Mode of action of antidepressant drugs

Major depressive disorder: hypothesis, mechanism, prevention and treatment

Worldwide, the incidence of major depressive disorder (MDD) is increasing annually, resulting in greater economic and social burdens. Moreover, the pathological mechanisms of MDD and the mechanisms underlying the effects of pharmacological treatments for MDD are complex and unclear, and additional diagnostic and therapeutic strategies for MDD still are needed. The currently widely accepted theories of MDD pathogenesis include the neurotransmitter and receptor hypothesis, hypothalamic-pituitary-adrenal (HPA) axis hypothesis, cytokine hypothesis, neuroplasticity hypothesis and systemic influence hypothesis, but these hypothesis cannot completely explain the pathological mechanism of MDD. Even it is still hard to adopt only one hypothesis to completely reveal the pathogenesis of MDD, thus in recent years, great progress has been made in elucidating the roles of multiple organ interactions in the pathogenesis MDD and identifying novel therapeutic approaches and multitarget modulatory strategies, further revealing the disease features of MDD. Furthermore, some newly discovered potential pharmacological targets and newly studied antidepressants have attracted widespread attention, some reagents have even been approved for clinical treatment and some novel therapeutic methods such as phototherapy and acupuncture have been discovered to have effective improvement for the depressive symptoms. In this work, we comprehensively summarize the latest research on the pathogenesis and diagnosis of MDD, preventive approaches and therapeutic medicines, as well as the related clinical trials.

Dopamine Receptors: Is It Possible to Become a Therapeutic Target for Depression?

Dopamine and its receptors are currently recognized targets for the treatment of several neuropsychiatric disorders, including Parkinson’s disease, schizophrenia, some drug use addictions, as well as depression. Dopamine receptors are widely distributed in various regions of the brain, but their role and exact contribution to neuropsychiatric diseases has not yet been thoroughly studied. Based on the types of dopamine receptors and their distribution in different brain regions, this paper reviews the current research status of the molecular, cellular and circuit mechanisms of dopamine and its receptors involved in depression. Multiple lines of investigation of these mechanisms provide a new future direction for understanding the etiology and treatment of depression and potential new targets for antidepressant treatments.

Les temps de la dépression

Revue à travers les données de la littérature, la dépression apparaît comme un sujet de recherche très important, qui a déjà suscité de nombreuses théories chronobiologiques, souvent fondées sur des ≪critères diagnostiques objectifs≫. En revanche, l’impact thérapeutique de ces approches reste souvent limité à de rares services ultraspécialisés où les patients déprimés sont adressés en dernier recours.

Dans cet article, les auteurs passent en revue quelques-unes des principales données de la littérature, en particulier celles qui concernent les aspects chronobiologiques de la dépression. Les investigations sophistiquées réalisées dans les unités de recherche peuvent avoir certaines conséquences cliniques et pratiques qui sont également évoquées. En effet, une évaluation clinique soigneuse, orientée sur des bases chronobiologiques suffit bien souvent à proposer des traitements individuels assez simples. Parmi ceux-ci, la privation partielle de sommeil (PPS) représente un moyen utile, permettant une amélioration rapide, mais malheureusement souvent imprévisible et transitoire, des troubles de l’humeur. Il semble possible de rendre plus fiables les PPS grâce à des interventions sur la température, la prise de nourriture et l’exposition à la lumiére.

De plus, les auteurs décrivent un moyen possible de pérenniser les effets antidépresseurs de la PPS par des «microprivations de sommeil» réalisées pendant 15 min, à un moment spécifique de la nuit. Les résultats concernant 11 patients déprimés graves soumis à cette méthode sont exposés, 7 de ces sujets étant maintenus depuis 6 à 20 mois dans un état euthymique.

Is depression a disorder of a receptor superfamily? A critical review of the receptor theory of depression and the appraisal of a new heuristic model

The monoamine hypothesis of depression and its direct derivation, the receptor theory, have constituted for several years a frame of reference for researchers working in the field of biological psychiatry. Although most of the data are derived from animal findings and must be considered inconclusive in view of various controversies, some guidelines may be identified: these would suggest that changes in postsynaptic beta-adrenoreceptors, presynaptic alpha 2-adrenoreceptors, as well as in type 2 serotonin receptors and dopaminergic autoreceptors may be involved in the mode of action of antidepressant drugs and, consequently, in the pathophysiology of depression. Nowadays, any attempt to correlate depression with the dysfunction of a single neurotransmitter or receptor is no longer tenable, since it is clear that depression is a heterogeneous disorder which involves abnormalities in the interactive relationships between neurotransmitters and receptors. If, on the one hand, this new model has opened up new fields of research and has led to the investigation of new systems,egthe GABAergic and GABA B receptors, on the other hand, it has been strongly limited by the lack of research tools and reliable peripheral CNS models forin vivostudies. A possible approach to this unresolved dilemma may be provided by molecular biology techniques, which have permitted the identification of the genes and sequencing of the primary structure of several membrane receptors. It is now established that receptors may be grouped into four superfamilies; in depression, there exists compelling evidence of alterations mainly in receptors belonging to the G-protein-coupled family: it is plausible that depression may be related to a disorder of the G-protein-coupled receptor superfamily. Such an hypothesis would represent an attempt to unify the different receptor abnormalities found in depression or following antidepressant treatments, and to shift from the monoamine paradigm to a new heuristic model. In addition, it would accommodate the various dysfunctions likely to be encountered and would open up new theoretical perspectives in the treatment of depression.

Calcium/Calmodulin-Dependent Protein Kinase II and Eukaryotic Elongation Factor 2 Kinase Pathways Mediate the Antidepressant Action of Ketamine

BACKGROUND

Ketamine is an N-methyl-D-aspartate receptor antagonist, which on administration produces fast-acting antidepressant responses in patients with major depressive disorder. Yet, the mechanism underlying the antidepressant action of ketamine remains unclear.

METHODS

To unravel the mechanism of action of ketamine, we treated wild-type C57BL/6 mice with calcium/calmodulin-dependent protein kinase II (CaMKII) specific inhibitor tatCN21 peptide. We also used eukaryotic elongation factor 2 kinase (eEF2K) (also known as CaMKIII) knockout mice. We analyzed the effects biochemically and behaviorally, using the forced swim, tail suspension, and novelty suppressed feeding tests.

RESULTS

Consistent with the literature, one of the major pathways mediating the antidepressant action of ketamine was reduction of phosphorylation of eEF2 via eEF2K. Specifically, knocking out eEF2K in mice eliminated phosphorylation of eEF2 at threonine at position 56, resulting in increased protein synthesis, and made mice resistant both biochemically and behaviorally to the antidepressant effects of ketamine. In addition, administration of ketamine led to differential regulation of CaMKII function, manifested as autoinhibition (pT305 phosphorylation) followed by autoactivation (pT286) of CaMKIIα in the hippocampus and cortex. The inhibition phase of CaMKII, which lasted 10 to 20 minutes after administration of ketamine, occurred concurrently with eEF2K-dependent increased protein synthesis. Moreover, ketamine administration-dependent delayed induction of GluA1 (24 hours) was regulated by the activation of CaMKII. Importantly, systemic administration of the CaMKII inhibitor tatCN21 increased global protein synthesis and induced behavioral resistance to ketamine.

CONCLUSIONS

Our data suggest that drugs that selectively target CaMKs and regulate protein synthesis offer novel strategies for treatment of major depressive disorder.

Molecular Neurobiology and Promising New Treatment in Depression

The limited effects of currently available antidepressants are becoming an urgent issue in depression research. It takes a long time to determine treatment effects, and the overall remission rate is low. Although we expect the development of non-monoamine antidepressants in the near future, efforts in this regard over the past several decades have not yet been compensated. Thus, researchers and clinicians should clarify the neurobiological mechanisms of integrated modulators that regulate changes in genes, cells, the brain, and behaviors associated with depression. In this study, we review molecular neurobiological theories and new treatments for depression. Beyond neuroanatomy and monoamine theory, we discuss cells and molecules, neural plasticity, neurotrophisms, endocrine mechanisms, immunological mechanisms, genetics, circadian rhythms, and metabolic regulation in depression. In addition, we introduce the possibility of new antidepressant drug development using protein translation signaling (mTOR) pathways.

The effect of antidepressant treatment on alpha2 adrenoceptor function in DSM 111 major depression

Twenty-one drug free patients fulfilling the DSM-111-R criteria for major depressive disorder were administered an alpha2 adrenoceptor challenge test. They were then treated with an antidepressant or ECT. Six weeks later, alpha2 function was again tested and found to be universally downregulated in treatment responders. Those who failed to respond to treatment (33%) had evidence of continuing alpha2 adrenoceptor activity. These results suggest central noradrenergic overactivity as a possible mechanism for depression, which runs counter to the classic catecholamine hypothesis.

Antidepressant effect of 5-methoxypsoralen: The melatonin synchronizer hypothesis

5-methoxypsoralen (5-MOP) stimulates pineal melatonin secretion, and a decrease in dark phase melatonin levels has been described in major depression. As exogenous melatonin has shown synchronizer properties, authors hypothesized that giving 5-MOP would have antidepressant properties. Twenty-six inpatients meeting the criteria of major depressive disorders were enrolled in a four-week, double blind trial of 5-MOP versus amitriptyline. Clinical improvement was identical in both treatment groups but biological changes were different in each group: 5-MOP patients showed an early nocturnal surge of melatonin levels that was maintained at the fourth treatment week, while melatonin levels remained unchanged in patients treated with amitriptyline.

Could the underestimation of bipolarity obstruct the search for novel antidepressant drugs?

INTRODUCTION

Despite the clinical and social relevance of depression, and the availability of numerous antidepressants and non-pharmacological interventions, response rates remain unsatisfactory and novel therapeutic targets are being explored.

AREAS COVERED

This review starts with a brief overview of the evolution of the current antidepressant drug scenario and ends with a focus on the potential influence of the underestimation of bipolarity on the exploration of novel antidepressant drugs.

EXPERT OPINION

The field of antidepressant drug development has suffered from a relative decline recently and, with the exception of agomelatine, innovative non-monoaminergic antidepressants have yet to be developed. The need for more effective compounds is evident. Clinicians and researchers should pay greater attention to the impact of bipolarity in depression. The ultimate goal of this review is not to discourage the use of antidepressants but rather to encourage judicious prescriptions, and also to solicit a better collaboration between clinicians and preclinical researchers so that more reliable diagnostic criteria can be adopted.

Paroxetine pretreatment does not change the effects induced in the rat cortical beta-adrenergic receptor system by repetitive transcranial magnetic stimulation and electroconvulsive shock

Repetitive transcranial magnetic stimulation (rTMS) has been proposed as a clinically effective antidepressant treatment, but meta-analysis suggests that its efficacy is marginal. We investigated whether the administration of rTMS together with paroxetine would enhance its effects on the beta-adrenergic system of the rat. We compared our results with the effects of electroconvulsive shock therapy (ECS). The experiment was performed for 12 d on male Wistar rats that received a physical treatment of either rTMS (B=1.4 T, f=10 Hz, 300 s) or ECS (I=130 mA, f=50 Hz, t=500 ms), preceded by sterile water or paroxetine (10 mg/kg i.p. 30 min earlier). All rats were decapitated 24 h after the final treatment. Cyclic AMP (cAMP) was measured in cortical slices prelabelled with [3H]adenine and stimulated with noradrenaline. beta-adrenoceptor parameters (Bmax and KD) were assessed in the P2 fraction of cortical homogenates using [3H]CGP 12177 as a ligand. ECS resulted in down-regulation of both the cAMP response and beta-adrenoceptor density, while rTMS depressed only the responsiveness of the cAMP-generating system. Paroxetine, which was only effective in dampening the cAMP response, did not change the effects of either physical treatment. The data suggest that any possible interaction between paroxetine and rTMS or ECS does not involve the beta-adrenergic mechanisms.

Depression: The predisposing influence of stress

Aversive experiences have been thought to provoke or exacerbate clinical depression. The present review provides a brief survey of the stress-depression literature and suggests that the effects of stressful experiences on affective state may be related to depletion of several neurotransmitters, including norepinephrine, dopamine, and serotonin. A major element in determining the neurochemical changes is the organism's ability to cope with the aversive stimuli through behavioral means. Aversive experiences give rise to behavioral attempts to cope with the stressor, coupled with increased utilization and synthesis of brain amines to contend with environmental demands. When behavioral coping is possible, neurochemical systems are not overly taxed, and behavioral pathology will not ensue. However, when there can be no behavioral control over the stressful stimuli, or when the aversive experience is perceived as uncontrollable, increased emphasis is placed on coping through endogenous neurochemical mechanisms. Amine utilization increases appreciably and may exceed synthesis, resulting in a net reduction of amine stores, which in turn promotes or exacerbates affective disorder. The processes governing the depletions may be subject to sensitization or conditioning, such that exposure to traumatic experiences may have long-term repercussions when the organism subsequently encounters related stressful stimuli. With continued uncontrollable stimulation, adaptation occurs in the form of increased activity of synthetic enzymes, and levels of amines approach basal values. It is suggested that either the initial amine depletion provoked by aversive experiences or a dysfunction of the adaptive processes, resulting in persistent amine depletion, contributes to behavioral depression. Aside from the contribution of behavioral coping, several organismic, experiential, and environmental variables will influence the effects of aversive experiences on neurochemical activity, and may thus influence vulnerability to depression.

Beta adrenergic receptor function in depression and the effect of antidepressant drugs

It has been suggested that alterations of monoamine receptor sensitivity in the central nervous system may be associated with some forms of affective illness. It has been observed by several investigators that chronic treatment with antidepressant drugs causes down regulation of NE receptor coupled adenylate cyclase and beta adrenergic receptor binding in rat brain. This observation has led to the suggestion that the therapeutic effects of antidepressant drugs may be related to the changes in the responsivity of beta adrenergic receptors. In order to examine if depressive illness may be associated with altered beta adrenergic function, we studied adenylate cyclase and its responsiveness to norepinephrine and isoproterenol in the leukocytes obtained from patients with psychiatric illness and normal controls as an index of beta adrenergic receptor function. We also studied the effects of antidepressant drugs, in vitro, on isoproterenol sensitive leukocyte adenylate cyclase. We observed that norepinephrine and isoproterenol sensitive leukocyte adenylate cyclase in depressed patients are significantly decreased as compared to normal controls. Our results appear to have been replicated by another group of investigators. We also observed that certain antidepressant drugs potentiate isoproterenol stimulated accumulation of cyclic AMP in human leukocytes. This potentiation was most pronounced in the case of iprindole. These results thus indicated a decreased beta adrenergic receptor function in patients with depressive illness. Whether or not such decreased receptor function is associated with depressive illness or is a manifestation of some other changes unrelated to the illness is not clear. Our results also indicate that some antidepressant drugs may enhance adrenergic transmission by potentiating the effects of neurotransmitters on beta adrenergic receptors.

Adrenergic and serotonergic mechanisms in depression and their response to amitriptyline

Our investigations into the chemical pathology of the affective disorders have indicated that depressed patients not only have significantly reduced rates of accumulation of 5-hydroxytryptamine (5-HT) into their blood platelets but their peripheral alpha-adrenoreceptors are supersensitive. Investigations into the mode of action of amitriptyline have centred on these abnormal adrenergic and serotonergic mechanisms in depressed patients. We have not detected any significant relationship between blood platelet 5-HT re-uptake inhibition and therapeutic response to amitriptyline in depressed patients, although there is a significant correlation with plasma levels of the drug. It is interesting to note that nortriptyline, the major metabolite of amitriptyline, blocks the alpha-adrenoreceptor but the degree of blocking of this supersensitive receptor is significantly correlated to poor outcome. Amitriptyline does not appear to correct these abnormal mechanisms in depressed patients. These results are discussed with reference to other pharmacological actions of amitriptyline and other antidepressant drugs.

Relationship between G-protein beta-3 subunit C825T polymorphism and mirtazapine responses in Korean patients with major depression

AIMS

This study aimed to determine the relationship between the C825T polymorphism in the G-protein beta 3 subunit (GNB3) gene and the response to mirtazapine in a Korean population with major depressive disorder (MDD).

METHOD

Mirtazapine was administered for 8 weeks to the 101 MDD patients who completed this study. All subjects were examined using the Structured Clinical Interview for DSM-IV, and the severity of depression was assessed using the 21-item Hamilton Depression Rating (HAMD-21) scale.

RESULTS

There was a significant main effect of time on the decrease in the HAMD-21 score during the 8-week study period. However, a main effect of or an interaction of genotype with time on the decrease in the HAMD-21 score during the 8-week study period was not found. ANOVA revealed no significant effects of the GNB3 C825T polymorphism on the decrease in the HAMD-21 score at each time period.

CONCLUSION

Although the C825T polymorphism of the GNB3 gene may affect the pathogenesis of MDD, our results do not support the hypothesis that this polymorphism is involved in the therapeutic response to mirtazapine in Korean patients with MDD.

Effects of chronically administered antidepressants and electroconvulsive treatment on cerebral neurotransmitter receptors in rodents with 'model depression'

The aim of this study was to develop a model of depression in laboratory animals in which chronically administered antidepressant drugs and electroconvulsive treatment (ECT) would produce receptor effects similar to but more marked than those in normal animals. The models discussed in detail are reserpinized and centrally chemosympathectomized rats. Other models currently under investigation are albino Swiss mice that respond with motor inhibition to high doses of morphine and rats tolerant to morphine. The reserpine model seems to be of some value, because in reserpinized rats antidepressants and ECT lead to adrenoceptor changes the same as or more marked than those observed in normal animals. Central chemosympathectomy with 6-hydroxydopamine prevents several receptor actions of imipramine, though not of ECT. The 'opiate models', though apparently not very promising, need further study.

Delayed effects of antidepressant drugs in rats

The present study has addressed the question of what is more important for the occurrence of adaptive changes observed in the organism treated with antidepressant drugs: a daily dosing of the drug or the period of time necessary for the plastic events to develop. Here, we report on the effects of desipramine given to rats acutely (and tested following 2 drug-free weeks) as when the drug was administered repeatedly, on behavior in the forced swim test (i.e. significant shortening of immobility time by ca. 60%) and on the binding of [3H]CGP12177 to beta-adrenergic receptors in the rat brain cortex (significant decrease of the binding by ca. 15%). Additionally, using the procedure of the repeated forced swim test (six times over 21 days), we show that the shortening of immobility time induced by a single dose of imipramine persisted throughout the whole experimental period and was similar to that seen in a group of animals treated repeatedly with the drug. Also, the effects of citalopram on immobility and climbing were similar after acute treatment and delayed testing to those seen after repeated drug exposure. The results obtained in the present study may question some conclusions that are usually drawn from the behavioral and, especially, biochemical studies concerning the need for repeated treatment with antidepressant drugs to induce various adaptive changes in the brain, which are thought to be responsible for the therapeutic efficacy of these drugs.

Golf protein levels in rat striatum are increased by chronic antidepressant administration and decreased by olfactory bulbectomy

There are many studies of the mechanisms of antidepressants; however, most of these studies were conducted on the hippocampus or frontal cortex. In the present study, we hypothesized that the nucleus accumbens and caudate/putamen might be major targets for antidepressant effects. Thus, we focused on G(olf) protein, a stimulant alpha-subunit of G protein that is coupled with the dopamine D1 receptor and specifically expressed in the striatum (nucleus accumbens, caudate/putamen and olfactory tubercle) in the rat brain. We examined the effects of chronic administration of imipramine, fluvoxamine, maprotiline and, as a negative control, cocaine on the level of G(olf) protein in the rat striatum. We also examined the effect of olfactory bulbectomy. Chronic imipramine treatment (10 mg/kg for 2 or 4 weeks) significantly increased the level of G(olf) in the striatum (by 17% or 18%, respectively), although this increase was not apparent after only 1 week of treatment. The time course of these changes corresponded well to that of the clinical efficacy of imipramine. Chronic fluvoxamine and maprotiline treatment (20 mg/kg for 2 weeks) also significantly increased the level of G(olf) (by 9% and 25%, respectively), but cocaine did not alter it significantly. Bulbectomy decreased the G(olf) protein level by 9%. The increases in G(olf) protein after chronic administration of these three different classes of antidepressants and the decrease after bulbectomy suggest that G(olf) protein may play an important role in the antidepressant effect.

Repeated treatment with antidepressants enhances dopamine D1 receptor gene expression in the rat brain

Many pharmacological investigations have demonstrated that antidepressant agents profoundly affect serotonergic and noradrenergic neurotransmission. The molecular mechanisms by which these drugs exert their therapeutic action have not been clearly established. In our study, the possibility that antidepressant drug action is associated with dopamine neurotransmission was examined. To this end, the effect of 21-day treatment with 10 mg/kg of amitryptyline, mirtazapine and sertraline on the striatal and nucleus accumbens dopamine receptors was verified. The striatum and nucleus accumbens tissues were dissected 24 h after the last dose of the drug and total RNA was isolated. The expression of dopamine D1 to dopamine D5 receptors using reverse-transcriptase polymerase chain reaction (RT-PCR) procedure was compared to the glyceraldehyde-3-phosphate-dehydrogenase (GAPDH) as constitutive gene activation internal control. Lab Works UV program has analyzed the mean optical density values of RT-PCR products. Statistical comparison of relative optical densities by a one-way analysis of variance (ANOVA) followed by Dunnett's test was performed. Despite their different pharmacological profiles, all three above-presented antidepressants significantly increased dopamine D(1) mRNA content. Our findings indicate that repeated antidepressant administration triggers induction of the brain dopaminergic receptors which is correlated with neuroadaptation of the brain dopaminergic pathway.

Is mood chemistry?

The chemical hypothesis of depression suggests that mood disorders are caused by a chemical imbalance in the brain, which can be corrected by antidepressant drugs. However, recent evidence indicates that problems in information processing within neural networks, rather than changes in chemical balance, might underlie depression, and that antidepressant drugs induce plastic changes in neuronal connectivity, which gradually lead to improvements in neuronal information processing and recovery of mood.

Invited review: the evolution of antidepressant mechanisms

Present antidepressants are all descendents of the serendipitous findings in the 1950s that the monoamine oxidase inhibitor iproniazid and the tricyclic antidepressant imipramine were effective antidepressants. The identification of their mechanism of action, and those of reserpine and amphetamine, in the 1960s, led to the monoamine theories of depression being postulated; first, with noradrenaline then 5-hydroxytryptamine being considered the more important amine. These monoamine theories of depression predominated both industrial and academic research for four decades. Recently, in attempts to design new drugs with faster onsets of action and more universal therapeutic action, downstream alterations common to current antidepressants are being examined as potential antidepressants. Additionally, the use of animal models has identified a number of novel targets some of which have been subjected to clinical trials in humans. However, monoamine antidepressants remain the best current medications and it may be some time before they are dislodged as the market leaders.

The antidepressant effect of ethanol extract of radix puerariae in mice exposed to cerebral ischemia reperfusion

In our pilot study, the depressive-like behaviors of mice exposed to cerebral ischemia reperfusion (CIR) were observed and the antidepressant effects of radix puerariae (RP; root of the Pueraria plant) extract in CIR mice were assessed because it was speculated that the neuronal damage caused by CIR played an important role in the development of poststroke depression (a common and severe complication after stroke) and the RP extract was reported to exhibit effect of neuronal protection from cerebral ischemia damage. Our studies above indicated that the RP extract markedly shortened the increased immobility time induced by CIR of male mice in the forced swimming test (FST) and tail suspension test (TST), indicating a possible antidepressant activity. Thus, the aim of the present study was to confirm the putative antidepressant effect of RP extract (75, 150, and 300 mg/kg, administered orally 24 h after the CIR) on reserpine-induced symptoms. To get further insight into the mode of antidepressant action of RP extract, biochemical examination was conducted concomitantly to examine possible involvement of the brain monoamine systems in the behavioral syndromes observed. In CIR mice, pronounced low levels of norepinephrine (NE) and 4-dihydroxyphenylacetic acid (DOPAC, a metabolite of dopamine) in the hippocampus or striatum were detected, which were reversed by RP extract, whereas no significant change of serotonin (5-HT) was detected in either CIR or RP extract-treated mice. The data suggested that the disturbance of NE and DA systems in hippocampus and striatum played more important roles in the development of depressive-like behavior of CIR mice than 5-HT system did, and RP extract ameliorated the abnormal symptoms caused by CIR, which may throw new lights on the treatment of poststroke depression.

Extracts of St. John's wort and various constituents affect beta-adrenergic binding in rat frontal cortex

The present study was designed to get further insight into the mode of antidepressant action of extracts prepared from St. John's wort (SJW) and relevant active constituents. Down-regulation of central beta-adrenergic receptors (beta-AR's) has been widely considered a common biochemical marker of antidepressant efficacy. Although previous studies have reported a beta-AR down-regulation for SJW extracts, in vivo studies that compare the effects of SJW extracts with those of relevant active constituents on beta-AR density have not been done yet. We used quantitative radioligand receptor-binding-studies to examine in rats the effects of short-term (2 wks) and long-term (8 wks) administration of different SJW extracts and constituents on beta-AR binding in rat frontal cortex. The effects were compared to those of the standard antidepressants imipramine and fluoxetine. [125I]CYP binding to beta-AR was found to be decreased after short as well as after long-term treatment with imipramine (36%, 40%). Short-term treatment with fluoxetine decreased the number of beta-adrenergic receptors (17%) while long-term treatment with fluoxetine elicited an increase (14%) in beta-AR-binding. This effect was comparable to that of the lipophilic CO2 extract which decreased beta-AR-binding (13%) after two weeks and slightly increased the number of beta-AR's after 8 weeks (9%). Short-term treatment with the methanolic SJW extract decreased beta-AR-binding (14%), no effects for this extract were observed after 8 weeks. Treatment with hypericin led to a significant down-regulation (13%) of beta-AR's in the frontal cortex after 8-weeks, but not after 2 weeks, while hyperforin (used as trimethoxybenzoate, TMB), and hyperoside were ineffective in both treatment paradigms. Compared to the SJW extracts and single compounds the effect of imipramine on beta-AR-binding was more pronounced in both treatment paradigms.

The promises and pitfalls of reboxetine

The antidepressant compound, morpholine, 2-[(2-ethoxyphenoxy)phenylmethyl]-,methanesulfonate, or reboxetine, is a selective noradrenergic reuptake inhibitor that acts by binding to the norepinephrine (NE) transporter and blocking reuptake of extracellular NE back into terminals. This compound has low affinity for other transporters and receptors. The development of reboxetine as a potential antidepressant stems from the prior demonstration that blockade of the NE transporter imparts antidepressant activity. Desipramine, lofepramine, and nortryptiline are examples of tricyclic antidepressant (TCA) compounds from the first generation of antidepressants that exert their effects by blockade of NE reuptake. Maprotiline, a non-tricyclic compound, is also a NE selective reuptake inhibitor. Unfortunately, these antidepressants are also associated with interactions with muscarinic, histaminergic, and adrenergic receptors, which are known to contribute to a variety of untoward side effects. Despite the positive pharmacological profile of reboxetine, i.e., selectivity and specificity, with relatively fewer side effects, its use as an antidepressant is currently limited to Europe. Reboxetine is marketed as Edronax in the UK, Norebox in Italy, and as Irenor in Spain. It is registered in Germany, Sweden, Denmark, Ireland, Austria and Finland. Based on studies conducted primarily outside the US, the FDA granted a preliminary letter of approval in 1999. However, more recent clinical studies conducted in the US and Canada, prompted by the FDA, resulted in a letter of non-approval. To date, it is unclear why the further development of reboxetine as an antidepressant in the US has been halted. Despite this setback, reboxetine has been a valuable pharmacological tool to assess the role of the noradrenergic system in preclinical studies of depressive disorder.

Mechanism of action of St John's wort in depression : what is known?

Extracts of Hypericum perforatum L. (St John's wort) are now successfully competing for status as a standard antidepressant therapy. Because of this, great effort has been devoted to identifying the active antidepressant compounds in the extract. From a phytochemical point of view, St John's wort is one of the best-investigated medicinal plants. A series of bioactive compounds has been detected in the crude material, namely flavonol derivatives, biflavones, proanthocyanidines, xanthones, phloroglucinols and naphthodianthrones. Although St John's wort has been subjected to extensive scientific studies in the last decade, there are still many open questions about its pharmacology and mechanism of action. Initial biochemical studies reported that St John's wort is only a weak inhibitor of monoamine oxidase-A and -B activity but that it inhibits the synaptosomal uptake of serotonin, dopamine and noradrenaline (norepinephrine) with approximately equal affinity. However, other in vitro binding assays carried out using St John's wort extract demonstrated significant affinity for adenosine, GABA(A), GABA(B) and glutamate receptors. In vivo St John's wort extract leads to a downregulation of beta-adrenergic receptors and an upregulation of serotonin 5-HT(2) receptors in the rat frontal cortex and causes changes in neurotransmitter concentrations in brain areas that are implicated in depression. In studies using the rat forced swimming test, an animal model of depression, St John's wort extracts induced a significant reduction of immobility. In other experimental models of depression, including acute and chronic forms of escape deficit induced by stressors, St John's wort extract was shown to protect rats from the consequences of unavoidable stress. Recent neuroendocrine studies suggest that St John's wort is involved in the regulation of genes that control hypothalamic-pituitary-adrenal axis function. With regard to the antidepressant effects of St John's wort extract, many of the pharmacological activities appear to be attributable to the naphthodianthrone hypericin, the phloroglucinol derivative hyperforin and several flavonoids. This review integrates new findings of possible mechanisms that may underlie the antidepressant action of St John's wort and its active constituents with a large body of existing literature.

Long-term effects of an Apocynum venetum extract on brain monoamine levels and beta-AR density in rats

The present study was designed to get further insight into the mode of antidepressant action of an extract prepared of the leaves of Apocynum venetum L. (AV). To evaluate biochemical changes, we used a high-performance liquid chromatography system to examine the effects of short-term (2 weeks) and long-term (8 weeks) administration of imipramine (15 mg/kg po) and an AV-extract (15, 60 and 250 mg/kg) on regional levels of serotonin (5-HT), norepinephrine (NE), dopamine (DA) and their metabolites in the rat hypothalamus, striatum and hippocampus. Pronounced changes in 5-HT, NE and DA levels were detected mainly after 8 weeks of daily imipramine treatment. Similar to imipramine, AV-extract reduced NE and DA concentrations after 8 weeks, whereas it failed to affect 5-HT levels. We speculate that the decrease in NE levels after chronic AV treatment might be based partly on the subsensitivity of presynaptic alpha(2)-receptors. In addition to the determination of central monoamine concentrations, quantitative radioligand receptor-binding studies were used to examine the effects of long-term administration of imipramine and AV-extract on beta-adrenergic binding in rat frontal cortex. [125I]CYP binding to beta-adrenergic receptors was found to be decreased after 8 weeks treatment with imipramine, whereas AV-extract had no effect on beta-receptor binding.

The locus coeruleus-noradrenergic system: modulation of behavioral state and state-dependent cognitive processes

Through a widespread efferent projection system, the locus coeruleus-noradrenergic system supplies norepinephrine throughout the central nervous system. Initial studies provided critical insight into the basic organization and properties of this system. More recent work identifies a complicated array of behavioral and electrophysiological actions that have in common the facilitation of processing of relevant, or salient, information. This involves two basic levels of action. First, the system contributes to the initiation and maintenance of behavioral and forebrain neuronal activity states appropriate for the collection of sensory information (e.g. waking). Second, within the waking state, this system modulates the collection and processing of salient sensory information through a diversity of concentration-dependent actions within cortical and subcortical sensory, attention, and memory circuits. Norepinephrine-dependent modulation of long-term alterations in synaptic strength, gene transcription and other processes suggest a potentially critical role of this neurotransmitter system in experience-dependent alterations in neural function and behavior. The ability of a given stimulus to increase locus coeruleus discharge activity appears independent of affective valence (appetitive vs. aversive). Combined, these observations suggest that the locus coeruleus-noradrenergic system is a critical component of the neural architecture supporting interaction with, and navigation through, a complex world. These observations further suggest that dysregulation of locus coeruleus-noradrenergic neurotransmission may contribute to cognitive and/or arousal dysfunction associated with a variety of psychiatric disorders, including attention-deficit hyperactivity disorder, sleep and arousal disorders, as well as certain affective disorders, including post-traumatic stress disorder. Independent of an etiological role in these disorders, the locus coeruleus-noradrenergic system represents an appropriate target for pharmacological treatment of specific attention, memory and/or arousal dysfunction associated with a variety of behavioral/cognitive disorders.

Co-release of noradrenaline and dopamine from noradrenergic neurons in the cerebral cortex induced by clozapine, the prototype atypical antipsychotic

RATIONALE

Clozapine has been shown to increase extracellular dopamine (DA) and noradrenaline (NA) in the medial prefrontal cortex (mPFC). A recent study of ours suggested that extracellular DA in the PFC originates not only from dopaminergic but also from noradrenergic terminals, its release being controlled by alpha(2)-adrenoceptors.

OBJECTIVES

Since clozapine binds to alpha(2)-adrenoceptors, the possibility that it might co-release DA and NA was studied.

METHODS

By means of microdialysis coupled to HPLC with electrochemical detection, the effect of clozapine on extracellular DA and NA in the mPFC, densely innervated by DA and NA, was compared to that in the occipital cortex, equally innervated by NA but receiving few DA projections.

RESULTS

Extracellular NA was found to be the same in the two cortices, consistent with homogeneous NA innervation. On the other hand, extracellular DA in the occipital cortex was only 29% lower than in the mPFC, in spite of the scarce dopaminergic innervation in the occipital cortex. Clozapine (10 mg/kg IP) increased extracellular DA and NA not only in the mPFC (by about 320% and 290%, respectively) but also in the occipital cortex (by 560% and 230%, respectively). Administration of the alpha(2)-agonist clonidine (0.15 mg/kg) reversed the effect of clozapine in both cortices, while the D(2)-agonist quinpirole (0.1 mg/kg IP) was ineffective.

CONCLUSIONS

The results suggest that clozapine, by inhibiting alpha(2)-adrenoceptors, co-releases DA and NA from noradrenergic terminals in the occipital cortex and that the same mechanism might be responsible for the concomitant increase of the two monoamines in the mPFC.

Administration of antidepressants. Single versus split dosing: a meta-analysis

OBJECTIVE

To evaluate the literature comparing antidepressant effects of multiple daily dosing versus single daily dosing of antidepressants.

METHOD

Studies comparing efficacy of single versus multiple daily dosing of antidepressants were reviewed. Data from the clinical trials meeting our inclusion criteria was subgrouped according to the half-life of the antidepressant drug studied. Meta-analyses were carried out to compare antidepressant efficacy of single versus multiple daily dosing overall and separately for the short, intermediate, and long half life antidepressant agent subgroups.

RESULTS

The review process identified 22 studies comparing the therapeutic effect of antidepressants according to their dosing schedules. Although most studies used antidepressant medications with short half-lives, none found a significant difference in therapeutic efficacy. Furthermore, the improvement rates in depression scores in between the two groups were almost identical (SDD versus MDD).

CONCLUSION

This meta-analytic approach found no advantage for multiple daily dosing and suggests that sustained therapeutic serum levels are not necessary for achievement of therapeutic activity. Antidepressant benefit may simply require a limited duration of exposure above the threshold serum level. Administration of antidepressants in single daily doses appears sufficient to perturb the physiological pathways associated with depression sufficiently to achieve an adaptive therapeutic response. Moreover, a single daily dosing regimen offers the potential advantages of simplicity, increased compliance, and reduced adverse effects, which in turn would increase the overall success rate in treatment of depression.