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Khosravi M, Alzahrani AA, Muhammed TM, Hjazi A, Abbas HH, AbdRabou MA, Mohmmed KH, Ghildiyal P, Yumashev A, Elawady A, Sarabandi S. Management of Refractory Functional Gastrointestinal Disorders: What Role Should Psychiatrists Have? PHARMACOPSYCHIATRY 2024. [PMID: 38897220 DOI: 10.1055/a-2331-7684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Currently, it has been stated that psychiatric and psychological problems are equally paramount aspects of the clinical modulation and manifestation of both the central nervous and digestive systems, which could be used to restore balance. The present narrative review aims to provide an elaborate description of the bio-psycho-social facets of refractory functional gastrointestinal disorders, psychiatrists' role, specific psychiatric approach, and the latest psychiatric and psychological perspectives on practical therapeutic management. In this respect, "psyche," "psychiatry," "psychology," "psychiatrist," "psychotropic," and "refractory functional gastrointestinal disorders" (as the keywords) were searched in relevant English publications from January 1, 1950, to March 1, 2024, in the PubMed, Web of Science, Scopus, EMBASE, Cochrane Library, and Google Scholar databases. Eventually, the narrative technique was adopted to reach a compelling story with a high level of cohesion through material synthesis. The current literature recognizes the brain-gut axis modulation as a therapeutic target for refractory functional gastrointestinal disorders and the bio-psycho-social model as an integrated framework to explain disease pathogenesis. The results also reveal some evidence to affirm the benefits of psychotropic medications and psychological therapies in refractory functional gastrointestinal disorders, even when psychiatric symptoms were absent. It seems that psychiatrists are required to pay higher levels of attention to both the assessment and treatment of patients with refractory functional gastrointestinal disorders, accompanied by educating and training practitioners who take care of these patients.
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Affiliation(s)
- Mohsen Khosravi
- Department of Psychiatry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Thikra M Muhammed
- Department of Biotechnology, College of Applied Sciences, University of Fallujah, Al-anbar, Iraq
| | - Ahmed Hjazi
- Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Huda H Abbas
- National University of Science and Technology, Dhi Qar, Iraq
| | - Mervat A AbdRabou
- Department of Biology, College of Science, Jouf University, Sakaka, Saudi Arabia
| | | | - Pallavi Ghildiyal
- Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun, India
| | - Alexey Yumashev
- Department of Prosthetic Dentistry, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ahmed Elawady
- College of technical engineering, the Islamic University, Najaf, Iraq
- College of technical engineering, the Islamic University of Al Diwaniyah, Al Diwaniyah, Iraq
- College of technical engineering, the Islamic University of Babylon, Babylon, Iraq
| | - Sahel Sarabandi
- Department of Clinical Biochemistry, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Yim SH, Sunwoo JS, Kim D, Chu MK, Yun CH, Yang KI. Fatigue or excessive daytime sleepiness: which is more closely related to depression? Sleep Breath 2024; 28:989-997. [PMID: 38095767 DOI: 10.1007/s11325-023-02964-4] [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: 06/27/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 05/31/2024]
Abstract
OBJECTIVE/BACKGROUND This study investigated fatigue and excessive daytime sleepiness to determine which was more closely related to depression in the general population. PATIENTS/METHODS Participants were investigated across 15 South Korean districts. Excessive daytime sleepiness, fatigue, and depression were evaluated using the Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Patient Health Questionnaire-9 (PHQ-9), respectively. Depression was defined as PHQ-9 ≥ 10. The authors classified the combination of excessive daytime sleepiness and fatigue as excessive daytime sleepiness with fatigue (E+F+, ESS ≥ 11, FSS ≥ 36), fatigue without excessive daytime sleepiness (E-F+, ESS < 11, FSS ≥ 36), excessive daytime sleepiness without fatigue (E+F-, ESS ≥ 11, FSS < 36), and no fatigue and excessive daytime sleepiness (E-F-, ESS < 11, FSS < 36). RESULTS Among 2,493 participants (1,257 women), mean age was 47.9 ± 0.3 years. The prevalence of depression, fatigue, and excessive daytime sleepiness was 8.4% (n = 210), 30.8% (n = 767), and 15.3% (n = 382), respectively. The frequency of the four categories with depression (vs. controls) was as follows.: E+F+ (n = 67, 31.9% vs. 7.3%) (P < 0.001), E-F+ (n = 71, 33.8% vs. 20.3%) (P < 0.001), E+F-( n = 16, 7.6% vs. 5.8%) (P = 0.294), and E-F- (n = 56, 26.7% vs. 66.6%) (P < 0.001). After adjusting for covariates, depression was associated with E+F+ (odds ratio, OR 8.804, 95% confidence interval (CI) 5.818-13.132), E-F+ (OR 3.942, 95% CI 2.704-5.747), E+F- (OR 2.812, 95% CI 1.542-5.131), and E-F- (reference). Additionally, we performed logistic regression according to two categories. There was no significant difference in the association of depression between E+F- (reference) and E-F+ (OR 1.399, 95% CI 0.760-2.575). CONCLUSION Although fatigue and excessive daytime sleepiness were associated with depression regardless of the presence of each other, we could not clarify which was more closely related to depression.
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Affiliation(s)
- Soo Hwan Yim
- Department of Neurology, Ulsan University, College of Medicine, Gangneung Asan Hospital, Gangneung, Republic of Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Min Kyung Chu
- Department of Neurology, College of Medicine, Severance Hospital, Yonsei University, Seoul, Republic of Korea
| | - Chang-Ho Yun
- Department of Neurology, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Kwang Ik Yang
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea.
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Oresanya IO, Orhan IE. Deciphering Neuroprotective Effect of Rosmarinus officinalis L. (syn. Salvia rosmarinus Spenn.) through Preclinical and Clinical Studies. Curr Drug Targets 2024; 25:330-352. [PMID: 38258779 DOI: 10.2174/0113894501255093240117092328] [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: 04/14/2023] [Revised: 09/25/2023] [Accepted: 12/06/2023] [Indexed: 01/24/2024]
Abstract
Rosmarinus officinalis L. (RO, rosemary) is a well-known medicinal, aromatic, and culinary herb with traditional use in European folk medicine against memory deficits and neurodegenerative disorders. This review highlights the different neuroprotective activities of RO investigated in both preclinical and clinical studies, as well as in silico molecular docking of bioactive compounds found in RO. The neuroprotective effect of RO was searched through databases including PubMed, Web of Science (WoS), Scopus, and Clinical Trials using the keywords "Rosmarinus officinalis, rosemary, neuroprotective effect, memory, cognitive dysfunction, Alzheimer's disease." RO, which is rich in secondary metabolites that have memory-enhancing potential, has displayed neuroprotection through different molecular mechanisms such as inhibition of cholinesterase, modulation of dopaminergic and oxytocinergic systems, mediation of oxidative and inflammatory proteins, involved in neuropathic pain, among others. RO extracts exhibited antidepressant and anxiolytic activities. Also, the plant has shown efficacy in scopolamine-, lipopolysaccharide-, AlCl3-, and H2O2-induced amnesia as well as amyloid-beta- and ibotenic acid-induced neurotoxicity and chronic constriction injury-related oxidative stress memory and cognitive impairments in animal models. A few clinical studies available supported the neuroprotective effects of RO and its constituents. However, more clinical studies are needed to confirm results from preclinical studies further and should include not only placebo-controlled studies but also studies including positive controls using approved drugs. Many studies underlined that constituents of RO may have the potential for developing drug candidates against Alzheimer's disease that possess high bioavailability, low toxicity, and enhanced penetration to CNS, as revealed from the experimental and molecular docking analysis.
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Affiliation(s)
- Ibukun O Oresanya
- Department of Pharmacognosy, Faculty of Pharmacy, Gazi University, 06330 Ankara, Türkiye
| | - Ilkay E Orhan
- Department of Pharmacognosy, Faculty of Pharmacy, Gazi University, 06330 Ankara, Türkiye
- Turkish Academy of Sciences (TÜBA), Vedat Dalokay Street, No. 112, 06670 Ankara, Türkiye
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Hori Y, Mimura K, Nagai Y, Hori Y, Kumata K, Zhang MR, Suhara T, Higuchi M, Minamimoto T. Reduced serotonergic transmission alters sensitivity to cost and reward via 5-HT1A and 5-HT1B receptors in monkeys. PLoS Biol 2024; 22:e3002445. [PMID: 38163325 PMCID: PMC10758260 DOI: 10.1371/journal.pbio.3002445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024] Open
Abstract
Serotonin (5-HT) deficiency is a core biological pathology underlying depression and other psychiatric disorders whose key symptoms include decreased motivation. However, the exact role of 5-HT in motivation remains controversial and elusive. Here, we pharmacologically manipulated the 5-HT system in macaque monkeys and quantified the effects on motivation for goal-directed actions in terms of incentives and costs. Reversible inhibition of 5-HT synthesis increased errors and reaction times on goal-directed tasks, indicating reduced motivation. Analysis found incentive-dependent and cost-dependent components of this reduction. To identify the receptor subtypes that mediate cost and incentive, we systemically administered antagonists specific to 4 major 5-HT receptor subtypes: 5-HT1A, 5-HT1B, 5-HT2A, and 5-HT4. Positron emission tomography (PET) visualized the unique distribution of each subtype in limbic brain regions and determined the systemic dosage for antagonists that would achieve approximately 30% occupancy. Only blockade of 5-HT1A decreased motivation through changes in both expected cost and incentive; sensitivity to future workload and time delay to reward increased (cost) and reward value decreased (incentive). Blocking the 5-HT1B receptor also reduced motivation through decreased incentive, although it did not affect expected cost. These results suggest that 5-HT deficiency disrupts 2 processes, the subjective valuation of costs and rewards, via 5-HT1A and 5-HT1B receptors, thus leading to reduced motivation.
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Affiliation(s)
- Yukiko Hori
- Department of Functional Brain Imaging, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Koki Mimura
- Department of Functional Brain Imaging, National Institutes for Quantum Science and Technology, Chiba, Japan
- Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Yuji Nagai
- Department of Functional Brain Imaging, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Yuki Hori
- Department of Functional Brain Imaging, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Katsushi Kumata
- Department of Advanced Nuclear Medicine Sciences, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Ming-Rong Zhang
- Department of Advanced Nuclear Medicine Sciences, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Tetsuya Suhara
- Department of Functional Brain Imaging, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Makoto Higuchi
- Department of Functional Brain Imaging, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Takafumi Minamimoto
- Department of Functional Brain Imaging, National Institutes for Quantum Science and Technology, Chiba, Japan
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Eggart M, Valdés-Stauber J, Müller-Oerlinghausen B, Heinze M. Dysfunctional self-reported interoception predicts residual symptom burden of fatigue in major depressive disorder: an observational study. BMC Psychiatry 2023; 23:667. [PMID: 37700276 PMCID: PMC10498532 DOI: 10.1186/s12888-023-05168-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Fatigue is a core symptom of major depressive disorder (MDD) and is frequently refractory to antidepressant treatment, leading to unfavorable clinical/psychosocial outcomes. Dysfunctional self-reported interoception (i.e., maladaptive focus on the body's physiological condition) is prevalent in MDD and could contribute to residual symptom burden of fatigue. Therefore, we explored (a.) cross-sectional correlations between both dimensions and investigated (b.) prospective associations between interoceptive impairments at admission and symptom severity of fatigue at the end of hospitalization. METHODS This observational, exploratory study included 87 patients suffering from MDD who completed self-rating scales, the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2), and the Multidimensional Fatigue Inventory (MFI-20), at the beginning and end of hospitalization. Bivariate correlations (r) and hierarchical regression analyses were performed. RESULTS The cross-sectional analysis showed moderate to large negative correlations between the MAIA-2 and MFI-20 dimensions except for the Not-Distracting scale. Symptoms of general, physical, and mental fatigue at the end of hospitalization were predicted by reduced body Trusting (β = -.31, p = .01; β = -.28, p = .02; β = -.31, p = .00, respectively). Increased Body Listening (β = .37, p = .00), Not-Worrying (β = .26, p = .02), and diminished Attention Regulation (β = -.32, p = .01) predicted higher mental fatigue. CONCLUSIONS Diminished body confidence at baseline identified patients at risk for post-treatment fatigue and could therefore serve as a target for improving antidepressant therapy. Body-centered, integrative approaches could address treatment-resistant fatigue in MDD. However, clinicians may also consider the potential adverse effect of increased Body Listening and Not-Worrying on mental fatigue in psychotherapeutic and counselling approaches. Due to the exploratory nature of this study, the results are preliminary and need to be replicated in pre-registered trials with larger sample sizes.
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Affiliation(s)
- Michael Eggart
- Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Neuruppin, 16816, Germany.
- Department of Psychiatry and Psychotherapy I, Ulm University and Center for Psychiatry Südwürttemberg, Ravensburg, 88214, Germany.
- Faculty Social Work, Health and Nursing, Ravensburg-Weingarten University of Applied Sciences, Weingarten, 88250, Germany.
| | - Juan Valdés-Stauber
- Department of Psychiatry and Psychotherapy I, Ulm University and Center for Psychiatry Südwürttemberg, Ravensburg, 88214, Germany
| | - Bruno Müller-Oerlinghausen
- Faculty of Medicine and Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, 16816, Germany
- Charité - Universitätsmedizin Berlin, Berlin, 10117, Germany
| | - Martin Heinze
- Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Neuruppin, 16816, Germany
- Faculty of Medicine and Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, 16816, Germany
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, 15562, Germany
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Carratalá-Ros C, Martínez-Verdú A, Olivares-García R, Salamone JD, Correa M. Effects of the dopamine depleting agent tetrabenazine in tests evaluating different components of depressive-like behavior in mice: sex-dependent response to antidepressant drugs with SERT and DAT blocker profiles. Psychopharmacology (Berl) 2023; 240:1615-1628. [PMID: 37407727 PMCID: PMC10349713 DOI: 10.1007/s00213-023-06412-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Depression is a disorder twice as common in women than in men. There are sex differences in the symptomatology and treatment response to this disorder. Impairments in behavioral activation (i.e. anergia, fatigue) are often seen in people with depression and are highly resistant to treatment. The role of mesolimbic dopamine (DA) in regulating behavioral activation has been extensively studied in male rodents, but little is known in female rodents. OBJECTIVE The present studies assessed potential sex differences in rodent paradigms used to study different components of depressive-like behavior, and in the treatment response to antidepressants with different mechanisms of action. METHODS Male and female CD1 mice received Tetrabenazine (TBZ), a VMAT-2 blocker that depletes DA and induces depressive symptoms in humans. Mice were tested on the Forced Swim Test, (FST), the Dark-Light box (DL), the elevated plus maze (EPM), Social Interaction (SI) test, and sucrose preference and consumption using the two bottles test. In addition, bupropion (a DA reuptake inhibitor) or fluoxetine (a serotonin reuptake inhibitor) were used to reverse TBZ-induced anergia. RESULTS In the FST, bupropion reversed TBZ effects in both sexes but fluoxetine was only effective in female mice. DA depletion did not affect other aspects of depression such as anxiety, sociability or sucrose consumption, and there was no interaction with bupropion on these parameters. In TBZ treated-females SERT-blockers may be effective at reversing anergia in aversive contexts (FST), and potentiating avoidance of anxiogenic stimuli. CONCLUSIONS Pro-dopaminergic antidepressants seem more efficacious at improving anergia in both sexes than SERT-blockers.
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Affiliation(s)
- Carla Carratalá-Ros
- Àrea de Psicobiologia, Universitat Jaume I, Campus de Riu Sec, 12071, Castelló, Spain
| | - Andrea Martínez-Verdú
- Àrea de Psicobiologia, Universitat Jaume I, Campus de Riu Sec, 12071, Castelló, Spain
| | | | - John D Salamone
- Behavioral Neuroscience Div, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Mercè Correa
- Àrea de Psicobiologia, Universitat Jaume I, Campus de Riu Sec, 12071, Castelló, Spain.
- Behavioral Neuroscience Div, University of Connecticut, Storrs, CT, 06269-1020, USA.
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Chen C, Yip HT, Leong KH, Yao WC, Hung CL, Su CH, Kuo CF, Tsai SY. Presence of depression and anxiety with distinct patterns of pharmacological treatments before the diagnosis of chronic fatigue syndrome: a population-based study in Taiwan. J Transl Med 2023; 21:98. [PMID: 36755267 PMCID: PMC9907887 DOI: 10.1186/s12967-023-03886-1] [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: 10/21/2022] [Accepted: 01/11/2023] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE An increased prevalence of psychiatric comorbidities (including depression and anxiety disorder) has been observed among patients with chronic fatigue syndrome (CFS). However, few studies have examined the presence of depression and anxiety disorder before the diagnosis of CFS. This study aimed to clarify the preexisting comorbidities and treatments associated with patients with subsequent CFS diagnosis in a population-based cohort in Taiwan. METHODS An analysis utilizing the National Health Insurance Research Database of Taiwan was conducted. Participants included were 6303 patients with CFS newly diagnosed between 2000 and 2010 and 6303 age-/sex-matched controls. RESULTS Compared with the control group, the CFS group had a higher prevalence of depression and anxiety disorder before the diagnosis of CFS. Sampled patients who took specific types of antidepressants, namely, selective serotonin reuptake inhibitors (adjusted odds ratio [aOR] = 1.21, 95% confidence interval [CI] 1.04-1.39), serotonin antagonists and reuptake inhibitors (SARI; aOR = 1.87, 95% CI 1.59-2.19), and tricyclic antidepressants (aOR = 1.46, 95% CI 1.09-1.95), had an increased risk of CFS. CFS risk was also higher among participants taking benzodiazepine, muscle relaxants, and analgesic drugs. A sub-group analysis revealed that SARI use was related to an increased risk of CFS in the depression, anxiety disorder, male, and female groups. In the depression and anxiety disorder groups, analgesic drug use was associated with an increased CFS risk. Nonpharmacological treatment administration differed between men and women. CONCLUSION This population-based retrospective cohort study revealed an increased risk of CFS among populations with preexisting depression and anxiety disorder, especially those taking SARI and analgesic drugs.
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Affiliation(s)
- Chi Chen
- grid.412094.a0000 0004 0572 7815Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Hei-Tung Yip
- grid.411508.90000 0004 0572 9415Management Office for Health Data, China Medical University Hospital, Taichung, 404 Taiwan
| | - Kam-Hang Leong
- grid.452449.a0000 0004 1762 5613Department of Medicine, MacKay Medical College, New Taipei City, 252 Taiwan ,grid.413593.90000 0004 0573 007XDepartment of Laboratory Medicine, MacKay Memorial Hospital, Taipei, 104 Taiwan
| | - Wei-Cheng Yao
- grid.415675.40000 0004 0572 8359Department of Anesthesiology and Pain Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Chung-Lieh Hung
- grid.452449.a0000 0004 1762 5613Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan
| | - Ching-Huang Su
- grid.413593.90000 0004 0573 007XDepartment of Laboratory Medicine, MacKay Memorial Hospital, Taipei, 104 Taiwan
| | - Chien-Feng Kuo
- grid.452449.a0000 0004 1762 5613Department of Medicine, MacKay Medical College, New Taipei City, 252 Taiwan ,Department of Nursing, Nursing and Management, MacKay Junior College of Medicine, New Taipei City, 25245 Taiwan ,grid.413593.90000 0004 0573 007XDivision of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shin-Yi Tsai
- Department of Medicine, MacKay Medical College, New Taipei City, 252, Taiwan. .,Department of Laboratory Medicine, MacKay Memorial Hospital, Taipei, 104, Taiwan. .,Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan. .,Institute of Long-Term Care, MacKay Medical College, New Taipei City, Taiwan. .,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
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Carney RM, Freedland KE, Steinmeyer BC, Rich MW. Symptoms that remain after depression treatment in patients with coronary heart disease. J Psychosom Res 2023; 165:111122. [PMID: 36608512 PMCID: PMC10249067 DOI: 10.1016/j.jpsychores.2022.111122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Symptoms which commonly remain after treatment for major depression increase the risk of relapse and recurrence in medically well patients. The same symptoms predict major adverse cardiac events in observational studies of patients with coronary heart disease (CHD). The purpose of this study was to determine the prevalence and predictors of residual depression symptoms in depressed patients with CHD-. METHODS Beck Depression Inventory-II data from two randomized clinical trials and an uncontrolled treatment study of depression in patients with CHD were combined to determine the prevalence and predictors of residual symptoms. RESULTS Loss of energy, loss of pleasure, loss of interest, fatigue, and difficulty concentrating were the five most common residual symptoms in all three studies. They are also among the most common residual symptoms in medically well patients who are treated for depression. The severity of pre-treatment anxiety predicted the post-treatment persistence of all these symptoms except for loss of energy. CONCLUSIONS The most common post-treatment residual symptoms found in this study of patients with coronary heart disease and comorbid major depression are the same as those that have been reported in previous studies of medically-well depressed patients. This suggests that they may be resistant to standard depression treatments across diverse patient populations. More effective treatments for these symptoms are needed.
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Affiliation(s)
- Robert M Carney
- Departments of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Kenneth E Freedland
- Departments of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Brian C Steinmeyer
- Departments of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael W Rich
- Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Shrashimirova M, Tyanev I, Cubała WJ, Wichniak A, Vodickova-Borzova C, Ruggieri A, Bonelli A, Lipone P, Comandini A, Cattaneo A. Long-Term Treatment with Trazodone Once-A-Day (TzOAD) in Patients with MDD: An Observational, Prospective Study. Neuropsychiatr Dis Treat 2023; 19:1181-1193. [PMID: 37201102 PMCID: PMC10187683 DOI: 10.2147/ndt.s399948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/27/2023] [Indexed: 05/20/2023] Open
Abstract
Purpose This was an observational, prospective, single-group, multicentre, international study aimed to describe the clinical response, functional impairment, and quality of life (QoL) of patients suffering from major depressive disorder (MDD) and in treatment with Trazodone Once-A-Day (TzOAD) monotherapy, over a 24-week period. Patients and Methods A total of 200 patients with a diagnosis of MDD who had been treated with TzOAD monotherapy were enrolled from 26 sites across 3 European countries (Bulgaria, Czech Republic, and Poland), including psychiatric private practices, and outpatient departments from general and psychiatric hospitals. Study assessments were completed by physicians and patients during routine visits within the normal practice of care. Results Clinical response was assessed by Clinical Global Impressions - Improvement (CGI-I) responders' percentage at 24 (±4) weeks. The majority of patients (86.5%) reported an improvement on the CGI-I compared to baseline. Results of the study confirm the well-known safety and tolerability of TzOAD, as well as its effectiveness on depressive symptoms, such as improvement in QoL, sleep quality, and overall functioning accompanied by favourable adherence and low drop-out rate. Conclusion To our knowledge, this is the first observational, long-term study in patients suffering from MDD, conducted with TzOAD. The improvement observed in clinical response, overall functioning, depressive symptoms, and QoL along the 24 weeks (+4) maintenance period and the very good retention rate, suggest that TzOAD may represent an effective and well tolerated treatment option for patients suffering from MDD.
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Affiliation(s)
| | - Ivan Tyanev
- Multiprofile Hospital for Active Treatment, Medical Clinic, Targovishte, Bulgaria
| | - Wiesław J Cubała
- Department of Psychiatry, Medical University of Gdańsk, Gdańsk, Poland
| | - Adam Wichniak
- Third Department of Psychiatry and Sleep Disorders Center, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Alessandro Ruggieri
- Global Medical Department, Angelini Pharma S.p.A, Rome, Italy
- Correspondence: Alessandro Ruggieri, Global Medical Department, Angelini Pharma S.p.A, Viale Amelia 70, Rome, 00181, Italy, Tel +390691045309, Email
| | | | - Paola Lipone
- Global Medical Department, Angelini Pharma S.p.A, Rome, Italy
| | | | - Agnese Cattaneo
- Global Medical Department, Angelini Pharma S.p.A, Rome, Italy
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Using type-2 fuzzy ontology to improve semantic interoperability for healthcare and diagnosis of depression. Artif Intell Med 2023; 135:102452. [PMID: 36628789 DOI: 10.1016/j.artmed.2022.102452] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 10/08/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022]
Abstract
Ontology enhances semantic interoperability through integrating health data from heterogeneous sources and sharing information in a meaningful way. In the field of smart health services, semantic interoperability means the exchange and interpretation of data without ambiguity and uncertainty. However, existing classical ontologies are not able to represent vague and uncertain knowledge, especially in contexts of mental health disorders which are associated with varying degrees of uncertainty and inaccuracy of diagnosis, and in this case, the treatment is a complex and common mental process necessitating to share information accurately and unambiguously. Type-2 fuzzy set theory can offer a fruitful solution in order to control uncertainty or express ambiguous concepts in a dynamic and complex environment such as healthcare systems. Herein, a semantic framework for healthcare, and also monitoring mental health disorders using type-2 fuzzy set theory based on the Internet of Thing (IoT) is suggested, in which all depression-related concepts are semantically annotated to share detailed information with the treatment staff. This framework not only paved the way to increasing the accuracy of medical diagnosis and decision-making but also provides the possibility of inference and semantic reasoning using the languages of SPARQL query and DL query.
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Gumusoglu SB, Schickling BM, Vignato JA, Santillan DA, Santillan MK. Selective serotonin reuptake inhibitors and preeclampsia: A quality assessment and meta-analysis. Pregnancy Hypertens 2022; 30:36-43. [PMID: 35963154 PMCID: PMC9712168 DOI: 10.1016/j.preghy.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
Abstract
Serotonin modulates vascular, immune, and neurophysiology and is dysregulated in preeclampsia. Despite biological plausibility that selective serotonin reuptake inhibitors (SSRIs) prevent preeclampsia pathophysiology, observational studies have indicated increased risk and providers may be hesitant. The objective of this meta-analysis and quality assessment was to evaluate the evidence linking SSRI use in pregnancy to preeclampsia/gestational hypertension. PubMed was searched through June 5, 2020 manually and using combinations of terms: "preeclampsia", "serotonin", and "SSRI". This review followed MOOSE guidelines. Inclusion criteria were: 1) Observational cohort or population study, 2) exposure defined as SSRI use during pregnancy, 3) cases defined as preeclampsia or gestational hypertension, and 4) human participants. Studies were selected that addressed the hypothesis that gestational SSRI use modulates preeclampsia and/or gestational hypertension risk. Review Manager Web was used to synthesize study findings. Articles were read and scored (Newcastle-Ottawa Quality Assessment Scale) for quality by two independent reviewers. Publication bias was assessed using a funnel plot and the Egger test. Of 179 screened studies, nine were included. The pooled risk ratio (random effects model) was 1.43 (95 % CI: 1.15-1.78, P < 0.001; range 0.96-4.86). Two studies were rated as moderate quality (both with total score of 6); others were high quality. Heterogeneity was high (I2 = 88 %) and funnel asymmetry was significant (p < 0.00001). Despite evidence for increased preeclampsia risk with SSRIs, shared risk factors and other variables are poorly controlled. Depression treatment should not be withheld due to perceived gestational hypertension risk. Mechanistic evidence for serotonin modulation in preeclampsia demonstrates a need for future research.
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Affiliation(s)
- Serena B Gumusoglu
- University of Iowa Department of Obstetrics and Gynecology and University of Iowa Department of Psychiatry, 200 Hawkins Dr., Iowa City, IA 52242, United States.
| | - Brandon M Schickling
- University of Iowa Department of Obstetrics and Gynecology, 200 Hawkins Dr., Iowa City, IA 52242, United States.
| | - Julie A Vignato
- University of Iowa College of Nursing, 50 Newton Rd, Iowa City IA 52242, United States.
| | - Donna A Santillan
- University of Iowa Department of Obstetrics and Gynecology, 200 Hawkins Dr., Iowa City IA 52242, United States.
| | - Mark K Santillan
- University of Iowa Department of Obstetrics and Gynecology, 200 Hawkins Dr., Iowa City IA 52242, United States.
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12
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Birnie MT, Eapen AV, Kershaw YM, Lodge D, Collingridge GL, Conway‐Campbell BL, Lightman SL. Time of day influences stress hormone response to ketamine. J Neuroendocrinol 2022; 34:e13194. [PMID: 36056546 PMCID: PMC9787621 DOI: 10.1111/jne.13194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 12/31/2022]
Abstract
Over 50% of depressed patients show hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis. Conventional therapy takes weeks to months to improve symptoms. Ketamine has rapid onset antidepressant effects. Yet its action on HPA axis activity is poorly understood. Here, we measured the corticosterone (CORT) response to ketamine administered at different times of day in the Wistar-Kyoto (WKY) rat. In male rats, blood was collected every 10 min for 28 h using an automated blood sampling system. Ketamine (5/10/25 mg · kg) was infused through a subcutaneous cannula at two time points-during the active and inactive period. CORT levels in blood were measured in response to ketamine using a radioimmunoassay. WKY rats displayed robust circadian secretion of corticosterone and was not overly different to Sprague Dawley rats. Ketamine (all doses) significantly increased CORT response at both infusion times. However, a dose dependent effect and marked increase over baseline was observed when ketamine was administered during the inactive phase. Ketamine has a robust and rapid effect on HPA axis function. The timing of ketamine injection may prove crucial for glucocorticoid-mediated action in depression.
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Affiliation(s)
- Matthew T. Birnie
- Henry Wellcome Laboratories for Integrative Neuroendocrinology, School of MedicineUniversity of BristolBristolUK
| | - Alen V. Eapen
- Henry Wellcome Laboratories for Integrative Neuroendocrinology, School of MedicineUniversity of BristolBristolUK
- School of Physiology, Pharmacology & NeuroscienceUniversity of BristolBristolUK
| | - Yvonne M. Kershaw
- Henry Wellcome Laboratories for Integrative Neuroendocrinology, School of MedicineUniversity of BristolBristolUK
| | - David Lodge
- School of Physiology, Pharmacology & NeuroscienceUniversity of BristolBristolUK
| | - Graham L. Collingridge
- Henry Wellcome Laboratories for Integrative Neuroendocrinology, School of MedicineUniversity of BristolBristolUK
- School of Physiology, Pharmacology & NeuroscienceUniversity of BristolBristolUK
| | - Becky L. Conway‐Campbell
- Henry Wellcome Laboratories for Integrative Neuroendocrinology, School of MedicineUniversity of BristolBristolUK
| | - Stafford L. Lightman
- Henry Wellcome Laboratories for Integrative Neuroendocrinology, School of MedicineUniversity of BristolBristolUK
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13
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Treadway MT, Salamone JD. Vigor, Effort-Related Aspects of Motivation and Anhedonia. Curr Top Behav Neurosci 2022; 58:325-353. [PMID: 35505057 DOI: 10.1007/7854_2022_355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In this chapter we provide an overview of the pharmacological and circuit mechanisms that determine the willingness to expend effort in pursuit of rewards. A particular focus will be on the role of the mesolimbic dopamine system, as well the contributing roles of limbic and cortical brains areas involved in the evaluation, selection, and invigoration of goal-directed actions. We begin with a review of preclinical studies, which have provided key insights into the brain systems that are necessary and sufficient for effort-based decision-making and have characterized novel compounds that enhance selection of high-effort activities. Next, we summarize translational studies identifying and expanding this circuitry in humans. Finally, we discuss the relevance of this work for understanding common motivational impairments as part of the broader anhedonia symptom domain associated with mental illness, and the identification of new treatment targets within this circuitry to improve motivation and effort-expenditure.
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Affiliation(s)
| | - John D Salamone
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
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14
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Leong KH, Yip HT, Kuo CF, Tsai SY. Treatments of chronic fatigue syndrome and its debilitating comorbidities: a 12-year population-based study. J Transl Med 2022; 20:268. [PMID: 35690765 PMCID: PMC9187893 DOI: 10.1186/s12967-022-03461-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background This study aims to provide 12-year nationwide epidemiology data to investigate the epidemiology and comorbidities of and therapeutic options for chronic fatigue syndrome (CFS) by analyzing the National Health Insurance Research Database. Methods 6306 patients identified as having CFS during the 2000–2012 period and 6306 controls (with similar distributions of age and sex) were analyzed. Result The patients with CFS were predominantly female and aged 35–64 years in Taiwan and presented a higher proportion of depression, anxiety disorder, insomnia, Crohn’s disease, ulcerative colitis, renal disease, type 2 diabetes, gout, dyslipidemia, rheumatoid arthritis, Sjogren syndrome, and herpes zoster. The use of selective serotonin receptor inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), Serotonin antagonist and reuptake inhibitors (SARIs), Tricyclic antidepressants (TCAs), benzodiazepine (BZD), Norepinephrine-dopamine reuptake inhibitors (NDRIs), muscle relaxants, analgesic drugs, psychotherapies, and exercise therapies was prescribed significantly more frequently in the CFS cohort than in the control group. Conclusion This large national study shared the mainstream therapies of CFS in Taiwan, we noticed these treatments reported effective to relieve symptoms in previous studies. Furthermore, our findings indicate that clinicians should have a heightened awareness of the comorbidities of CFS, especially in psychiatric problems.
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Affiliation(s)
- Kam-Hang Leong
- Department of Medicine, Mackay Medical College, New Taipei City, 252, Taiwan.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, 21205, USA
| | - Hei-Tung Yip
- Management Office for Health Data, China Medical University Hospital, Taichung City, 404, Taiwan
| | - Chien-Feng Kuo
- Department of Medicine, Mackay Medical College, New Taipei City, 252, Taiwan.,Institute of Infectious Disease, Mackay Memorial Hospital, Taipei City, 104, Taiwan.,Department of Nursing, Nursing and Management, MacKay Junior College of Medicine, New Taipei City, 25245, Taiwan
| | - Shin-Yi Tsai
- Department of Medicine, Mackay Medical College, New Taipei City, 252, Taiwan. .,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, 21205, USA. .,Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, 252, Taiwan. .,Institute of Long-Term Care, Mackay Medical College, New Taipei City, 252, Taiwan. .,Department of Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei, 104, Taiwan.
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15
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Nunes EJ, Kebede N, Bagdas D, Addy NA. Cholinergic and dopaminergic-mediated motivated behavior in healthy states and in substance use and mood disorders. J Exp Anal Behav 2022; 117:404-419. [PMID: 35286712 PMCID: PMC9743782 DOI: 10.1002/jeab.747] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/16/2022] [Accepted: 01/20/2022] [Indexed: 02/06/2023]
Abstract
Acetylcholine is an important neuromodulator of the mesolimbic dopamine (DA) system, which itself is a mediator of motivated behavior. Motivated behavior can be described by two primary components, termed directional and activational motivation, both of which can be examined and dissociated using effort-choice tasks. The directional component refers to motivated behavior directed towards reinforcing stimuli and away from aversive stimuli. Behaviors characterized by increased vigor, persistence, and work output are considered to reflect activational components of motivation. Disruption of DA signaling has been shown to decrease activational components of motivation, while leaving directional features intact. Facilitation of DA release promotes the activational aspects of motivated behavior. In this review, we discuss cholinergic and DA regulation of motivated behaviors. We place emphasis on effort-choice processes and the ability of effort-choice tasks to examine and dissociate changes of motivated behavior in the context of substance use and mood disorders. Furthermore, we consider how altered cholinergic transmission impacts motivated behavior across disease states, and the possible role of cholinergic dysregulation in the etiology of these illnesses. Finally, we suggest that treatments targeting cholinergic activity may be useful in ameliorating motivational disruptions associated with substance use and comorbid substance use and mood disorders.
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Affiliation(s)
- Eric J. Nunes
- Department of Psychiatry, Yale School of Medicine,Yale Tobacco Center of Regulatory Science, Yale School of Medicine
| | - Nardos Kebede
- Department of Psychiatry, Yale School of Medicine,Yale Tobacco Center of Regulatory Science, Yale School of Medicine
| | - Deniz Bagdas
- Department of Psychiatry, Yale School of Medicine,Yale Tobacco Center of Regulatory Science, Yale School of Medicine
| | - Nii A. Addy
- Department of Psychiatry, Yale School of Medicine,Yale Tobacco Center of Regulatory Science, Yale School of Medicine,Department of Cellular and Molecular Physiology, Yale School of Medicine,Interdepartmental Neuroscience Program, Yale University,Wu Tsai Institute, Yale University
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16
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Salamone J, Ecevitoglu A, Carratala-Ros C, Presby R, Edelstein G, Fleeher R, Rotolo R, Meka N, Srinath S, Masthay JC, Correa M. Complexities and Paradoxes in Understanding the Role of Dopamine in Incentive Motivation and Instrumental Action: Exertion of Effort vs. Anhedonia. Brain Res Bull 2022; 182:57-66. [DOI: 10.1016/j.brainresbull.2022.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/11/2022] [Accepted: 01/29/2022] [Indexed: 02/08/2023]
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17
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Lee W, Au Yeung K, Lam H, Wong C, Wong T, Fu C, Sham S, Au M, Lam T, Ki‐Yan Mak D. Consensus statements on the clinical understanding and use of bupropion in Hong Kong. CNS Neurosci Ther 2021; 27 Suppl 1:20-24. [PMID: 33555615 PMCID: PMC7869927 DOI: 10.1111/cns.13376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To develop a local consensus to guide medical practitioners and psychiatrists on the use of bupropion in different psychiatric conditions in Hong Kong. METHODS By utilizing the modified Delphi technique, a group of 10 local physicians with extensive experience in the management of major depressive disorder (MDD) developed and voted (using an anonymous, electronic voting system) on the practicality of recommendation of a set of consensus statements on the clinical use and understanding of bupropion in Hong Kong. RESULTS There was a very high degree of agreement among the panelists on the 11 finalized consensus statements. CONCLUSIONS The present consensus statements are developed as general recommendations for medical practitioners and psychiatrists to be practically referred to in clinical settings.
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Affiliation(s)
- Wing‐King Lee
- Department of PsychiatryKwai Chung HospitalHong KongChina
| | | | - Ho‐Bun Lam
- Department of PsychiatryShatin HospitalHong KongChina
| | - Chi‐Keung Wong
- Department of PsychiatryPamela Youde Nethersole Eastern HospitalHong KongChina
| | | | - Chi‐Kin Fu
- Private PracticeEducation, Prevention and Publication SubcommitteeThe Mental Health Association of Hong KongHong KongChina
| | | | | | - Tat‐Chung Lam
- Private PracticeThe University of Hong KongHong KongChina
| | - Daniel Ki‐Yan Mak
- Private PracticeThe Mental Health Association of Hong KongHong KongChina
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18
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Presby RE, Rotolo RA, Hurley EM, Ferrigno SM, Murphy CE, McMullen HP, Desai PA, Zorda EM, Kuperwasser FB, Carratala-Ros C, Correa M, Salamone JD. Sex differences in lever pressing and running wheel tasks of effort-based choice behavior in rats: Suppression of high effort activity by the serotonin transport inhibitor fluoxetine. Pharmacol Biochem Behav 2021; 202:173115. [PMID: 33493546 DOI: 10.1016/j.pbb.2021.173115] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/18/2020] [Accepted: 01/13/2021] [Indexed: 12/25/2022]
Abstract
Selective serotonin transport (SERT) inhibitors such as fluoxetine are the most commonly prescribed treatments for depression. Although efficacious for many symptoms of depression, motivational impairments such as psychomotor retardation, anergia, fatigue and amotivation are relatively resistant to treatment with SERT inhibitors, and these drugs have been reported to exacerbate motivational deficits in some people. In order to study motivational dysfunctions in animal models, procedures have been developed to measure effort-related decision making, which offer animals a choice between high effort actions leading to highly valued reinforcers, or low effort/low reward options. In the present studies, male and female rats were tested on two different tests of effort-based choice: a fixed ratio 5 (FR5)/chow feeding choice procedure and a running wheel (RW)/chow feeding choice task. The baseline pattern of choice differed across tasks for males and females, with males pressing the lever more than females on the operant task, and females running more than males on the RW task. Administration of the SERT inhibitor and antidepressant fluoxetine suppressed the higher effort activity on each task (lever pressing and wheel running) in both males and females. The serotonin receptor mediating the suppressive effects of fluoxetine is uncertain, because serotonin antagonists with different patterns of receptor selectivity failed to reverse the effects of fluoxetine. Nevertheless, these studies uncovered important sex differences, and demonstrated that the suppressive effects of fluoxetine on high effort activities are not limited to tasks involving food reinforced behavior or appetite suppressive effects. It is possible that this line of research will contribute to an understanding of the neurochemical factors regulating selection of voluntary physical activity vs. sedentary behaviors, which could be relevant for understanding the role of physical activity in psychiatric disorders.
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Affiliation(s)
- Rose E Presby
- Behavioral Neuroscience Division, Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269-1020, USA
| | - Renee A Rotolo
- Behavioral Neuroscience Division, Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269-1020, USA
| | - Erin M Hurley
- Behavioral Neuroscience Division, Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269-1020, USA
| | - Sarah M Ferrigno
- Behavioral Neuroscience Division, Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269-1020, USA
| | - Cayla E Murphy
- Behavioral Neuroscience Division, Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269-1020, USA
| | - Haley P McMullen
- Behavioral Neuroscience Division, Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269-1020, USA
| | - Pranally A Desai
- Behavioral Neuroscience Division, Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269-1020, USA
| | - Emma M Zorda
- Behavioral Neuroscience Division, Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269-1020, USA
| | - Felicita B Kuperwasser
- Behavioral Neuroscience Division, Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269-1020, USA
| | - Carla Carratala-Ros
- Behavioral Neuroscience Division, Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269-1020, USA; Area de Psicobiologia, Universitat Jaume I, Castelló, Spain
| | - Merce Correa
- Behavioral Neuroscience Division, Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269-1020, USA; Area de Psicobiologia, Universitat Jaume I, Castelló, Spain
| | - John D Salamone
- Behavioral Neuroscience Division, Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269-1020, USA.
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19
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Delcourte S, Etievant A, Haddjeri N. Role of central serotonin and noradrenaline interactions in the antidepressants' action: Electrophysiological and neurochemical evidence. PROGRESS IN BRAIN RESEARCH 2021; 259:7-81. [PMID: 33541681 DOI: 10.1016/bs.pbr.2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The development of antidepressant drugs, in the last 6 decades, has been associated with theories based on a deficiency of serotonin (5-HT) and/or noradrenaline (NA) systems. Although the pathophysiology of major depression (MD) is not fully understood, numerous investigations have suggested that treatments with various classes of antidepressant drugs may lead to an enhanced 5-HT and/or adapted NA neurotransmissions. In this review, particular morpho-physiological aspects of these systems are first considered. Second, principal features of central 5-HT/NA interactions are examined. In this regard, the effects of the acute and sustained antidepressant administrations on these systems are discussed. Finally, future directions including novel therapeutic strategies are proposed.
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Affiliation(s)
- Sarah Delcourte
- Univ Lyon, Université Claude Bernard Lyon 1, Inserm, Stem Cell and Brain Research Institute U1208, Bron, France
| | - Adeline Etievant
- Integrative and Clinical Neurosciences EA481, University of Bourgogne Franche-Comté, Besançon, France
| | - Nasser Haddjeri
- Univ Lyon, Université Claude Bernard Lyon 1, Inserm, Stem Cell and Brain Research Institute U1208, Bron, France.
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20
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Carratalá-Ros C, Olivares-García R, Martínez-Verdú A, Arias-Sandoval E, Salamone JD, Correa M. Energizing effects of bupropion on effortful behaviors in mice under positive and negative test conditions: modulation of DARPP-32 phosphorylation patterns. Psychopharmacology (Berl) 2021; 238:3357-3373. [PMID: 34498115 PMCID: PMC8629809 DOI: 10.1007/s00213-021-05950-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/02/2021] [Indexed: 11/24/2022]
Abstract
Motivational symptoms such as anergia, fatigue, and reduced exertion of effort are seen in depressed people. To model this, nucleus accumbens (Nacb) dopamine (DA) depletions are used to induce a low-effort bias in rodents tested on effort-based decision-making. We evaluated the effect of the catecholamine uptake blocker bupropion on its own, and after administration of tetrabenazine (TBZ), which blocks vesicular storage, depletes DA, and induces depressive symptoms in humans. Male CD1 mice were tested on a 3-choice-T-maze task that assessed preference between a reinforcer involving voluntary physical activity (running wheel, RW) vs. sedentary activities (sweet food pellet intake or a neutral non-social odor). Mice also were tested on the forced swim test (FST), two anxiety-related measures (dark-light box (DL), and elevated plus maze (EPM)). Expression of phosphorylated DARPP-32 (Thr34 and Thr75) was evaluated by immunohistochemistry as a marker of DA-related signal transduction. Bupropion increased selection of RW activity on the T-maze. TBZ reduced time running, but increased time-consuming sucrose, indicating an induction of a low-effort bias, but not an effect on primary sucrose motivation. In the FST, bupropion reduced immobility, increasing swimming and climbing, and TBZ produced the opposite effects. Bupropion reversed the effects of TBZ on the T-maze and the FST, and also on pDARPP32-Thr34 expression in Nacb core. None of these manipulations affected anxiety-related parameters. Thus, bupropion improved active behaviors, which were negatively motivated in the FST, and active behaviors that were positively motivated in the T-maze task, which has implications for using catecholamine uptake inhibitors for treating anergia and fatigue-like symptoms.
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Affiliation(s)
- Carla Carratalá-Ros
- Àrea de Psicobiologia, Universitat Jaume I, Campus de Riu Sec, 12071 Castelló, Spain
| | | | - Andrea Martínez-Verdú
- Àrea de Psicobiologia, Universitat Jaume I, Campus de Riu Sec, 12071 Castelló, Spain
| | - Edgar Arias-Sandoval
- Àrea de Psicobiologia, Universitat Jaume I, Campus de Riu Sec, 12071 Castelló, Spain
| | - John D. Salamone
- Behavioral Neuroscience Division, University of Connecticut, Storrs, CT 06269-1020 USA
| | - Mercè Correa
- Àrea de Psicobiologia, Universitat Jaume I, Campus de Riu Sec, 12071, Castelló, Spain.
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21
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Surova G, Ulke C, Schmidt FM, Hensch T, Sander C, Hegerl U. Fatigue and brain arousal in patients with major depressive disorder. Eur Arch Psychiatry Clin Neurosci 2021; 271:527-536. [PMID: 33275166 PMCID: PMC7981331 DOI: 10.1007/s00406-020-01216-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/07/2020] [Indexed: 12/14/2022]
Abstract
Fatigue is considered a key symptom of major depressive disorder (MDD), yet the term lacks specificity. It can denote a state of increased sleepiness and lack of drive (i.e., downregulated arousal) as well as a state of high inner tension and inhibition of drive with long sleep onset latencies (i.e., upregulated arousal), the latter typically found in depression. It has been proposed to differentiate fatigue along the dimension of brain arousal. We investigated whether such stratification within a group of MDD patients would reveal a subgroup with distinct clinical features. Using an automatic classification of EEG vigilance stages, an arousal stability score was calculated for 15-min resting EEGs of 102 MDD patients with fatigue. 23.5% of the patients showed signs of hypoarousal with EEG patterns indicating drowsiness or sleep; this hypoaroused subgroup was compared with remaining patients (non-hypoaroused subgroup) concerning self-rated measures of depressive symptoms, sleepiness, and sleep. The hypoaroused subgroup scored higher on the Beck Depression Inventory items "loss of energy" (Z = - 2.13, p = 0.033; ɳ2 = 0.044, 90% CI 0.003-0.128) and "concentration difficulty" (Z = - 2.40, p = 0.017; ɳ2 = 0.056, 90% CI 0.009-0.139), and reported higher trait and state sleepiness (p < 0.05) as compared to the non-hypoaroused group. The non-hypoaroused subgroup, in contrast, reported more frequently the presence of suicidal ideation (Chi2 = 3.81, p = 0.051; ɳ2 = 0.037, 90% CI 0.0008-0.126). In this study, we found some evidence that stratifying fatigued MDD patients by arousal may lead to subgroups that are pathophysiologically and clinically more homogeneous. Brain arousal may be a worth while target in clinical research for better understanding the mechanisms underlying suicidal tendencies and to improve treatment response.
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Affiliation(s)
- Galina Surova
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Semmelweisstrasse 10, 04103, Leipzig, Germany.
- Depression Research Center, German Depression Foundation, Leipzig, Germany.
| | - Christine Ulke
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Semmelweisstrasse 10, 04103, Leipzig, Germany
- Depression Research Center, German Depression Foundation, Leipzig, Germany
| | - Frank Martin Schmidt
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Semmelweisstrasse 10, 04103, Leipzig, Germany
| | - Tilman Hensch
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Semmelweisstrasse 10, 04103, Leipzig, Germany
- IUBH International University, Erfurt, Germany
| | - Christian Sander
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Semmelweisstrasse 10, 04103, Leipzig, Germany
| | - Ulrich Hegerl
- Depression Research Center, German Depression Foundation, Leipzig, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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22
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Hu S, Chen Y, Chen Y, Wang C. Depression and Anxiety Disorders in Patients With Inflammatory Bowel Disease. Front Psychiatry 2021; 12:714057. [PMID: 34690829 PMCID: PMC8531580 DOI: 10.3389/fpsyt.2021.714057] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 12/12/2022] Open
Abstract
Mental health is a significant yet overlooked aspect of inflammatory bowel disease (IBD) patient care, with challenges in determining optimal treatments and psychological health resources. The most common psychological conditions in patients with IBD are anxiety and depression. The increased prevalence of these mental disorders appeals to mental screening of each person diagnosed with IBD at initial consultation. There are simple and clinically viable methods available to screen for mental problems. Psychological methods may be as or even more significant as a therapeutic modality. Herein we discuss the three major areas of psychological co-morbidity in IBD: (1) the prevalence and risk factors associated with anxiety and depression disorders for patients with IBD; (2) diagnosis of psychological disorders for patients with IBD; (3) treatment with patients with IBD and mental disorders. The gastroenterologists are encouraged to screen and treat these patients with IBD and mental disorders, which may improve outcomes.
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Affiliation(s)
- Shurong Hu
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiping Chen
- Department of Psychiatry, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Chen
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Caihua Wang
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Rotolo RA, Kalaba P, Dragacevic V, Presby RE, Neri J, Robertson E, Yang JH, Correa M, Bakulev V, Volkova NN, Pifl C, Lubec G, Salamone JD. Behavioral and dopamine transporter binding properties of the modafinil analog (S, S)-CE-158: reversal of the motivational effects of tetrabenazine and enhancement of progressive ratio responding. Psychopharmacology (Berl) 2020; 237:3459-3470. [PMID: 32770257 PMCID: PMC7572767 DOI: 10.1007/s00213-020-05625-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022]
Abstract
RATIONALE Atypical dopamine (DA) transport blockers such as modafinil and its analogs may be useful for treating motivational symptoms of depression and other disorders. Previous research has shown that the DA depleting agent tetrabenazine can reliably induce motivational deficits in rats, as evidenced by a shift towards a low-effort bias in effort-based choice tasks. This is consistent with human studies showing that people with major depression show a bias towards low-effort activities. OBJECTIVES Recent studies demonstrated that the atypical DA transport (DAT) inhibitor (S)-CE-123 reversed tetrabenazine-induced motivational deficits, increased progressive ratio (PROG) lever pressing, and increased extracellular DA in the nucleus accumbens. In the present studies, a recently synthesized modafinil analog, (S, S)-CE-158, was assessed in a series of neurochemical and behavioral studies in rats. RESULTS (S, S)-CE-158 demonstrated the ability to reverse the effort-related effects of tetrabenazine and increase selection of high-effort PROG lever pressing in rats tested on PROG/chow feeding choice task. (S, S)-CE-158 showed a high selectivity for inhibiting DAT compared with other monoamine transporters, and systemic administration of (S, S)-CE-158 increased extracellular DA in the nucleus accumbens during the behaviorally active time course, which is consistent with the effects of (S)-CE-123 and other DAT inhibitors that enhance high-effort responding. CONCLUSIONS These studies provide an initial neurochemical characterization of a novel atypical DAT inhibitor, and demonstrate that this compound is active in models of effort-related choice. This research could contribute to the development of novel compounds for the treatment of motivational dysfunctions in humans.
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Affiliation(s)
- Renee A. Rotolo
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Predrag Kalaba
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Althanstraße 14, 1090 Vienna, Austria,Department of Neuroproteomics, Paracelsus Medical University, Salzburg, Austria
| | - Vladimir Dragacevic
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Althanstraße 14, 1090 Vienna, Austria
| | - Rose E. Presby
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Julia Neri
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Emily Robertson
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Jen-Hau Yang
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Merce Correa
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA,Àrea de Psicobiologia, Campus de Riu Sec, Universitat Jaume I, 12071 Castelló, Spain
| | - Vasiliy Bakulev
- Ural Federal University named after the first President of Russia B. N. Yeltsin, 19 Mira St., Yekaterinburg 620002, Russia
| | - Natalia N. Volkova
- Ural Federal University named after the first President of Russia B. N. Yeltsin, 19 Mira St., Yekaterinburg 620002, Russia
| | - Christian Pifl
- Centre for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Gert Lubec
- Department of Neuroproteomics, Paracelsus Medical University, Salzburg, Austria.
| | - John D. Salamone
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA,Corresponding authors: John D. Salamone () and Gert Lubec ()
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Rotolo RA, Presby RE, Tracy O, Asar S, Yang JH, Correa M, Murray F, Salamone JD. The novel atypical dopamine transport inhibitor CT-005404 has pro-motivational effects in neurochemical and inflammatory models of effort-based dysfunctions related to psychopathology. Neuropharmacology 2020; 183:108325. [PMID: 32956676 DOI: 10.1016/j.neuropharm.2020.108325] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 01/23/2023]
Abstract
Depressed individuals suffer from effort-related motivational symptoms such as anergia and fatigue, which are resistant to treatment with many common antidepressants. While drugs that block dopamine transport (DAT) reportedly have positive motivational effects, DAT inhibitors such as cocaine and amphetamines produce undesirable side effects. Thus, there is a need to develop and characterize novel atypical DAT inhibitors with unique and selective binding profiles. Rodent effort-based choice tasks provide useful models of motivational dysfunctions. With these tasks, animals choose between a high-effort instrumental action leading to highly valued reinforcement vs. a low effort/low reward option. The present studies focused on the initial characterization of a novel atypical DAT inhibitor, CT-005404, which binds to DAT with high selectivity relative to serotonin and norepinephrine transport, and produces long-term elevations of extracellular DA. CT-005404 was assessed for its ability to attenuate the effort-related motivational effects of the DA depleting agent tetrabenazine and the pro-inflammatory cytokine interleukin-1β (IL-1β) using a fixed ratio 5/chow feeding choice test. Tetrabenazine (1.0 mg/kg i.p.) shifted choice behavior, decreasing lever pressing and increasing chow intake. IL-1β (4.0 μg/kg i.p.) also decreased lever pressing. CT-005404 was co-administered (7.5-30.0 mg/kg p.o.) with either tetrabenazine or IL-1β, and the 15.0 and 30.0 mg/kg doses significantly reversed the effects of tetrabenazine and IL-1β. CT-005404 administered alone produced a dose-related increase in lever pressing in rats tested on a progressive ratio/chow feeding choice task. Atypical DAT inhibitors such as CT-005404 offer potential as a new avenue for drug treatment of motivational dysfunctions in humans.
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Affiliation(s)
- Renee A Rotolo
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06261-1020, USA
| | - Rose E Presby
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06261-1020, USA
| | - Olivia Tracy
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06261-1020, USA
| | - Sokaina Asar
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06261-1020, USA
| | - Jen-Hau Yang
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06261-1020, USA
| | - Merce Correa
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06261-1020, USA; Àrea de Psicobiologia, Campus de Riu Sec, Universitat Jaume I, 12071, Castelló, Spain
| | - Fraser Murray
- Chronos Therapeutics, The Magdalen Centre, Oxford Science Park, Oxford, OX4 4GA, UK
| | - John D Salamone
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06261-1020, USA.
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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: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [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,Correspondence: Lindsey Marwood, PhD, 103 Denmark Hill, PO74, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE58AF, 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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26
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Jim HSL, Hoogland AI, Han HS, Culakova E, Heckler C, Janelsins M, Williams GC, Bower J, Cole S, Desta Z, Babilonia MB, Morrow G, Peppone L. A randomized placebo-controlled trial of bupropion for Cancer-related fatigue: Study design and procedures. Contemp Clin Trials 2020; 91:105976. [PMID: 32147571 PMCID: PMC7263969 DOI: 10.1016/j.cct.2020.105976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cancer-related fatigue is a significant problem and is associated with poor quality of life. Behavioral interventions include exercise and cognitive-behavioral therapy, which survivors may be unwilling or unable to adopt. Pharmacologic interventions (e.g., selective serotonin reuptake inhibitors) have been disappointing. One potential therapy is the antidepressant bupropion, a norepinephrine-dopamine reuptake inhibitor that targets both inflammation and the hypothalamic-pituitary-adrenal axis. The current study is intended to provide a rigorous test of the efficacy and tolerability of bupropion for cancer-related fatigue. METHODS A randomized, double-blind, placebo-controlled trial will examine the effects of bupropion on cancer-related fatigue. The trial will be conducted nationwide through the University of Rochester Medical Center (URMC) National Cancer Institute Community Oncology Research Program (NCORP). Disease-free breast cancer survivors (n = 422) who completed chemotherapy and/or radiotherapy 12-60 months previously and report significant fatigue will be randomized 1:1 to receive bupropion (300 mg/day) or placebo. Outcomes will be assessed at baseline and the 12-week follow-up. The primary outcome, fatigue, will be measured with the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F). Secondary outcomes include quality of life, depression, and drug tolerability. Exploratory outcomes include cognition and symptomatology. Potential biological mechanisms and genetic moderators of cancer-related fatigue will also be explored. DISCUSSION This study is the first placebo-controlled trial to our knowledge to evaluate bupropion for cancer-related fatigue. Positive results could revolutionize the treatment of cancer-related fatigue, as bupropion is safe, inexpensive, widely-available, and may be more tolerable and acceptable for many patients than current, limited treatment options.
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Affiliation(s)
| | | | | | - Eva Culakova
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | | | - Julienne Bower
- University of California Los Angeles, Los Angeles, CA, USA
| | - Stephen Cole
- University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Gary Morrow
- University of Rochester Medical Center, Rochester, NY, USA
| | - Luke Peppone
- University of Rochester Medical Center, Rochester, NY, USA
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27
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Webb CA, Cohen ZD, Beard C, Forgeard M, Peckham AD, Björgvinsson T. Personalized prognostic prediction of treatment outcome for depressed patients in a naturalistic psychiatric hospital setting: A comparison of machine learning approaches. J Consult Clin Psychol 2020; 88:25-38. [PMID: 31841022 DOI: 10.1037/ccp0000451] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Research on predictors of treatment outcome in depression has largely derived from randomized clinical trials involving strict standardization of treatments, stringent patient exclusion criteria, and careful selection and supervision of study clinicians. The extent to which findings from such studies generalize to naturalistic psychiatric settings is unclear. This study sought to predict depression outcomes for patients seeking treatment within an intensive psychiatric hospital setting and while comparing the performance of a range of machine learning approaches. METHOD Depressed patients (N = 484; ages 18-72; 89% White) receiving treatment within a psychiatric partial hospital program delivering pharmacotherapy and cognitive behavioral therapy were split into a training sample and holdout sample. First, within the training sample, 51 pretreatment variables were submitted to 13 machine learning algorithms to predict, via cross-validation, posttreatment Patient Health Questionnaire-9 depression scores. Second, the best performing modeling approach (lowest mean squared error; MSE) from the training sample was selected to predict outcome in the holdout sample. RESULTS The best performing model in the training sample was elastic net regularization (ENR; MSE = 20.49, R2 = .28), which had comparable performance in the holdout sample (MSE = 11.26; R2 = .38). There were 14 pretreatment variables that predicted outcome. To demonstrate the translation of an ENR model to personalized prediction of treatment outcome, a patient-specific prognosis calculator is presented. CONCLUSIONS Informed by pretreatment patient characteristics, such predictive models could be used to communicate prognosis to clinicians and to guide treatment planning. Identified predictors of poor prognosis may suggest important targets for intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Christian A Webb
- Department of Psychiatry, Harvard Medical School/McLean Hospital
| | - Zachary D Cohen
- Department of Psychology, University of California, Los Angeles
| | - Courtney Beard
- Department of Psychiatry, Harvard Medical School/McLean Hospital
| | - Marie Forgeard
- Department of Clinical Psychology, William James College
| | - Andrew D Peckham
- Department of Psychiatry, Harvard Medical School/McLean Hospital
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28
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Plante DT, Hagen EW, Ravelo LA, Peppard PE. Impaired neurobehavioral alertness quantified by the psychomotor vigilance task is associated with depression in the Wisconsin Sleep Cohort study. Sleep Med 2019; 67:66-70. [PMID: 31918119 DOI: 10.1016/j.sleep.2019.11.1248] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/24/2019] [Accepted: 11/27/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Excessive daytime sleepiness plays an important role in the presentation and course of mood disorders. Standard objective measures of daytime sleep propensity are of little to no value in depressive illness. This study examined the psychomotor vigilance task (PVT), an objective measure of neurobehavioral alertness, and its cross-sectional and longitudinal associations with depressive symptomatology in the Wisconsin Sleep Cohort Study. METHODS The sample consisted of 1569 separate 10-min PVT assessments conducted in 942 unique individuals. Cross-sectional and longitudinal conditional logistic regression models were used to estimate associations between the primary outcome of depression symptomatology (adjusted Zung scale≥50) and six separate PVT variables: mean reciprocal reaction time (1/RT); total lapses (RTs≥500 msec; LAPSE); total false responses (FALSE); reciprocal of the mean of the 10% fastest (FAST) and 10% slowest (SLOW) RTs; and slope of the linear regression line for all transformed 1/RTs (SLOPE). RESULTS In fully-adjusted cross-sectional models, 1/RT, LAPSE, FAST, and SLOW were each significantly associated with depression, such that worse neurobehavioral alertness was associated with higher odds of depressive symptomatology. Similar, though attenuated, findings were observed in fully-adjusted conditional longitudinal models that examined within-subject changes in depression status in the subset of participants with repeated PVT assessments. FALSE and SLOPE were not associated with depression in either cross-sectional or conditional longitudinal models. CONCLUSIONS These findings suggest components of the PVT are associated with depressive symptomatology. Further research is indicated to clarify the role of the PVT in the assessment of hypersomnolence in mood disorders.
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Affiliation(s)
- David T Plante
- University of Wisconsin-Madison, Department of Psychiatry, Madison, WI, USA.
| | - Erika W Hagen
- University of Wisconsin-Madison, Department of Population Health Sciences, Madison, WI, USA
| | - Laurel A Ravelo
- University of Wisconsin-Madison, Department of Population Health Sciences, Madison, WI, USA
| | - Paul E Peppard
- University of Wisconsin-Madison, Department of Population Health Sciences, Madison, WI, USA
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29
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Rotolo RA, Dragacevic V, Kalaba P, Urban E, Zehl M, Roller A, Wackerlig J, Langer T, Pistis M, De Luca MA, Caria F, Schwartz R, Presby RE, Yang JH, Samels S, Correa M, Lubec G, Salamone JD. The Novel Atypical Dopamine Uptake Inhibitor (S)-CE-123 Partially Reverses the Effort-Related Effects of the Dopamine Depleting Agent Tetrabenazine and Increases Progressive Ratio Responding. Front Pharmacol 2019; 10:682. [PMID: 31316379 PMCID: PMC6611521 DOI: 10.3389/fphar.2019.00682] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 05/27/2019] [Indexed: 12/21/2022] Open
Abstract
Animal studies of effort-based choice behavior are being used to model effort-related motivational dysfunctions in humans. With these procedures, animals are offered a choice between high-effort instrumental actions leading to highly valued reinforcers vs. low effort/low reward options. Several previous studies have shown that dopamine (DA) uptake inhibitors, including GBR12909, lisdexamfetamine, methylphenidate, and PRX-14040, can reverse the effort-related effects of the vesicular monoamine transport blocker tetrabenazine, which inhibits DA storage. Because many drugs that block DA transport act as major stimulants that also release DA, and produce a number of undesirable side effects, there is a need to develop and characterize novel atypical DA transport inhibitors. (S)-CE-123 ((S)-5-((benzhydrylsulfinyl) methyl)thiazole) is a recently developed analog of modafinil with the biochemical characteristics of an atypical DA transport blocker. The present paper describes the enantioselective synthesis and initial chemical characterization of (S)-CE-123, as well as behavioral experiments involving effort-based choice and microdialysis studies of extracellular DA. Rats were assessed using the fixed ratio 5/chow feeding choice test. Tetrabenazine (1.0 mg/kg) shifted choice behavior, decreasing lever pressing and increasing chow intake. (S)-CE-123 was coadministered at doses ranging from 6.0 to 24.0 mg/kg, and the highest dose partially but significantly reversed the effects of tetrabenazine, although this dose had no effect on fixed ratio responding when administered alone. Additional experiments showed that (S)-CE-123 significantly increased lever pressing on a progressive ratio/chow feeding choice task and that the effective dose (24.0 mg/kg) increased extracellular DA in nucleus accumbens core. In summary, (S)-CE-123 has the behavioral and neurochemical profile of a compound that can block DA transport, reverse the effort-related effects of tetrabenazine, and increase selection of high-effort progressive ratio responding. This suggests that (S)-CE-123 or a similar compound could be useful as a treatment for effort-related motivational dysfunction in humans.
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Affiliation(s)
- Renee A Rotolo
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Vladimir Dragacevic
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Predrag Kalaba
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Ernst Urban
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Martin Zehl
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Vienna, Austria
| | - Alexander Roller
- X-ray Structure Analysis Centre, Faculty of Chemistry, University of Vienna, Vienna, Austria
| | - Judith Wackerlig
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Thierry Langer
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Marco Pistis
- Department of Biomedical Sciences, University of Cagliari, National Institute of Neuroscience (INN), Cagliari, Italy
| | - Maria Antonietta De Luca
- Department of Biomedical Sciences, University of Cagliari, National Institute of Neuroscience (INN), Cagliari, Italy
| | - Francesca Caria
- Department of Biomedical Sciences, University of Cagliari, National Institute of Neuroscience (INN), Cagliari, Italy
| | - Rebecca Schwartz
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Rose E Presby
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Jen-Hau Yang
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Shanna Samels
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Merce Correa
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States.,Àrea de Psicobiologia, Universitat Jaume I, Castelló, Spain
| | - Gert Lubec
- Department of Neuroproteomics, Paracelsus Medical University, Salzburg, Austria
| | - John D Salamone
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
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30
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Chakraborty S, Lennon JC, Malkaram SA, Zeng Y, Fisher DW, Dong H. Serotonergic system, cognition, and BPSD in Alzheimer's disease. Neurosci Lett 2019; 704:36-44. [PMID: 30946928 DOI: 10.1016/j.neulet.2019.03.050] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 12/20/2022]
Abstract
Behavioral and Psychological Symptoms of Dementia (BPSD), present in almost 90% of patients with Alzheimer's Disease (AD), cause extensive impairment leading to reduced independence and inability to complete activities of daily living. Though BPSD includes a wide range of symptoms, such as agitation, aggression, disinhibition, anxiety, depression, apathy, delusions, and hallucinations. Certain BPSD in AD co-present and can be clustered into distinct domains based on their frequency of co-occurrence. As these BPSD are so pervasive in any stages of AD, the disease may be better characterized as a disorder of heterogeneous degenerative symptoms across a number of symptom domains, with the most prominent domain comprising memory and cognitive deficits. Importantly, there are no FDA-approved drugs to treat these BPSD, and new approaches must be considered to develop effective treatments for AD patients. The biogenic monoamine 5-hydroxytryptamine (5-HT), or serotonin, works as both a neurotransmitter and neuromodulator, which has been tied to cognitive decline and multiple BPSD domains. This review summarizes the evidence for specific serotonergic system alterations across some of the well-studied cognitive, behavioral, and psychiatric domains. Though differences in overall serotonergic transmission occur in AD, circuit-specific alterations in individual 5-HT receptors (5-HTRs) are likely linked to the heterogeneous presentation of BPSD in AD.
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Affiliation(s)
- Saikat Chakraborty
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, 60611, USA
| | - Jack C Lennon
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, 60611, USA
| | - Sridhar A Malkaram
- Department of Biology, West Virginia State University Institute, WV-25112, USA
| | - Yan Zeng
- Brain and Cognition Research Institute, Wuhan University of Science and Technology, China
| | - Daniel W Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, 60611, USA
| | - Hongxin Dong
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, 60611, USA.
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31
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Salamone JD, Correa M, Ferrigno S, Yang JH, Rotolo RA, Presby RE. The Psychopharmacology of Effort-Related Decision Making: Dopamine, Adenosine, and Insights into the Neurochemistry of Motivation. Pharmacol Rev 2019; 70:747-762. [PMID: 30209181 DOI: 10.1124/pr.117.015107] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Effort-based decision making is studied using tasks that offer choices between high-effort options leading to more highly valued reinforcers versus low-effort/low-reward options. These tasks have been used to study the involvement of neural systems, including mesolimbic dopamine and related circuits, in effort-related aspects of motivation. Moreover, such tasks are useful as animal models of some of the motivational symptoms that are seen in people with depression, schizophrenia, Parkinson's disease, and other disorders. The present review will discuss the pharmacology of effort-related decision making and will focus on the use of these tasks for the development of drug treatments for motivational dysfunction. Research has identified pharmacological conditions that can alter effort-based choice and serve as models for depression-related symptoms (e.g., the vesicular monoamine transport-2 inhibitor tetrabenazine and proinflammatory cytokines). Furthermore, tests of effort-based choice have identified compounds that are particularly useful for stimulating high-effort work output and reversing the deficits induced by tetrabenazine and cytokines. These studies indicate that drugs that act by facilitating dopamine transmission, as well as adenosine A2A antagonists, are relatively effective at reversing effort-related impairments. Studies of effort-based choice may lead to the identification of drug targets that could be useful for treating motivational treatments that are resistant to commonly used antidepressants such as serotonin transport inhibitors.
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Affiliation(s)
- John D Salamone
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut (J.D.S., S.F., J.-H.Y., R.A.R., R.E.P.); and Area de Psicobiologia, Universitat de Jaume I, Castelló, Spain (M.C.)
| | - Mercè Correa
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut (J.D.S., S.F., J.-H.Y., R.A.R., R.E.P.); and Area de Psicobiologia, Universitat de Jaume I, Castelló, Spain (M.C.)
| | - Sarah Ferrigno
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut (J.D.S., S.F., J.-H.Y., R.A.R., R.E.P.); and Area de Psicobiologia, Universitat de Jaume I, Castelló, Spain (M.C.)
| | - Jen-Hau Yang
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut (J.D.S., S.F., J.-H.Y., R.A.R., R.E.P.); and Area de Psicobiologia, Universitat de Jaume I, Castelló, Spain (M.C.)
| | - Renee A Rotolo
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut (J.D.S., S.F., J.-H.Y., R.A.R., R.E.P.); and Area de Psicobiologia, Universitat de Jaume I, Castelló, Spain (M.C.)
| | - Rose E Presby
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut (J.D.S., S.F., J.-H.Y., R.A.R., R.E.P.); and Area de Psicobiologia, Universitat de Jaume I, Castelló, Spain (M.C.)
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Abstract
Purpose of Review The functional gastrointestinal disorders, or disorders of gut-brain interaction as defined by the Rome IV criteria, are the most common diagnostic entities in gastroenterology. Treatments that address the dysregulation of gut-brain interaction with these disorders are increasingly gaining interest as a better option than for example traditional analgesics, particularly opioids. Antidepressants, antianxiety and antipsychotic medications, and visceral analgesics, now termed neuromodulators, are included in this update addressing the evidence of treatment benefit in disorders of brain-gut interaction. Recent Findings By a careful selection based on a multidimensional clinical profile, a decreased symptom burden, particularly regarding abdominal pain, nausea, and vomiting, as well as improved social function and quality of life, can be obtained by use of neuromodulators. There is good evidence for the peripheral neuromodulators from studies in bowel disorders, and the central neuromodulators both from indirect evidence in chronic pain disorders as well as selected disorders of brain-gut interaction. Summary Basic knowledge about the pharmacologic properties and clinical use of neuromodulators in disorders of brain-gut interaction improves the treatment outcome and avoids use of traditional analgesics.
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Solopchuk O, Sebti M, Bouvy C, Benoit CE, Warlop T, Jeanjean A, Zénon A. Locus Coeruleus atrophy doesn't relate to fatigue in Parkinson's disease. Sci Rep 2018; 8:12381. [PMID: 30120287 PMCID: PMC6098016 DOI: 10.1038/s41598-018-30128-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 07/18/2018] [Indexed: 01/24/2023] Open
Abstract
Fatigue is a frequent complaint among healthy population and one of the earliest and most debilitating symptoms in Parkinson's disease (PD). Earlier studies have examined the role of dopamine and serotonin in pathogenesis of fatigue, but the plausible role of noradrenalin (NA) remains underexplored. We investigated the relationship between fatigue in Parkinsonian patients and the extent of degeneration of Locus Coeruleus (LC), the main source of NA in the brain. We quantified LC and Substantia Nigra (SN) atrophy using neuromelanin-sensitive imaging, analyzed with a novel, fully automated algorithm. We also assessed patients' fatigue, depression, sleep disturbance and vigilance. We found that LC degeneration correlated with the levels of depression and vigilance but not with fatigue, while fatigue correlated weakly with atrophy of SN. These results indicate that LC degeneration in Parkinson's disease is unlikely to cause fatigue, but may be involved in mood and vigilance alterations.
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Affiliation(s)
- Oleg Solopchuk
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.
- INCIA, 33076, Bordeaux, France.
| | - Moustapha Sebti
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Céline Bouvy
- Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | | | - Thibault Warlop
- Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - Anne Jeanjean
- Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - Alexandre Zénon
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- INCIA, 33076, Bordeaux, France
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34
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Post RJ, Warden MR. Depression: the search for separable behaviors and circuits. Curr Opin Neurobiol 2018; 49:192-200. [PMID: 29529482 PMCID: PMC6042519 DOI: 10.1016/j.conb.2018.02.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 02/06/2018] [Accepted: 02/26/2018] [Indexed: 11/21/2022]
Abstract
Major depressive disorder can manifest as different combinations of symptoms, ranging from a profound and incapacitating sadness, to a loss of interest in daily life, to an inability to engage in effortful, goal-directed behavior. Recent research has focused on defining the neural circuits that mediate separable features of depression in patients and preclinical animal models, and connections between frontal cortex and brainstem neuromodulators have emerged as candidate targets. The development of methods permitting recording and manipulation of neural circuits defined by connectivity has enabled the investigation of prefrontal-neuromodulatory circuit dynamics in animal models of depression with exquisite precision, a systems-level approach that has brought new insights by integrating these fields of depression research.
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Affiliation(s)
- Ryan J Post
- Department of Neurobiology and Behavior, Cornell University, Ithaca, NY, United States
| | - Melissa R Warden
- Department of Neurobiology and Behavior, Cornell University, Ithaca, NY, United States; Cornell Neurotech, Cornell University, Ithaca, NY, United States.
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35
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Salamone JD, Correa M, Yang JH, Rotolo R, Presby R. Dopamine, Effort-Based Choice, and Behavioral Economics: Basic and Translational Research. Front Behav Neurosci 2018; 12:52. [PMID: 29628879 PMCID: PMC5876251 DOI: 10.3389/fnbeh.2018.00052] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/28/2018] [Indexed: 01/14/2023] Open
Abstract
Operant behavior is not only regulated by factors related to the quality or quantity of reinforcement, but also by the work requirements inherent in performing instrumental actions. Moreover, organisms often make effort-related decisions involving economic choices such as cost/benefit analyses. Effort-based decision making is studied using behavioral procedures that offer choices between high-effort options leading to relatively preferred reinforcers vs. low effort/low reward choices. Several neural systems, including the mesolimbic dopamine (DA) system and other brain circuits, are involved in regulating effort-related aspects of motivation. Considerable evidence indicates that mesolimbic DA transmission exerts a bi-directional control over exertion of effort on instrumental behavior tasks. Interference with DA transmission produces a low-effort bias in animals tested on effort-based choice tasks, while increasing DA transmission with drugs such as DA transport blockers tends to enhance selection of high-effort options. The results from these pharmacology studies are corroborated by the findings from recent articles using optogenetic, chemogenetic and physiological techniques. In addition to providing important information about the neural regulation of motivated behavior, effort-based choice tasks are useful for developing animal models of some of the motivational symptoms that are seen in people with various psychiatric and neurological disorders (e.g., depression, schizophrenia, Parkinson’s disease). Studies of effort-based decision making may ultimately contribute to the development of novel drug treatments for motivational dysfunction.
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Affiliation(s)
- John D Salamone
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Merce Correa
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States.,Area de Psicobiologia, Universitat de Jaume I, Castelló, Spain
| | - Jen-Hau Yang
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Renee Rotolo
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Rose Presby
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
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36
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Drossman DA, Tack J, Ford AC, Szigethy E, Törnblom H, Van Oudenhove L. Neuromodulators for Functional Gastrointestinal Disorders (Disorders of Gut-Brain Interaction): A Rome Foundation Working Team Report. Gastroenterology 2018; 154:1140-1171.e1. [PMID: 29274869 DOI: 10.1053/j.gastro.2017.11.279] [Citation(s) in RCA: 210] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/13/2017] [Accepted: 11/24/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Central neuromodulators (antidepressants, antipsychotics, and other central nervous system-targeted medications) are increasingly used for treatment of functional gastrointestinal disorders (FGIDs), now recognized as disorders of gut-brain interaction. However, the available evidence and guidance for the use of central neuromodulators in these conditions is scanty and incomplete. In this Rome Foundation Working Team report, a multidisciplinary team summarized available research evidence and clinical experience to provide guidance and treatment recommendations. METHODS The working team summarized the literature on the pharmacology of central neuromodulators and their effects on gastrointestinal sensorimotor function and conducted an evidence-based review on their use for treating FGID syndromes. Because of the paucity of data for FGIDs, we included data for non-gastrointestinal painful disorders and specific symptoms of pain, nausea, and vomiting. This information was combined into a final document comprising a synthesis of available evidence and recommendations for clinical use guided by the research and clinical experience of the experts on the committee. RESULTS The evidence-based review on neuromodulators in FGID, restricted by the limited available controlled trials, was integrated with open-label studies and case series, along with the experience of experts to create recommendations using a consensus (Delphi) approach. Due to the diversity of conditions and complexity of treatment options, specific recommendations were generated for different FGIDs. However, some general recommendations include: (1) low to modest dosages of tricyclic antidepressants provide the most convincing evidence of benefit for treating chronic gastrointestinal pain and painful FGIDs and serotonin noradrenergic reuptake inhibitors can also be recommended, though further studies are needed; (2) augmentation, that is, adding a second treatment (adding quetiapine, aripiprazole, buspirone α2δ ligand agents) is recommended when a single medication is unsuccessful or produces side effects at higher dosages; (3) treatment should be continued for 6-12 months to potentially prevent relapse; and (4) implementation of successful treatment requires effective communication skills to improve patient acceptance and adherence, and to optimize the patient-provider relationship. CONCLUSIONS Based on systematic and selectively focused review and the consensus of a multidisciplinary panel, we have provided summary information and guidelines for the use of central neuromodulators in the treatment of chronic gastrointestinal symptoms and FGIDs. Further studies are needed to confirm and refine these recommendations.
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Affiliation(s)
- Douglas A Drossman
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina; Center for Education and Practice of Biopsychosocial Care and Drossman Gastroenterology, Chapel Hill, North Carolina.
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Alexander C Ford
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom; Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom
| | - Eva Szigethy
- Departments of Psychiatry and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hans Törnblom
- Departments of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies, Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
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37
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Abstract
SummaryPersistent major depression that does not respond to adequate first- or
second-line treatment is a common problem in psychiatry. This article
updates evidence on recommended treatment strategies and reviews the
prospects of more experimental approaches. The main pharmacological
development in recent years has been the demonstration that several atypical
antipsychotic drugs are effective adjunctive agents in improving symptoms in
depression unresponsive to selective serotonin reuptake inhibitors, although
their adverse effect burden is high. There is optimism about novel
pharmacological strategies based on glutamatergic and anti-inflammatory
mechanisms. It is important to combine drug and psychological treatments
whenever possible. With persistent therapeutic engagement, the majority of
patients remit eventually, but subsequent relapse remains a problem.
Clinicians should pursue an active and collaborative treatment plan that
makes use of all effective therapeutic modalities and continues into the
relapse-prevention phase.
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38
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Ghanean H, Ceniti AK, Kennedy SH. Fatigue in Patients with Major Depressive Disorder: Prevalence, Burden and Pharmacological Approaches to Management. CNS Drugs 2018; 32:65-74. [PMID: 29383573 DOI: 10.1007/s40263-018-0490-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Fatigue is a frequently reported symptom in major depressive disorder, occurring in over 90% of patients. Clinical presentations of fatigue within major depressive disorder encompass overlapping physical, cognitive and emotional aspects. While this review addresses the epidemiology, burden, functional impact and management of fatigue in major depressive disorder, the main focus is on available pharmacotherapy options and their comparative efficacies. Our review of the effects of pharmacological treatments on fatigue in major depressive disorder found that medications with dopaminergic and/or noradrenergic action such as modafinil, flupenthixol and atomoxetine were most effective in improving symptoms of fatigue and low energy. However, significant variation across studies in assessment tools and study inclusion/exclusion criteria may have contributed to inconsistent findings. The efficacy of non-pharmacological interventions is also discussed, including light therapy and exercise.
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Affiliation(s)
- Helia Ghanean
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Amanda K Ceniti
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,ASR Suicide and Depression Studies Program, St. Michael's Hospital, 193 Yonge Street, Suite 6-001A, Toronto, ON, M5B 1M8, Canada
| | - Sidney H Kennedy
- Centre for Mental Health, University Health Network, Toronto, ON, Canada. .,Institute of Medical Science, University of Toronto, Toronto, ON, Canada. .,ASR Suicide and Depression Studies Program, St. Michael's Hospital, 193 Yonge Street, Suite 6-001A, Toronto, ON, M5B 1M8, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada. .,Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada. .,Li Ka Shing Knowledge Institute, Toronto, ON, Canada.
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39
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Yohn SE, Gorka D, Mistry A, Collins S, Qian E, Correa M, Manchanda A, Bogner RH, Salamone JD. Oral Ingestion and Intraventricular Injection of Curcumin Attenuates the Effort-Related Effects of the VMAT-2 Inhibitor Tetrabenazine: Implications for Motivational Symptoms of Depression. JOURNAL OF NATURAL PRODUCTS 2017; 80:2839-2844. [PMID: 28905625 DOI: 10.1021/acs.jnatprod.7b00425] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Effort-related choice tasks are used for studying depressive motivational symptoms such as anergia/fatigue. These studies investigated the ability of the dietary supplement curcumin to reverse the low-effort bias induced by the monoamine storage blocker tetrabenazine. Tetrabenazine shifted effort-related choice in rats, decreasing high-effort lever pressing but increasing chow intake. The effects of tetrabenazine were reversed by oral ingestion of curcumin (80.0-160.0 mg/kg) and infusions of curcumin into the cerebral ventricles (2.0-8.0 μg). Curcumin attenuates the effort-related effects of tetrabenazine in this model via actions on the brain, suggesting that curcumin may be useful for treating human motivational symptoms.
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Affiliation(s)
| | | | | | | | | | - Merce Correa
- Àrea de Psicobiologia, Universitat Jaume I , Campus de Riu Sec, 12071 Castelló, Spain
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40
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Törnblom H, Drossman DA. Centrally Targeted Pharmacotherapy for Chronic Abdominal Pain: Understanding and Management. Handb Exp Pharmacol 2017; 239:417-440. [PMID: 28204956 DOI: 10.1007/164_2016_106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Chronic abdominal pain has a widespread impact on the individual and the society. Identifying and explaining mechanisms of importance for the pain experience within a biopsychosocial context are central in order to select treatment that has a chance for symptom reduction. With current knowledge of brain-gut interactions, chronic abdominal pain, which mostly appears in functional gastrointestinal disorders, to a large extent involves pain mechanisms residing within the brain. As such, the use of centrally targeted pharmacotherapy as an effective treatment option is obvious in a selected number of patients. The antidepressants are most common, but also other classes of medications can be used, either alone or in combination. The latter option refers to when there is insufficient effect of one drug alone or side effects limiting dosage, and when combined in lower doses, certain drugs give rise to augmentation effects. This chapter outlines basic mechanisms of importance for the understanding of chronic abdominal pain and the pharmacologic treatment options.
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Affiliation(s)
- Hans Törnblom
- Dept of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-41345, Gothenburg, Sweden.
| | - Douglas A Drossman
- Drossman Center for the Education and Practice of Biopsychosocial Care, Professor Emeritus of Medicine and Psychiatry, UNC Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Drossman Gastroenterology PLLC, Chapel Hill, NC, USA
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41
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Abstract
The history and present status of the definition, prevalence, neurobiology, and treatment of atypical depression (AD) is presented. The concept of AD has evolved through the years, and currently, in Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, the specifier of depressive episode with atypical feature is present for both diagnostic groups, that is, depressive disorders and bipolar and related disorders. This specifier includes mood reactivity, hyperphagia, hypersomnia, leaden paralysis, and interpersonal rejection sensitivity. Prevalence rates of AD are variable, depending on the criteria, methodology, and settings. The results of epidemiological studies using DSM criteria suggest that 15%-29% of depressed patients have AD, and the results of clinical studies point to a prevalence of 18%-36%. A relationship of AD with bipolar depression, seasonal depression, and obesity has also been postulated. Pathogenic research has been mostly focused on distinguishing AD from melancholic depression. The differences have been found in biochemical studies in the areas of hypothalamic-pituitary-adrenal axis, inflammatory markers, and the leptin system, although the results obtained are frequently controversial. A number of findings concerning such differences have also been obtained using neuroimaging and neurophysiological and neuropsychological methods. An initial concept of AD as a preferentially monoamine oxidase inhibitor-responsive depression, although confirmed in some further studies, is of limited use nowadays. Currently, despite numerous drug trials, there are no comprehensive treatment guidelines for AD. We finalize the article by describing the future research perspectives for the definition, neurobiology, and treatment. A better specification of diagnostic criteria and description of clinical picture, a genome-wide association study of AD, and establishing updated treatment recommendations for this clinical phenomenon should be the priorities for the coming years.
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Affiliation(s)
| | - Janusz K Rybakowski
- Department of Adult Psychiatry.,Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
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42
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Meyniel F, Goodwin GM, Deakin JW, Klinge C, MacFadyen C, Milligan H, Mullings E, Pessiglione M, Gaillard R. A specific role for serotonin in overcoming effort cost. eLife 2016; 5. [PMID: 27824554 PMCID: PMC5100997 DOI: 10.7554/elife.17282] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/05/2016] [Indexed: 02/06/2023] Open
Abstract
Serotonin is implicated in many aspects of behavioral regulation. Theoretical attempts to unify the multiple roles assigned to serotonin proposed that it regulates the impact of costs, such as delay or punishment, on action selection. Here, we show that serotonin also regulates other types of action costs such as effort. We compared behavioral performance in 58 healthy humans treated during 8 weeks with either placebo or the selective serotonin reuptake inhibitor escitalopram. The task involved trading handgrip force production against monetary benefits. Participants in the escitalopram group produced more effort and thereby achieved a higher payoff. Crucially, our computational analysis showed that this effect was underpinned by a specific reduction of effort cost, and not by any change in the weight of monetary incentives. This specific computational effect sheds new light on the physiological role of serotonin in behavioral regulation and on the clinical effect of drugs for depression. CLINICAL TRIAL REGISTRATION ISRCTN75872983.
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Affiliation(s)
- Florent Meyniel
- Motivation, Brain and Behavior team, Institut du Cerveau et de la Moelle épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,INSERM UMRS 1127, CNRS UMR 7225, Université Pierre et Marie Curie (UPMC-P6), Paris, France.,Cognitive Neuroimaging Unit, NeuroSpin Center, INSERM U992, Institut d'Imagerie Biomédicale, Direction de la recherche fondamentale, Commissariat à l'énergie atomique et aux énergies alternatives, Gif-sur-Yvette, France
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Jf William Deakin
- Neuroscience and Psychiatry Unit, The University of Manchester, Manchester, United Kingdom
| | - Corinna Klinge
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Christine MacFadyen
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Holly Milligan
- Neuroscience and Psychiatry Unit, The University of Manchester, Manchester, United Kingdom
| | - Emma Mullings
- Neuroscience and Psychiatry Unit, The University of Manchester, Manchester, United Kingdom
| | - Mathias Pessiglione
- Motivation, Brain and Behavior team, Institut du Cerveau et de la Moelle épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,INSERM UMRS 1127, CNRS UMR 7225, Université Pierre et Marie Curie (UPMC-P6), Paris, France
| | - Raphaël Gaillard
- Centre Hospitalier Sainte-Anne, Service de Psychiatrie, Paris, France.,Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Laboratoire de Physiopathologie des maladies Psychiatriques, Centre de Psychiatrie et Neurosciences, INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Human Histopathology and Animal Models, Department of Infection and Epidemiology, Institut Pasteur, Paris, France
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43
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Abstract
Sleep and wake states involve interaction among many brain centers via multiple neurotransmitters, including dopamine, norepinephrine, hypocretin, acetylcholine, histamine and serotonin (wake promoting), and γ amino butyric acid (GABA) and melatonin (sleep promoting). Most medications for insomnia or hypersomnia act on elements of these neural systems. Initial treatment of insomnia includes sleep hygiene measures. Cognitive-behavioral therapy for insomnia is useful. Medications approved by the Food and Drug Administration for insomnia act on GABA receptors or on melatonin receptors. A frequent cause of insomnia is restless legs syndrome, which is linked to reduced dopaminergic activity in brain structures; idiopathic restless legs syndrome is best treated with dopamine agonists such as ropinerole or pramipexole. Excessive daytime sleepiness is most often due to insufficient sleep hours or sleep apnea but is also caused by medications, illnesses, narcolepsy, or idiopathic hypersomnia. Stimulants generally act through enhanced dopamine action (amphetamines, methylphenidate) or acetylcholine action (caffeine). Modafinil may act through enhanced central histamine, hypocretin, and possibly dopamine action. A newer agent, γ -hydroxybutyrate (GHB), acts on GABA and GHB receptors to consolidate sleep, improving daytime sleepiness in narcolepsy. Improving knowledge of sleep/wake mechanisms should lead to more specific and rational treatments for sleep disorders.
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Affiliation(s)
- Jeremiah Suhl
- Sleep Disorders Center, Lexington Veterans Affairs Medical Center, and voluntary assistant professor of medicine, Neurology Department, University of Kentucky College of Medicine, Lexington, Kentucky,
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44
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The relationship between bupropion and suicide in post-mortem investigations. Forensic Sci Int 2016; 266:343-348. [PMID: 27372438 DOI: 10.1016/j.forsciint.2016.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 06/13/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
Abstract
We reviewed the 33727 postmortem toxicology investigations performed in Finland over a period of 5years (2009-2013) and identified those in which the antidepressant bupropion was detected. Cases positive for other antidepressant drugs were reviewed for comparison. The postmortem toxicological examination included, in all cases, the routine screening and quantification of hundreds of drugs and poisons using quality-controlled methods. Bupropion was detected in 65 cases. A large proportion of the bupropion-positive deaths resulted from suicide (55%). In fatal poisoning cases found positive for bupropion, the proportion of suicide was even higher (77%). The measured median bupropion postmortem blood concentration (0.69mg/L) was markedly higher than the normal therapeutic range in plasma in the treatment of depression (up to 0.1mg/L) and even higher in fatal bupropion poisonings (13mg/L). Only 14% of the deceased positive for bupropion were estimated to be drug abusers. However, nearly all of the drug abuse cases were from the last year of the study (2013), indicating a recent increase of the use of bupropion among drug abusers and possibly even abuse of bupropion itself. Suicide victims positive for bupropion were younger than those who died with other antidepressant drugs in their blood. In addition, the percentage of fatal poisonings among bupropion-positive postmortem cases was higher than among the users of other antidepressant drugs. Suicide was significantly more common among the deceased positive for bupropion than among users of other antidepressant drugs. An unknown degree of bupropion degradation before the assay and post-mortem redistribution of bupropion may have impacted the measured levels. Nonetheless, all post-mortem concentrations of bupropion were elevated and especially high concentrations were detected in suicides.
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45
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Yohn SE, Errante EE, Rosenbloom-Snow A, Somerville M, Rowland M, Tokarski K, Zafar N, Correa M, Salamone JD. Blockade of uptake for dopamine, but not norepinephrine or 5-HT, increases selection of high effort instrumental activity: Implications for treatment of effort-related motivational symptoms in psychopathology. Neuropharmacology 2016; 109:270-280. [PMID: 27329556 DOI: 10.1016/j.neuropharm.2016.06.018] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/07/2016] [Accepted: 06/17/2016] [Indexed: 12/21/2022]
Abstract
Deficits in behavioral activation, exertion of effort, and other psychomotor/motivational symptoms are frequently seen in people with depression and other disorders. Depressed people show a decision bias towards selection of low effort activities, and animal tests of effort-related decision making are being used as models of motivational dysfunctions seen in psychopathology. The present studies investigated the ability of drugs that block dopamine transport (DAT), norepinephrine transport (NET), and serotonin transport (SERT) to modulate work output in rats responding on a test of effort-related decision making (i.e., a progressive ratio (PROG)/chow feeding choice task). With this task, rats choose between working for a preferred food (high carbohydrate pellets) by lever pressing on a PROG schedule vs. obtaining a less preferred lab chow that is freely available in the chamber. The present studies focused on the effects of the selective DAT inhibitor GBR12909, the selective SERT inhibitor fluoxetine, and the selective NET inhibitors desipramine and atomoxetine. Acute and repeated administration of GBR12909 shifted choice behavior, increasing measures of PROG lever pressing but decreasing chow intake. In contrast, fluoxetine, desipramine and atomoxetine failed to increase lever pressing output, and actually decreased it at higher doses. In the behaviorally effective dose range, GBR12909 elevated extracellular dopamine levels in accumbens core as measured by microdialysis, but fluoxetine, desipramine and atomoxetine decreased extracellular dopamine. Thus, blockade of DAT increases selection of the high effort instrumental activity, while inhibition of SERT or NET does not. These results have implications for the use of monoamine uptake inhibitors for the treatment of effort-related psychiatric symptoms in humans.
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Affiliation(s)
- Samantha E Yohn
- Department of Psychology, University of Connecticut, Storrs, CT, 06261-1020, USA
| | - Emily E Errante
- Department of Psychology, University of Connecticut, Storrs, CT, 06261-1020, USA
| | | | - Matthew Somerville
- Department of Psychology, University of Connecticut, Storrs, CT, 06261-1020, USA
| | - Margaret Rowland
- Department of Psychology, University of Connecticut, Storrs, CT, 06261-1020, USA
| | - Kristin Tokarski
- Department of Psychology, University of Connecticut, Storrs, CT, 06261-1020, USA
| | - Nadia Zafar
- Department of Psychology, University of Connecticut, Storrs, CT, 06261-1020, USA
| | - Merce Correa
- Department of Psychology, University of Connecticut, Storrs, CT, 06261-1020, USA; Àrea de Psicobiologia, Campus de Riu Sec, Universitat Jaume I, 12071, Castelló, Spain
| | - John D Salamone
- Department of Psychology, University of Connecticut, Storrs, CT, 06261-1020, USA.
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Yohn SE, Gogoj A, Haque A, Lopez-Cruz L, Haley A, Huxley P, Baskin P, Correa M, Salamone JD. Evaluation of the effort-related motivational effects of the novel dopamine uptake inhibitor PRX-14040. Pharmacol Biochem Behav 2016; 148:84-91. [PMID: 27296079 DOI: 10.1016/j.pbb.2016.06.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Samantha E Yohn
- Department of Psychology, University of Connecticut, Storrs, CT 06261-1020, USA
| | - Augustyna Gogoj
- Department of Psychology, University of Connecticut, Storrs, CT 06261-1020, USA
| | - Aileen Haque
- Department of Psychology, University of Connecticut, Storrs, CT 06261-1020, USA
| | - Laura Lopez-Cruz
- Àrea de Psicobiologia, Campus de Riu Sec, Universitat Jaume I, 12071 Castelló, Spain
| | - Allison Haley
- Department of Psychology, University of Connecticut, Storrs, CT 06261-1020, USA
| | - Philip Huxley
- Prexa Pharmaceuticals, 745 Atlantic Ave., 3rd floor, Boston, MA 02111, USA
| | - Patricia Baskin
- Prexa Pharmaceuticals, 745 Atlantic Ave., 3rd floor, Boston, MA 02111, USA
| | - Merce Correa
- Àrea de Psicobiologia, Campus de Riu Sec, Universitat Jaume I, 12071 Castelló, Spain
| | - John D Salamone
- Department of Psychology, University of Connecticut, Storrs, CT 06261-1020, USA.
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Abstract
BACKGROUND The use of psychotropic medications, particularly antidepressants, is common in patients with inflammatory bowel disease (IBD) in spite of a lack of their robust efficacy in this population. This review provides an overview of the use trends of different classes of antidepressant and anti-anxiety medication and their effects on mood, nervous system function, gastrointestinal physiology and immunity drawing from the literature available in the general population, other medical conditions, and when available, patients with IBD. It also covers the evidence base for the actions, efficacy, and potential complications of antidepressants organized by different classes. METHODS We conducted a PubMed search of articles relating the different drug classes probed to the terms above in different populations of interest. All types of articles were accepted including case reports and series, open and randomized trials, reviews, and expert opinion. We also examined the reference lists of the publications found. RESULTS Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are the most commonly prescribed agents for anxiety and depression in patients with IBD, though their efficacy for these conditions in the general population are mild to moderate at best. SSRIs are generally well tolerated, though at higher doses, they, like most antidepressant classes, can be associated with activation, serotonergic syndrome, and increased suicidal ideation. TCAs have many more serious side effects but have some shown efficacy for functional GI symptoms. A newer class, the serotonin noradrenergic reuptake inhibitors (SNRIs), can be effective for refractory depression, anxiety and chronic pain syndromes with a side effect profile similar to both SSRIs and more mild manifestations of TCAs. Mirtazapine has moderate efficacy for depression if sedation and weight gain side effects are tolerated and some small support for use in nausea and vomiting. Bupropion targets dopamine and noradrenaline reuptake and has moderate efficacy for depression, and some small support for use in fatigue and smoking cessation. Buspirone has an indication for generalized anxiety disorder though studies show only a minimal benefit. It has some growing evidence for use in functional dyspepsia. Most of these agents have physiological effects on the brain, immune system, and gastrointestinal tract (with the exception of bupropion) hence their therapeutic and side effects manifested in these systems. CONCLUSION Antidepressant medications are frequently prescribed for depression, anxiety disorders, and chronic pain syndromes, but overall support for their efficacy is modest at best. Psychological interventions have growing support for having much more robust effects without the side effects of antidepressants and should be considered first-line treatment or at least an adjunct to psychotropic medications for these conditions.
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Salamone JD, Yohn SE, López-Cruz L, San Miguel N, Correa M. Activational and effort-related aspects of motivation: neural mechanisms and implications for psychopathology. Brain 2016; 139:1325-47. [PMID: 27189581 PMCID: PMC5839596 DOI: 10.1093/brain/aww050] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/15/2016] [Accepted: 02/12/2016] [Indexed: 01/18/2023] Open
Abstract
Motivation has been defined as the process that allows organisms to regulate their internal and external environment, and control the probability, proximity and availability of stimuli. As such, motivation is a complex process that is critical for survival, which involves multiple behavioural functions mediated by a number of interacting neural circuits. Classical theories of motivation suggest that there are both directional and activational aspects of motivation, and activational aspects (i.e. speed and vigour of both the instigation and persistence of behaviour) are critical for enabling organisms to overcome work-related obstacles or constraints that separate them from significant stimuli. The present review discusses the role of brain dopamine and related circuits in behavioural activation, exertion of effort in instrumental behaviour, and effort-related decision-making, based upon both animal and human studies. Impairments in behavioural activation and effort-related aspects of motivation are associated with psychiatric symptoms such as anergia, fatigue, lassitude and psychomotor retardation, which cross multiple pathologies, including depression, schizophrenia, and Parkinson's disease. Therefore, this review also attempts to provide an interdisciplinary approach that integrates findings from basic behavioural neuroscience, behavioural economics, clinical neuropsychology, psychiatry, and neurology, to provide a coherent framework for future research and theory in this critical field. Although dopamine systems are a critical part of the brain circuitry regulating behavioural activation, exertion of effort, and effort-related decision-making, mesolimbic dopamine is only one part of a distributed circuitry that includes multiple neurotransmitters and brain areas. Overall, there is a striking similarity between the brain areas involved in behavioural activation and effort-related processes in rodents and in humans. Animal models of effort-related decision-making are highly translatable to humans, and an emerging body of evidence indicates that alterations in effort-based decision-making are evident in several psychiatric and neurological disorders. People with major depression, schizophrenia, and Parkinson's disease show evidence of decision-making biases towards a lower exertion of effort. Translational studies linking research with animal models, human volunteers, and clinical populations are greatly expanding our knowledge about the neural basis of effort-related motivational dysfunction, and it is hoped that this research will ultimately lead to improved treatment for motivational and psychomotor symptoms in psychiatry and neurology.
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Affiliation(s)
- John D Salamone
- Department of Psychology, University of Connecticut, Storrs, CT 06269-1020, USA
| | - Samantha E Yohn
- Department of Psychology, University of Connecticut, Storrs, CT 06269-1020, USA
| | - Laura López-Cruz
- Àrea de Psicobiologia, Universitat Jaume I, 12071 Castelló, Spain
| | - Noemí San Miguel
- Àrea de Psicobiologia, Universitat Jaume I, 12071 Castelló, Spain
| | - Mercè Correa
- Department of Psychology, University of Connecticut, Storrs, CT 06269-1020, USA Àrea de Psicobiologia, Universitat Jaume I, 12071 Castelló, Spain
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Effects of lisdexamfetamine and s-citalopram, alone and in combination, on effort-related choice behavior in the rat. Psychopharmacology (Berl) 2016; 233:949-60. [PMID: 26694811 DOI: 10.1007/s00213-015-4176-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 11/25/2015] [Indexed: 12/29/2022]
Abstract
RATIONALE Effort-related motivational symptoms, such as anergia, psychomotor retardation, and fatigue, are an important aspect of depression and other disorders. Motivational symptoms are resistant to some treatments, including serotonin transport (SERT) inhibitors. OBJECTIVES Tests of effort-based choice using operant behavior tasks (e.g., concurrent lever pressing/ chow feeding tasks) can be used as animal models of motivational symptoms. Tests of effort-related choice allow animals to choose between high-effort actions that lead to more highly valued rewards vs. low-effort alternatives that lead to less valued rewards (i.e., less preferred or lower magnitude). Rats treated with the vesicular monoamine transport inhibitor tetrabenazine, or the cytokine interleukin-1β (IL-1β), which are associated with depressive symptoms in humans, can alter effort-related choice, reducing selection of the high effort alternative (lever pressing) while increasing intake of freely available chow. METHODS The present studies focused upon the ability of lisdexamfetamine (LDX) to increase exertion of effort in rats responding on effort-based choice tasks under several different conditions. RESULTS LDX attenuated the shift from fixed ratio 5 lever pressing to chow intake induced by tetrabenazine and IL-1β. In contrast, the SERT inhibitor s-citalopram failed to reverse the effects of tetrabenazine. When given in combination with tetrabenazine+s-citalopram, LDX significantly increased lever pressing output compared to tetrabenaine+citalopram alone. LDX also increased work output in rats responding on a progressive ratio/chow feeding choice task. CONCLUSIONS LDX can increase work output in rats responding on effort-based choice tasks, which may have implications for understanding the neurochemistry of motivational symptoms in humans.
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