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Fornaro M, Cattaneo CI, De Berardis D, Ressico FV, Martinotti G, Vieta E. Antidepressant discontinuation syndrome: A state-of-the-art clinical review. Eur Neuropsychopharmacol 2023; 66:1-10. [PMID: 36345093 DOI: 10.1016/j.euroneuro.2022.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/13/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
Antidepressant drugs are prescribed to patients with depressive, anxiety disorders, and other conditions. Evidence about antidepressant discontinuation syndrome (ADS) and related outcomes is sparse, although potentially burdensome in some patients. The present state-of-the-art review aims to appraise the most current evidence about ADS critically. ADS has been documented for most antidepressant drugs, although most literature focuses on selective serotonin reuptake inhibitors prescribed for depression. While down-titration cannot exclude the chance of ADS, it is nonetheless warranted in the clinical setting, especially for short half-life and sedative compounds such as paroxetine. Integrative management with concurrent pharmacotherapy and psychotherapy may minimize the eventual unpleasant effects arising within the discontinuation process. In addition, patient-tailored interventions and education should be part of the discontinuation strategy. Future research must rely on broadly accepted definitions for ADS and related phenomena such as antidepressant withdrawal and shed further light on the underpinning neurobiology. Discriminating between ADS-related phenomena and relapse of depression is likewise warranted, along with a neuroscience-based nomenclature instead of a class one.
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Affiliation(s)
- M Fornaro
- Department of Psychiatry, Federico II University of Naples, via Pansini n.5, building 18, Psychiatry, Naples ZIP 80131, Italy.
| | - C I Cattaneo
- Department of Mental Health, Borgomanero ASL, Novara, Italy
| | - D De Berardis
- Department of Mental Health Psychiatric Service, Diagnosis and Treatment. Hospital "G. Mazzini", ASL 4, NHS, Teramo, Italy
| | - F V Ressico
- Department of Mental Health, Borgomanero ASL, Novara, Italy
| | - G Martinotti
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy; Department of Pharmacy, Pharmacology, Postgraduate Medicine, University of Hertfordshire, Herts AL10 9AB, UK
| | - E Vieta
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Wang QQ, Cheng L, Wu BY, Xu P, Qiu HY, Wang B, Yan XJ, Chen SL. Short-course antidepressant therapy reduces discontinuation syndrome while maintaining treatment efficacy in patients with refractory functional dyspepsia: A randomized controlled trial. Front Psychiatry 2022; 13:1063722. [PMID: 36569610 PMCID: PMC9772443 DOI: 10.3389/fpsyt.2022.1063722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Long-course (LC) antidepressants for the treatment of disorders of gut-brain interaction, such as refractory functional dyspepsia (rFD), pose patients at risk of antidepressant discontinuation syndrome (ADS). Short-course (SC) therapy of rapid-acting antidepressant may reduce discontinuation syndromes while maintaining efficacy for dyspeptic symptoms. However, the evidence-based research is lacking. This study aims to determine whether SC therapy with antidepressants could decrease the risk of ADS with comparable treatment efficacy to LC therapy in rFD. METHODS This randomized clinical trial with rFD patients was conducted at a tertiary hospital in China. Participants (N = 240) were randomly allocated to receive flupentixol-melitracen (FM) plus omeprazole therapy for 2 (SC group) or 4 (LC group) weeks, respectively. Scores for Leeds Dyspepsia Questionnaire (LDQ), Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 for Depression (PHQ-9) were assessed at baseline and every 2 weeks, ending at 4 weeks after treatment. ADS was assessed after drug cessation. Medication possession ratio (MPR) for FM was calculated. RESULTS The severity and incidence of ADS of patients in SC group were significantly lower than those in LC group (0.60 ± 0.62 vs. 1.71 ± 1.58 and 3.64 vs. 39.45%; both P < 0.0001). The MPR values for FM were significantly higher in patients of SC group than in LC group (P < 0.0001). Scores for LDQ, GAD-7 and PHQ-9 decreased in patients of both groups, and the symptom improvement in SC group was comparable to that in LC group after treatment. CONCLUSIONS Compared to 4-week FM therapy, the 2-week FM therapy reduces the risk of ADS with non-inferior treatment efficacy in patients with rFD. CLINICAL TRIAL REGISTRATION Clinical trials.gov, identifier NCT05099913.
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Affiliation(s)
- Qian-Qian Wang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li Cheng
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bi-Yu Wu
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ping Xu
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong-Yi Qiu
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Wang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiu-Juan Yan
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sheng-Liang Chen
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Senese NB, Rasenick MM. Antidepressants Produce Persistent G α s-Associated Signaling Changes in Lipid Rafts after Drug Withdrawal. Mol Pharmacol 2021; 100:66-81. [PMID: 34011569 DOI: 10.1124/molpharm.120.000226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/10/2021] [Indexed: 12/14/2022] Open
Abstract
Termination of antidepressant therapy often has negative consequences. Although symptoms of antidepressant withdrawal are widely recognized, the molecular processes that underlie them are not well characterized. We show that certain aspects of Gα s signaling remain suppressed after antidepressant withdrawal, even after others have reverted to baseline. Antidepressant treatment causes translocation of Gα s protein from lipid rafts to nonraft membrane regions. This results in augmented Gα s signaling, including facilitated activation of adenylyl cyclase and increased cAMP accumulation. Using CC6 or SK-N-SH cells and a lipid raft-localized cAMP sensor, we show that Gα s signaling is reduced in lipid rafts, even while signaling is enhanced elsewhere in the cell. These signaling changes mirror the changes in Gα s localization observed after antidepressant treatment. Furthermore, we show that suppression of Gα s signaling in lipid rafts persists at least 24 hours after cessation of antidepressant treatment. Gα s localization was quantified after membrane isolation and sequential detergent extraction. We show that suppression of lipid raft Gα s signaling persists for an extended time period after antidepressant withdrawal, whereas increased nonraft membrane Gα s signaling reverts partially or fully upon cessation of antidepressant treatment. Translocation of Gα s out of lipid rafts is also persistent. These events may reflect cellular adaptations to antidepressant treatment that contribute to antidepressant discontinuation syndromes and may aid in the discovery of new treatments and strategies to mitigate the symptoms of depression and antidepressant withdrawal. SIGNIFICANCE STATEMENT: This work explores, for the first time, the effects of antidepressants on Gα s signaling after drug withdrawal. This provides novel insight into the cellular and molecular processes affected by antidepressant drugs and their persistence after discontinuation of treatment.
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Affiliation(s)
- Nicolas B Senese
- Departments of Psychiatry and Physiology and Biophysics, University of Illinois Chicago, Chicago, Illinois, and Jesse Brown VA Medical Center, Chicago, Illinois
| | - Mark M Rasenick
- Departments of Psychiatry and Physiology and Biophysics, University of Illinois Chicago, Chicago, Illinois, and Jesse Brown VA Medical Center, Chicago, Illinois
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Rizkalla M, Kowalkowski B, Prozialeck WC. Antidepressant Discontinuation Syndrome: A Common but Underappreciated Clinical Problem. J Osteopath Med 2020; 120:2761944. [PMID: 32077900 DOI: 10.7556/jaoa.2020.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
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Forsman J, Taipale H, Masterman T, Tiihonen J, Tanskanen A. Adherence to psychotropic medication in completed suicide in Sweden 2006-2013: a forensic-toxicological matched case-control study. Eur J Clin Pharmacol 2019; 75:1421-1430. [PMID: 31218371 DOI: 10.1007/s00228-019-02707-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/04/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the influence of adherence to psychotropic medications upon the risk of completed suicide by comparing person-level prescriptions and postmortem toxicological findings among complete-suicide cases and non-suicide controls in Sweden 2006-2013. METHODS Using national registries with full coverage on dispensed prescriptions, results of medico-legal autopsies, causes of death, and diagnoses from inpatient care, estimated continuous drug use for 30 commonly prescribed psychotropic medications was compared with forensic-toxicological findings. Subjects who had died by suicide (cases) were matched (1:2) with subjects who had died of other causes (controls) for age, sex, and year of death. Odds ratios were calculated using logistic regression to estimate the risk of completed suicide conferred by partial adherence and non-adherence to pharmacotherapy. Adjustments were made for previous inpatient care and the ratio of initiated and discontinued dispensed prescriptions, a measure of the continued need of treatment preceding death. RESULTS In 5294 suicide cases and 9879 non-suicide controls, after adjusting for the dispensation ratio and other covariates, partial adherence and non-adherence to antipsychotics were associated with 6.7-fold and 12.4-fold risks of completed suicide, respectively, whereas corresponding risk estimates for antidepressant treatment were not statistically significant and corresponding risk increases for incomplete adherence to antidepressant treatment were lower (1.6-fold and 1.5-fold, respectively) and lacked statistical significance. CONCLUSION After adjustment for the need of treatment, biochemically verified incomplete adherence to antipsychotic pharmacotherapy was associated with markedly increased risks of completed suicide.
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Affiliation(s)
- Jonas Forsman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- National Board of Forensic Medicine, PO Box 4044, SE-141 04, Huddinge, Sweden.
| | - Heidi Taipale
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Thomas Masterman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- National Board of Forensic Medicine, PO Box 4044, SE-141 04, Huddinge, Sweden
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
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Demin KA, Sysoev M, Chernysh MV, Savva AK, Koshiba M, Wappler-Guzzetta EA, Song C, De Abreu MS, Leonard B, Parker MO, Harvey BH, Tian L, Vasar E, Strekalova T, Amstislavskaya TG, Volgin AD, Alpyshov ET, Wang D, Kalueff AV. Animal models of major depressive disorder and the implications for drug discovery and development. Expert Opin Drug Discov 2019; 14:365-378. [PMID: 30793996 DOI: 10.1080/17460441.2019.1575360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Depression is a highly debilitating psychiatric disorder that affects the global population and causes severe disabilities and suicide. Depression pathogenesis remains poorly understood, and the disorder is often treatment-resistant and recurrent, necessitating the development of novel therapies, models and concepts in this field. Areas covered: Animal models are indispensable for translational biological psychiatry, and markedly advance the study of depression. Novel approaches continuously emerge that may help untangle the disorder heterogeneity and unclear categories of disease classification systems. Some of these approaches include widening the spectrum of model species used for translational research, using a broader range of test paradigms, exploring new pathogenic pathways and biomarkers, and focusing more closely on processes beyond neural cells (e.g. glial, inflammatory and metabolic deficits). Expert opinion: Dividing the core symptoms into easily translatable, evolutionarily conserved phenotypes is an effective way to reevaluate current depression modeling. Conceptually novel approaches based on the endophenotype paradigm, cross-species trait genetics and 'domain interplay concept', as well as using a wider spectrum of model organisms and target systems will enhance experimental modeling of depression and antidepressant drug discovery.
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Affiliation(s)
- Konstantin A Demin
- a Institute of Experimental Medicine , Almazov National Medical Research Centre , St. Petersburg , Russia.,b Institute of Translational Biomedicine , St. Petersburg State University , St. Petersburg , Russia
| | - Maxim Sysoev
- c Laboratory of Preclinical Bioscreening , Russian Research Center for Radiology and Surgical Technologies , St. Petersburg , Russia.,d Institute of Experimental Medicine , St. Petersburg , Russia
| | - Maria V Chernysh
- b Institute of Translational Biomedicine , St. Petersburg State University , St. Petersburg , Russia
| | - Anna K Savva
- e Faculty of Biology , St. Petersburg State University , St. Petersburg , Russia
| | | | | | - Cai Song
- h Research Institute of Marine Drugs and Nutrition , Guangdong Ocean University , Zhanjiang , China.,i Marine Medicine Development Center, Shenzhen Institute , Guangdong Ocean University , Shenzhen , China
| | - Murilo S De Abreu
- j Bioscience Institute , University of Passo Fundo (UPF) , Passo Fundo , Brazil
| | | | - Matthew O Parker
- l Brain and Behaviour Lab , School of Pharmacy and Biomedical Science, University of Portsmouth , Portsmouth , UK
| | - Brian H Harvey
- m Center of Excellence for Pharmaceutical Sciences , Division of Pharmacology, School of Pharmacy, North-West University , Potchefstroom , South Africa
| | - Li Tian
- n Institute of Biomedicine and Translational Medicine , University of Tartu , Tartu , Estonia
| | - Eero Vasar
- n Institute of Biomedicine and Translational Medicine , University of Tartu , Tartu , Estonia
| | - Tatyana Strekalova
- o Laboratory of Psychiatric Neurobiology, Institute of Molecular Medicine, and Department of Normal Physiology , Sechenov First Moscow State Medical University , Moscow , Russia.,p Laboratory of Cognitive Dysfunctions , Institute of General Pathology and Pathophysiology , Moscow , Russia.,q Department of Neuroscience , Maastricht University , Maastricht , The Netherlands
| | | | - Andrey D Volgin
- g The International Zebrafish Neuroscience Research Consortium (ZNRC) , Slidell , LA , USA.,r Scientific Research Institute of Physiology and Basic Medicine , Novosibirsk , Russia
| | - Erik T Alpyshov
- s School of Pharmacy , Southwest University , Chongqing , China
| | - Dongmei Wang
- s School of Pharmacy , Southwest University , Chongqing , China
| | - Allan V Kalueff
- s School of Pharmacy , Southwest University , Chongqing , China.,t Almazov National Medical Research Centre , St. Petersburg , Russia.,u Ural Federal University , Ekaterinburg , Russia.,v Granov Russian Research Center of Radiology and Surgical Technologies , St. Petersburg , Russia.,w Laboratory of Biological Psychiatry, Institute of Translational Biomedicine , St. Petersburg State University , St. Petersburg , Russia.,x Laboratory of Translational Biopsychiatry , Scientific Research Institute of Physiology and Basic Medicine , Novosibirsk , Russia.,y ZENEREI Institute , Slidell , LA , USA.,z The International Stress and Behavior Society (ISBS), US HQ , New Orleans , LA , USA
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Zebrafish models of epigenetic regulation of CNS functions. Brain Res Bull 2018; 142:344-351. [DOI: 10.1016/j.brainresbull.2018.08.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/22/2018] [Accepted: 08/30/2018] [Indexed: 12/12/2022]
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