treatments.

Altered neuronal sensitivity of lateral geniculate neurones to noradrenaline and 5-HT following exposure to continuous lighting

Rats were housed in either continuous lighting (LL), an extended photoperiod of 18 h light-6 h dark (LD 18:6) or a 12 h light-12 h dark (LD 12:12) lighting cycle. The effects of these various lighting regimens on the sensitivity of dorsal lateral geniculate neurones to iontophoresed noradrenaline and serotonin (5-HT) was examined. Exposure to either continuous lighting or to an extended photoperiod (LD 18:6) resulted in the development of an enhanced responsiveness to iontophoresed noradrenaline (alpha 1-adrenoceptor) and 5-HT. The development of light-induced noradrenaline and 5-HT supersensitivity resembles the changes obtained with antidepressant treatments.

Validation of the I.T50 method for assessing neuronal responsiveness to microiontophoretic applications: a single-cell recording study

The I.T50 method consists of determining the charge required to obtain a 50% depression of firing activity of neurons recorded extracellularly with microiontophoretic applications of inhibitory agents. This method has been used successfully to detect modification of neuronal responsiveness, but the limits of its validity had never been determined. In the present study, it was found that the use of microiontophoretic currents greater than 3 nA yielded consistent I.T50 values when serotonin (5-HT) was applied to rat hippocampal pyramidal neurons. The departure from linearity of I.T50 values measured from applications carried out with a very low current (0.5 nA) of 5-HT is probably due to the relatively important contribution of the leak when a minimal ejecting current is used. The responsiveness to 5-HT was not altered by the activation of the recorded neuron produced by acetylcholine.

Responsiveness of suprachiasmatic and ventral lateral geniculate neurons to serotonin and imipramine: a microiontophoretic study in normal and imipramine-treated rats

The suprachiasmatic nuclei (SCN) are a major pacemaker of circadian rhythms in mammals. The SCN receive a direct retinal projection and a second optic input via the ventral lateral geniculate nucleus (vLGN). Both visual pathways mediate the entrainment of circadian rhythms, whereas both the SCN and the vLGN receive serotonergic afferents from the raphe nuclei. We investigated the effects of microiontophoretically applied serotonin (5HT) on SCN and vLGN cells in normal rats and rats chronically treated with the 5HT reuptake blocker imipramine (IMI). In the SCN of both groups over 40% of all recorded cells (N = 80) responded to 5HT with a dose-dependent suppression of their spontaneous or glutamate-evoked discharge, while twenty percent were tonically light-responsive. Except for one cell with an inconsistent 5HT response, none of the visual SCN neurons were 5HT-sensitive. In the vLGN of normal and IMI-treated rats about 60% of the cells recorded (N = 42) were inhibited by 5HT. In IMI-treated rats a few cases of excitation by 5HT were encountered in the vLGN. Visual as well as non-visual vLGN cells were responsive to 5HT. Microiontophoretic application of IMI resulted in suppression of electrical activity in both brain regions and enhanced the response induced by 5HT. Chronic IMI-treatment produced a significant increase in the sensitivity of cells in the SCN and vLGN to iontophoresed 5HT, without affecting the relative magnitude of the inhibition. The recovery from 5HT-induced inhibition was slow in these animals. Interestingly, the spontaneous discharge rate of both 5HT-sensitive and 5HT-insensitive SCN and vLGN cells was significantly lower in the imipramine-treated group.(ABSTRACT TRUNCATED AT 250 WORDS)

The antidepressant effect of beta-adrenoreceptor subsensitivity: a brief review and clinical implications

This paper reviews briefly the very common finding in chronic antidepressant use, of subsensitivity of the beta-adrenoreceptor-linked cyclic AMP system. This subsensitivity is observed with a number of different antidepressant treatments, including pharmacological, electrical and sleep deprivation. The subsensitivity requires intact noradrenergic and serotonergic systems, functionally linking the two neurotransmitters most often implicated in depression. Thyroid hormones and estrogens also cause subsensitivity, while the opposite effect is seen with Reserpine and Propranolol. A modified conditioning/sensitization model is proposed, implicating psychosocial stressors with a biological inability to down-regulate beta-adrenoreceptors.

Effects of chronic diazepam exposure on GABA sensitivity and on benzodiazepine potentiation of GABA-mediated responses of substantia nigra pars reticulata neurons of rats

This study examined the effects of chronic diazepam treatment on GABA sensitivity of substantia nigra pars reticulata neurons and on the ability of benzodiazepines to enhance GABAergic responses of these neurons in rats. Chronic diazepam exposure failed to significantly alter the sensitivity of reticulata neurons to microiontophoretically applied GABA. However, following chronic diazepam treatment for 1 day, or 1, 3 or 7-11 weeks, reticulata neurons showed tolerance to additional systemically or iontophoretically applied benzodiazepines and displayed an increased firing rate following injection of Ro 15-1788. These changes were not apparent 24 h after cessation of chronic treatment. Thus, tolerance to the effects of benzodiazepines on reticulata neurons appeared to develop after a single day of diazepam exposure and to dissipate by 24 h after cessation of treatment. When compared to our previous studies on dorsal raphe neurons, these results demonstrate regional differences in neuronal responses to chronic diazepam exposure, which may help elucidate neural systems which are involved in tolerance to the various functional aspects of benzodiazepines.

Time course for development of anticonvulsant tolerance and GABAergic subsensitivity after chronic diazepam

The time courses for development of neuronal and behavioral tolerance to diazepam (DZ) were estimated in rats continuously exposed to low levels of DZ for 3, 7, 14 or 21 days. Microiontophoretic sensitivity of dorsal raphe neurons to gamma-aminobutyric acid (GABA) was initially facilitated after short-term exposure to DZ released from implanted capsules for up to 3 days but returned to control levels by 7 days postimplantation and continued to decrease thereafter. GABAergic sensitivity remained depressed for a minimum of 5 days following removal of DZ capsules. To obtain a behavioral measure of tolerance, the anticonvulsant activity of DZ against bicuculline-induced seizures was also assessed. Rats studied 3 days after capsule implantation showed a significant elevation in seizure threshold. Seizure liability returned to control levels ca. 7 days after chronic treatment was initiated. These results indicate that tolerance to anticonvulsant efficacy against bicuculline seizures are temporally related to the onset of reduced GABA sensitivity on dorsal raphe neurons during prolonged exposure to DZ.

[Current hypotheses on the mechanism of action of lithium]

This article aims to clarify and organize the recent advances in research on the central action mechanism of lithium. It begins by tackling the process of cellular transport of the cation, then it moves on to describe the effects of lithium on ionic distribution and on membranous functioning in general. Neurotransmission in this article is the object of a more detailed study. The metabolism of neurotransmitters (and their disturbances) is first discussed. The emphasis is placed on certain current domains, the gabaergic system in particular. Neurotransmitters, by themselves, do not satisfy any longer the curiosity of biologists. Technological progress has given these scientists access to the intimate functioning of receptors and to their natural support system, the membrane. The stabilizing effect of lithium is mentioned often. Initially seen at a superficial level, it leads to a study of the mechanisms of the transference of information from the receptor to the cell. The membranous phospholipids and the enzymatic systems controlling the metabolism of the second messengers (cyclic nucleotides but also calcium) will provide as many potential targets to the action of lithium.

Diurnal rhythms in the responsiveness of hippocampal pyramidal neurons to serotonin, norepinephrine, gamma-aminobutyric acid and acetylcholine

Radioligand binding studies have revealed the existence of endogenous circadian rhythms in the number of several receptors in the rat brain. The present microiontophoretic study was undertaken to assess diurnal rhythms in the responsiveness of rat hippocampal pyramidal neurons to serotonin (5-HT), norepinephrine (NE), gamma-aminobutyric acid (GABA), and acetylcholine (ACh). Between December and April, there was a significant diurnal variation in the responsiveness of hippocampal pyramidal neurons to 5-HT and ACh. Between May and August, the responsiveness to NE and ACh showed a diurnal variation. There was no diurnal variation in the responsiveness to GABA in either period of the year. Short-term exposure to constant light or darkness produced a phase-shift of the serotoninergic and cholinergic rhythms, suggesting their endogenous nature and their synchronization to clock-time by the light-dark cycle. The diurnal rhythms in responsiveness to 5-HT and NE underwent phase-shifts from the December-April to the May-August period in rats entrained to 12:12 light-dark cycle, suggesting the existence of seasonal modulation of these rhythms. These circadian rhythms in the postsynaptic responsiveness of hippocampal pyramidal cells and their seasonal fluctuation may be related to the diurnal variation of mood seen in major depression as well as to the seasonal incidence of this illness.

Noradrenergic denervation prevents sensitization of rat forebrain neurons to serotonin by tricyclic antidepressant treatment

The effect of prior lesioning of noradrenergic neurons with 6-hydroxydopamine (6-OHDA) on the ability of amitriptyline to enhance the responsiveness of hippocampal pyramidal neurons to serotonin (5-HT) was examined in Sprague-Dawley rats. In control rats, amitriptyline (5 mg/kg/day for 14 days), administered either by daily injection or by an osmotic minipump, enhanced the responsiveness of these neurons to microiontophoretically applied 5-HT, leaving their responsiveness to norepinephrine (NE) and to acetylcholine unaltered. However, in 6-OHDA-pretreated rats, amitriptyline failed to enhance the responsiveness of hippocampal pyramidal neurons to 5-HT. The effect of NE and, to a lesser extent, that of 5-HT were prolonged in 6-OHDA-pretreated rats, presumably because NE and 5-HT released by microiontophoresis are taken up by NE terminals in the intact rat. The present results provide additional evidence that the integrity of the NE system is required for antidepressant treatments to modify 5-HT neurotransmission.

Serotoninergic but not noradrenergic neurons in rat central nervous system adapt to long-term treatment with monoamine oxidase inhibitors

Repeated administration of monoamine oxidase inhibitors induces a transient decrease in the firing rate of serotoninergic neurons followed by complete recovery, whereas it results in a persistent reduction of the firing rate of noradrenergic neurons. Under these conditions, serotoninergic, but not noradrenergic, neurons undergo a desensitization of their somatic autoreceptors. Serotoninergic neurons therefore show the capacity to free themselves from their autoregulatory control, a property which noradrenergic neurons appear to be lacking. The time course of the recovery in the firing rate of the serotoninergic neurons is consistent with the delayed antidepressant effect of monoamine oxidase inhibitors.

Effect of atmospheric ions on hippocampal pyramidal neuron responsiveness to serotonin

The effect of long-term exposure to positive or negative atmospheric ions on the responsiveness of rat forebrain neurons to serotonin (5-HT) was studied. Male Sprague-Dawley rats were exposed to positive or negative ions (1.5 X 10(6) ions/ml) for 21 days, and a third group of rats served as controls. Unitary extracellular recordings from pyramidal neurons of the CA1 and CA3 regions of the dorsal hippocampus were obtained under urethane anesthesia, and their responsiveness to microiontophoretically applied acetylcholine (ACh), norepinephrine (NE) and 5-HT was assessed. Spontaneous rate of discharge and sensitivity to NE and ACh of hippocampal neurons were not affected by exposure to atmospheric ions. Exposure to negative ions increased and that to positive ions decreased the responsiveness of these neurons to 5-HT. During the winter, a circadian rhythm of responsiveness to 5-HT was observed in the control group, sensitivity being lowest in the morning and highest in the evening. Exposure to ions disrupted this circadian rhythm; in rats exposed to negative ions, responsiveness throughout the day was similar to that observed in the evening in the controls, whereas in rats exposed to positive ions, the circadian rhythm of responsiveness to 5-HT was inverted. Brain concentrations of 5-HT, tryptophan, and 5-hydroxyindoleacetic acid were unchanged by exposure to atmospheric ions.

Continuous release of diazepam: electrophysiological, biochemical and behavioral consequences

Neuronal GABAergic sensitivity was assessed using electrophysiological, biochemical and behavioral techniques following the continuous release and maintenance of relatively constant brain levels of diazepam for greater than or equal to 21 days. Our studies indicate that long-term exposure to diazepam results in: (1) a decrease in iontophoretic sensitivity to GABA in the dorsal raphe nucleus, (2) an increase in the affinity of the GABA recognition site in brain tissue and (3) an increase in susceptibility to bicuculline-induced seizures in the intact animal. Since the decrease in GABAergic responsiveness was observed in the presence of measurable levels of diazepam, it was concluded that this subsensitivity phenomenon is associated with tolerance and not with withdrawal effects of the benzodiazepines.

Short-term lithium administration enhances serotonergic neurotransmission: electrophysiological evidence in the rat CNS

Rats received lithium-containing chow for 48 h. Brain and plasma lithium concentrations ranged from 0.4 to 1.0 mEq/l. A first series of experiments served to assess the responsiveness of CA3 hippocampal pyramidal neurons to microiontophoretically applied serotonin (5-HT) and norepinephrine (NE). The response of the same neurons to electrical stimulation of the ventro-medial 5-HT pathway was measured after lithium treatment. The responsiveness to 5-HT and NE was not modified whereas the effect of activation of the ascending 5-HT pathway was increased two-fold by the lithium treatment. These neurons were activated to their physiological firing rate by means of small ejection currents of acetylcholine. A pretreatment with the 5-HT neurotoxin 5,7-dihydroxytryptamine abolished the response to the electrical stimulation in lithium-treated rats. In a second series of experiments, unitary recordings of 5-HT neurons were obtained from the dorsal raphe nucleus. The lithium treatment modified neither the number of spontaneously active 5-HT neurons nor their mean firing rate. These results provide direct electrophysiological evidence for the enhancement of 5-HT neurotransmission by short-term lithium treatment through its presynaptic action on 5-HT terminals.

Neurochemical aspects of depression: the past and the future?

The role of aberrant neurochemical substrates in the etiology of depression and the neurochemical mechanisms of antidepressant therapies have been the subjects of many hypotheses in the last 30 years. Pharmacological studies of early antidepressant drugs indicated that brain monoamines were significantly affected by these drugs and these led to the formulation of the biogenic amine hypothesis of depression. Although this hypothesis has been of heuristic value in the study of drug mechanisms and has provided a basis for screening drugs for antidepressant potential, deficiencies in it have become apparent. Neuroanatomical and neurochemical considerations favour the view that brain noradrenaline and serotonin systems may serve as bias adjusting systems for each other and numerous other neural systems. As a consequence of such a relationship, a primary defect in some other neural system would appear amplified in measurements of serotonin or noradrenaline. A possible site for this primary defect may be in membrane composition and function. Recent studies have found that typical and other antidepressant therapies have a pronounced effect on membrane lipids. Thus, in view of the important functions of membrane lipids and the fact that they have been linked to the initiation and development of a number of other disease processes, it is now suggested that consideration be given to them as playing primary causal roles in the etiology of depression and as a site of action for antidepressant drugs.

Electrophysiological and receptor studies in rat brain: effects of clorgyline

Acute high doses of clorgyline produce a rapid inhibition of monoamine oxidase type A (MAO A) in the rat brain, together with an increase in norepinephrine and a decrease in the firing rate of locus coeruleus (LC) neurones: this decrease is reversed by piperoxane, an alpha 2 antagonist. In control animals, piperoxane increases LC neuronal firing showing that these noradrenergic neurones are under alpha 2-adrenoceptor-mediated tonic inhibition. Chronic administration of clorgyline, like acute doses of this MAO A inhibitor, significantly decreases cell firing in the LC and the effect is partially reversed by piperoxane. Chronic clorgyline treatment also produces significant decreases in [3H]clonidine and [3H]dihydroalprenolol binding in cerebral cortex, receptor changes which are slightly greater in animals showing greater inhibition of LC neuronal firing: such receptor changes do not occur following a single exposure to clorgyline. Electrophysiological studies in hippocampal pyramidal cells show that the chronic clorgyline treatment does not significantly induced subsensitivity to NE in these adrenoreceptive cells.

The neurochemistry of mania. The effect of lithium on catecholamines, indoleamines and calcium mobilization

In an attempt to elucidate the chemical pathology of mania one has to consider the pharmacology of the two most effective treatments for this illness: lithium and the neuroleptics. Some of the possible mechanisms of action of these drugs on catecholamine and indoleamine mechanisms are discussed. The majority of this article is based on my and my colleagues' work which has been carried out in this MRC Laboratory on the effect of lithium on biological variates in bipolar patients and the effects of the administration of antidepressant treatments in these patients. It is concluded that lithium has a similar action on these mechanisms in both unipolar and bipolar patients which might suggest a common pathology in both unipolar and bipolar illness. It is suggested that in order to maintain an euthymic state in a bipolar patient one should maintain a certain degree of sensitivity of 5-HT2 receptors. This sensitivity may be related to the activity of calcium channels and to the polyphosphoinositide system. The former system can be regulated by the administration of calcium channel antagonists which have been shown to be effective in the treatment of mania. The polyphosphoinositide system is one that can be regulated by therapeutic concentrations of lithium. It is concluded that co-administration of a calcium channel antagonist and lithium may be a very effective treatment for mania.

Spontaneous and RO 15-1788-induced reversal of subsensitivity to GABA following chronic benzodiazepines

Chronic daily injections of diazepam (5 mg/kg i.p.) for 21-30 days have previously been shown to cause a selective subsensitivity to microiontophoretically applied GABA in serotonergic dorsal raphe neurons in the rat. Following termination of chronic benzodiazepine treatment, GABAergic sensitivity remained depressed for up to 96 h even though pharmacologically active concentrations of diazepam and its active metabolites could no longer be detected in brain tissue. In contrast, a single injection of the specific benzodiazepine antagonist, RO 15-1788, given 22 h prior to electrophysiological recording, restored GABAergic sensitivity to the control range. Sensitivity of dorsal raphe neurons to serotonin was not altered by either chronic treatment with or withdrawal from diazepam. These results indicate that (1) RO 15-1788 can accelerate the time course of withdrawal and (2) administration of this benzodiazepine antagonist can induce a persistent change in GABAergic responsiveness.

The effect of prolonged treatment with tricyclic antidepressants on the actions of 5-hydroxytryptamine in the hippocampal slice of the rat

The effect of long-term treatment with the tricyclic antidepressants imipramine (IMI) and desmethylimipramine (DMI) on neuronal responsiveness to 5-hydroxytryptamine (5-HT) was examined in the hippocampal slice preparation from the rat. Population spikes, evoked by electrical stimulation of the stratum radiatum, were recorded in the pyramidal cell layer of the CA1 region of the isolated hippocampus. When 5-HT (10(-7) to 2 X 10(-5) M) was applied there was an initial increase followed by a decrease in the amplitude of the population spike. On washout of 5-HT the amplitude increased transiently above control levels. Daily injection of 10 mg/kg of imipramine or desmethylimipramine, intraperitoneally, into rats for 4-5 weeks was found to produce a significant decrease in the inhibitory effect of 10(-5) M 5-HT, whereas there was no apparent change in the excitatory effects. The acute application of 10(-5) M imipramine or desmethylimipramine antagonized the inhibitory effect of 10(-5) M 5-HT without affecting the excitatory effects. Acute application of the 5-HT receptor antagonists cyproheptadine (10(-5) M) and ketanserin (7.5 X 10(-6) M) completely prevented the appearance of the inhibitory effect of 10(-5) M 5-HT without affecting the excitatory effects. It was concluded that the decreased inhibitory effect of 5-HT which was produced by chronic treatment with imipramine or desmethylimipramine was probably due to a reduction in the number of 5-HT receptors or a reduction in the post-receptor effector mechanisms for 5-HT.

Changes in mouse brain serotonin turnover following chronic imipramine administration

Mice were injected daily for 2 weeks with saline, tryptophan or p-chlorophenylalanine, alone or in combination with the tricyclic antidepressant imipramine. Serotonin turnover in several brain regions was determined by the accumulation of serotonin after pargyline and 5-hydroxyindoleacetic acid after probenecid. Both methods agreed closely. Imipramine tended to depress serotonin turnover. This effect was more marked in hypothalamus, which has high serotonin activity, and was much less in cerebellum, which has low serotonin activity. Chronic imipramine treatment completely abolished the increase in serotonin turnover induced by tryptophan, but had no effect on serotonin turnover in mice treated with p-chlorophenylalanine, which itself reduced serotonin activity.

Antidepressants and serotonergic neurotransmission: an integrative review

The effects of acute and chronic antidepressant treatment on various aspects of 5-HT neurotransmission are reviewed, in order to assess the net effect of antidepressants on transmission across 5-HT synapses. Events considered include presynaptic effects of antidepressants (on autoreceptor function, uptake and turnover) and effects on postsynaptic receptor function (assessed by electrophysiological, neuroendocrine, behavioural, and receptor binding methods). Acute antidepressant treatment has variable effects: transmission may be enhanced, unchanged or reduced, depending mainly upon the relative contributions of 5-HT uptake blockade and 5-HT receptor antagonism. However, on chronic administration, most antidepressants appear to enhance 5-HT transmission. This effect is clearest in the case of ECS, which has little effect on 5-HT turnover, but reduces uptake and increases postsynaptic receptor function. MAOIs may be an exception: there is little evidence that MAOIs enhance 5-HT transmission following chronic treatment. Most other antidepressant drugs, including some which are powerful receptor antagonists on acute administration, reduce 5-HT receptor function briefly, but enhance receptor function if several hours elapse between the final injection and testing. Zimelidine has little effect on postsynaptic receptor function, but enhances 5-HT transmission by its powerful blockade of 5-HT uptake. Chronic treatment with antidepressant drugs has usually been found to reduce binding to 5-HT2 receptors; it is difficult to reconcile these observations with the functional studies. In general, with the possible exception of MAOIs, chronic administration of antidepressants may enhance 5-HT transmission by both pre- and post-synaptic effects, and the relative contributions vary. This conclusion supports the classical "indoleamine hypothesis of depression" rather than the more recent "hypersensitive serotonin receptor" theory.

Chronic antidepressants and GABA "B" receptors: a GABA hypothesis of antidepressant drug action

Amitryptyline (10 mg/kg), desipramine (5 mg/kg), citalopram (10 mg/kg) and viloxazine (10 mg/kg) were administered to rats either acutely (decapitation 1 hr after i.p. injection) or subacutely (by subcutaneous minipump implantation for 18 days followed by decapitation 24 hr after removal). After acute administration there was not any consistent alteration in GABA levels, GAD activity, 3H GABA "A" or 3H-GABA "B" receptor binding or 3H-nipecotic acid binding to the recognition site for GABA uptake in the frontal cortex or hippocampus. Upon subacute antidepressant drug infusion, GABA levels, GAD activity and 3H-GABA-"A" binding showed only scattered differences in drug treated animals as compared to saline treated rats. However, 3H-GABA "B" binding in the frontal cortex was consistently elevated after all drug treatments (in % of control: amitryptyline = 155%; desipramine = 151%; citalopram = 173%; viloxazine = 189%). Scatchard analysis showed that this was due to a Bmax increase without an effect in Kd. These findings were reproduced by subacute administration of pargyline, a MAO inhibitor. These data suggest that GABA "B" receptors may be involved in the mechanism of action of antidepressant drugs and provide a link between GABAergic and monoaminergic hypotheses of depression.

Sensitization of rat forebrain neurons to serotonin by adinazolam, an antidepressant triazolobenzodiazepine

Adinazolam , a triazolobenzodiazepine , has been reported to be an effective antidepressant treatment in major depression. In the present study, a 14-day (but not a five-day) treatment with adinazolam enhanced the responsiveness of rat hippocampal pyramidal neurons to microiontophoretically applied 5-HT but not to NE. A 14-day treatment with diazepam failed to induce sensitization to either 5-HT or NE. Acute intravenous administration of adinazolam did not modify dorsal raphe 5-HT neuron firing rate. It is proposed that the antidepressant activity of adinazolam might be mediated by a heightened 5-HT neurotransmission.

Chronic benzodiazepine treatment decreases postsynaptic GABA sensitivity

Benzodiazepines exert most of their pharmacological effects by a selective facilitation of the postsynaptic actions of GABA. Clinical, behavioural and electrophysiological studies have shown reduced drug response following chronic benzodiazepine administration. We present here electrophysiological evidence for decreased postsynaptic sensitivity to GABA following chronic benzodiazepine administration as measured by the direct iontophoretic application of GABA and serotonin onto serotonergic cells in the midbrain dorsal raphe nucleus (DRN), known to receive GABAergic input. The subsensitivity to GABA was found to be dose dependent and was seen when diazepam administration was three weeks or longer. Further, acute injection of the specific benzodiazepine antagonist, Ro15-1788, was found to reverse rapidly the decrease in GABA sensitivity observed in chronically diazepam-treated animals without altering GABA sensitivity in vehicle-treated rats. Decreased response to chronic benzodiazepines does not appear to be consistently related to alterations in the number or affinity of receptors for benzodiazepines. Our studies of radioligand-binding showed a decrease in the ability of GABA to enhance benzodiazepine binding in cerebral cortical membranes from chronic diazepam-treated animals without significant changes in benzodiazepine binding site density or affinity.

Effects of the two antidepressant drugs mianserin and indalpine on the serotonergic system: single-cell studies in the rat

Several antidepressant treatments enhance serotonergic neurotransmission. The present electrophysiological studies were undertaken to assess the effect of mianserin and indalpine, two antidepressant drugs with different pharmacological profiles, on serotonergic neurotransmission. In a first series of experiments, the responsiveness of hippocampal pyramidal neurons to microiontophoretic applications of serotonin (5-HT), norepinephrine (NE) and gamma-aminobutyric acid (GABA) was assessed following mianserin, imipramine (5 mg/kg/day IP) or saline administration for 14 days. At 48 h after the last dose of mianserin, responsiveness to 5-HT was increased whereas that to NE and GABA was not modified. The degree of sensitization to 5-HT was the same as that produced by imipramine. Acute IV administration of mianserin (up to 10 mg/kg) did not decrease the firing rate of dorsal raphe 5-HT neurons. In a second series of experiments, long-term administration of indalpine (5 mg/kg/day IP for 14 days) did not modify the responsiveness of hippocampal pyramidal neurons to microiontophoretically applied 5-HT, NE and GABA whereas imipramine treatment (5 mg/kg/day IP) increased selectively their sensitivity to 5-HT when compared to indalpine-treated rats. In keeping with its potent reuptake-blocking property, acute IV indalpine produced a marked decrease in the firing rate of dorsal raphe 5-HT neurons (ED50 0.33 mg/kg). The firing rate of dorsal raphe 5-HT neurons was assessed following 2-, 7- and 14-day treatments with indalpine (5 mg/day IP). After 2 days, the firing rate of 5-HT neurons was greatly reduced, after 7 days it had recovered partially and after 14 days it had returned to normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Antidepressant treatments: effects in rodents on dose-response curves of 5-hydroxytryptamine- and dopamine-mediated behaviours and 5-HT2 receptor number in frontal cortex

The effects of repeated electroconvulsive shock (ECS) administration, repeated desmethylimipramine injection (5 mg kg-1, twice daily for 14 days) and acute administration of the beta-adrenoceptor, clenbuterol, on 5-hydroxytryptamine (5-HT)- and dopamine-mediated behaviours in mice have been examined. All three treatments enhanced the carbidopa/5-hydroxytryptophan (5-HTP)-induced head-twitch response at all doses of 5-HTP examined, producing a parallel shift in the dose-response curve. A single ECS administration or single dose of desmethylimipramine had no effect. Only repeated ECS enhanced the locomotor response to injection of apomorphine. The dose-response curve shift was not parallel. A single ECS had no effect. A 6-hydroxydopamine lesion of brain dopamine terminals also enhanced the apomorphine response, but again did not produce a parallel shift in the dose-response curve. Both repeated ECS and repeated desmethylimipramine administration to rats increased the number of 5-HT2 receptor sites in rat brain. Clenbuterol had no effect. The enhancing effects of repeated ECS and clenbuterol administration on the 5-HTP-induced head-twitch response were additive. Enhanced 5-HT-mediated behavioural responses are seen in both mice and rats after these treatments. If it is assumed, therefore, that similar receptor changes occur in both species it appears that there is no relationship in either behavioural system between the ability of the treatment to alter receptor number and the change in the dose-response curve (parallel or non-parallel). All three antidepressant treatments (ECS, a tricyclic and a beta-adrenoceptor agonist) increase 5-HT-mediated behavioural responses although clenbuterol did not increase 5-HT2 receptor number. Only ECS increased dopamine-mediated responses.

Effects of chronic antidepressant treatment on serotonin receptor activity in mice

The effect of acute and chronic treatments with conventional and atypical antidepressant drugs on serotonin receptor activity was assessed by the responsiveness of mice to the serotonin receptor agonist 5-methoxy-N,N-dimethyltryptamine. Acute treatment with 10 mg/kg of amitriptyline, imipramine, trazodone, mianserin or viloxazine reduced the head twitch response measured 1 h following a challenged dose of the serotonin agonist. Acute iprindole and desmethylimipramine, however, had no effect on the serotonergic response. Chronic treatment with the clinically effective antidepressants amitriptyline, imipramine, desmethylimipramine, iprindole, and trazodone produced an enhanced responsiveness to 5-MeODMT. The enhanced responsiveness was first observed 24 h after cessation of treatment with most drugs. The effect lasted for at least 48 h. Chronic treatment with the neuroleptic haloperidol did not result in altered responsivity to the serotonin agonist. Brain accumulation of imipramine and amitriptyline and their deaminated metabolites were measured. Brain drug and metabolite levels peaked 1 h following both acute and chronic treatments. Brain accumulations of amitriptyline and its metabolite were much greater than those of imipramine and its metabolite. This pharmacokinetic data is consistent with an early (1 h) antagonism of the 5-MeODMT response and the emergence of hightened responsiveness to 5-MeODMT after chronic treatment, when brain drug levels are reduced. These findings are also consistent with the greater inhibitory effect found after treatment with amitriptyline than with imipramine. It is concluded that enhanced serotonin neurotransmission which develops during chronic treatment with antidepressant drugs may be related to the clinical action of these drugs.

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

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

Chronic antidepressant therapy and associated changes in central monoaminergic receptor functioning

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

Enhancement of responsiveness of the central serotonergic system and serotonin-2 receptor density in rat frontal cortex by electroconvulsive treatment

The effect of a series of 10 electroconvulsive shocks (ECS) on the hyperthermic response of heat-adapted rats to a serotonergic stimulant, 3-chlorophenylpiperazine (CPP), and on radioligand binding to serotonin-1 and serotonin-2 receptors in frontal cortical membranes was investigated. Chronic ECS augmented the hyperthermic response of rats to CPP, did not affect [3H]serotonin binding to serotonin-1 receptors, and increased [3H]spiroperidol binding to serotonin-2 receptors. The treatment increased the density of serotonin-2 receptors by about 40%. It is suggested that the increased responsiveness of the central serotonergic system may be an important factor in the antidepressant action of chronic ECS.

The sensitivity of cortical neurons to serotonin: effect of chronic treatment with antidepressants, serotonin-uptake inhibitors and monoamine-oxidase-blocking drugs

The sensitivity of rostral and cingulate cortical neurons to microiontophoretically administered serotonin (5-HT) was compared in groups of rats treated either acutely or chronically for different periods with various drugs. The drugs used were: desipramine (10 mg/kg), clomipramine (10 mg/kg), CGP 6085 (10 mg/kg), clorgyline (0.3 mg/kg), and deprenyl (1 mg/kg). Serotonin and, in some instances, gamma-aminobutyric acid (GABA) were applied microiontophoretically over periods of 60 sec with various ejection currents to spontaneously active neurons in the rostral and cingulate cortex. Of all the compounds tested, only clorgyline produced a marked desensitization to 5-HT in both cortical areas. After prolonged treatment with all the other drugs, no change in the sensitivity to serotonin was observed. The desensitization to 5-HT induced by clorgyline developed after 4 to 10 days of treatment. The responsiveness of these cells to GABA was unchanged after chronic exposure to clorgyline. The present results are consistent with those biochemical studies showing that chronic treatment with 5-HT-uptake-blocking compounds has no effect on 5-HT-binding characteristics, as well as with the observation that prolonged treatment with the monoamine-oxidase A-type blocker clorgyline reduces the number of 5-HT-binding sites.

Lithium induces rapid relief of depression in tricyclic antidepressant drug non-responders

Eight patients suffering from a major unipolar depression and having field to respond to treatment for three weeks or more with tricyclic antidepressants were given lithium. All eight patients experienced a remarkable relief of their depression within 48 hours. This rapid antidepressant effect of lithium in "treatment-resistant' patients might be due to the enhancement of the efficacy of the central serotoninergic system, unveiling the tricyclic antidepressant-induced sensitization of the serotoninergic postsynaptic receptors.

Monoaminergic denervation of the rat hippocampus: microiontophoretic studies on pre- and postsynaptic supersensitivity to norepinephrine and serotonin

The responsiveness of hippocampal CA3 pyramidal neurons to microiontophoretic applications of serotonin (5-HT), norepinephrine (NE), gamma-aminobutyric acid (GABA) and isoproterenol (ISO) was assessed in rats following 5,7-dihydroxy-tryptamine (5,7-DHT) and 6-hydroxydopamine (6-OHDA) pretreatments and bilateral locus coeruleus lesions. The intraventricular administration of 200 micrograms (free base) of 5,7-DHT and of 6-OHDA produced 89% and 93% decreases of 5-HT and NE respectively. None of these pretreatments modified the inital responsiveness to, or recovery from iontophoretic application of 5-HT. In 6-OHDA pretreated and locus-lesioned rats, the initial effectiveness of NE was not altered but its effect was markedly prolonged. However, there was no such prolongation of the effect of ISO which is not a substrate for the high affinity NE reuptake. The effect of GABA was not affected by these pretreatments. Acute pharmacological blockade of the NE reuptake with desipramine (5 mg/kg, i.p.) similarly induced a prolongation of the effect of iontophoretically applied NE, while fluoxetine (10 mg/kg, i.p.) a 5-HT reuptake blocker, failed to alter the recovery of pyramidal cells from iontophoretic application of 5-HT. It is concluded that 5-HT denervation induces neither pre- nor postsynaptic types of supersensitivity in hippocampal pyramidal cells, contrasting with the previously shown supersensitivity of ventral lateral geniculate and amygdaloid neurons following 5-HT denervation. NE denervation fails to induce a postsynaptic type of supersensitivity but leads to a marked prolongation of the response to NE indicative of a presynaptic mechanism. These results underscore the necessity for regional studies of neurotransmitters and drug action.

Effect of chronic tricylic antidepressant treatment on the serotoninergic autoreceptor: a microiontophoretic study in the rat

Chronic treatment with tricyclic antidepressant (TCA) drugs has been shown to enhance the responsiveness of rat forebrain neurons to serotonin (5-HT). In the present study, imipramine (5 mg and 10 mg/kg), iprindole (2.5 mg/kg), desipramine and femoxetine (5 mg/kg) were administered daily for 14 days. The response of dorsal raphe neurons to intravenous injection of LSD (4 microgram/kg) and to microiontophoretic applications of 5-HT and LSD was assessed 24 h after the last dose. The responsiveness to intravenous LSD and the effectiveness of microiontophoretic applications of 5-HT and LSD were not altered by TCA drug pretreatments. Furthermore, the treatments did not change the mean firing rate of these 5-HT neurons. Those results suggest that chronic treatment with TCA drugs does not alter the sensitivity of the 5-HT autoreceptor. Thus, the effect of the previously reported increase of postsynaptic neuron responsiveness to 5-HT would not be dampened by a decreased activity of the presynaptic neurons.