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Loeffler DA. Enhancing of cerebral Abeta clearance by modulation of ABC transporter expression: a review of experimental approaches. Front Aging Neurosci 2024; 16:1368200. [PMID: 38872626 PMCID: PMC11170721 DOI: 10.3389/fnagi.2024.1368200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/01/2024] [Indexed: 06/15/2024] Open
Abstract
Clearance of amyloid-beta (Aβ) from the brain is impaired in both early-onset and late-onset Alzheimer's disease (AD). Mechanisms for clearing cerebral Aβ include proteolytic degradation, antibody-mediated clearance, blood brain barrier and blood cerebrospinal fluid barrier efflux, glymphatic drainage, and perivascular drainage. ATP-binding cassette (ABC) transporters are membrane efflux pumps driven by ATP hydrolysis. Their functions include maintenance of brain homeostasis by removing toxic peptides and compounds, and transport of bioactive molecules including cholesterol. Some ABC transporters contribute to lowering of cerebral Aβ. Mechanisms suggested for ABC transporter-mediated lowering of brain Aβ, in addition to exporting of Aβ across the blood brain and blood cerebrospinal fluid barriers, include apolipoprotein E lipidation, microglial activation, decreased amyloidogenic processing of amyloid precursor protein, and restricting the entrance of Aβ into the brain. The ABC transporter superfamily in humans includes 49 proteins, eight of which have been suggested to reduce cerebral Aβ levels. This review discusses experimental approaches for increasing the expression of these ABC transporters, clinical applications of these approaches, changes in the expression and/or activity of these transporters in AD and transgenic mouse models of AD, and findings in the few clinical trials which have examined the effects of these approaches in patients with AD or mild cognitive impairment. The possibility that therapeutic upregulation of ABC transporters which promote clearance of cerebral Aβ may slow the clinical progression of AD merits further consideration.
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Affiliation(s)
- David A. Loeffler
- Department of Neurology, Beaumont Research Institute, Corewell Health, Royal Oak, MI, United States
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2
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Iordache AM, Voica C, Roba C, Nechita C. Lithium Content and Its Nutritional Beneficence, Dietary Intake, and Impact on Human Health in Edibles from the Romanian Market. Foods 2024; 13:592. [PMID: 38397569 PMCID: PMC10888284 DOI: 10.3390/foods13040592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Lithium (Li) is present in human nutrition based on food intake, and several studies recommend it for treating mood disorders, even if the biological proprieties and biochemical mechanisms represent the basis for its use as an essential element. The Li content was evaluated using the inductively coupled plasma mass spectrometry technique (ICP-MS) in 1071 food and beverage samples from the Romanian market. The results show that Li had a decreasing mean concentration in the food samples as follows: vegetables leafy > bulbous > fructose > leguminous > egg whites > root vegetables > milk products > egg yolks > meats. Approximately a quarter of all data from each dataset category was extreme values (range between the third quartile and maximum value), with only 10% below the detection limit. Mean Li concentration indicated higher values in red wine, white wines, beers, and fruit juice and lower in ciders and bottled waters. A particular interest was addressed to plants for teas and coffee seeds, which showed narrow amounts of Li. For both food and beverages, two similar matrices, including egg whites and yolks and white and red wines, were found to have significant differences, which explains the high variability of Li uptake in various matrices. For 99.65% of the analyzed samples, the estimated daily intake of Li was below the provisional subchronic and chronic reference dose (2 µg/kgbw/day) for adverse effects in several organs and systems. Even so, a risk occurs in consuming bulbous vegetables (Li > 13.47 mg/kg) and fructose solano vegetables (Li > 11.33 mg/kg). The present study's findings indicate that ingesting most of the analyzed beverages and food samples could be considered safe, even if future studies regarding Li content, nutritional aspects, and human cohort diseases must be conducted.
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Affiliation(s)
- Andreea Maria Iordache
- National Research and Development Institute for Cryogenics and Isotopic Technologies—ICSI Ramnicu Valcea, 4 Uzinei Street, 240050 Ramnicu Valcea, Romania;
| | - Cezara Voica
- National Institute for Research and Development of Isotopic and Molecular Technologies, 67-103 Donat St., 400293 Cluj-Napoca, Romania
| | - Carmen Roba
- Faculty of Environmental Science and Engineering, Babes-Bolyai University, 30 Fântânele Street, 400294 400535 Cluj-Napoca, Romania;
| | - Constantin Nechita
- National Research and Development Institute for Forestry “Marin Drăcea”—INCDS, 128 Boulvard Eroilor, 077190 Voluntari, Romania
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Dai X, Chen W, Qiao Y, Chen X, Chen Y, Zhang K, Zhang Q, Duan X, Li X, Zhao J, Tian F, Liu K, Dong Z, Lu J. Dihydroartemisinin inhibits the development of colorectal cancer by GSK-3β/TCF7/MMP9 pathway and synergies with capecitabine. Cancer Lett 2024; 582:216596. [PMID: 38101610 DOI: 10.1016/j.canlet.2023.216596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
Patients with colorectal cancer (CRC) suffer from poor prognosis and lack effective drugs. Dihydroartemisinin (DHA) has anti-cancer potential but the mechanism remains unclear. We elucidated the effects and mechanism of DHA on CRC development with the aim of providing an effective, low-toxicity drug and a novel strategy for CRC. Herein, proliferation assay, transwell assay, tube formation assay, metastasis models, PDX model and AOM/DSS model were used to reveal the effects of DHA on CRC. The key pathway and target were identified by RNA-seq, ChIP, molecular docking, pull down and dual-luciferase reporter assays. As a result, DHA showed a strong inhibitory effect on the growth, metastasis and angiogenesis of CRC with no obvious toxicity, and the inhibitory effect was similar to that of the clinical drug Capecitabine (Cap). Indeed, DHA directly targeted GSK-3β to inhibit CRC development through the GSK-3β/TCF7/MMP9 pathway. Meaningfully, DHA in combination with Cap enhanced the anti-cancer effect, and alleviated Cap-induced diarrhoea, immunosuppression and inflammation. In conclusion, DHA has the potential to be an effective and low-toxicity drug for the treatment of CRC. Furthermore, DHA in combination with Cap could be a novel therapeutic strategy for CRC with improved efficacy and reduced side effects.
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Affiliation(s)
- Xiaoshuo Dai
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China
| | - Wei Chen
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China
| | - Yan Qiao
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China; Collaborative Innovation Center of Henan Province for Cancer Chemoprevention, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China; State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan Province, 450052, PR China
| | - Xinhuan Chen
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China; Collaborative Innovation Center of Henan Province for Cancer Chemoprevention, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China; State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan Province, 450052, PR China
| | - Yihuan Chen
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China
| | - Kai Zhang
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China
| | - Qiushuang Zhang
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China
| | - Xiaoxuan Duan
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China
| | - Xiang Li
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China; Collaborative Innovation Center of Henan Province for Cancer Chemoprevention, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China; State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan Province, 450052, PR China
| | - Jimin Zhao
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China; Collaborative Innovation Center of Henan Province for Cancer Chemoprevention, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China; State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan Province, 450052, PR China
| | - Fang Tian
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China; Collaborative Innovation Center of Henan Province for Cancer Chemoprevention, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China; State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan Province, 450052, PR China
| | - Kangdong Liu
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China; Collaborative Innovation Center of Henan Province for Cancer Chemoprevention, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China; State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan Province, 450052, PR China
| | - Ziming Dong
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China; Collaborative Innovation Center of Henan Province for Cancer Chemoprevention, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China; State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan Province, 450052, PR China
| | - Jing Lu
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China; Collaborative Innovation Center of Henan Province for Cancer Chemoprevention, Zhengzhou University, Zhengzhou, Henan Province, 450001, PR China; State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan Province, 450052, PR China.
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Matar D, Serhan A, El Bilani S, Faraj RA, Hadi BA, Fakhoury M. Psychopharmacological Approaches for Neural Plasticity and Neurogenesis in Major Depressive Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1456:27-48. [PMID: 39261422 DOI: 10.1007/978-981-97-4402-2_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Major depressive disorder (MDD) is a mental health disorder associated with cognitive impairment, dysregulated appetite, fatigue, insomnia or hypersomnia, and severe mood changes that significantly impact the ability of the affected individual to perform day-to-day tasks, leading to suicide in the worst-case scenario. As MDD is becoming more prevalent, affecting roughly 300 million individuals worldwide, its treatment has become a major point of interest. Antidepressants acting as selective serotonin reuptake inhibitors (SSRIs) are currently used as the first line of treatment for MDD. Other antidepressants currently used for the treatment of MDD include the serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). However, although effective in alleviating symptoms of MDD, most antidepressants require weeks or even months of regular administration prior to eliciting a rational clinical effect. Owing to the strong evidence showing a relationship between neural plasticity, neurogenesis, and MDD, researchers have also looked at the possibility of using treatment modalities that target these processes in an attempt to improve clinical outcome. The overarching aim of this chapter is to highlight the role of neural plasticity and neurogenesis in the pathophysiology of MDD and discuss the most recently studied treatment strategies that target these processes by presenting supporting evidence from both animal and human studies.
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Affiliation(s)
- Dina Matar
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Aya Serhan
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Sabah El Bilani
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Rashel Abi Faraj
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Bayan Ali Hadi
- School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Marc Fakhoury
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon.
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Davis RA, Branagan T, Schneck CD, Schold JD, Thant T, Kaplan B. Lithium and the living kidney donor: Science or stigma? Am J Transplant 2023; 23:1300-1306. [PMID: 37236400 DOI: 10.1016/j.ajt.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023]
Abstract
Nearly 10 000 people are removed from the kidney transplant waiting list each year either due to becoming too ill for transplant or due to death. Live donor kidney transplant (LDKT) provides superior outcomes and survival benefit relative to deceased donor transplant, but the number of LDKT has decreased over the past few years. Therefore, it is of paramount importance that transplant centers employ evaluation processes that safely maximize LDKT. Decisions about donor candidacy should be based on the best available data, rather than on processes prone to bias. Here, we examine the common practice of declining potential donors based solely on treatment with lithium. We conclude that the risk of end-stage renal disease related to lithium treatment is comparable to other generally accepted risks in LDKT. We present this viewpoint to specifically challenge the carte blanche exclusion of individuals taking lithium and highlight the importance of using the best available data relevant to any risk factor, rather than relying on biases, when evaluating potential living kidney donors.
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Affiliation(s)
- Rachel A Davis
- Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA.
| | - Tyler Branagan
- Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Christopher D Schneck
- Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Jesse D Schold
- Department of Surgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Thida Thant
- Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Bruce Kaplan
- Department of Surgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education, Aurora, Colorado, USA; Department of Medicine, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
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6
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Rybakowski JK. Mood Stabilizers of First and Second Generation. Brain Sci 2023; 13:741. [PMID: 37239213 PMCID: PMC10216063 DOI: 10.3390/brainsci13050741] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
The topic of this narrative review is mood stabilizers. First, the author's definition of mood-stabilizing drugs is provided. Second, mood-stabilizing drugs meeting this definition that have been employed until now are described. They can be classified into two generations based on the chronology of their introduction into the psychiatric armamentarium. First-generation mood stabilizers (FGMSs), such as lithium, valproates, and carbamazepine, were introduced in the 1960s and 1970s. Second-generation mood stabilizers (SGMSs) started in 1995, with a discovery of the mood-stabilizing properties of clozapine. The SGMSs include atypical antipsychotics, such as clozapine, olanzapine, quetiapine, aripiprazole, and risperidone, as well as a new anticonvulsant drug, lamotrigine. Recently, as a candidate for SGMSs, a novel antipsychotic, lurasidone, has been suggested. Several other atypical antipsychotics, anticonvulsants, and memantine showed some usefulness in the treatment and prophylaxis of bipolar disorder; however, they do not fully meet the author's criteria for mood stabilizers. The article presents clinical experiences with mood stabilizers of the first and second generations and with "insufficient" ones. Further, current suggestions for their use in preventing recurrences of bipolar mood disorder are provided.
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Affiliation(s)
- Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, 61-701 Poznan, Poland
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7
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Korlatowicz A, Kolasa M, Pabian P, Solich J, Latocha K, Dziedzicka-Wasylewska M, Faron-Górecka A. Altered Intracellular Signaling Associated with Dopamine D2 Receptor in the Prefrontal Cortex in Wistar Kyoto Rats. Int J Mol Sci 2023; 24:ijms24065941. [PMID: 36983013 PMCID: PMC10056486 DOI: 10.3390/ijms24065941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Wistar-Kyoto rats (WKY), compared to Wistar rats, are a well-validated animal model for drug-resistant depression. Thanks to this, they can provide information on the potential mechanisms of treatment-resistant depression. Since deep brain stimulation in the prefrontal cortex has been shown to produce rapid antidepressant effects in WKY rats, we focused our study on the prefrontal cortex. Using quantitative autoradiography, we observed a decrease in the binding of [3H] methylspiperone to the dopamine D2 receptor, specifically in that brain region-but not in the striatum, nor the nucleus accumbens-in WKY rats. Further, we focused our studies on the expression level of several components associated with canonical (G proteins), as well as non-canonical, D2-receptor-associated intracellular pathways (e.g., βarrestin2, glycogen synthase kinase 3 beta-Gsk-3β, and β-catenin). As a result, we observed an increase in the expression of mRNA encoding the regulator of G protein signaling 2-RGS2 protein, which is responsible, among other things, for internalizing the D2 dopamine receptor. The increase in RGS2 expression may therefore account for the decreased binding of the radioligand to the D2 receptor. In addition, WKY rats are characterized by the altered signaling of genes associated with the dopamine D2 receptor and the βarrestin2/AKT/Gsk-3β/β-catenin pathway, which may account for certain behavioral traits of this strain and for the treatment-resistant phenotype.
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Affiliation(s)
- Agata Korlatowicz
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343 Kraków, Poland
| | - Magdalena Kolasa
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343 Kraków, Poland
| | - Paulina Pabian
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343 Kraków, Poland
| | - Joanna Solich
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343 Kraków, Poland
| | - Katarzyna Latocha
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343 Kraków, Poland
| | - Marta Dziedzicka-Wasylewska
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343 Kraków, Poland
| | - Agata Faron-Górecka
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343 Kraków, Poland
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Osterland SL, Adli M, Saritas T, Schlattmann P, Behr J, Müller-Mertel R, Hoffmann K, Stamm TJ, Bschor T, Richter C, Steinacher B, Jockers-Scherübl MC, Köhler S, Heinz A, Ricken R, Buspavanich P. Acute effects of lithium augmentation on the kidney in geriatric compared with non-geriatric patients with treatment-resistant depression. Acta Psychiatr Scand 2023; 147:267-275. [PMID: 36585782 DOI: 10.1111/acps.13531] [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] [Received: 09/20/2022] [Revised: 12/13/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Lithium augmentation (LA) of antidepressants is a first-line therapy option for treatment-resistant depression (TRD). Nevertheless, it is rarely used in geriatric patients mostly because of the fear of kidney toxicity. The purpose of this study is to investigate estimated glomerular filtration rate (eGFR) changes and number of acute kidney injuries (AKI) using LA in geriatric compared with non-geriatric patients. METHODS In a prospective multicenter cohort study, eGFR changes were measured in 201 patients with unipolar depression (nage≥65years = 29; nage<65years = 172) at baseline and over 2-6 weeks of LA. We used linear mixed models to investigate changes in eGFR upon LA and assessed the number of AKIs, according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. RESULTS Both age groups showed a significant eGFR decline over the course of treatment with lower eGFR in geriatric patients. The lithium serum level (interpretable as "effect of LA") had a significant effect on eGFR decline. Both effects (age group and lithium serum level) on eGFR decline did not influence each other, meaning the effect of LA on eGFR decline did not differ between age groups. Two AKIs were observed in the geriatric age group when serum lithium levels exceeded the therapeutic range of >0.8 mmol/L. CONCLUSION This is the first study investigating eGFR change and AKI upon LA for TRD in geriatric compared with non-geriatric patients. Our data suggest that LA, as an effective treatment option in geriatric patients, should be closely monitored to avoid AKIs.
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Affiliation(s)
- Sarah Luise Osterland
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany
| | - Turgay Saritas
- Division of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany.,University Hospital RWTH Aachen, Institute of Experimental Medicine and Systems Biology, Aachen, Germany
| | - Peter Schlattmann
- Department of Statistics, Informatics and Data Sciences, Jena University Hospital, Jena, Germany
| | - Joachim Behr
- Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.,Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg University of Technology Cottbus-Senftenberg and Brandenburg Medical School, Potsdam, Germany.,Research Department of Experimental and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ronja Müller-Mertel
- Department of Psychology - Clinical Psychology and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Kai Hoffmann
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychology - Clinical Psychology and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Tom Bschor
- Department of Psychiatry and Psychotherapy, Technical University of Dresden Medical School, Dresden, Germany
| | - Christoph Richter
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Vivantes Klinikum Kaulsdorf, Berlin, Germany
| | - Bruno Steinacher
- Department of Psychiatry and Psychotherapy, Vivantes Wenckebach-Klinikum, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | | | - Stephan Köhler
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Roland Ricken
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Pichit Buspavanich
- Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.,Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg University of Technology Cottbus-Senftenberg and Brandenburg Medical School, Potsdam, Germany.,Research Unit Gender in Medicine, Department of Psychiatry and Psychotherapy, Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Rybakowski JK, Ferensztajn-Rochowiak E. Updated perspectives on how and when lithium should be used in the treatment of mood disorders. Expert Rev Neurother 2023; 23:157-167. [PMID: 36809989 DOI: 10.1080/14737175.2023.2181076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Lithium is one of the most important drugs for the treatment of mood disorders. The appropriate guidelines can ensure that more patients benefit from its use in a personalized way. AREAS COVERED This manuscript provides an update on the application of lithium in mood disorders, including prophylaxis of bipolar and unipolar mood disorder, treatment of acute manic and depressive episodes, augmentation of antidepressants in treatment-resistant depression, and use of lithium in pregnancy and the postpartum period. EXPERT OPINION Lithium remains the gold standard for the prevention of recurrences in bipolar mood disorder. For long-term treatment/management of bipolar mood disorder, clinicians should also consider lithium's anti-suicidal effect. Furthermore, after prophylactic treatment, lithium may also be augmented with antidepressants in treatment-resistant depression. There have also been some demonstration of lithium having some efficacy in acute episodes of mania and bipolar depression as well as in the prophylaxis of unipolar depression.
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Affiliation(s)
- Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
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10
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Rybakowski JK, Ferensztajn-Rochowiak E. Mini-review: Anomalous association between lithium data and lithium use. Neurosci Lett 2022; 777:136590. [PMID: 35346779 DOI: 10.1016/j.neulet.2022.136590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 01/14/2023]
Abstract
This mini-review aims to show a discrepancy between favorable data of lithium's therapeutic activity and the decreased use of the drug worldwide. The data point to lithium as the best mood stabilizer in the maintenance treatment of bipolar disorder for the prevention of manic and depressive recurrences. The second most encouraging psychiatric use of lithium is the augmentation of antidepressants in treatment-resistant depression. In addition to its mood-stabilizing properties, lithium is the most efficacious antisuicidal drug among all mood stabilizers. The drug also exerts antiviral, immunomodulatory, and neuroprotective effects which may be of major clinical value. On the other hand, the data of lithium use show that its therapeutic application in many countries has declined. A reason for this can be the introduction and heavy promotion of other mood-stabilizers, while lithium is an "orphan" drug with the minimal interest of any drug company. Probably, very important is also a perception of lithium as a "toxic drug", pointing to its side effects, mainly thyroid, renal and cognitive ones. In recent years, several proposals to turn back this anomalous association appeared, challenging a negative perception of lithium and optimizing its long-term administration. They show the data on lithium superiority over other mood stabilizers and point to the proper management of the lithium-induced side effects. This endeavor aims to allow a larger number of mood disorder patients to become beneficiaries of lithium use.
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Affiliation(s)
- Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, 60-572 Poznan, ul. Szpitalna 27/33, Poland.
| | - Ewa Ferensztajn-Rochowiak
- Department of Adult Psychiatry, Poznan University of Medical Sciences, 60-572 Poznan, ul. Szpitalna 27/33, Poland
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11
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Yazıcı MK, Özçelik Eroğlu E, Ertuğrul A, Anıl Yağcıoğlu AE, Ağaoğlu E, Karahan S, Eni N, Sağlam Aykut D, Kavak Ö, Erdem Y. Renal effects of long-term lithium therapy, revisited. Hum Psychopharmacol 2022; 37:e2812. [PMID: 34541707 DOI: 10.1002/hup.2812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/21/2021] [Accepted: 08/24/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effect of lithium treatment on renal function and to determine influencing factors. In addition, the utility of spot urine protein/creatinine ratio in detection of lithium induced nephropathy was also investigated. METHODS Serum concentrations of lithium, blood urea nitrogen (BUN), creatinine, estimated glomerular filtration rate (eGFR), and urinalysis including protein/creatinine ratio were measured in 375 patients using lithium. RESULTS Patients taking lithium for ≥8 years had higher BUN, creatinine levels, percentage of proteinuria, percentages of stage 2 and 3 chronic kidney disease (CKD); lower urine density and eGFR compared to patients taking lithium <8 years. Urine density was lower in groups with >0.8 and 0.6-0.8 mmol/L lithium level than <0.6 mmol/L. Predictors of CKD were serum level of lithium, dose of lithium, cumulative duration of lithium use, age at onset of illness, and caffeine consumption. CONCLUSIONS Detrimental effects of lithium on renal functions were detected after lithium use for ≥8 years. Proteinuria measured by spot urine protein/creatinine ratio can be detected even when eGFR is >90 ml/min/1.73 m2 . Spot urine protein/creatinine ratio, which is a cost-effective and practical laboratory test, can be used to monitor lithium-treated patients.
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Affiliation(s)
- M Kâzım Yazıcı
- Faculty of Medicine, Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - Elçin Özçelik Eroğlu
- Faculty of Medicine, Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - Aygün Ertuğrul
- Faculty of Medicine, Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | | | - Esen Ağaoğlu
- Faculty of Medicine, Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - Sevilay Karahan
- Faculty of Medicine, Department of Biostatistics, Hacettepe University, Ankara, Turkey
| | - Nurhayat Eni
- Faculty of Medicine, Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - Demet Sağlam Aykut
- Faculty of Medicine, Department of Psychiatry, Karadeniz Technical University, Trabzon, Turkey
| | - Özlem Kavak
- Faculty of Medicine, Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - Yunus Erdem
- Faculty of Medicine, Department of Internal Diseases, Division of Nephrology, Hacettepe Universitye, Ankara, Turkey
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12
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Electrocardiographic Changes During Initiation of Lithium Augmentation of Antidepressant Pharmacotherapy. J Clin Psychopharmacol 2022; 42:87-91. [PMID: 34854829 DOI: 10.1097/jcp.0000000000001496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE/BACKGROUND Lithium augmentation of antidepressants represents a common strategy to overcome treatment resistance in patients with major depressive disorder. The use of lithium has been associated with cardiovascular adverse effects such as QTc prolongation and tachyarrhythmia. Although the previous studies investigated monotherapy with lithium, the aim of this study was to investigate electrocardiographic changes in LA. METHODS/PROCEDURES A 12-lead surface electrocardiogram (ECG) was obtained from 38 patients with major depressive disorder before and during LA. Changes in heart rate, PQ, QRS and QTc interval, QT dispersion, ST segment, and T- and U-wave alterations were analyzed using a linear mixed model. FINDINGS/RESULTS The ECG readings of 33 patients were evaluated. Lithium augmentation was not significantly associated with changes in heart rate, QTc, PQ, or QRS interval. We found a significant decrease in QT dispersion. These results were independent of sex, age, stable comedication, and comorbidities. During LA, we observed 9 cases of T-wave alterations and 2 cases of new U waves. CONCLUSIONS Our data provide no evidence for serious ECG abnormalities at therapeutic serum lithium levels in patients treated with LA. In particular, we did not find evidence for QTc time lengthening or tachyarrhythmia, such as torsades des pointes. The recommended intervals for ECG checks should be considered to detect long-term effects of LA.
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13
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Yavi M, Henter ID, Park LT, Zarate C. Key considerations in the pharmacological management of treatment-resistant depression. Expert Opin Pharmacother 2021; 22:2405-2415. [PMID: 34252320 PMCID: PMC8648908 DOI: 10.1080/14656566.2021.1951225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
Introduction: Treatment-resistant depression (TRD) is a complex, multifactorial, and biologically heterogeneous disorder with debilitating outcomes. Understanding individual reasons why patients do not respond to treatment is necessary for improving clinical recommendations regarding medication regimens, augmentation strategies, and alternative treatments.Areas covered: This manuscript reviews evidence-based treatment strategies for the clinical management of TRD. Current developments in the field and potential future recommendations for personalized treatment of TRD are also discussed.Expert opinion: Treatment guidelines for TRD are limited by the heterogeneous nature of the disorder. Furthermore, current strategies reflect this heterogeneity by emphasizing disease characteristics as well as drug trial response or failure. Developing robust biomarkers that could one day be integrated into clinical practice has the potential to advance specific treatment targets and ultimately improve treatment and remission outcomes.
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Affiliation(s)
- Mani Yavi
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental HealthNational Institutes of Health Bethesda, MD, USA
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14
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Puglisi-Allegra S, Ruggieri S, Fornai F. Translational evidence for lithium-induced brain plasticity and neuroprotection in the treatment of neuropsychiatric disorders. Transl Psychiatry 2021; 11:366. [PMID: 34226487 PMCID: PMC8257731 DOI: 10.1038/s41398-021-01492-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 02/06/2023] Open
Abstract
Increasing evidence indicates lithium (Li+) efficacy in neuropsychiatry, pointing to overlapping mechanisms that occur within distinct neuronal populations. In fact, the same pathway depending on which circuitry operates may fall in the psychiatric and/or neurological domains. Li+ restores both neurotransmission and brain structure unveiling that psychiatric and neurological disorders share common dysfunctional molecular and morphological mechanisms, which may involve distinct brain circuitries. Here an overview is provided concerning the therapeutic/neuroprotective effects of Li+ in different neuropsychiatric disorders to highlight common molecular mechanisms through which Li+ produces its mood-stabilizing effects and to what extent these overlap with plasticity in distinct brain circuitries. Li+ mood-stabilizing effects are evident in typical bipolar disorder (BD) characterized by a cyclic course of mania or hypomania followed by depressive episodes, while its efficacy is weaker in the opposite pattern. We focus here on neural adaptations that may underlie psychostimulant-induced psychotic development and to dissect, through the sensitization process, which features are shared in BD and other psychiatric disorders, including schizophrenia. The multiple functions of Li+ highlighted here prove its exceptional pharmacology, which may help to elucidate its mechanisms of action. These may serve as a guide toward a multi-drug strategy. We propose that the onset of sensitization in a specific BD subtype may predict the therapeutic efficacy of Li+. This model may help to infer in BD which molecular mechanisms are relevant to the therapeutic efficacy of Li+.
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Affiliation(s)
| | | | - Francesco Fornai
- IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli (IS), Italy.
- Human Anatomy, Department of Translational Research and New technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126, Pisa (PI), Italy.
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15
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Amare AT, Schubert KO, Hou L, Clark SR, Papiol S, Cearns M, Heilbronner U, Degenhardt F, Tekola-Ayele F, Hsu YH, Shekhtman T, Adli M, Akula N, Akiyama K, Ardau R, Arias B, Aubry JM, Backlund L, Bhattacharjee AK, Bellivier F, Benabarre A, Bengesser S, Biernacka JM, Birner A, Brichant-Petitjean C, Cervantes P, Chen HC, Chillotti C, Cichon S, Cruceanu C, Czerski PM, Dalkner N, Dayer A, Del Zompo M, DePaulo JR, Étain B, Jamain S, Falkai P, Forstner AJ, Frisen L, Frye MA, Fullerton JM, Gard S, Garnham JS, Goes FS, Grigoroiu-Serbanescu M, Grof P, Hashimoto R, Hauser J, Herms S, Hoffmann P, Hofmann A, Jiménez E, Kahn JP, Kassem L, Kuo PH, Kato T, Kelsoe JR, Kittel-Schneider S, Kliwicki S, König B, Kusumi I, Laje G, Landén M, Lavebratt C, Leboyer M, Leckband SG, Tortorella A, Manchia M, Martinsson L, McCarthy MJ, McElroy SL, Colom F, Mitjans M, Mondimore FM, Monteleone P, Nievergelt CM, Nöthen MM, Novák T, O'Donovan C, Ozaki N, Ösby U, Pfennig A, Potash JB, Reif A, Reininghaus E, Rouleau GA, Rybakowski JK, Schalling M, Schofield PR, Schweizer BW, Severino G, Shilling PD, Shimoda K, Simhandl C, Slaney CM, Squassina A, Stamm T, Stopkova P, Maj M, Turecki G, Vieta E, Veeh J, Witt SH, Wright A, Zandi PP, Mitchell PB, Bauer M, Alda M, Rietschel M, McMahon FJ, Schulze TG, Baune BT. Association of polygenic score for major depression with response to lithium in patients with bipolar disorder. Mol Psychiatry 2021; 26:2457-2470. [PMID: 32203155 DOI: 10.1038/s41380-020-0689-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/28/2020] [Accepted: 02/13/2020] [Indexed: 11/09/2022]
Abstract
Lithium is a first-line medication for bipolar disorder (BD), but only one in three patients respond optimally to the drug. Since evidence shows a strong clinical and genetic overlap between depression and bipolar disorder, we investigated whether a polygenic susceptibility to major depression is associated with response to lithium treatment in patients with BD. Weighted polygenic scores (PGSs) were computed for major depression (MD) at different GWAS p value thresholds using genetic data obtained from 2586 bipolar patients who received lithium treatment and took part in the Consortium on Lithium Genetics (ConLi+Gen) study. Summary statistics from genome-wide association studies in MD (135,458 cases and 344,901 controls) from the Psychiatric Genomics Consortium (PGC) were used for PGS weighting. Response to lithium treatment was defined by continuous scores and categorical outcome (responders versus non-responders) using measurements on the Alda scale. Associations between PGSs of MD and lithium treatment response were assessed using a linear and binary logistic regression modeling for the continuous and categorical outcomes, respectively. The analysis was performed for the entire cohort, and for European and Asian sub-samples. The PGSs for MD were significantly associated with lithium treatment response in multi-ethnic, European or Asian populations, at various p value thresholds. Bipolar patients with a low polygenic load for MD were more likely to respond well to lithium, compared to those patients with high polygenic load [lowest vs highest PGS quartiles, multi-ethnic sample: OR = 1.54 (95% CI: 1.18-2.01) and European sample: OR = 1.75 (95% CI: 1.30-2.36)]. While our analysis in the Asian sample found equivalent effect size in the same direction: OR = 1.71 (95% CI: 0.61-4.90), this was not statistically significant. Using PGS decile comparison, we found a similar trend of association between a high genetic loading for MD and lower response to lithium. Our findings underscore the genetic contribution to lithium response in BD and support the emerging concept of a lithium-responsive biotype in BD.
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Affiliation(s)
- Azmeraw T Amare
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
- South Australian Academic Health Science and Translation Centre, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Klaus Oliver Schubert
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network, Mental Health Services, Adelaide, SA, Australia
| | - Liping Hou
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
| | - Scott R Clark
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Sergi Papiol
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Micah Cearns
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center (UMG), Georg-August University Göttingen, Göttingen, Germany
| | - Franziska Degenhardt
- Institute of Human Genetics, University of Bonn and Department of Genomics, Life & Brain Center, Bonn, Germany
| | - Fasil Tekola-Ayele
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Yi-Hsiang Hsu
- HSL Institute for Aging Research, Harvard Medical School, Boston, MA, USA
- Program for Quantitative Genomics, Harvard School of Public Health, Boston, MA, USA
| | - Tatyana Shekhtman
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Nirmala Akula
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
| | - Kazufumi Akiyama
- Department of Biological Psychiatry and Neuroscience, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Raffaella Ardau
- Unit of Clinical Pharmacology, Hospital University Agency of Cagliari, Cagliari, Italy
| | - Bárbara Arias
- Unitat de Zoologia i Antropologia Biològica (Dpt. Biologia Evolutiva, Ecologia i Ciències Ambientals), Facultat de Biologia and Institut de Biomedicina (IBUB), University of Barcelona, CIBERSAM, Barcelona, Spain
| | - Jean-Michel Aubry
- Department of Psychiatry, Mood Disorders Unit, HUG - Geneva University Hospitals, Geneva, Switzerland
| | - Lena Backlund
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Frank Bellivier
- INSERM UMR-S 1144, Université Paris Diderot, Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-F.Widal, Paris, France
| | - Antonio Benabarre
- Bipolar Disorder Program, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for bipolar affective disorder, Medical University of Graz, Graz, Austria
| | - Joanna M Biernacka
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for bipolar affective disorder, Medical University of Graz, Graz, Austria
| | - Clara Brichant-Petitjean
- INSERM UMR-S 1144, Université Paris Diderot, Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-F.Widal, Paris, France
| | - Pablo Cervantes
- The Neuromodulation Unit, McGill University Health Centre, Montreal, QC, Canada
| | - Hsi-Chung Chen
- Department of Psychiatry & Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan
| | - Caterina Chillotti
- Unit of Clinical Pharmacology, Hospital University Agency of Cagliari, Cagliari, Italy
| | - Sven Cichon
- Institute of Human Genetics, University of Bonn and Department of Genomics, Life & Brain Center, Bonn, Germany
- Human Genomics Research Group, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Cristiana Cruceanu
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Piotr M Czerski
- Psychiatric Genetic Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for bipolar affective disorder, Medical University of Graz, Graz, Austria
| | - Alexandre Dayer
- Department of Psychiatry, Mood Disorders Unit, HUG - Geneva University Hospitals, Geneva, Switzerland
| | - Maria Del Zompo
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - J Raymond DePaulo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Bruno Étain
- INSERM UMR-S 1144, Université Paris Diderot, Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-F.Widal, Paris, France
| | - Stephane Jamain
- Inserm U955, Translational Psychiatry laboratory, Fondation FondaMental, Créteil, France
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Andreas J Forstner
- Institute of Human Genetics, University of Bonn and Department of Genomics, Life & Brain Center, Bonn, Germany
- Human Genomics Research Group, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Louise Frisen
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Janice M Fullerton
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Sébastien Gard
- Service de psychiatrie, Hôpital Charles Perrens, Bordeaux, France
| | - Julie S Garnham
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Maria Grigoroiu-Serbanescu
- Biometric Psychiatric Genetics Research Unit, Alexandru Obregia Clinical Psychiatric Hospital, Bucharest, Romania
| | - Paul Grof
- Mood Disorders Center of Ottawa, Ottawa, ON, Canada
| | - Ryota Hashimoto
- Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, Osaka, Japan
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Joanna Hauser
- Psychiatric Genetic Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Stefan Herms
- Institute of Human Genetics, University of Bonn and Department of Genomics, Life & Brain Center, Bonn, Germany
- Human Genomics Research Group, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn and Department of Genomics, Life & Brain Center, Bonn, Germany
- Human Genomics Research Group, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Andrea Hofmann
- Institute of Human Genetics, University of Bonn and Department of Genomics, Life & Brain Center, Bonn, Germany
| | - Esther Jiménez
- Bipolar Disorder Program, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jean-Pierre Kahn
- Service de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy - Université de Lorraine, Nancy, France
| | - Layla Kassem
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
| | - Po-Hsiu Kuo
- Department of Public Health & Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tadafumi Kato
- Laboratory for Molecular Dynamics of Mental Disorders, RIKEN Center for Brain Science, Saitama, Japan
| | - John R Kelsoe
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Sebastian Kliwicki
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Barbara König
- Department of Psychiatry and Psychotherapeutic Medicine, Landesklinikum Neunkirchen, Neunkirchen, Austria
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Gonzalo Laje
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
| | - Mikael Landén
- Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the Gothenburg University, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Catharina Lavebratt
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Marion Leboyer
- Inserm U955, Translational Psychiatry laboratory, Université Paris-Est-Créteil, Department of Psychiatry and Addictology of Mondor University Hospital, AP-HP, Fondation FondaMental, Créteil, France
| | - Susan G Leckband
- Office of Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Lina Martinsson
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Michael J McCarthy
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, VA San Diego Healthcare System, San Diego, CA, USA
| | - Susan L McElroy
- Department of Psychiatry, Lindner Center of Hope / University of Cincinnati, Mason, OH, USA
| | - Francesc Colom
- Mental Health Research Group, IMIM-Hospital del Mar, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Marina Mitjans
- Unitat de Zoologia i Antropologia Biològica (Dpt. Biologia Evolutiva, Ecologia i Ciències Ambientals), Facultat de Biologia and Institut de Biomedicina (IBUB), University of Barcelona, CIBERSAM, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Francis M Mondimore
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Palmiero Monteleone
- Neurosciences Section, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn and Department of Genomics, Life & Brain Center, Bonn, Germany
| | - Tomas Novák
- National Institute of Mental Health, Klecany, Czech Republic
| | - Claire O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Norio Ozaki
- Department of Psychiatry & Department of Child and Adolescent Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Urban Ösby
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - James B Potash
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for bipolar affective disorder, Medical University of Graz, Graz, Austria
| | - Guy A Rouleau
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Martin Schalling
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Peter R Schofield
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Barbara W Schweizer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Giovanni Severino
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Paul D Shilling
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Katzutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Christian Simhandl
- Bipolar Center Wiener Neustadt, Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Claire M Slaney
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Alessio Squassina
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Thomas Stamm
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Pavla Stopkova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gustavo Turecki
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Eduard Vieta
- Bipolar Disorder Program, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Julia Veeh
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Adam Wright
- School of Psychiatry, University of New South Wales, and Black Dog Institute, Sydney, NSW, Australia
| | - Peter P Zandi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, and Black Dog Institute, Sydney, NSW, Australia
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Francis J McMahon
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
| | - Thomas G Schulze
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center (UMG), Georg-August University Göttingen, Göttingen, Germany
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bernhard T Baune
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany.
- Department of Psychiatry, Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia.
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.
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16
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Lithium increases mitochondrial respiration in iPSC-derived neural precursor cells from lithium responders. Mol Psychiatry 2021; 26:6789-6805. [PMID: 34075196 PMCID: PMC8760072 DOI: 10.1038/s41380-021-01164-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023]
Abstract
Lithium (Li), valproate (VPA) and lamotrigine (LTG) are commonly used to treat bipolar disorder (BD). While their clinical efficacy is well established, the mechanisms of action at the molecular level are still incompletely understood. Here we investigated the molecular effects of Li, LTG and VPA treatment in induced pluripotent stem cell (iPSC)-derived neural precursor cells (NPCs) generated from 3 healthy controls (CTRL), 3 affective disorder Li responsive patients (Li-R) and 3 Li non-treated patients (Li-N) after 6 h and 1 week of exposure. Differential expression (DE) analysis after 6 h of treatment revealed a transcriptional signature that was associated with all three drugs and most significantly enriched for ribosome and oxidative phosphorylation (OXPHOS) pathways. In addition to the shared DE genes, we found that Li exposure was associated with 554 genes uniquely regulated in Li-R NPCs and enriched for spliceosome, OXPHOS and thermogenesis pathways. In-depth analysis of the treatment-associated transcripts uncovered a significant decrease in intron retention rate, suggesting that the beneficial influence of these drugs might partly be related to splicing. We examined the mitochondrial respiratory function of the NPCs by exploring the drugs' effects on oxygen consumption rate (OCR) and glycolytic rate (ECAR). Li improved OCR levels only in Li-R NPCs by enhancing maximal respiration and reserve capacity, while VPA enhanced maximal respiration and reserve capacity in Li-N NPCs. Overall, our findings further support the involvement of mitochondrial functions in the molecular mechanisms of mood stabilizers and suggest novel mechanisms related to the spliceosome, which warrant further investigation.
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Perugi G, Calò P, De Filippis S, Rosso G, Vita A, Adami M, Ascione G, Morrens J, Delmonte D. Clinical Features and Outcomes of 124 Italian Patients With Treatment Resistant Depression: A Real-World, Prospective Study. Front Psychiatry 2021; 12:769693. [PMID: 34803777 PMCID: PMC8603563 DOI: 10.3389/fpsyt.2021.769693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/13/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction: Treatment-resistant depression (TRD) is a debilitating condition affecting 20-30% of patients with major depressive disorders (MDD). Currently, there is no established standard of care for TRD, and wide variation in the clinical approach for disease management has been documented. Real-world data could help describe TRD clinical features, disease burden, and treatment outcome and identify a potential unmet medical need. Methods: We analyzed the Italian data from a European, prospective, multicentric, observational cohort study of patients fulfilling TRD criteria by the European Medicine Agency, with moderate to severe major depressive episode, and starting a new antidepressant treatment according to routinary clinical practice. They were followed up for minimum 6 months. Treatments received throughout the study period, disease severity, health-related quality of life and functioning were prospectively recorded and analyzed. Results: The Italian subcohort included 124 TRD patients (30.2% of patients of the European cohort; mean age 53.2 [sd = 9.8], women: 82, 66.1%). At enrollement, the mean (SD) duration of MDD was 16 years (sd = 11.1) and the mean duration of the ongoing major depressive episode (MDE) was 97.5 weeks (sd = 143.5); low scores of quality of life and functioning were reported. The most frequently antidepressant classes started at baseline (data available for 98 subjects) were selective serotonin reuptake inhibitors (SSRI, 42 patients [42.9%]) and serotonin-norepinephrine reuptake inhibitors (SNRI, 32 patients [32.7%]). In terms of treatment strategies, 50 patients (51%) started augmentation therapies, 18 (18.4%) combination therapies and 24 (24.5%) monoterapies (6 patients [6%] started a non-antidepressant drug only). Fourteen patients (11.3%) were treated with a psychosocial approach, including psychotherapy. After 6 months of treatment, clinical assessments were collected for 89 patients: 64 (71.9%) showed no response, 9 (10.1%) response without remission and 16 (18.0%) were in remission; non-responder patients showed lower quality of life and higher disability scores than responder patients. Conclusions: In our sample of TRD patients, we documented substantial illness burden, low perceived quality of life and poor outcome, suggesting an unmet treatment need in TRD care in Italy. Registration Number: ClinicalTrials.gov, number: NCT03373253.
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Affiliation(s)
- Giulio Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paola Calò
- Mental Health Department, Azienda Sanitaria Locale Lecce, Lecce, Italy
| | | | - Gianluca Rosso
- Department of Neurosciences 'Rita Levi Montalcini', University of Torino, Turin, Italy.,San Luigi Gonzaga University Hospital of Orbassano, Orbassano, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy
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18
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Taylor RW, Marwood L, Oprea E, DeAngel V, Mather S, Valentini B, Zahn R, Young AH, Cleare AJ. Pharmacological Augmentation in Unipolar Depression: A Guide to the Guidelines. Int J Neuropsychopharmacol 2020; 23:587-625. [PMID: 32402075 PMCID: PMC7710919 DOI: 10.1093/ijnp/pyaa033] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/27/2020] [Accepted: 05/12/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pharmacological augmentation is a recommended strategy for patients with treatment-resistant depression. A range of guidelines provide advice on treatment selection, prescription, monitoring and discontinuation, but variation in the content and quality of guidelines may limit the provision of objective, evidence-based care. This is of importance given the side effect burden and poorer long-term outcomes associated with polypharmacy and treatment-resistant depression. This review provides a definitive overview of pharmacological augmentation recommendations by assessing the quality of guidelines for depression and comparing the recommendations made. METHODS A systematic literature search identified current treatment guidelines for depression published in English. Guidelines were quality assessed using the Appraisal of Guidelines for Research and Evaluation II tool. Data relating to the prescription of pharmacological augmenters were extracted from those developed with sufficient rigor, and the included recommendations compared. RESULTS Total of 1696 records were identified, 19 guidelines were assessed for quality, and 10 were included. Guidelines differed in their quality, the stage at which augmentation was recommended, the agents included, and the evidence base cited. Lithium and atypical antipsychotics were recommended by all 10, though the specific advice was not consistent. Of the 15 augmenters identified, no others were universally recommended. CONCLUSIONS This review provides a comprehensive overview of current pharmacological augmentation recommendations for major depression and will support clinicians in selecting appropriate treatment guidance. Although some variation can be accounted for by date of guideline publication, and limited evidence from clinical trials, there is a clear need for greater consistency across guidelines to ensure patients receive consistent evidence-based care.
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Affiliation(s)
- Rachael W Taylor
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Lindsey Marwood
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
| | - Emanuella Oprea
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Valeria DeAngel
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Sarah Mather
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Beatrice Valentini
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- Department of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Roland Zahn
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Allan H Young
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Anthony J Cleare
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, United Kingdom
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19
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Abstract
OBJECTIVES A narrative review of past, present, and future of lithium use in psychiatry. METHODS The most important references on the topic were reviewed with special emphasis on the author's works. RESULTS The history of medical and psychiatric use of lithium dates back to more than one and a half-century ago. However, modern psychiatric history began with the publication of John Cade, in 1949, showing a therapeutic effect of lithium in mania. Currently, lithium is a drug of choice as a mood-stabilizer for the maintenance treatment of the bipolar disorder. The second most important use of lithium is probably augmentation of antidepressants in treatment-resistant depression. In addition to its mood-stabilizing properties, lithium exerts anti-suicidal, immunomodulatory, and neuroprotective action. The drug may protect against dementia and some promising effects of lithium in neurodegenerative disorders have been observed. CONCLUSION Given the clinical and biological properties of lithium, this drug is presently greatly underutilized in mood disorders. Therefore, the efforts should be undertaken for challenging a skepticism about the use of lithium and optimizing its long-term administration. In such a way, more patients with mood disorders can become the beneficiaries of lithium's therapeutic action. KEY POINTS Lithium is a drug of choice as a mood-stabiliser for the maintenance treatment of bipolar disorder. Augmentation of antidepressants by lithium is one of the best strategies in treatment-resistant depression. Lithium exerts anti-suicidal, immunomodulatory, and neuroprotective action and may protect against dementia. Despite the evidence for the efficacy and added favourable properties, lithium is greatly underutilised in mood disorders. Challenging a scepticism about the use of lithium and optimising its long-term administration can make more patients with mood disorders the beneficiaries of lithium's therapeutic action.
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Affiliation(s)
- Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland.,Department of Psychiatric Nursing, Poznan University of Medical Sciences, Poznan, Poland
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20
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Mesocortical BDNF signaling mediates antidepressive-like effects of lithium. Neuropsychopharmacology 2020; 45:1557-1566. [PMID: 32428928 PMCID: PMC7360776 DOI: 10.1038/s41386-020-0713-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 12/16/2022]
Abstract
Lithium has been used to treat major depressive disorder, yet the neural circuit mechanisms underlying this therapeutic effect remain unknown. Here, we demonstrated that the ventral tegmental area (VTA) dopamine (DA) neurons that project to the medial prefrontal cortex (mPFC), but not to nucleus accumbens (NAc), contributed to the antidepressive-like effects of lithium. Projection-specific electrophysiological recordings revealed that high concentrations of lithium increased firing rates in mPFC-, but not NAc-, projecting VTA DA neurons in mice treated with chronic unpredictable mild stress (CMS). In parallel, chronic administration of high-dose lithium in CMS mice restored the firing properties of mPFC-projecting DA neurons, and also rescued CMS-induced depressive-like behaviors. Nevertheless, chronic lithium treatment was insufficient to change the basal firing rates in NAc-projecting VTA DA neurons. Furthermore, chemogenetic activation of mPFC-, but not NAc-, projecting VTA DA neurons mimicked the antidepressive-like effects of lithium in CMS mice. Chemogenetic downregulation of VTA-mPFC DA neurons' firing activity abolished the antidepressive-like effects of lithium in CMS mice. Finally, we found that the antidepressant-like effects induced by high-dose lithium were mediated by BNDF signaling in the mesocortical DA circuit. Together, these results demonstrated the role of mesocortical DA projection in antidepressive-like effects of lithium and established a circuit foundation for lithium-based antidepressive treatment.
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21
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Biological Targets Underlying the Antisuicidal Effects of Lithium. Curr Behav Neurosci Rep 2020. [DOI: 10.1007/s40473-020-00208-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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22
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Young RS, Deslandes P, Cooper J, Williams H, Kenkre J, Carson-Stevens A. A mixed methods analysis of lithium-related patient safety incidents in primary care. Ther Adv Drug Saf 2020; 11:2042098620922748. [PMID: 32551037 PMCID: PMC7281636 DOI: 10.1177/2042098620922748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/07/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Lithium is a drug with a narrow therapeutic range and has been associated with a number of serious adverse effects. This study aimed to characterise primary care lithium-related patient safety incidents submitted to the National Reporting and Learning System (NRLS) database with respect to incident origin, type, contributory factors and outcome. The intention was to identify ways to minimise risk to future patients by examining incidents with a range of harm outcomes. METHODS A mixed methods analysis of patient safety incident reports related to lithium was conducted. Data from healthcare organisations in England and Wales were extracted from the NRLS database. An exploratory descriptive analysis was undertaken to characterise the most frequent incident types, the associated chain of events and other contributory factors. RESULTS A total of 174 reports containing the term 'lithium' were identified. Of these, 41 were excluded and, from the remaining 133 reports, 138 incidents were identified and coded. Community pharmacies reported 100 incidents (96 dispensing related, two administration, two other), general practitioner (GP) practices filed 22 reports and 16 reports originated from other sources. A total of 99 dispensing-related incidents were recorded, 39 resulted from the wrong medication dispensed, 31 the wrong strength, 8 the wrong quantity and 21 other. A total of 128 contributory factors were identified overall; for dispensing incidents, the most common related to medication storage/packaging (n = 41), and 'mistakes' (n = 22), whereas no information regarding contributory factors was provided in 41 reports. CONCLUSION Despite the established link between medication packaging and the risk of dispensing errors, our study highlighted storage and packaging as the most commonly described contributory factors to dispensing errors. The absence of certain relevant data limited the ability to fully characterise a number of reports. This highlighted the need to include clear and complete information when submitting reports. This, in turn, may help to better inform the further development of interventions designed to reduce the risk of incidents and improve patient safety.
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Affiliation(s)
| | - Paul Deslandes
- University of South Wales, Pontypridd, Rhondda
Cynon Taff, UK
| | | | | | - Joyce Kenkre
- University of South Wales, Pontypridd, Rhondda
Cynon Taff, UK
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23
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Cordner ZA, MacKinnon DF, DePaulo JR. The Care of Patients With Complex Mood Disorders. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:129-138. [PMID: 33162850 PMCID: PMC7587882 DOI: 10.1176/appi.focus.20200007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article focuses on some common dilemmas facing clinicians, patients, and families in managing the treatment of complicated mood disorders. Specifically, this article reviews the interaction of depressive states, including unipolar, bipolar, and mixed, with other adversities, including comorbid physical and psychological disorders, personality vulnerabilities, misuse of drugs and alcohol, and social and family problems. These issues are not always clearly differentiated from the depressive illness. Each of these adversities can worsen an existing mood disorder and influence the patient's resolve to persist with a treatment plan. Although this article is not focused strictly on treatment-resistant depression, these coexisting issues make depressive states harder to manage therapeutically. For brevity, the aim of this article has been limited to discussion of some complex situations that psychiatrists in general practice may encounter.
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Affiliation(s)
- Zachary A Cordner
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cordner, MacKinnon, DePaulo)
| | - Dean F MacKinnon
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cordner, MacKinnon, DePaulo)
| | - J Raymond DePaulo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cordner, MacKinnon, DePaulo)
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24
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Rybakowski JK. Lithium treatment in the era of personalized medicine. Drug Dev Res 2020; 82:621-627. [PMID: 32207857 DOI: 10.1002/ddr.21660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022]
Abstract
In 1949, an Australian psychiatrist, John Cade, reported on the antimanic efficacy of lithium carbonate, which is regarded as an introduction of lithium into contemporary psychiatry. Since the 1960s, lithium has been a precursor of mood stabilizers and has become first-choice drug for the prevention of affective episodes in mood disorders. For nearly four decades, lithium has also been used for the augmentation of antidepressant drugs in treatment-resistant depression. The knowledge of clinical and biological factors connected with the capability of long-term lithium treatment to prevent manic and depressive recurrences makes an important element of the personalized medicine of mood disorders. Excellent prophylactic lithium responders can be characterized by distinct mood episodes, with full remissions between them, the absence of other psychiatric morbidity, and the family history of bipolar illness. In recent years, many other clinical and biological factors connected with such a response have been identified, helping to select the best candidates for lithium prophylaxis. The antisuicidal effect of lithium during its long-term administration has been demonstrated and should also be taken into account as the element of personalized medicine for the pharmacological prophylaxis of patients with mood disorders. Several studies pertaining to personalized medicine were also dedicated to lithium treatment of acute mood episodes. Lithium still has a value in the treatment of mania and bipolar depression. However, it seems that the more important indication would be the augmentation of antidepressant drugs in treatment-resistant depression. The factors connected with the efficacy of lithium in these conditions are reviewed.
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Affiliation(s)
- Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland.,Department of Psychiatric Nursing, Poznan University of Medical Sciences, Poznan, Poland
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25
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Morlet E, Costemale-Lacoste JF, Poulet E, McMahon K, Hoertel N, Limosin F, Alezrah C, Amado I, Amar G, Andréi O, Arbault D, Archambault G, Aurifeuille G, Barrière S, Béra-Potelle C, Blumenstock Y, Bardou H, Bareil-Guérin M, Barrau P, Barrouillet C, Baup E, Bazin N, Beaufils B, Ben Ayed J, Benoit M, Benyacoub K, Bichet T, Blanadet F, Blanc O, Blanc-Comiti J, Boussiron D, Bouysse AM, Brochard A, Brochart O, Bucheron B, Cabot M, Camus V, Chabannes JM, Charlot V, Charpeaud T, Clad-Mor C, Combes C, Comisu M, Cordier B, Costi F, Courcelles JP, Creixell M, Cuche H, Cuervo-Lombard C, Dammak A, Da Rin D, Denis JB, Denizot H, Deperthuis A, Diers E, Dirami S, Donneau D, Dreano P, Dubertret C, Duprat E, Duthoit D, Fernandez C, Fonfrede P, Freitas N, Gasnier P, Gauillard J, Getten F, Gierski F, Godart F, Gourevitch R, Grassin Delyle A, Gremion J, Gres H, Griner V, Guerin-Langlois C, Guggiari C, Guillin O, Hadaoui H, Haffen E, Hanon C, Haouzir S, Hazif-Thomas C, Heron A, Hubsch B, Jalenques I, Januel D, Kaladjian A, Karnycheff JF, Kebir O, Krebs MO, Lajugie C, Leboyer M, Legrand P, Lejoyeux M, Lemaire V, Leroy E, Levy-Chavagnat D, Leydier A, Liling C, Llorca PM, Loeffel P, Louville P, Lucas Navarro S, Mages N, Mahi M, Maillet O, Manetti A, Martelli C, Martin P, Masson M, Maurs-Ferrer I, Mauvieux J, Mazmanian S, Mechin E, Mekaoui L, Meniai M, Metton A, Mihoubi A, Miron M, Mora G, Niro Adès V, Nubukpo P, Omnes C, Papin S, Paris P, Passerieux C, Pellerin J, Perlbarg J, Perron S, Petit A, Petitjean F, Portefaix C, Pringuey D, Radtchenko A, Rahiou H, Raucher-Chéné D, Rauzy A, Reinheimer L, Renard M, René M, Rengade CE, Reynaud P, Robin D, Rodrigues C, Rollet A, Rondepierre F, Rousselot B, Rubingher S, Saba G, Salvarelli JP, Samuelian JC, Scemama-Ammar C, Schurhoff F, Schuster JP, Sechter D, Segalas B, Seguret T, Seigneurie AS, Semmak A, Slama F, Taisne S, Taleb M, Terra JL, Thefenne D, Tran E, Tourtauchaux R, Vacheron MN, Vandel P, Vanhoucke V, Venet E, Verdoux H, Viala A, Vidon G, Vitre M, Vurpas JL, Wagermez C, Walter M, Yon L, Zendjidjian X. Psychiatric and physical outcomes of long-term use of lithium in older adults with bipolar disorder and major depressive disorder: A cross-sectional multicenter study. J Affect Disord 2019; 259:210-217. [PMID: 31446382 DOI: 10.1016/j.jad.2019.08.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/11/2019] [Accepted: 08/18/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Although lithium is widely used in current practice to treat bipolar disorder (BD) and treatment-resistant major depressive disorder (MDD) among older adults, little is known about its efficacy and tolerability in this population, which is generally excluded from randomized clinical trials. The objective of this study was to evaluate the efficacy and tolerability of long-term use of lithium among older adults with BD and MDD. METHOD Data from the Cohort of individuals with Schizophrenia and mood disorders Aged 55 years or more (CSA) were used. Two groups of patients with BD and MDD were compared: those who were currently receiving lithium versus those who were not. The effects of lithium on psychiatric (i.e., depressive symptoms severity, perceived clinical severity, rates of psychiatric admissions in the past-year), geriatric (overall and cognitive functioning) and physical outcomes (i.e., rates of non-psychiatric medical comorbidities and general hospital admissions in the past-year) were evaluated. All analyses were adjusted for age, sex, duration of disorder, diagnosis, smoking status, alcohol use, and use of antipsychotics, antiepileptics or antidepressants. RESULTS Among the 281 older participants with BD or MDD, 15.7% were taking lithium for a mean duration of 12.5(SD = 11.6) years. Lithium use was associated with lower intensity of depressive symptoms, reduced perceived clinical global severity and lower benzodiazepine use (all p < 0.05), without being linked to greater rates of medical comorbidities, except for hypothyroidism. LIMITATIONS Data were cross-sectional and data on lifetime history of psychotropic medications was not assessed. CONCLUSION Our results suggest that long-term lithium use may be efficient and relatively well-tolerated in older adults with BD or treatment-resistant MDD.
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Affiliation(s)
- Elise Morlet
- Department of Psychiatry, Corentin Celton Hospital, 4 Parvis Corentin Celton, 92130 Issy-les-Moulineaux, France
| | - Jean-François Costemale-Lacoste
- Department of Psychiatry, Corentin Celton Hospital, 4 Parvis Corentin Celton, 92130 Issy-les-Moulineaux, France; INSERM UMRS 1178, CESP, Le Kremlin Bicêtre, France.
| | - Emmanuel Poulet
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, PSY-R2 Team, Lyon F-69000, France
| | - Kibby McMahon
- Department of Psychology & Neuroscience, Duke University, 2213 Elba Street, Durham, NC 27710, United States
| | - Nicolas Hoertel
- Department of Psychiatry, Corentin Celton Hospital, 4 Parvis Corentin Celton, 92130 Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Frédéric Limosin
- Department of Psychiatry, Corentin Celton Hospital, 4 Parvis Corentin Celton, 92130 Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
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Alastanos JN, Potter TG, Crouse EL. Lithium-related medication problems on nonpsychiatric inpatient medical units. Am J Health Syst Pharm 2019; 76:S96-S101. [DOI: 10.1093/ajhp/zxz212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Abstract
Purpose
Results of a study of medication-related problems (MRPs) associated with lithium use on nonpsychiatric inpatient medical units are reported.
Methods
In a single-center, retrospective study, the records of all patients hospitalized over a 21-month period who received lithium or had a documented serum lithium concentration during hospitalization were evaluated. The primary objective was to identify patient-specific factors associated with lithium MRPs on nonpsychiatric inpatient medical units. Secondary objectives included characterization of lithium MRPs. Identified MRP occurrences were further evaluated to determine if an intervention was necessary to resolve the MRP and whether or not an intervention was made.
Results
A total of 150 patients were included in the study sample. One or more lithium MRPs were identified in 85% of the patients, with a total of 255 lithium MRPs identified. None of the patient-specific factors analyzed were significantly associated with MRP occurrence. Of the 128 patients in whom a lithium MRP occurred, 92.2% (n = 118) were judged to be appropriate candidates for interventions as defined per the study definitions; among those 118 patients, such interventions were documented for only 40.7% (n = 48).
Conclusion
Lithium MRPs were found to have occurred frequently on nonpsychiatric inpatient medical units at 1 hospital. Laboratory test– related MRPs and drug–drug interactions were the most commonly identified types of MRPs. Interventions to address MRPs were not made in the majority of patients; however, interventions were more frequently made when psychiatry consultation was involved.
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Affiliation(s)
| | - Teresa G Potter
- Virginia Commonwealth University Health System, Richmond, VA
| | - Ericka L Crouse
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA
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Nederlof M, Egberts TCG, van Londen L, de Rotte MCFJ, Souverein PC, Herings RMC, Heerdink ER. Compliance with the guidelines for laboratory monitoring of patients treated with lithium: A retrospective follow-up study among ambulatory patients in the Netherlands. Bipolar Disord 2019; 21:419-427. [PMID: 30472760 PMCID: PMC6767377 DOI: 10.1111/bdi.12730] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Laboratory monitoring of patients using lithium is important to prevent harm and to increase effectiveness. The aim of this study is to determine compliance with the guidelines for laboratory monitoring of patients treated with lithium overall and within subgroups. METHODS Patients having at least one lithium dispensing for 6 months or longer between January 2010 and December 2015 were identified retrospectively using data from the Dutch PHARMO Database Network. Laboratory monitoring was defined as being compliant with the Dutch Multidisciplinary Clinical Guideline Bipolar Disorders when lithium serum levels, creatinine and thyroid-stimulating hormone (TSH) had been measured at least every 6 months during lithium use. RESULTS Data were analyzed from 1583 patients with a median duration of 7- to 6-months period of lithium use. Results indicated that patients had been monitored over 6-month period for lithium serum levels 65% of the time, for creatinine 73% of the time and for TSH 54% of the time. Just over one seventh (16%) of patients had been monitored in compliance with the guidelines for all three parameters during total follow-up. Especially males, patients aged below 65 years, patients receiving prescriptions solely from general practitioners, prevalent users of lithium, patients without interacting co-medication, and patients without other days with laboratory measurements had been monitored less frequently in compliance with the guidelines. CONCLUSIONS A considerable proportion of patients had not been monitored in accordance with the guidelines. Further research is needed to understand the reasons for noncompliance and to implement strategies with the ultimate goal of optimizing safety and effectiveness for patients treated with lithium.
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Affiliation(s)
- Mariëtte Nederlof
- Division of Pharmacoepidemiology and Clinical PharmacologyUtrecht Institute for Pharmaceutical Sciences, Utrecht UniversityUtrechtThe Netherlands,Brocacef ZiekenhuisfarmacieMaarssenThe Netherlands
| | - Toine CG Egberts
- Division of Pharmacoepidemiology and Clinical PharmacologyUtrecht Institute for Pharmaceutical Sciences, Utrecht UniversityUtrechtThe Netherlands,Clinical PharmacyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Liesbeth van Londen
- TransparantCentre for PsychiatryLeidenThe Netherlands,Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | | | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical PharmacologyUtrecht Institute for Pharmaceutical Sciences, Utrecht UniversityUtrechtThe Netherlands
| | - Ron MC Herings
- PHARMO Institute for Drug Outcomes ResearchUtrechtThe Netherlands,Department of Epidemiology and BiostatisticsVU University Medical CenterAmsterdamNetherlands
| | - Eibert R Heerdink
- Division of Pharmacoepidemiology and Clinical PharmacologyUtrecht Institute for Pharmaceutical Sciences, Utrecht UniversityUtrechtThe Netherlands,Clinical PharmacyUniversity Medical Center UtrechtUtrechtThe Netherlands,Research Group Innovation of Pharmaceutical CareUniversity of Applied Sciences UtrechtUtrechtThe Netherlands
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Treatment response of lithium augmentation in geriatric compared to non-geriatric patients with treatment-resistant depression. J Affect Disord 2019; 251:136-140. [PMID: 30921597 DOI: 10.1016/j.jad.2019.03.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/09/2019] [Accepted: 03/19/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Lithium augmentation (LA) of antidepressants is an effective strategy for treatment-resistant depression (TRD). Nevertheless, it is rarely used in geriatric patients. The purpose of this study was to investigate treatment response of LA in geriatric compared to non-geriatric patients. METHOD In a prospective multicenter cohort study, severity of depression was measured weekly in 167 patients with unipolar depression (nage≥65years = 22; nage<65years = 145) at baseline and over at least four weeks of LA. RESULTS Geriatric patients showed a significantly better response to LA compared to non-geriatric patients (Hazard Ratio = 1.91; p = 0.04). LIMITATIONS An important limitation of our study is the lack of a control group of LA and the missing evaluation of side effects in both groups. CONCLUSIONS This is the first study investigating the efficacy of LA for TRD in geriatric compared to non-geriatric patients. Our data suggest that LA is an effective treatment option in geriatric patients that clinicians might consider more frequently and earlier on in the course of treatment.
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Brus O, Cao Y, Hammar Å, Landén M, Lundberg J, Nordanskog P, Nordenskjöld A. Lithium for suicide and readmission prevention after electroconvulsive therapy for unipolar depression: population-based register study. BJPsych Open 2019; 5:e46. [PMID: 31189487 PMCID: PMC6582214 DOI: 10.1192/bjo.2019.37] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is effective for unipolar depression but relapse and suicide are significant challenges. Lithium could potentially lower these risks, but is used only in a minority of patients.AimsThis study quantifies the effect of lithium on risk of suicide and readmission and identifies factors that are associate with readmission and suicide. METHOD This population-based register study used data from the Swedish National Quality Register for ECT and other Swedish national registers. Patients who have received ECT for unipolar depression as in-patients between 2011 and 2016 were followed until death, readmission to hospital or the termination of the study at the end of 2016. Cox regression was used to estimate hazard ratios (HR) of readmission and suicide in adjusted models. RESULTS Out of 7350 patients, 56 died by suicide and 4203 were readmitted. Lithium was prescribed to 638 (9%) patients. Mean follow-up was 1.4 years. Lithium was significantly associated with lower risk of suicide (P = 0.014) and readmission (HR 0.84 95% CI 0.75-0.93). The number needed to be treated with lithium to prevent one readmission was 16. In addition, the following factors were statistically associated with suicide: male gender, being a widow, substance use disorder and a history of suicide attempts. Readmission was associated with young age, being divorced or unemployed, comorbid anxiety disorder, nonpsychotic depression, more severe symptoms before ECT, no improvement with ECT, not receiving continuation ECT or antidepressants, usage of antipsychotics, anxiolytics or benzodiazepines, severity of medication resistance and number of previous admissions. CONCLUSIONS More patients could benefit from lithium treatment.Declaration of interestNone.
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Affiliation(s)
- Ole Brus
- Statistician, Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Sweden
| | - Yang Cao
- Statistician, Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University; and Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Åsa Hammar
- Professor, Department of Biological and Medical Psychology, University of Bergen; and Division of Psychiatry, Haukeland University Hospital, Norway
| | - Mikael Landén
- Professor, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University; and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Johan Lundberg
- Physician and Associate Professor, Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet; and Stockholm County Council, Sweden
| | - Pia Nordanskog
- Physician, Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University; and Department of Psychiatry, Region Östergötland, Sweden
| | - Axel Nordenskjöld
- Physician, University Health Care Research Centre, Faculty of Health and Medical Sciences, Örebro University, Sweden
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Undurraga J, Sim K, Tondo L, Gorodischer A, Azua E, Tay KH, Tan D, Baldessarini RJ. Lithium treatment for unipolar major depressive disorder: Systematic review. J Psychopharmacol 2019; 33:167-176. [PMID: 30698058 DOI: 10.1177/0269881118822161] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The potential value of lithium treatment in particular aspects of unipolar major depressive disorder remains uncertain. METHODS With reports of controlled trials identified by systematic searching of Medline, Cochrane Library, and PsycINFO literature databases, we summarized responses with lithium and controls followed by selective random-effects meta-analyses. RESULTS We identified 36 reports with 39 randomized controlled trials: six for monotherapy and 12 for adding lithium to antidepressants for acute major depression, and 21 for long-term treatment. Data for monotherapy of acute depression were few and inconclusive. As an adjunct to antidepressants, lithium was much more effective than placebo ( p<0.0001). For long-term maintenance treatment, lithium was more effective than placebo in monotherapy ( p=0.011) and to supplement antidepressants ( p=0.038), and indistinguishable from antidepressant monotherapy. CONCLUSIONS The findings indicate efficacy of lithium as a treatment for some aspects of major depressive disorder, especially as an add-on to antidepressants and for long-term prophylaxis. It remains uncertain whether some benefits of lithium treatment occur with many major depressive disorder patients, or if efficacy is particular to a subgroup with bipolar disorder-like characteristics or mixed-features.
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Affiliation(s)
- Juan Undurraga
- 1 International Consortium for Mood and Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.,3 Early Intervention Program, J Horwitz Psychiatric Institute, Santiago, Chile
| | - Kang Sim
- 1 International Consortium for Mood and Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.,4 Research Division, Institute of Mental Health/Woodbridge Hospital, Singapore
| | - Leonardo Tondo
- 1 International Consortium for Mood and Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.,5 Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,6 Lucio Bini Mood Disorder Centers, Cagliari and Rome, Italy
| | - Ariel Gorodischer
- 7 Department of Psychiatry, Universidad de Los Andes, Santiago, Chile
| | - Emilio Azua
- 8 Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Kai Hong Tay
- 4 Research Division, Institute of Mental Health/Woodbridge Hospital, Singapore
| | - David Tan
- 4 Research Division, Institute of Mental Health/Woodbridge Hospital, Singapore
| | - Ross J Baldessarini
- 1 International Consortium for Mood and Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.,5 Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Perez-Caballero L, Torres-Sanchez S, Romero-López-Alberca C, González-Saiz F, Mico JA, Berrocoso E. Monoaminergic system and depression. Cell Tissue Res 2019; 377:107-113. [PMID: 30627806 DOI: 10.1007/s00441-018-2978-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/06/2018] [Indexed: 12/21/2022]
Abstract
Major depressive disorder is a severe, disabling disorder that affects around 4.7% of the population worldwide. Based on the monoaminergic hypothesis of depression, monoamine reuptake inhibitors have been developed as antidepressants and nowadays, they are used widely in clinical practice. However, these drugs have a limited efficacy and a slow onset of therapeutic action. Several strategies have been implemented to overcome these limitations, including switching to other drugs or introducing combined or augmentation therapies. In clinical practice, the most often used augmenting drugs are lithium, triiodothyronine, atypical antipsychotics, buspirone, and pindolol, although some others are in the pipeline. Moreover, multitarget antidepressants have been developed to improve efficacy. Despite the enormous effort exerted to improve these monoaminergic drugs, they still fail to produce a rapid and sustained antidepressant response in a substantial proportion of depressed patients. Recently, new compounds that target other neurotransmission system, such as the glutamatergic system, have become the focus of research into fast-acting antidepressant agents. These promising alternatives could represent a new pharmacological trend in the management of depression.
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Affiliation(s)
- L Perez-Caballero
- Department of Psychology, University of Cádiz, 11510 Puerto Real, Cádiz, Spain.,Neuropsychopharmacology and Psychobiology Research Group, University of Cádiz, 11003, Cádiz, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029, Madrid, Spain.,Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, 11009, Cádiz, Spain
| | - S Torres-Sanchez
- Neuropsychopharmacology and Psychobiology Research Group, University of Cádiz, 11003, Cádiz, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029, Madrid, Spain.,Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, 11009, Cádiz, Spain
| | - C Romero-López-Alberca
- Department of Psychology, University of Cádiz, 11510 Puerto Real, Cádiz, Spain.,Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, 11009, Cádiz, Spain
| | - F González-Saiz
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, 11009, Cádiz, Spain.,Community Mental Health Unit, Andalusian Health Service, Hospital of Jerez, 11407 Jerez de la Frontera, Cádiz, Spain.,Department of Neuroscience, University of Cádiz, 11003, Cádiz, Spain
| | - J A Mico
- Neuropsychopharmacology and Psychobiology Research Group, University of Cádiz, 11003, Cádiz, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029, Madrid, Spain.,Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, 11009, Cádiz, Spain.,Department of Neuroscience, University of Cádiz, 11003, Cádiz, Spain
| | - Esther Berrocoso
- Department of Psychology, University of Cádiz, 11510 Puerto Real, Cádiz, Spain. .,Neuropsychopharmacology and Psychobiology Research Group, University of Cádiz, 11003, Cádiz, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029, Madrid, Spain. .,Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, 11009, Cádiz, Spain.
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Chen P. Optimized Treatment Strategy for Depressive Disorder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1180:201-217. [DOI: 10.1007/978-981-32-9271-0_11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Caraci F, Calabrese F, Molteni R, Bartova L, Dold M, Leggio GM, Fabbri C, Mendlewicz J, Racagni G, Kasper S, Riva MA, Drago F. International Union of Basic and Clinical Pharmacology CIV: The Neurobiology of Treatment-resistant Depression: From Antidepressant Classifications to Novel Pharmacological Targets. Pharmacol Rev 2018; 70:475-504. [PMID: 29884653 DOI: 10.1124/pr.117.014977] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Major depressive disorder is one of the most prevalent and life-threatening forms of mental illnesses and a major cause of morbidity worldwide. Currently available antidepressants are effective for most patients, although around 30% are considered treatment resistant (TRD), a condition that is associated with a significant impairment of cognitive function and poor quality of life. In this respect, the identification of the molecular mechanisms contributing to TRD represents an essential step for the design of novel and more efficacious drugs able to modify the clinical course of this disorder and increase remission rates in clinical practice. New insights into the neurobiology of TRD have shed light on the role of a number of different mechanisms, including the glutamatergic system, immune/inflammatory systems, neurotrophin function, and epigenetics. Advances in drug discovery processes in TRD have also influenced the classification of antidepressant drugs and novel classifications are available, such as the neuroscience-based nomenclature that can incorporate such advances in drug development for TRD. This review aims to provide an up-to-date description of key mechanisms in TRD and describe current therapeutic strategies for TRD before examining novel approaches that may ultimately address important neurobiological mechanisms not targeted by currently available antidepressants. All in all, we suggest that drug targeting different neurobiological systems should be able to restore normal function but must also promote resilience to reduce the long-term vulnerability to recurrent depressive episodes.
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Affiliation(s)
- F Caraci
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - F Calabrese
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - R Molteni
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - L Bartova
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - M Dold
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - G M Leggio
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - C Fabbri
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - J Mendlewicz
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - G Racagni
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - S Kasper
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - M A Riva
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
| | - F Drago
- Departments of Drug Sciences (F.Car.) and Biomedical and Biotechnological Sciences, School of Medicine (G.M.L., F.D.), University of Catania, Catania, Italy; Oasi-Research-Institute-IRCCS, Troina, Italy (F.Car.); Departments of Pharmacological and Biomolecular Sciences (F.Cal., G.R., M.A.R.) and Medical Biotechnology and Translational Medicine (R.M.), Università degli Studi di Milano, Milan, Italy; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (L.B., M.D., S.K.); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (C.F.); and School of Medicine, Universite' Libre de Bruxelles, Bruxelles, Belgium (J.M.)
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Dold M, Bartova L, Kautzky A, Serretti A, Porcelli S, Souery D, Mendlewicz J, Montgomery S, Zohar J, Kasper S. Clinical factors associated with augmentation treatment with second-generation antipsychotics and lithium in major depression - Results from a European multicenter study. Eur Neuropsychopharmacol 2018; 28:1305-1313. [PMID: 30446357 DOI: 10.1016/j.euroneuro.2018.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/12/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
This cross-sectional European multicenter study with retrospective assessment of treatment response sought to determine variables associated with the administration of augmentation strategies with second-generation antipsychotics (SGAs) and lithium in the pharmacotherapy of major depressive disorder (MDD). In 349 DSM-IV-TR MDD patients, differences in socio-demographic, clinical, treatment, and pharmacological features between participants receiving add-on treatment of their antidepressants with either SGAs (n = 318) or lithium (n = 31) were investigated using analyses of covariance, chi-squared tests, and binary logistic regression analyses. As only significant between-group difference, we found SGA augmentation (compared with lithium augmentation) to be associated with high depressive symptom severity expressed by a higher mean Montgomery and Åsberg Depression Rating (MADRS) total score (27.19 ± 11.35 vs 18.87 ± 12.88, F = 14.82, p = < .0001) and a higher mean 21-item Hamilton Rating Scale for Depression (HAM-D) total score (21.27 ± 9.30 vs 13.74 ± 9.11, F = 18.60, p = < .0001). No significant differences for socio-demographic features, psychotic symptoms, suicidality, psychiatric and somatic comorbidities, antidepressant pharmacotherapy, and other add-on medications could be seen. Even if there was no significant superiority of one augmentation strategy with regard to treatment response pattern, a trend whereupon adjunctive SGAs were more likely dispensed in treatment-resistant and difficult-to-treat MDD conditions could be observed. In terms of the prescription pattern, we could demonstrate that lithium is less frequently used than SGAs in the clinical routine care which may reflect the need of continuous plasma level determinations and the anticipation of adverse effects.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123 Bologna, Italy
| | - Stefano Porcelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123 Bologna, Italy
| | - Daniel Souery
- Psy Pluriel - European Center of Psychological Medicine, Rue des Trois Arbres 62, 1180 Brussels, Belgium; School of Medicine, Free University of Brussels, Route de Lennik 808, 1070 Brussels, Belgium
| | - Julien Mendlewicz
- School of Medicine, Free University of Brussels, Route de Lennik 808, 1070 Brussels, Belgium
| | - Stuart Montgomery
- Imperial College School of Medicine, University of London, PO Box 8751, London W13 8WH, United Kingdom
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Grant B, Salpekar JA. Using Lithium in Children and Adolescents with Bipolar Disorder: Efficacy, Tolerability, and Practical Considerations. Paediatr Drugs 2018; 20:303-314. [PMID: 29651656 DOI: 10.1007/s40272-018-0289-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lithium has been an intriguing treatment option in psychiatry for over a century. While seemingly just a simple elemental compound, it has powerful treatment effects for both depression and bipolar disorder. The evidence base for treatment of pediatric bipolar disorder is relatively small, but, in recent years, additional clinical trial data have enabled lithium to re-emerge as a valuable and, in many cases, preferred treatment. Pharmacologically, lithium is complex, with varied effects at both intracellular and extracellular levels. As a treatment for bipolar disorder in pediatrics, lithium is challenging, given its narrow therapeutic window and myriad of potential side effects. However, the efficacy of lithium continues to match that of newer pharmacologic agents, and its tolerability has been shown to be comparable with more commonly prescribed medications. Lithium is still one of few drugs that have been proven to reduce the risk of suicidality, and it may have utility in illnesses beyond affective disorders. Practically, as a primary agent or as an adjunct, lithium continues to claim a rightful place in the treatment armamentarium of child psychiatry. New dosing paradigms have improved tolerability and reduced potential side effects. Recent evidence affirms that lithium is effective for pediatric bipolar disorder in multiple phases of the illness.
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Affiliation(s)
- B Grant
- Department of Psychiatry, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, 716 N. Broadway, Baltimore, MD, 21205, USA
| | - J A Salpekar
- Department of Psychiatry, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, 716 N. Broadway, Baltimore, MD, 21205, USA.
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Lithium, Stress, and Resilience in Bipolar Disorder: Deciphering this key homeostatic synaptic plasticity regulator. J Affect Disord 2018; 233:92-99. [PMID: 29310970 DOI: 10.1016/j.jad.2017.12.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 11/30/2017] [Accepted: 12/19/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Lithium is the lightest metal and the only mood stabilizer that has been used for over half a century for the treatment of bipolar disorder (BD). As a small ion, lithium is omnipresent, and consequently, its molecular mechanisms and targets are widespread. Currently, lithium is a crucial pharmacotherapy for the treatment of acute mood episodes, prophylactic therapy, and suicide prevention in BD. Besides, lithium blood level is the most widely used biomarker in clinical psychiatry. The concept of stress in BD characterizes short- and long-term deleterious effects at multiple levels (from genes to behaviors) and the ability to establish homeostatic regulatory mechanisms to either prevent or reverse these effects. Within this concept, lithium has consistently shown anti-stress effects, by normalizing components across several levels associated with BD-induced impairments in cellular resilience and plasticity. METHODS A literature search for biomarkers associated with lithium effects at multiple targets, with a particular focus on those related to clinical outcomes was performed. An extensive search of the published literature using PubMed, Medline and Google Scholar was performed. Example search terms included lithium, plasticity, stress, efficacy, and neuroimaging. Articles determined by the author to focus on lithium's impact on neural plasticity markers (central and periphery) and clinical outcomes were examined in greater depth. Relevant papers were evaluated, selected and included in this review. RESULTS Lithium induces neurotrophic and neuroprotective effects in a wide range of preclinical and translational models. Lithium's neurotrophic effects are related to the enhancement of cellular proliferation, differentiation, growth, and regeneration, whereas its neuroprotective effects limit the progression of neuronal atrophy or cell death following the onset of BD. Lithium's neurotrophic and neuroprotective effects seem most pronounced in the presence of pathology, which again supports its pivotal role as an active homeostatic regulator. LIMITATIONS Few studies associated with clinical outcomes. Due to space limitations, the author was unable to detail all findings, in special those originated from preclinical studies. CONCLUSIONS These results support a potential role for biomarkers involved in neuroprotection and activation of plasticity pathways in lithium's clinical response. Evidence supporting this model comes from results evaluating macroscopic and microscopic brain structure as well neurochemical findings in vivo from cellular to sub-synaptic (molecules and intracellular signaling) compartments using central and peripheral biomarkers. Challenges to precisely decipher lithium's biological mechanisms involved in its therapeutic profile include the complex nature of the illness and clinical subtypes, family history and comorbid conditions. In the context of personalized medicine, it is necessary to validate predictive biomarkers of response to lithium by designing longitudinal clinical studies during mood episodes and associated clinical dimensions in BD.
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Boeckel GR, Ehrlich BE. NCS-1 is a regulator of calcium signaling in health and disease. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2018; 1865:1660-1667. [PMID: 29746899 DOI: 10.1016/j.bbamcr.2018.05.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 02/07/2023]
Abstract
Neuronal Calcium Sensor-1 (NCS-1) is a highly conserved calcium binding protein which contributes to the maintenance of intracellular calcium homeostasis and regulation of calcium-dependent signaling pathways. It is involved in a variety of physiological cell functions, including exocytosis, regulation of calcium permeable channels, neuroplasticity and response to neuronal damage. Over the past 30 years, continuing investigation of cellular functions of NCS-1 and associated disease states have highlighted its function in the pathophysiology of several disorders and as a therapeutic target. Among the diseases that were found to be associated with NCS-1 are neurological disorders such as bipolar disease and non-neurological conditions such as breast cancer. Furthermore, alteration of NCS-1 expression is associated with substance abuse disorders and severe side effects of chemotherapeutic agents. The objective of this article is to summarize the current body of evidence describing NCS-1 and its interactions on a molecular and cellular scale, as well as describing macroscopic implications in physiology and medicine. Particular attention is paid to the role of NCS-1 in development and prevention of chemotherapy induced peripheral neuropathy (CIPN).
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Affiliation(s)
- Göran R Boeckel
- Department of Pharmacology, Yale University, New Haven, CT, United States; Institut für Physiologie, Universität zu Lübeck, Ratzeburger Allee 160, D-23562 Lübeck, Germany
| | - Barbara E Ehrlich
- Department of Pharmacology, Yale University, New Haven, CT, United States; Institut für Physiologie, Universität zu Lübeck, Ratzeburger Allee 160, D-23562 Lübeck, Germany.
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Dold M, Bartova L, Mendlewicz J, Souery D, Serretti A, Porcelli S, Zohar J, Montgomery S, Kasper S. Clinical correlates of augmentation/combination treatment strategies in major depressive disorder. Acta Psychiatr Scand 2018; 137:401-412. [PMID: 29492960 PMCID: PMC5947736 DOI: 10.1111/acps.12870] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This multicenter, multinational, cross-sectional study aimed to investigate clinical characteristics and treatment outcomes associated with augmentation/combination treatment strategies in major depressive disorder (MDD). METHOD Sociodemographic, clinical, and treatment features of 1410 adult MDD patients were compared between MDD patients treated with monotherapy and augmentation/combination medication using descriptive statistics, analyses of covariance (ancova), and Spearman's correlation analyses. RESULTS 60.64% of all participants received augmentation and/or combination strategies with a mean number of 2.18 ± 1.22 simultaneously prescribed psychiatric drugs. We found male gender, older age, Caucasian descent, higher weight, low educational status, absence of occupation, psychotic symptoms, melancholic and atypical features, suicide risk, in-patient treatment, longer duration of hospitalization, some psychiatric comorbidities (panic disorder, agoraphobia, obsessive-compulsive disorder, and bulimia nervosa), comorbid somatic comorbidity in general and concurrent hypertension, thyroid dysfunction, diabetes, and heart disease in particular, higher current and retrospective Montgomery and Åsberg Depression Rating Scale total scores, treatment resistance, and higher antidepressant dosing to be significantly associated with augmentation/combination treatment. These findings were corroborated when examining the number of concurrently administered psychiatric drugs in the statistical analyses. CONCLUSION Our findings suggest a clear association between augmentation/combination strategies and treatment-resistant/difficult-to-treat MDD conditions characterized by severe symptomatology and high amount of psychiatric and somatic comorbidities.
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Affiliation(s)
- M. Dold
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - L. Bartova
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - J. Mendlewicz
- School of MedicineFree University of BrusselsBrusselsBelgium
| | - D. Souery
- School of MedicineFree University of BrusselsBrusselsBelgium,European Centre of Psychological Medicine ‐ Psy PlurielBrusselsBelgium
| | - A. Serretti
- Department of Biomedical and NeuroMotor SciencesUniversity of BolognaBolognaItaly
| | - S. Porcelli
- Department of Biomedical and NeuroMotor SciencesUniversity of BolognaBolognaItaly
| | - J. Zohar
- Psychiatric DivisionChaim Sheba Medical CenterTel HashomerIsrael
| | - S. Montgomery
- Imperial CollegeUniversity of LondonLondonUnited Kingdom
| | - S. Kasper
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
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Ricken R, Bopp S, Schlattmann P, Himmerich H, Bschor T, Richter C, Elstner S, Stamm TJ, Schulz-Ratei B, Lingesleben A, Reischies FM, Sterzer P, Borgwardt S, Bauer M, Heinz A, Hellweg R, Lang UE, Adli M. Ghrelin Serum Concentrations Are Associated with Treatment Response During Lithium Augmentation of Antidepressants. Int J Neuropsychopharmacol 2017; 20:692-697. [PMID: 28911006 PMCID: PMC5581484 DOI: 10.1093/ijnp/pyw082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 10/28/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Lithium augmentation of antidepressants is an effective strategy in treatment-resistant depression. The proteohormone ghrelin is thought to be involved in the pathophysiology of depression. The purpose of this study was to investigate the association of treatment response with the course of ghrelin levels during lithium augmentation. METHOD Ghrelin serum concentrations and severity of depression were measured in 85 acute depressive patients before and after 4 weeks of lithium augmentation. RESULTS In a linear mixed model analysis, we found a significant effect of response*time interaction (F1.81=9.48; P=.0028): under treatment, ghrelin levels increased in nonresponders and slightly decreased in responders to lithium augmentation. The covariate female gender had a significant positive effect (F1.83=4.69; P=.033), whereas time, response, appetite, and body mass index (kg/m2) did not show any significant effect on ghrelin levels (P>.05). CONCLUSION This is the first study showing that the course of ghrelin levels separates responders and nonresponders to lithium augmentation. Present results support the hypothesis that ghrelin serum concentrations might be involved in response to pharmacological treatment of depression.
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Affiliation(s)
- Roland Ricken
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor).,Correspondence: Roland Ricken, MD, Department of Psychiatry and Psychotherapy Charité – Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany ()
| | - Sandra Bopp
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Peter Schlattmann
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Hubertus Himmerich
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Tom Bschor
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Christoph Richter
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Samuel Elstner
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Brigitte Schulz-Ratei
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Alexandra Lingesleben
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Friedel M Reischies
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Philipp Sterzer
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Rainer Hellweg
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Undine E Lang
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany (Drs Ricken, Bopp, Richter, Stamm, Sterzer, Heinz, Hellweg, and Adli); Department of Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany (Dr Schlattmann); Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany (Dr Himmerich); King’s College London, London, Great Britain (Dr Himmerich); Department of Psychiatry and Psychotherapy, Schlosspark-Klinik Berlin, Berlin, Germany (Dr Bschor); Department of Psychiatry and Psychotherapy, Vivantes Wenckebach Klinikum, Berlin, Germany (Dr Richter); Vivantes Klinikum Kaulsdorf, Berlin, Germany (Dr Richter); Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany (Dr Elstner); Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany (Dr Stamm); Department of Psychiatry and Psychotherapy, Fliedner Klinik Berlin, Berlin, Germany (Dr Schulz-Ratei); Department of Psychiatry and Psychotherapy, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (Dr Lingesleben); Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh-Klinik, Berlin, Germany (Dr Reischies); Department of Psychiatry and Psychotherapy, University Psychiatric Clinics (UPK), Switzerland (Drs Borgwardt and Lang); Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (Drs Bauer and Bschor)
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Marwood L, Taylor R, Goldsmith K, Romeo R, Holland R, Pickles A, Hutchinson J, Dietch D, Cipriani A, Nair R, Attenburrow MJ, Young AH, Geddes J, McAllister-Williams RH, Cleare AJ. Study protocol for a randomised pragmatic trial comparing the clinical and cost effectiveness of lithium and quetiapine augmentation in treatment resistant depression (the LQD study). BMC Psychiatry 2017; 17:231. [PMID: 28651526 PMCID: PMC5485607 DOI: 10.1186/s12888-017-1393-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/21/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Approximately 30-50% of patients with major depressive disorder can be classed as treatment resistant, widely defined as a failure to respond to two or more adequate trials of antidepressants in the current episode. Treatment resistant depression is associated with a poorer prognosis and higher mortality rates. One treatment option is to augment an existing antidepressant with a second agent. Lithium and the atypical antipsychotic quetiapine are two such add-on therapies and are currently recommended as first line options for treatment resistant depression. However, whilst neither treatment has been established as superior to the other in short-term studies, they have yet to be compared head-to-head in longer term studies, or with a superiority design in this patient group. METHODS The Lithium versus Quetiapine in Depression (LQD) study is a parallel group, multi-centre, pragmatic, open-label, patient randomised clinical trial designed to address this gap in knowledge. The study will compare the clinical and cost effectiveness of the decision to prescribe lithium or quetiapine add-on therapy to antidepressant medication for patients with treatment resistant depression. Patients will be randomised 1:1 and followed up over 12 months, with the hypothesis being that quetiapine will be superior to lithium. The primary outcomes will be: (1) time to all-cause treatment discontinuation over one year, and (2) self-rated depression symptoms rated weekly for one year via the Quick Inventory of Depressive Symptomatology. Other outcomes will include between group differences in response and remission rates, quality of life, social functioning, cost-effectiveness and the frequency of serious adverse events and side effects. DISCUSSION The trial aims to help shape the treatment pathway for patients with treatment resistant depression, by determining whether the decision to prescribe quetiapine is superior to lithium. Strengths of the study include its pragmatic superiority design, broad inclusion criteria (external validity) and longer follow up than previous studies. TRIAL REGISTRATION ISRCTN registry: ISRCTN16387615 , registered 28 February 2016. ClinicalTrials.gov: NCT03004521 , registered 17 November 2016.
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Affiliation(s)
- L. Marwood
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - R. Taylor
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - K. Goldsmith
- Biostatistics & Health Informatics Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - R. Romeo
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - R. Holland
- Biostatistics & Health Informatics Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - A. Pickles
- Biostatistics & Health Informatics Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - J. Hutchinson
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | | | - A. Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - R. Nair
- Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - M.-J. Attenburrow
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - A. H. Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - J. Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - R. H. McAllister-Williams
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - A. J. Cleare
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Cussotto S, Cryan JF, O'Leary OF. The hippocampus and dorsal raphe nucleus are key brain areas associated with the antidepressant effects of lithium augmentation of desipramine. Neurosci Lett 2017; 648:14-20. [PMID: 28351776 DOI: 10.1016/j.neulet.2017.03.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/09/2017] [Accepted: 03/23/2017] [Indexed: 11/25/2022]
Abstract
Approximately 50% of depressed individuals fail to achieve remission with first-line antidepressant drugs and a third remain treatment-resistant. When first-line antidepressant treatment is unsuccessful, second-line strategies include dose optimisation, switching to another antidepressant, combination with another antidepressant, or augmentation with a non-antidepressant medication. Much of the evidence for the efficacy of augmentation strategies comes from studies using lithium to augment the effects of tricyclic antidepressants. The neural circuitry underlying the therapeutic effects of lithium augmentation is not yet fully understood. Recently, we reported that chronic treatment with a combination of lithium and the antidepressant desipramine, exerted antidepressant-like behavioural effects in a mouse strain (BALB/cOLaHsd) that did not exhibit an antidepressant-like behavioural response to either drug alone. In the present study, we used this model in combination with ΔFosB/FosB immunohistochemistry to identify brain regions chronically affected by lithium augmentation of desipramine when compared to either treatment alone. The data suggest that the dorsal raphe nucleus and the CA3 regions of the dorsal hippocampus are key nodes in the neural circuitry underlying antidepressant action of lithium augmentation of desipramine. These data give new insight into the neurobiology underlying the mechanism of lithium augmentation in the context of treatment-resistant depression.
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Affiliation(s)
- Sofia Cussotto
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland; APC Microbiome Institute, University College Cork, Ireland
| | - John F Cryan
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland; APC Microbiome Institute, University College Cork, Ireland
| | - Olivia F O'Leary
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland; APC Microbiome Institute, University College Cork, Ireland.
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Abstract
Treatment resistance to the antidepressive pharmacotherapy represents one of the most important clinical challenges in the pharmacological management of unipolar depression. In this review, we aimed to summarise the evidence for various pharmacological treatment options in therapy-resistant unipolar depression derived from clinical trials, systematic reviews, meta-analyses and treatment guidelines. The first measure in case of insufficient response to the initial antidepressant monotherapy contains the debarment of 'pseudo-resistance', potentially caused by inadequate dose and treatment duration of the antidepressant, insufficient plasma levels, non-compliance of the patient regarding medication intake or relevant psychiatric and/or somatic comorbidities. Applying a dose escalation of the current antidepressant cannot be generally recommended as evidence-based treatment option and the efficacy depends on the class of antidepressants. There is no compelling evidence for a switch to another, new antidepressant compound after insufficient response to a previous antidepressant. The combination of two antidepressants should be preferentially established with antidepressants characterised by different mechanisms of action (e.g. reuptake inhibitors together with presynaptic autoreceptor inhibitors). At present, the most convincing body of evidence exists for the augmentation of antidepressants with second-generation antipsychotic drugs and lithium. Hence, both strategies are consistently advised by treatment guidelines as pharmacological first-line strategy in treatment-resistant depression.
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Affiliation(s)
- Markus Dold
- a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria
| | - Siegfried Kasper
- a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria
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Osman M, Badawi E. Evening primrose oil reducing serum lithium concentration. Ther Adv Psychopharmacol 2016; 6:343-344. [PMID: 27721973 PMCID: PMC5036139 DOI: 10.1177/2045125316658617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mugtaba Osman
- Consultant Psychiatrist, Department of Psychiatry, Letterkenny General Hospital, Letterkenny, Co. Donegal, Republic of Ireland
| | - Einas Badawi
- Foundation Year Trainee in Psychiatry, Letterkenny General Hospital, Co. Donegal, Ireland
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Cheung PW, Nomura N, Nair AV, Pathomthongtaweechai N, Ueberdiek L, Lu HAJ, Brown D, Bouley R. EGF Receptor Inhibition by Erlotinib Increases Aquaporin 2-Mediated Renal Water Reabsorption. J Am Soc Nephrol 2016; 27:3105-3116. [PMID: 27694161 PMCID: PMC5042667 DOI: 10.1681/asn.2015080903] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 01/28/2016] [Indexed: 01/04/2023] Open
Abstract
Nephrogenic diabetes insipidus (NDI) is caused by impairment of vasopressin (VP) receptor type 2 signaling. Because potential therapies for NDI that target the canonical VP/cAMP/protein kinase A pathway have so far proven ineffective, alternative strategies for modulating aquaporin 2 (AQP2) trafficking have been sought. Successful identification of compounds by our high-throughput chemical screening assay prompted us to determine whether EGF receptor (EGFR) inhibitors stimulate AQP2 trafficking and reduce urine output. Erlotinib, a selective EGFR inhibitor, enhanced AQP2 apical membrane expression in collecting duct principal cells and reduced urine volume by 45% after 5 days of treatment in mice with lithium-induced NDI. Similar to VP, erlotinib increased exocytosis and decreased endocytosis in LLC-PK1 cells, resulting in a significant increase in AQP2 membrane accumulation. Erlotinib increased phosphorylation of AQP2 at Ser-256 and Ser-269 and decreased phosphorylation at Ser-261 in a dose-dependent manner. However, unlike VP, the effect of erlotinib was independent of cAMP, cGMP, and protein kinase A. Conversely, EGF reduced VP-induced AQP2 Ser-256 phosphorylation, suggesting crosstalk between VP and EGF in AQP2 trafficking and a role of EGF in water homeostasis. These results reveal a novel pathway that contributes to the regulation of AQP2-mediated water reabsorption and suggest new potential therapeutic strategies for NDI treatment.
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Affiliation(s)
- Pui W Cheung
- Center for Systems Biology, Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Naohiro Nomura
- Center for Systems Biology, Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anil V Nair
- Center for Systems Biology, Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nutthapoom Pathomthongtaweechai
- Center for Systems Biology, Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lars Ueberdiek
- Center for Systems Biology, Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hua A Jenny Lu
- Center for Systems Biology, Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Dennis Brown
- Center for Systems Biology, Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Richard Bouley
- Center for Systems Biology, Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Kennedy SH, Lam RW, McIntyre RS, Tourjman SV, Bhat V, Blier P, Hasnain M, Jollant F, Levitt AJ, MacQueen GM, McInerney SJ, McIntosh D, Milev RV, Müller DJ, Parikh SV, Pearson NL, Ravindran AV, Uher R. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 3. Pharmacological Treatments. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:540-60. [PMID: 27486148 PMCID: PMC4994790 DOI: 10.1177/0706743716659417] [Citation(s) in RCA: 707] [Impact Index Per Article: 88.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. "Pharmacological Treatments" is the third of six sections of the 2016 guidelines. With little new information on older medications, treatment recommendations focus on second-generation antidepressants. RESULTS Evidence-informed responses are given for 21 questions under 4 broad categories: 1) principles of pharmacological management, including individualized assessment of patient and medication factors for antidepressant selection, regular and frequent monitoring, and assessing clinical and functional outcomes with measurement-based care; 2) comparative aspects of antidepressant medications based on efficacy, tolerability, and safety, including summaries of newly approved drugs since 2009; 3) practical approaches to pharmacological management, including drug-drug interactions and maintenance recommendations; and 4) managing inadequate response and treatment resistance, with a focus on switching antidepressants, applying adjunctive treatments, and new and emerging agents. CONCLUSIONS Evidence-based pharmacological treatments are available for first-line treatment of MDD and for management of inadequate response. However, given the limitations of the evidence base, pharmacological management of MDD still depends on tailoring treatments to the patient.
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Affiliation(s)
- Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario *Co-first authors.
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia *Co-first authors
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Venkat Bhat
- Department of Psychiatry, McGill University, Montréal, Quebec
| | - Pierre Blier
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario
| | - Mehrul Hasnain
- Department of Psychiatry, Memorial University, St. John's, Newfoundland
| | - Fabrice Jollant
- Department of Psychiatry, McGill University, Montréal, Quebec
| | - Anthony J Levitt
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | | | - Diane McIntosh
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | | | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
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An Y, Inoue T, Kitaichi Y, Chen C, Nakagawa S, Wang C, Kusumi I. Combined treatment with subchronic lithium and acute intracerebral mirtazapine microinjection into the median raphe nucleus exerted an anxiolytic-like effect synergistically. Eur J Pharmacol 2016; 783:112-6. [PMID: 27154172 DOI: 10.1016/j.ejphar.2016.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/03/2016] [Accepted: 05/02/2016] [Indexed: 02/07/2023]
Abstract
Although preclinical and clinical studies have established the efficacy of lithium augmentation of antidepressant drugs, the mechanism of action of lithium augmentation is not fully understood. Our previous study reported that subchronic lithium treatment enhanced the anxiolytic-like effect of systemic mirtazapine. In the present study, we examined the effect of subchronic lithium in combination with acute local intracerebral injection of mirtazapine on fear-related behaviors in a contextual fear conditioning test in rats to clarify the target brain region of lithium augmentation of mirtazapine. After conditioning by footshock, diet (food pellets) containing Li2CO3 at a concentration of 0.2% was administered for 7 days. Ten min before testing and 7 days after conditioning, mirtazapine (3μg/site) in a volume of 0.5µl was acutely injected into the median raphe nucleus (MRN), hippocampus or amygdala. The combination of subchronic lithium and acute mirtazapine microinjection into the MRN but not the hippocampus or the amygdala reduced fear expression synergistically. These results suggest that intra-MRN mirtazapine treatment with subchronic lithium exerts the anxiolytic-like effect through the facilitation of the MRN-5HT pathway.
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Affiliation(s)
- Yan An
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Tokyo 160-0023, Japan.
| | - Yuji Kitaichi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Chong Chen
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Shin Nakagawa
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Ce Wang
- Department of Neuropharmacology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
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Ionescu DF, Rosenbaum JF, Alpert JE. Pharmacological approaches to the challenge of treatment-resistant depression. DIALOGUES IN CLINICAL NEUROSCIENCE 2016. [PMID: 26246787 PMCID: PMC4518696 DOI: 10.31887/dcns.2015.17.2/dionescu] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although monoaminergic antidepressants revolutionized the treatment of Major Depressive Disorder (MDD) over a half-century ago, approximately one third of depressed patients experience treatment-resistant depression (TRD). Such patients account for a disproportionately large burden of disease, as evidenced by increased disability, cost, human suffering, and suicide. This review addresses the definition, causes, evaluation, and treatment of unipolar TRD, as well as the major treatment strategies, including optimization, augmentation, combination, and switch therapies. Evidence for these options, as outlined in this review, is mainly focused on large-scale trials or meta-analyses. Finally, we briefly review emerging targets for antidepressant drug discovery and the novel effects of rapidly acting antidepressants, with a focus on ketamine.
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Affiliation(s)
- Dawn F Ionescu
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jerrold F Rosenbaum
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan E Alpert
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Hashmi AM, Khawaja IS, Shah AA. A 35-Year-Old Man with Depressed Mood, Insomnia, and Suicidal Ideation. Psychiatr Ann 2016. [DOI: 10.3928/00485713-20160223-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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49
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Costemale-Lacoste JF, Guilloux JP, Gaillard R. The role of GSK-3 in treatment-resistant depression and links with the pharmacological effects of lithium and ketamine: A review of the literature. Encephale 2016; 42:156-64. [PMID: 26995153 DOI: 10.1016/j.encep.2016.02.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/27/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Since the discovery of antidepressants, new treatments have emerged with fewer side effects but no greater efficacy. Glycogen synthase kinase 3 β (GSK-3β), a kinase known for its activity on glycogen synthesis, has in the last few years raised growing interest in biological psychiatry. Several efficient treatments in major depression have an inhibitory effect on this kinase, which could be targeted in new mood disorder treatments. METHODS The aim of this review is to summarize findings concerning the intracellular pharmacologic effects of GSK-3β inhibitors on mood. After a brief description of the intracellular transduction pathways implicated in both GSK-3β and mood disorders, we reviewed the results demonstrating GSK-3β involvement in the effects of lithium and ketamine. RESULTS GSK-3β can be inhibited through several mechanisms such as serine phosphorylation or binding in a proteic scaffold and others. Its inhibition is implicated in numerous cellular pathways of interest involved in neuronal growth and architecture, cell survival, neurogenesis or synaptic plasticity. This inhibition appears to be both efficient and sufficient in improving mood in animal models. In human beings, several levels of evidence show GSK-3β inhibition with antidepressant use. Crucially, strong inhibition has been shown with lithium via the proteic scaffold PP2A/β-arrestin/AKT, and with the rapid antidepressant effect of ketamine via p70S6K. CONCLUSION Our review focuses on mechanisms whereby the GSK-3β pathway has a part in the antidepressant effect of lithium and ketamine. This article highlights the importance of translational research from cell and animal models to the clinical setting in order to develop innovative therapeutic targets.
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Affiliation(s)
- J F Costemale-Lacoste
- Inserm U1178, équipe « Dépression et antidépresseurs », CESP, université Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Service de psychiatrie de l'adulte, centre hospitalier universitaire Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - J P Guilloux
- Inserm U1178, équipe « Dépression et antidépresseurs », CESP, université Paris-Sud, 94275 Le Kremlin-Bicêtre, France; EA3544, faculté de pharmacie, université Paris-Sud, 92296 Châtenay-Malabry, France
| | - R Gaillard
- Laboratoire de physiopathologie des maladies psychiatriques, centre de psychiatrie et neurosciences U894, université Paris Descartes, Sorbonne Paris Cité, Paris, France; Centre hospitalier Sainte-Anne, Paris, France
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Interpersonal psychotherapy as add-on for treatment-resistant depression: A pragmatic randomized controlled trial. J Affect Disord 2016; 193:373-80. [PMID: 26799332 DOI: 10.1016/j.jad.2016.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Treatment-resistant depression (TRD) is an extremely prevalent clinical condition. Although Interpersonal Psychotherapy (IPT) is an established treatment for uncomplicated depression, its effectiveness has never before been studied in patients with TRD in real-world settings. We investigate IPT as an adjunct strategy to treatment as usual (TAU) for TRD patients in a pragmatic, randomized, controlled trial. METHODS A total of 40 adult patients with TRD (satisfying the criteria for major depressive disorder despite adequate antidepressant treatment) were recruited from a tertiary care facility for this pragmatic trial and blinded to the evaluator. Patients were randomized to one of two treatment conditions: (1) TAU - pharmacotherapy freely chosen by the clinician (n=23) and (2) TAU+IPT (n=17). Assessments were performed at weeks 8, 12, 19 and 24. Changes in the estimated means of the Hamilton Depression Rating Scale score were the primary outcome measure. Secondary outcomes included patient-rated scales and quality of life scales. We used a linear mixed model to compare changes over time between the two groups. RESULTS Both treatments lead to improvements in depressive symptoms from baseline to week 24 with no significant between group differences in either primary: TAU (mean difference: 4.57; CI95%: 0.59-8.55; d=0.73) vs. IPT+TAU (mean difference: 5.86, CI95%: 1.50-10.22; d=0.93) or secondary outcomes. LIMITATIONS Our relatively small sample limits our ability to detect differences between treatments. CONCLUSIONS Both treatments lead to equal improvements in depressive symptoms. We found no evidence to support adding IPT to pharmacotherapy in patients with TRD. TRIAL REGISTRATION ClinicalTrials.gov-NCT01896349.
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