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Amanzade A, Khakpai F, Zarrindast MR. Synergistic antidepressant-like effect of citicoline and CB 1 agonist in male mice. Psychopharmacology (Berl) 2024; 241:753-766. [PMID: 38383902 DOI: 10.1007/s00213-023-06507-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/14/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND The endocannabinoid system plays a key role in the control of many emotional-correlated reactions such as stress, depressed mood, and anxiety. Moreover, citicoline has neuroprotective properties and indicates beneficial effects in the treatment of depressive problems. Acute restraint stress (ARS) is an experimental model used for the induction of rodent models of depression. OBJECTIVE This research was designed to assess the effects of intracerebroventricular (i.c.v.) injection of cannabinoid CB1 receptor agents on citicoline-induced response to depression-like behaviors in the non-acute restraint stress (NARS) and ARS mice. METHODS For i.c.v. microinjection, a guide cannula was implanted in the left lateral ventricle of male mice. The ARS model was carried out by movement restraint for 4 h. Depression-related behaviors were assessed by forced swimming test (FST), tail suspension test (TST), and splash test. RESULTS The results exhibited that the ARS mice showed depressive-like responses. I.c.v. infusion of ACPA (1 μg/mouse) induced an antidepressant-like effect in the NARS and ARS mice by reduction of immobility time in the FST and TST as well as enhancement of grooming activity time in the splash test. On the other hand, i.c.v. microinjection of AM251 dose-dependently (0.5 and 1 μg/mouse) induced a depressant-like effect in the NARS mice. I.p. injection of citicoline (80 mg/kg) induced an antidepressant-like response in the NARS and ARS mice. Furthermore, ACPA (0.25 μg/mouse, i.c.v.) potentiated the antidepressant-like response induced by citicoline (20 mg/kg, i.p.) in the NARS and ARS mice. However, AM251 (0.25 μg/mouse, i.c.v.) reversed the antidepressant-like effect produced by the citicoline (80 mg/kg, i.p.) in the NARS and ARS mice. Interestingly, our results indicated a synergistic effect between citicoline and ACPA based on the induction of an antidepressant-like effect in the NARS and ARS mice. CONCLUSIONS These results suggested an interaction between citicoline and cannabinoid CB1 receptors on the modulation of depression-like behaviors in the NARS and ARS mice.
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Affiliation(s)
- Aysan Amanzade
- Department of Pharmacology and Toxicology, Faculty of Pharmacy and Pharmaceutical Sciences, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Fatemeh Khakpai
- Department of Physiology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mohammad-Reza Zarrindast
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.
- Institute for Cognitive Science Studies (ICSS), Tehran, Iran.
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Amnzade A, Zarrindast MR, Khakpai F. Additive anxiolytic-like effect of citicoline and ACPA in the non-acute restraint stress (NARS) and acute restraint stress (ARS) mice. Physiol Behav 2024; 277:114506. [PMID: 38432442 DOI: 10.1016/j.physbeh.2024.114506] [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: 09/15/2023] [Revised: 02/08/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
The cannabinoid system plays a key role in stress-related emotional symptoms such as anxiety. Citicoline is a supplemental substance with neuroprotective properties that alleviates anxiety-related behaviors. There is a relation between the actions of cannabinoids and cholinergic systems. So, we decided to evaluate the effects of intracerebroventricular (i.c.v.) infusion of cannabinoid CB1 receptor agents on citicoline-produced response to anxiety-like behaviors in the non-acute restraint stress (NARS) and acute restraint stress (ARS) mice. For i.c.v. microinjection of drugs, a guide cannula was inserted in the left lateral ventricle. ARS was induced by movement restraint for 4 h. Anxiety-related behaviors were assessed using an elevated plus maze (EPM). The results showed that induction of ARS for 4 h decreased the percentage of time spent in the open arms (%OAT) and the percentage of entries to the open arms (%OAE) without affecting locomotor activity, showing anxiogenic-like behaviors. i.c.v. infusion of ACPA (1 µg/mouse) induced an anxiolytic-like effect due to the enhancement of %OAT in the NARS and ARS mice. Nonetheless, i.c.v. microinjection of AM251 (1 µg/mouse) decreased %OAT in the NARS and ARS mice which suggested an anxiogenic-like response. Intraperitoneal (i.p.) administration of citicoline (80 mg/kg) induced an anxiolytic-like effect by the augmentation of %OAT in the ARS mice. Furthermore, when ACPA and citicoline were co-administrated, ACPA potentiated the anxiolytic-like effect induced by citicoline in the NARS and ARS mice. On the other hand, when AM251 and the citicoline were co-injected, AM251 reversed the anxiolytic-like response induced by the citicoline in the NARS and ARS mice. The results of this research exhibited an additive effect between citicoline and ACPA on the induction of anxiolytic-like response in the NARS and ARS mice. Our results indicated an interaction between citicoline and cannabinoid CB1 receptor drugs on the control of anxiety-like behaviors in the NARS and ARS mice.
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Affiliation(s)
- Aysan Amnzade
- Department of Pharmacology and Toxicology, Faculty of Pharmacy and Pharmaceutical Sciences, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mohammad-Reza Zarrindast
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran; Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Fatemeh Khakpai
- Department of Physiology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
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Hersi M, Corace K, Hamel C, Esmaeilisaraji L, Rice D, Dryburgh N, Skidmore B, Garber G, Porath A, Willows M, MacPherson P, Sproule B, Flores-Aranda J, Dickey C, Hutton B. Psychosocial and pharmacologic interventions for problematic methamphetamine use: Findings from a scoping review of the literature. PLoS One 2023; 18:e0292745. [PMID: 37819931 PMCID: PMC10566716 DOI: 10.1371/journal.pone.0292745] [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: 03/02/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023] Open
Abstract
RATIONALE Methamphetamine use and related harms have risen at alarming rates. While several psychosocial and pharmacologic interventions have been described in the literature, there is uncertainty regarding the best approach for the management of methamphetamine use disorder (MUD) and problematic methamphetamine use (PMU). We conducted a scoping review of recent systematic reviews (SR), clinical practice guidelines (CPG), and primary controlled studies of psychosocial and pharmacologic treatments for MUD/PMU. METHODS Guided by an a priori protocol, electronic database search updates (e.g., MEDLINE, Embase) were performed in February 2022. Screening was performed following a two-stage process, leveraging artificial intelligence to increase efficiency of title and abstract screening. Studies involving individuals who use methamphetamine, including key subgroups (e.g. those with mental health comorbidities; adolescents/youths; gay, bisexual, and other men who have sex with men) were sought. We examined evidence related to methamphetamine use, relapse, use of other substances, risk behaviors, mental health, harms, and retention. Figures, tables and descriptive synthesis were used to present findings from the identified literature. RESULTS We identified 2 SRs, one CPG, and 54 primary studies reported in 69 publications that met our eligibility criteria. Amongst SRs, one concluded that psychostimulants had no effect on methamphetamine abstinence or treatment retention while the other reported no effect of topiramate on cravings. The CPG strongly recommended psychosocial interventions as well as self-help and family support groups for post-acute management of methamphetamine-related disorders. Amongst primary studies, many interventions were assessed by only single studies; contingency management was the therapy most commonly associated with evidence of potential effectiveness, while bupropion and modafinil were analogously the most common pharmacologic interventions. Nearly all interventions showed signs of potential benefit on at least one methamphetamine-related outcome measure. DISCUSSION This scoping review provides an overview of available interventions for the treatment of MUD/PMU. As most interventions were reported by a single study, the effectiveness of available interventions remains uncertain. Primary studies with longer durations of treatment and follow-up, larger sample sizes, and of special populations are required for conclusive recommendations of best approaches for the treatment of MUD/PMU.
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Affiliation(s)
- Mona Hersi
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kim Corace
- Ottawa Hospital Research Institute, Ottawa, Canada
- Substance Use and Concurrent Disorders Program, The Royal Ottawa Mental Health Centre, Ottawa, Ontario Canada
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Danielle Rice
- Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Nicole Dryburgh
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | | | - Gary Garber
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Amy Porath
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, Canada
| | - Melanie Willows
- Substance Use and Concurrent Disorders Program, The Royal Ottawa Mental Health Centre, Ottawa, Ontario Canada
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Paul MacPherson
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Beth Sproule
- Department of Pharmacy, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Chandlee Dickey
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
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Payamshad S, Khakpai F, Nasehi M, Zarrindast MR. Effect of citicoline and transcranial direct current stimulation on depressive-like behaviors in mice & quot. Behav Brain Res 2023; 450:114495. [PMID: 37182742 DOI: 10.1016/j.bbr.2023.114495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/16/2023]
Abstract
Recent investigations revealed the positive role of transcranial direct current stimulation (tDCS) in the treatment of depressive-like behavior & quot. Citicoline is a dietary supplement. It acts as a neuroprotective factor for the treatment of neurological disorders. The aim of this research was to evaluate a possible interaction between tDCS and citicoline on the modulation of depressive-like behavior s & quot in male mice. For tDCS, an electrode was surgically implanted in the left prefrontal of the brain of male mice & quot. Acute restraint stress was induced by movement restraint for 4h. Locomotor activity and depressive-like behaviors & quot were examined by open field test (OFT), forced swimming test (FST), and tail suspension test (TST). The results indicated that the intraperitoneal (i.p.) administration of citicoline, left prefrontal anodal tDCS, and co-treatment of citicoline and tDCS had no significant effect on locomotor activity. I.p. injection of citicoline (30mg/kg) decreased immobility time in the FST and TST, showing an antidepressant-like effect & quot. Moreover, the application of left prefrontal anodal tDCS (0.2mA) for 20min induced antidepressant-like effect & quot by reducing immobility time in the FST and TST. Co-administration of citicoline (7 and 15mg/kg) along with tDCS (0.1mA) decreased immobility time in the FST and TST, indicating an antidepressant-like effect & quot. Therefore, it can be concluded that administration of citicoline in combination with tDCS enhanced the efficacy of tDCS for remedy of depressive-like behaviors & quot.
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Affiliation(s)
- Sara Payamshad
- Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Fatemeh Khakpai
- Department of Physiology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mohammad Nasehi
- Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Mohammad-Reza Zarrindast
- Institute for Cognitive Science Studies (ICSS), Tehran, Iran; Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.
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Fischler PV, Soyka M, Seifritz E, Mutschler J. Off-label and investigational drugs in the treatment of alcohol use disorder: A critical review. Front Pharmacol 2022; 13:927703. [PMID: 36263121 PMCID: PMC9574013 DOI: 10.3389/fphar.2022.927703] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Compounds known to be successful in the treatment of alcohol use disorder include the aversive agent, Disulfiram, the glutamatergic NMDA receptor antagonist, Acamprosate, and the opioid receptor antagonists, Naltrexone and Nalmefene. Although all four are effective in maintaining abstinence or reduction of alcohol consumption, only a small percentage of patients receive pharmacological treatment. In addition, many other medications have been investigated for their therapeutic potential in the treatment of alcohol use disorder. In this review we summarize and compare Baclofen, Gabapentin, Topiramate, Ondansetron, Varenicline, Aripiprazole, Quetiapine, Clozapine, Antidepressants, Lithium, Neuropeptide Y, Neuropeptide S, Corticotropin-releasing factor antagonists, Oxytocin, PF-05190457, Memantine, Ifenprodil, Samidorphan, Ondelopran, ABT-436, SSR149415, Mifepristone, Ibudilast, Citicoline, Rimonabant, Surinabant, AM4113 and Gamma-hydroxybutyrate While some have shown promising results in the treatment of alcohol use disorder, others have disappointed and should be excluded from further investigation. Here we discuss the most promising results and highlight medications that deserve further preclinical or clinical study. Effective, patient-tailored treatment will require greater understanding provided by many more preclinical and clinical studies.
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Affiliation(s)
- Pascal Valentin Fischler
- Department for Gynecology and Obstetrics, Women’s Clinic Lucerne, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- *Correspondence: Pascal Valentin Fischler,
| | - Michael Soyka
- Psychiatric Hospital University of Munich, Munich, Germany
| | - Erich Seifritz
- Director of the Clinic for Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Clinic Zürich, Zürich, Switzerland
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Preuss UW, Schaefer M, Born C, Grunze H. Bipolar Disorder and Comorbid Use of Illicit Substances. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111256. [PMID: 34833474 PMCID: PMC8623998 DOI: 10.3390/medicina57111256] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 02/05/2023]
Abstract
Substance use disorders (SUD) are highly prevalent in bipolar disorder (BD) and significantly affect clinical outcomes. Incidence and management of illicit drug use differ from alcohol use disorders, nicotine use of behavioral addictions. It is not yet clear why people with bipolar disorder are at higher risk of addictive disorders, but recent data suggest common neurobiological and genetic underpinnings and epigenetic alterations. In the absence of specific diagnostic instruments, the clinical interview is conducive for the diagnosis. Treating SUD in bipolar disorder requires a comprehensive and multidisciplinary approach. Most treatment trials focus on single drugs, such as cannabis alone or in combination with alcohol, cocaine, or amphetamines. Synopsis of data provides limited evidence that lithium and valproate are effective for the treatment of mood symptoms in cannabis users and may reduce substance use. Furthermore, the neuroprotective agent citicoline may reduce cocaine consumption in BD subjects. However, many of the available studies had an open-label design and were of modest to small sample size. The very few available psychotherapeutic trials indicate no significant differences in outcomes between BD with or without SUD. Although SUD is one of the most important comorbidities in BD with a significant influence on clinical outcome, there is still a lack both of basic research and clinical trials, allowing for evidence-based and specific best practices.
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Affiliation(s)
- Ulrich W. Preuss
- Klinik für Psychiatrie, Psychotherapie und Psychosomatische Medizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640 Ludwigsburg, Germany
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Martin-Luther-Universität, Halle-Wittenberg, Julius-Kühn-Str. 7, 06112 Halle/Saale, Germany
- Correspondence:
| | - Martin Schaefer
- Klinik für Psychiatrie, Psychotherapie, Psychosomatik und Suchtmedizin, Evang. Kliniken Essen-Mitte, Henricistr. 92, 45136 Essen, Germany;
- Klinik für Psychiatrie und Psychotherapie (CCM), Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Christoph Born
- Psychiatrie Schwäbisch Hall, 74523 Schwäbisch Hall, Germany; (C.B.); (H.G.)
- Campus Nuremberg-Nord, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall, 74523 Schwäbisch Hall, Germany; (C.B.); (H.G.)
- Campus Nuremberg-Nord, Paracelsus Medical University, 90419 Nuremberg, Germany
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Khakpai F, Ramezanikhah M, Valizadegan F, Zarrindast MR. Synergistic effect between imipramine and citicoline upon induction of analgesic and antidepressant effects in mice. Neurosci Lett 2021; 760:136095. [PMID: 34216716 DOI: 10.1016/j.neulet.2021.136095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 06/11/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022]
Abstract
Imipramine is a tricyclic antidepressant (TCA) drug that is sometimes used to treat neuropathic pain. Citicoline is a dietary supplement that has been used as a neuroprotective agent for neurological disorders. Probable interaction between imipramine and citicoline on pain and depression behaviors was examined in mice using a tail-flick test, open field test (OFT), forced swimming test (FST), and tail suspension test (TST). The results indicated that the intraperitoneal (i.p.) administration of citicoline (50 mg/kg) induced analgesic and antidepressant-like behaviors in mice. Similarly, i.p. injection of imipramine (5 mg/kg) induced dose-dependent anti-nociceptive and anti-depressive effects. Co-administration of different doses of imipramine (1.25, 2.5, and 5 mg/kg) along with an ineffective dose of citicoline (6.25 mg/kg) increased tail-flick latency and decreased immobility time in the FST, suggesting an analgesic and antidepressant-like behaviors. Interestingly, there is a synergistic effect between imipramine and citicoline upon the induction of analgesic and antidepressant effects. All doses of the drugs had no significant effect on the locomotor activity. Based on these results, it can be concluded that the administration of citicoline (as an adjuvant drug) in combination with imipramine increased the efficacy of TCA drugs for modulation of pain and depression behaviors.
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Affiliation(s)
- Fatemeh Khakpai
- Cognitive and Neuroscience Research Center (CNRC), Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mahsa Ramezanikhah
- Department of Biology, Faculty of Basic Sciences, University of Mazandaran, Babolsar, Iran
| | - Farhad Valizadegan
- Department of Biology, Faculty of Basic Sciences, University of Mazandaran, Babolsar, Iran
| | - Mohammad-Reza Zarrindast
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Stokes PRA, Jokinen T, Amawi S, Qureshi M, Husain MI, Yatham LN, Strang J, Young AH. Pharmacological Treatment of Mood Disorders and Comorbid Addictions: A Systematic Review and Meta-Analysis: Traitement Pharmacologique des Troubles de L'humeur et des Dépendances Comorbides: Une Revue Systématique et une Méta-Analyse. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:749-769. [PMID: 32302221 PMCID: PMC7564307 DOI: 10.1177/0706743720915420] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Addiction comorbidity is an important clinical challenge in mood disorders, but the best way of pharmacologically treating people with mood disorders and addictions remains unclear. The aim of this study was to assess the efficacy of pharmacological treatments for mood and addiction symptoms in people with mood disorders and addiction comorbidity. METHODS A systematic search of placebo-controlled randomized controlled trials investigating the effects of pharmacological treatments in people with bipolar disorder (BD) or major depressive disorder (MDD), and comorbid addictions was performed. Treatment-related effects on mood and addiction measures were assessed in a meta-analysis, which also estimated risks of participant dropout and adverse effects. RESULTS A total of 32 studies met systematic review inclusion criteria. Pharmacological therapy was more effective than placebo for improving manic symptoms (standardized mean difference [SMD] = -0.15; 95% confidence interval [95% CI], -0.29 to -0.02; P = 0.03) but not BD depressive symptoms (SMD = -0.09; 95% CI, -0.22 to 0.03; P = 0.15). Quetiapine significantly improved manic symptoms (SMD = -0.23; 95% CI, -0.39 to -0.06; P = 0.008) but not BD depressive symptoms (SMD = -0.07; 95% CI, -0.23 to 0.10; P = 0.42). Pharmacological therapy was more effective than placebo for improving depressive symptoms in MDD (SMD = -0.16; 95% CI, -0.30 to -0.03; P = 0.02). Imipramine improved MDD depressive symptoms (SMD = -0.58; 95% CI, -1.03 to -0.13; P = 0.01) but Selective serotonin reuptake Inhibitors (SSRI)-based treatments had no effect (SMD = -0.06; 95% CI, -0.30 to 0.17; P = 0.60). Pharmacological treatment improved the odds of alcohol abstinence in MDD but had no effects on opiate abstinence. CONCLUSIONS Pharmacological treatments were significantly better than placebo in improving manic symptoms, MDD depressive symptoms, and alcohol abstinence but were not better for bipolar depression symptoms. Importantly, quetiapine was not more effective than placebo in improving bipolar depression symptoms nor were SSRI's for the treatment of MDD depression. Our findings highlight the need for further high-quality clinical trials of treatments for mood disorders and comorbid addictions.
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Affiliation(s)
- Paul R A Stokes
- Department of Psychological Medicine, Centre for Affective Disorders, 34426Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.,South London and Maudsley NHS Foundation Trust, Beckenham, Kent, United Kingdom.,National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) at South London Maudsley Foundation Trust and King's College London, United Kingdom
| | - Tahir Jokinen
- Department of Psychological Medicine, Centre for Affective Disorders, 34426Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Sami Amawi
- Department of Psychological Medicine, Centre for Affective Disorders, 34426Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Mutahira Qureshi
- South London and Maudsley NHS Foundation Trust, Beckenham, Kent, United Kingdom
| | - Muhammad Ishrat Husain
- Department of Psychiatry, University of Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | | | - John Strang
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) at South London Maudsley Foundation Trust and King's College London, United Kingdom.,Department of Addictions, 34426Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Allan H Young
- Department of Psychological Medicine, Centre for Affective Disorders, 34426Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.,South London and Maudsley NHS Foundation Trust, Beckenham, Kent, United Kingdom.,National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) at South London Maudsley Foundation Trust and King's College London, United Kingdom
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9
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Corallo F, Scarfì C, Arcadi FA, Formica C, Di Cara M, Palmeri R, Romeo L, Lo Buono V, Bramanti P, Marino S, De Cola MC. Role of functional pharmacological therapy in post-stroke depression: a narrative review. J Int Med Res 2020; 48:300060520950557. [PMID: 33081542 PMCID: PMC7588775 DOI: 10.1177/0300060520950557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective We conducted a narrative review to investigate whether antidepressant therapy, including the use of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) or the use of supportive drugs (i.e., citicoline or choline alfoscerate) as a substitute for antidepressant therapy, reduces depression in patients with cerebrovascular diseases. Methods A systematic search of the PubMed and Web of Science databases was performed, including review articles and other studies to identify additional citations. Only 4 of 1566 publications met the inclusion/exclusion criteria and were selected. Results Studies showed that post-stroke depression (PSD) could be treated with antidepressant therapy, as well as supportive drugs such as citicoline or choline alfoscerate, which may have antidepressant effects. Conclusions The findings support the efficacy of citicoline as a treatment for depression. Studies aimed to discover the characteristics of these psychostimulants in relation to PSD treatment should be performed.
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Affiliation(s)
- Francesco Corallo
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Chiara Scarfì
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | | | - Caterina Formica
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Marcella Di Cara
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Rosanna Palmeri
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Laura Romeo
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Viviana Lo Buono
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
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Balanzá-Martínez V, Shansis FM, Tatay-Manteiga A, López-García P. Diet and Neurocognition in Mood Disorders - An Overview of the Overlooked. Curr Pharm Des 2020; 26:2353-2362. [PMID: 32188376 DOI: 10.2174/1381612826666200318152530] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/27/2020] [Indexed: 01/02/2023]
Abstract
Bipolar disorder and major depression are associated with significant disability, morbidity, and reduced life expectancy. People with mood disorders have shown higher ratios of unhealthy lifestyle choices, including poor diet quality and suboptimal nutrition. Diet and nutrition impact on brain /mental health, but cognitive outcomes have been less researched in psychiatric disorders. Neurocognitive dysfunction is a major driver of social dysfunction and a therapeutic target in mood disorders, although effective cognitive-enhancers are currently lacking. This narrative review aimed to assess the potential cognitive benefits of dietary and nutritional interventions in subjects diagnosed with mood disorders. Eight clinical trials with nutrients were identified, whereas none involved dietary interventions. Efficacy to improve select cognitive deficits has been reported, but results are either preliminary or inconsistent. Methodological recommendations for future cognition trials in the field are advanced. Current evidence and future views are discussed from the perspectives of precision medicine, clinical staging, nutritional psychiatry, and the brain-gut-microbiota axis.
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Affiliation(s)
- Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry, Department of Medicine, University of Valencia, Valencia, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Flavio M Shansis
- Centro de Pesquisa Translacional en Transtorno del Humor y Suicidio (CEPETTHS), Programa de Pos Grado en Ciencias Medicas, Universidade do Vale do Taquari (Univates), Lajeado, Brazil
| | | | - Pilar López-García
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Psychiatry. Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
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11
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Chan B, Freeman M, Kondo K, Ayers C, Montgomery J, Paynter R, Kansagara D. Pharmacotherapy for methamphetamine/amphetamine use disorder-a systematic review and meta-analysis. Addiction 2019; 114:2122-2136. [PMID: 31328345 DOI: 10.1111/add.14755] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/08/2019] [Accepted: 07/16/2019] [Indexed: 12/19/2022]
Abstract
AIMS Addiction to methamphetamine/amphetamine (MA/A) is a major public health problem. Currently there are no pharmacotherapies for MA/A use disorder that have been approved for use by the US Food and Drug Administration or the European Medicines Agency. We reviewed the effectiveness of pharmacotherapy for MA/A use disorder to assess the quality, publication bias and overall strength of the evidence. METHODS Systematic review and meta-analysis. We searched multiple data sources (MEDLINE, PsycINFO and Cochrane Library) to April 2019 for systematic reviews (SRs) and randomized controlled trials (RCTs). Included studies recruited adults who had MA/A use disorder; sample sizes ranged from 19 to 229 participants. Outcomes of interest were abstinence, defined as 3 or more consecutive weeks with negative urine drug screens (UDS); overall use, analyzed as the proportion of MA/A negative UDS specimens; and treatment retention. One SR of pharmacotherapies for MA/A use disorder and 17 additional RCTs met our inclusion criteria encompassing 17 different drugs (antidepressants, antipsychotics, psychostimulants, anticonvulsants and opioid antagonists). We combined the findings of trials with comparable interventions and outcome measures in random-effects meta-analyses. We assessed quality, publication bias and the strength of evidence for each outcome using standardized criteria. RESULTS There was low-strength evidence from two RCTs that methylphenidate may reduce MA/A use: 6.5 versus 2.8% MA/A-negative UDS in one study (n = 34, P = 0.008) and 23 versus 16% in another study (n = 54, P = 0.047). Antidepressants as a class had no statistically significant effect on abstinence or retention on the basis of moderate strength evidence. Studies of anticonvulsants, antipsychotics (aripiprazole), opioid antagonists (naltrexone), varenicline and atomoxetine provided either low-strength or insufficient evidence of no effect on the outcomes of interest. Many of the studies had high or unclear risk of bias. CONCLUSIONS On the basis of low- to moderate-strength evidence, most medications evaluated for methamphetamine/amphetamine use disorder have not shown a statistically significant benefit. However, there is low-strength evidence that methylphenidate may reduce use.
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Affiliation(s)
- Brian Chan
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR, USA.,Central City Concern, Portland, OR, USA
| | - Michele Freeman
- Evidence-based Synthesis Program Center, VA Portland Health Care System, Portland, USA
| | - Karli Kondo
- Evidence-based Synthesis Program Center, VA Portland Health Care System, Portland, USA
| | - Chelsea Ayers
- Evidence-based Synthesis Program Center, VA Portland Health Care System, Portland, USA
| | - Jessica Montgomery
- Evidence-based Synthesis Program Center, VA Portland Health Care System, Portland, USA
| | - Robin Paynter
- Evidence-based Synthesis Program Center, VA Portland Health Care System, Portland, USA
| | - Devan Kansagara
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR, USA.,Evidence-based Synthesis Program Center, VA Portland Health Care System, Portland, USA.,Department of Medicine, VA Portland Health Care System, Portland, OR, USA
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12
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Coles AS, Sasiadek J, George TP. Pharmacotherapies for co-occurring substance use and bipolar disorders: A systematic review. Bipolar Disord 2019; 21:595-610. [PMID: 31077521 DOI: 10.1111/bdi.12794] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Substance use disorders (SUDs), including those for alcohol, stimulants, tobacco, opioids and cannabis, in patients with bipolar disorder are a major clinical and public health problem, and are present in the majority of these patients. Nonetheless, the development of effective pharmacological treatments for co-occurring SUDs in bipolar illness have not been well-developed and may be an important practical reason for the reduced effectiveness of these medications in community practice. METHODS We conducted a systematic review of the literature (PubMed, Medline, Google Scholar), and identified N = 29 clinical studies, which evaluated both mental health and SUD outcomes in patients with co-occurring bipolar disorders and SUDs. RESULTS Our findings suggest the potential of valproate sodium and lamotrigine as preferred pharmacological agents for the treatment of co-occurring psychiatric and substance use outcomes in these patients. However, many of the reviewed studies are of open-label designs and of modest sample sizes. CONCLUSIONS Thus, given the gaps in our knowledge, recommendations for treatment of this common and important co-morbidity are preliminary. Accordingly, the conduct of larger, randomized controlled trials for this co-morbidity is clearly needed.
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Affiliation(s)
- Alexandria S Coles
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Julia Sasiadek
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tony P George
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Division of Brain and Therapeutics, Department of Psychiatry, Institute of Medical Sciences (IMS), University of Toronto, Toronto, ON, Canada
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13
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Soares E, Pereira FC. Pharmacotherapeutic strategies for methamphetamine use disorder: mind the subgroups. Expert Opin Pharmacother 2019; 20:2273-2293. [PMID: 31671001 DOI: 10.1080/14656566.2019.1681970] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction: Drug use related deaths are increasing and the lack of effective treatment for psychostimulants can be largely held responsible. Particularly, no pharmacotherapy is approved for methamphetamine (METH) use disorder despite decades of research. Only psychosocial interventions are clinically used, with limited long-term recovery and relapse.Areas covered: This review aims to select and describe the most relevant findings to date. Selected clinical trials were found in PubMed using the following keywords ('methamphetamine') and ('addiction' OR 'withdrawal' OR 'treatment' OR 'pharmacotherapy'). Randomized placebo-controlled trials enrolling treatment-seeking METH-dependent subjects and inherent secondary analysis were included.Expert opinion: Overall, end-of-treatment abstinence, reduced METH use or lower relapse rates were seen on METH dependent subgroups or attained significance only following post hoc analysis, irrespective of the medication tested. For example, light and heavy METH users seem to respond differently to pharmacotherapy. This together with the heterogeneous nature of the METH dependent population strongly suggests that some drugs herein described (e.g. mirtazapine, methylphenidate) should be further tested in clinical trials focused on subgroups. Lastly, objective measures, such as urinalysis, are mandatory to include in clinical trials and early treatment response and/or medication compliance should be carefully monitored and considered as predictors of success/failure.
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Affiliation(s)
- Edna Soares
- Institute of Pharmacology and Experimental Therapeutics/iCBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Neuroscience, Vision and Brain Diseases, CNC.IBILI-University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Frederico C Pereira
- Institute of Pharmacology and Experimental Therapeutics/iCBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Neuroscience, Vision and Brain Diseases, CNC.IBILI-University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
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14
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Dulawa SC, Janowsky DS. Cholinergic regulation of mood: from basic and clinical studies to emerging therapeutics. Mol Psychiatry 2019; 24:694-709. [PMID: 30120418 PMCID: PMC7192315 DOI: 10.1038/s41380-018-0219-x] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/06/2018] [Accepted: 07/09/2018] [Indexed: 12/16/2022]
Abstract
Mood disorders are highly prevalent and are the leading cause of disability worldwide. The neurobiological mechanisms underlying depression remain poorly understood, although theories regarding dysfunction within various neurotransmitter systems have been postulated. Over 50 years ago, clinical studies suggested that increases in central acetylcholine could lead to depressed mood. Evidence has continued to accumulate suggesting that the cholinergic system has a important role in mood regulation. In particular, the finding that the antimuscarinic agent, scopolamine, exerts fast-onset and sustained antidepressant effects in depressed humans has led to a renewal of interest in the cholinergic system as an important player in the neurochemistry of major depression and bipolar disorder. Here, we synthesize current knowledge regarding the modulation of mood by the central cholinergic system, drawing upon studies from human postmortem brain, neuroimaging, and drug challenge investigations, as well as animal model studies. First, we describe an illustrative series of early discoveries which suggest a role for acetylcholine in the pathophysiology of mood disorders. Then, we discuss more recent studies conducted in humans and/or animals which have identified roles for both acetylcholinergic muscarinic and nicotinic receptors in different mood states, and as targets for novel therapies.
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Affiliation(s)
- Stephanie C. Dulawa
- Department of Psychiatry, University of California at San Diego,Corresponding author: Stephanie Dulawa, Ph.D., Associate Professor in Psychiatry, University of California San Diego, 9500 Gilman Drive, Mailcode 0804, La Jolla, CA 92093-0804, USA ()
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15
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Dome P, Tombor L, Lazary J, Gonda X, Rihmer Z. Natural health products, dietary minerals and over-the-counter medications as add-on therapies to antidepressants in the treatment of major depressive disorder: a review. Brain Res Bull 2019; 146:51-78. [DOI: 10.1016/j.brainresbull.2018.12.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/04/2018] [Accepted: 12/26/2018] [Indexed: 12/23/2022]
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16
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Brown ES, Van Enkevort E, Kulikova A, Escalante C, Nakamura A, Ivleva EI, Holmes T. A Randomized, Double-Blind, Placebo-Controlled Trial of Citicoline in Patients with Alcohol Use Disorder. Alcohol Clin Exp Res 2018; 43:317-323. [PMID: 30457668 DOI: 10.1111/acer.13928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alcohol use disorder is a major societal and individual burden that exacerbates health outcomes, decreases quality of life, and negatively affects U.S. healthcare spending. Although pharmacological treatments are available for alcohol use disorder, many of them are limited by small effect sizes and used infrequently. Citicoline is a widely available over-the-counter supplement with a favorable side effect profile. It acts through cholinergic pathways and phospholipid metabolism. The current report examines the effect of oral citicoline on alcohol use, craving, depressive symptoms, and cognitive outcomes in individuals with alcohol use disorder. METHODS A 12-week, randomized, double-blind, parallel-group, placebo-controlled, pilot study of citicoline (titrated to 2,000 mg/d) in 62 adults (age 18 to 75) with alcohol use disorder was conducted. Alcohol use, such as number of drinking days, amount used, and number of heavy drinking days, was assessed using the Timeline Followback method and liver enzymes, while alcohol craving was measured using the Penn Alcohol Craving Scale. A neurocognitive battery (e.g., Rey Auditory Verbal Learning Test) and depressive symptoms scale (e.g., Inventory of Depressive Symptomatology Self-Report) scores were also collected. Data were analyzed using a random regression analysis. RESULTS The primary outcome analysis was conducted in the intent-to-treat sample and consisted of 55 participants (78.2% men and 21.8% women, mean age of 46.47 ± 9.15 years). In the assessment period, the drinking days, on average, represented 77% of the assessed days. Significant between-group differences were not observed on alcohol use, craving, and cognitive or depressive symptom measures. Citicoline was well tolerated. CONCLUSIONS This proof-of-concept study observed that citicoline was well tolerated, but was not associated with a reduction in alcohol use or other outcomes, as compared to placebo. The favorable effects reported with citicoline for cocaine use, cognitive disorders, and other conditions do not appear to extend to alcohol use disorder.
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Affiliation(s)
- E Sherwood Brown
- Department of Psychiatry(ESB, EVE, AK, CE, AN, EII, TH), The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Erin Van Enkevort
- Department of Psychiatry(ESB, EVE, AK, CE, AN, EII, TH), The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alexandra Kulikova
- Department of Psychiatry(ESB, EVE, AK, CE, AN, EII, TH), The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chastity Escalante
- Department of Psychiatry(ESB, EVE, AK, CE, AN, EII, TH), The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alyson Nakamura
- Department of Psychiatry(ESB, EVE, AK, CE, AN, EII, TH), The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elena I Ivleva
- Department of Psychiatry(ESB, EVE, AK, CE, AN, EII, TH), The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Traci Holmes
- Department of Psychiatry(ESB, EVE, AK, CE, AN, EII, TH), The University of Texas Southwestern Medical Center, Dallas, Texas
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17
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Gouzoulis-Mayfrank E, Härtel-Petri R, Hamdorf W, Havemann-Reinecke U, Mühlig S, Wodarz N. Methamphetamine-Related Disorders. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:455-461. [PMID: 28705298 DOI: 10.3238/arztebl.2017.0455] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 03/14/2017] [Accepted: 04/07/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Methamphetamine is considered more dangerous than other stimulants because of its acute complications, long-term neurotoxicity, and potential for drug dependence. Until now, there have been no evidence-based guidelines for the treatment of methamphetamine-related disorders, either in Germany or abroad. METHODS A systematic literature search was performed on the treatment of methamphetamine-related disorders. Based on this literature review, a multidisciplinary expert panel developed recommendations using the nominal group technique. RESULTS The evidence base for the treatment of methamphetamine-related disorders is sparse. The efficacy of psychotherapeutic techniques such as cognitive behavioral therapy and contingency management and the efficacy of complex, disorder-specific treatment programs have been proven in ran - domized controlled trials, but it remains unclear which method is best. Persons carrying a diagnosis of substance abuse should be offered psychotherapy. Structured exercise programs, whether self-directed or professionally led, can improve addiction-specific endpoints as well as comorbid disorders and should, therefore, be offered as well. Pharmacotherapy has shown little to no effect in relatively low-quality clinical trials with low case numbers and high dropout rates, and therefore only a few weak recommendations were made. These include tranquilizers for the short-term treatment of agitation and atypical antipsychotics if necessary. Attempts to substitute other substances, such as methylphenidate or dexamphetamine, for methamphetamine have not yielded any robust evidence to date. Sertraline should not be administered due to serious adverse events. CONCLUSION Many of the recommendations in the guideline are made with a weak grade of recommendation because of the poor evidence base and the modest size of the reported therapeutic effects. In acute situations, symptomoriented treatment is recommended. Psychotherapy and exercise should be offered as well.
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Affiliation(s)
- Euphrosyne Gouzoulis-Mayfrank
- *All of the authors of the S3 guideline are listed in eTable1. They contributed equally to this article; Landschaftsverband Rheinland (Rhineland Regional Council, LVR)-Klinik Köln; Psychotherapeutic Practice Bayreuth; Allgemeine Hospitalgesellschaft (AHG) Klinik Mecklenburg; University Medical Center Göttingen; Technische Universität Chemnitz; Department of Psychiatry and Psychotherapy, University Hospital of Regensburg
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18
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MacLean RR, Sofuoglu M. Stimulants and Mood Disorders. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0212-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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19
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Roohi-Azizi M, Torkaman-Boutorabi A, Akhondzadeh S, Nejatisafa AA, Sadat-Shirazi MS, Zarrindast MR. Influence of citicoline on citalopram-induced antidepressant activity in depressive-like symptoms in male mice. Physiol Behav 2018; 195:151-157. [PMID: 30107190 DOI: 10.1016/j.physbeh.2018.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/21/2018] [Accepted: 08/10/2018] [Indexed: 12/21/2022]
Abstract
Depression is associated with significant functional disabilities. Application of new drugs which could enhance the effectiveness of antidepressants drug and reduce side effects of their long-term use seems necessary. Citicoline is used as an effective chemical agent for improving the symptoms of some neurodegenerative diseases. Therefore, in this survey, the application of citicoline as an adjuvant drug was evaluated in mice model of depression. A total of 180 adult NMRI male albino mice were used in this study. All groups were exposed to chronic unexpected mild stress (CUMS) followed by treatment with various doses of citalopram or/and citicoline or saline for 21 days. Sucrose preference (SP), open field (OF), and forced swimming test (FST) were applied to evaluate depression symptoms in the groups. The results indicated that only citicoline at the 5 mg/kg dose had shifted its status from being noneffective to become significantly effective in the co-administered group. The means of SP, OFT, and FST of the treatment groups were significantly different in favor of co-administered group compared with the other groups as well as the control group. Based on the results, it can be concluded that administration of citicoline, as an adjuvant drug, in combination with citalopram, enhanced the effectiveness of selective serotonin reuptake inhibitors (SSRI) drugs for depression treatment.
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Affiliation(s)
- Mahtab Roohi-Azizi
- Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran; Department of Rehabilitation Basic Sciences, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Anahita Torkaman-Boutorabi
- Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali-Akbar Nejatisafa
- Department of Psychiatry, Psychosomatic Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra-Sadat Sadat-Shirazi
- Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran; Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Zarrindast
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.; Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroendocrinology, Endocrinology and Metabolism Research Institute, Tehran University of Medical Science, Tehran, Iran.
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20
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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M, MacQueen G, Milev RV, Ravindran A, O'Donovan C, McIntosh D, Lam RW, Vazquez G, Kapczinski F, McIntyre RS, Kozicky J, Kanba S, Lafer B, Suppes T, Calabrese JR, Vieta E, Malhi G, Post RM, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord 2018; 20:97-170. [PMID: 29536616 PMCID: PMC5947163 DOI: 10.1111/bdi.12609] [Citation(s) in RCA: 909] [Impact Index Per Article: 151.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 12/14/2022]
Abstract
The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.
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Affiliation(s)
- Lakshmi N Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | | | - Sagar V Parikh
- Department of PsychiatryUniversity of MichiganAnn ArborMIUSA
| | - Ayal Schaffer
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | - David J Bond
- Department of PsychiatryUniversity of MinnesotaMinneapolisMNUSA
| | - Benicio N Frey
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Verinder Sharma
- Departments of Psychiatry and Obstetrics & GynaecologyWestern UniversityLondonONCanada
| | | | - Soham Rej
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Serge Beaulieu
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Glenda MacQueen
- Department of PsychiatryUniversity of CalgaryCalgaryABCanada
| | - Roumen V Milev
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Arun Ravindran
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | | | - Diane McIntosh
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Raymond W Lam
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Gustavo Vazquez
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | | | - Jan Kozicky
- School of Population and Public HealthUniversity of British ColumbiaVancouverBCCanada
| | | | - Beny Lafer
- Department of PsychiatryUniversity of Sao PauloSao PauloBrazil
| | - Trisha Suppes
- Bipolar and Depression Research ProgramVA Palo AltoDepartment of Psychiatry & Behavioral Sciences Stanford UniversityStanfordCAUSA
| | - Joseph R Calabrese
- Department of PsychiatryUniversity Hospitals Case Medical CenterCase Western Reserve UniversityClevelandOHUSA
| | - Eduard Vieta
- Bipolar UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Gin Malhi
- Department of PsychiatryUniversity of SydneySydneyNSWAustralia
| | - Robert M Post
- Department of PsychiatryGeorge Washington UniversityWashingtonDCUSA
| | - Michael Berk
- Deakin UniveristyIMPACT Strategic Research CentreSchool of Medicine, Barwon HealthGeelongVic.Australia
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van Lee L, Quah PL, Saw SM, Yap FKP, Godfrey KM, Chong YS, Meaney MJ, Chen H, Chong MFF. Maternal choline status during pregnancy, but not that of betaine, is related to antenatal mental well-being: The growing up in Singapore toward healthy outcomes cohort. Depress Anxiety 2017; 34:877-887. [PMID: 28471488 PMCID: PMC5553109 DOI: 10.1002/da.22637] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 04/06/2017] [Accepted: 04/09/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Choline and betaine status have previously been associated with symptoms of depression. However, the relation of maternal plasma choline and betaine concentrations in pregnancy to peripartum maternal mood is unknown. METHODS Maternal plasma choline and betaine concentrations (μmol/L) were measured at 26-28 weeks gestation in the Growing Up in Singapore Toward healthy Outcomes (GUSTO) mother-offspring cohort. Participants completed the State-Trait Anxiety Inventory (STAI) and Edinburgh Postnatal Depression Scale (EDPS) at 26-28 weeks gestation (n = 949) and at 3 months postnatal (n = 689): higher scores are indicative of more symptoms of anxiety and depression. Multivariate linear regression models were used to estimate the association of choline and betaine with ante- and postnatal mental well-being adjusting for covariates. RESULTS Mean (SD) antenatal plasma choline and betaine concentrations were 9.2 μmol/L (1.6) and 13.1 μmol/L (2.7), respectively. Plasma choline concentrations were positively associated with antenatal depressive (β = .24 EPDS score [95% CI: 0.05-0.43] per μmol/L] and anxiety symptoms (β = .46 STAI-state score [95% CI: 0.03-0.88] per μmol/L) adjusting for covariates. Plasma betaine concentrations were not associated with antenatal depression or anxiety symptoms. No associations were observed between pregnancy choline or betaine and postnatal mental well-being. CONCLUSION This study suggests that higher maternal plasma choline status during pregnancy is associated with more symptoms of antenatal depression and anxiety, whereas plasma betaine concentrations showed no associations. No associations were observed for postnatal mental well-being. Prospective studies are required to replicate these findings and further examine the direction of causality and possible biological mechanisms.
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Affiliation(s)
- Linde van Lee
- Singapore Institute for Clinical Science, Agency for Science, Technology and Research, Singapore, Singapore
| | - Phaik Ling Quah
- Singapore Institute for Clinical Science, Agency for Science, Technology and Research, Singapore, Singapore
| | - Seang Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Fabian KP Yap
- Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore,Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Yap Seng Chong
- Singapore Institute for Clinical Science, Agency for Science, Technology and Research, Singapore, Singapore,Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Michael J Meaney
- Singapore Institute for Clinical Science, Agency for Science, Technology and Research, Singapore, Singapore,Departments of Psychiatry and Neurology & Neurosurgery, McGill University, Montreal, Canada
| | - Helen Chen
- KK Women’s and Children’s Hospital (KKH), Singapore, Singapore
| | - Mary Foong-Fong Chong
- Singapore Institute for Clinical Science, Agency for Science, Technology and Research, Singapore, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore,Clinical Nutrition Research Center, Agency for Science, Technology and Research, Singapore, Singapore
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Salloum IM, Brown ES. Management of comorbid bipolar disorder and substance use disorders. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 43:366-376. [PMID: 28301219 DOI: 10.1080/00952990.2017.1292279] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The comorbidity of substance use disorders (SUDs) in bipolar disorder is among the highest in psychiatric disorders. Evidence-based controlled psychosocial or pharmacological interventions trials, which may guide treatment decisions, have not been systematically reviewed. OBJECTIVE To present a narrative review of the public health and clinical significance of this condition, including diagnostic and treatment implications, and to evaluate controlled trials conducted to date. METHODS Controlled trials reports in the English language were identified from multiple electronic databases and hand-searching bibliographies. We searched for treatment studies of bipolar disorder and comorbid SUDs (alcohol, cocaine, stimulants, opioid, tobacco, cannabis). Search period included all reports through September of 2016. We selected only randomized psychosocial studies or double-blind, placebo-controlled pharmacotherapy trials. We also reviewed reports of the public health and clinical significance and principle of managements of this condition. RESULTS We identified 16 treatment studies: 3 psychotherapy, and 13 pharmacotherapy trials. The following medications were evaluated: lithium carbonate, valproate, lamotrigine, topiramate, naltrexone, acamprosate, disulfiram, quetiapine, and citicoline. SUDs have substantial impact on the recognition and management of bipolar disorder. Integrated psychosocial interventions are helpful in decreasing substance abuse. Valproate and naltrexone may decrease alcohol use and citicoline may decrease cocaine use and enhance cognition. CONCLUSIONS There is a very limited number of pharmacotherapy and an even smaller number of psychosocial interventions. Our review highlights the need for more research in this area and for larger, multisite studies with generalizable samples to provide more definite guidance for clinical practice.
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Affiliation(s)
- Ihsan M Salloum
- a Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Edson Sherwood Brown
- b Department of Psychiatry , The University of Texas Southwestern Medical Center , Dallas , TX , USA
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Citicoline Combination Therapy for Major Depressive Disorder: A Randomized, Double-Blind, Placebo-Controlled Trial. Clin Neuropharmacol 2017; 40:1-5. [PMID: 28085707 DOI: 10.1097/wnf.0000000000000185] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Residual symptoms of major depressive disorder are a source of long-term morbidity. New therapeutic strategies are required to alleviate this morbidity and enhance patient quality of life. Citicoline has been used for vascular accidents and has been effective in cognitive rehabilitation. It has been used successfully to reduce craving in patients with substance abuse disorder and for mood management of bipolar disorder. Here, we test citicoline effectiveness as an adjuvant therapy in major depression. METHOD A double-blind randomized trial was designed on 50 patients with major depressive disorder who were under treatment with citalopram. Patients were allocated to 2 groups and received citicoline (100 mg twice a day) or placebo as an adjuvant treatment for 6 weeks. Depressive symptoms were assessed by the Hamilton Depression Rating Scale (HDRS) at baseline and at weeks 2, 4, and 6. RESULTS Significantly greater improvement was observed in the HDRS scores of the citicoline group compared with the placebo group from baseline to weeks 2, 4, and 6 (Ps = 0.030, 0.032, and 0.021, respectively). Repeated-measures general linear model demonstrated a significant effect for time × treatment interaction on the HDRS score (F2.10,101.22 = 3.12, P = 0.04). Remission rate was significantly higher in the citicoline group compared with the placebo group (P = 0.045). CONCLUSIONS Citicoline was an effective adjuvant to citalopram in the therapy of major depressive disorder.
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Miskowiak KW, Carvalho AF, Vieta E, Kessing LV. Cognitive enhancement treatments for bipolar disorder: A systematic review and methodological recommendations. Eur Neuropsychopharmacol 2016; 26:1541-61. [PMID: 27593623 DOI: 10.1016/j.euroneuro.2016.08.011] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/09/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
Abstract
Cognitive dysfunction is an emerging treatment target in bipolar disorder (BD). Several trials have assessed the efficacy of novel pharmacological and psychological treatments on cognition in BD but the findings are contradictory and unclear. A systematic search following the PRISMA guidelines was conducted on PubMed and PsychInfo. Eligible articles reported randomized, controlled or open-label trials investigating pharmacological or psychological treatments targeting cognitive dysfunction in BD. The quality of the identified randomized controlled trials (RCTs) was evaluated with the Cochrane Collaboration's Risk of Bias tool. We identified 19 eligible studies of which 13 were RCTs and six were open-label or non-randomized studies. The findings regarding efficacy on cognition were overall disappointing or preliminary, possibly due to several methodological challenges. For the RCTs, the risk of bias was high in nine cases, unclear in one case and low in three cases. Key reasons for the high risk of bias were lack of details on the randomization process, suboptimal handling of missing data and lack of a priori priority between cognition outcomes. Other challenges were the lack of consensus on whether and how to screen for cognitive impairment and on how to assess efficacy on cognition. In conclusion, methodological problems are likely to impede the success rates of cognition trials in BD. We recommend adherence to the CONSORT guidelines for RCTs, screening for cognitive impairment before inclusion of trial participants and selection of one primary cognition outcome. Future implementation of a 'neurocircuitry-based' biomarker model to evaluate neural target engagement is warranted.
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Affiliation(s)
- Kamilla W Miskowiak
- Copenhagen Psychiatric Centre, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - André F Carvalho
- Translational Psychiatry Research Group and Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
| | - Eduard Vieta
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, Barcelona 08036, Catalonia, Spain.
| | - Lars V Kessing
- Copenhagen Psychiatric Centre, Copenhagen University Hospital, Rigshospitalet, Denmark.
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25
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Tolliver BK, Anton RF. Assessment and treatment of mood disorders in the context of substance abuse. DIALOGUES IN CLINICAL NEUROSCIENCE 2016. [PMID: 26246792 PMCID: PMC4518701 DOI: 10.31887/dcns.2015.17.2/btolliver] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Recognition and management of mood symptoms in individuals using alcohol and/or other drugs represent a daily challenge for clinicians in both inpatient and outpatient treatment settings. Diagnosis of underlying mood disorders in the context of ongoing substance abuse requires careful collection of psychiatric history, and is often critical for optimal treatment planning and outcomes. Failure to recognize major depression or bipolar disorders in these patients can result in increased relapse rates, recurrence of mood episodes, and elevated risk of completed suicide. Over the past decade, epidemiologic research has clarified the prevalence of comorbid mood disorders in substance-dependent individuals, overturning previous assumptions that depression in these patients is simply an artifact of intoxication and/or withdrawal, therefore requiring no treatment. However, our understanding of the bidirectional relationships between mood and substance use disorders in terms of their course(s) of illness and prognoses remains limited. Like-wise, strikingly little treatment research exists to guide clinical decision making in co-occurring mood and substance use disorders, given their high prevalence and public health burden. Here we overview what is known and the salient gaps of knowledge where data might enhance diagnosis and treatment of these complicated patients.
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Affiliation(s)
- Bryan K Tolliver
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Raymond F Anton
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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26
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Secades-Álvarez A, Fernández-Rodríguez C. Review of the efficacy of treatments for bipolar disorder and substance abuse. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2016; 10:113-124. [PMID: 26778814 DOI: 10.1016/j.rpsm.2015.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 10/02/2015] [Accepted: 10/06/2015] [Indexed: 11/17/2022]
Abstract
The aim of this study was to provide a descriptive overview of different psychological and pharmacological interventions used in the treatment of patients with bipolar disorder and substance abuse, in order to determine their efficacy. A review of the current literature was performed using the databases Medline and PsycINFO (2005-2015). A total of 30 experimental studies were grouped according to the type of therapeutic modality described (pharmacological 19; psychological 11). Quetiapine and valproate have demonstrated superiority on psychiatric symptoms and a reduction in alcohol consumption, respectively. Group psychological therapies with education, relapse prevention and family inclusion have also been shown to reduce the symptomatology and prevent alcohol consumption and dropouts. Although there seems to be some recommended interventions, the multicomponent base, the lack of information related to participants during treatment, experimental control or the number of dropouts of these studies suggest that it would be irresponsible to assume that there are well established treatments.
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27
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Bagheri M, Mokri A, Khosravi A, Kabir K. Effect of Abstinence on Depression, Anxiety, and Quality of Life in Chronic Methamphetamine Users in a Therapeutic Community. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2015; 4:e23903. [PMID: 26495258 PMCID: PMC4609503 DOI: 10.5812/ijhrba.23903] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/10/2014] [Accepted: 01/04/2015] [Indexed: 11/26/2022]
Abstract
Background: During withdrawal, patients experience different symptoms. These symptoms are associated with relapse. Understanding different outcomes of methamphetamine abstinence is useful for finding better treatments for dependence. Objectives: This study aimed to show the effects of abstinence on depression, anxiety, and quality of life in methamphetamine users. Patients and Methods: A prospective quasi-experimental (before and after study) method was used to show the effect of 3 weeks abstinence on depression, anxiety, and quality of life. A convenient sample of addicted people entered into the study and 34 people completed the study. Beck Depression Scale, Cattell Anxiety Inventory and Short Form Health Survey (SF-36) (for assessing quality of life), were used for outcome assessments. Results: The mean depression score after abstinence decreased significantly (P < 0.001). Both hidden and obvious anxiety and total anxiety had a high level at admission and after 3 weeks of abstinence, the mean level of anxiety did not change significantly (P < 0.096). However, the quality of life increased after 3 weeks of abstinence (P < 0.001). Conclusions: Depression and anxiety are prevalent in methamphetamine users. Short-term abstinence improves depression and quality of life but does not improve anxiety in methamphetamine abusers. During follow up of these patients, addressing depression and anxiety is important to achieve better results.
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Affiliation(s)
- Maryam Bagheri
- Central Tehran Branch, Islamic Azad University, Tehran, IR Iran
| | - Azarakhsh Mokri
- Clinical Department, Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, IR Iran
| | | | - Kourosh Kabir
- Community Medicine Department, School of Medicine, Alborz University of Medical Sciences, Karaj, IR Iran
- Corresponding author: Kourosh Kabir, Community Medicine Department, School of Medicine, Alborz University of Medical Sciences, Karaj, IR Iran. Tel: +98-2122037513, E-mail:
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28
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Hellem TL, Sung YH, Shi XF, Pett MA, Latendresse G, Morgan J, Huber RS, Kuykendall D, Lundberg KJ, Renshaw PF. Creatine as a Novel Treatment for Depression in Females Using Methamphetamine: A Pilot Study. J Dual Diagn 2015; 11:189-202. [PMID: 26457568 PMCID: PMC4684979 DOI: 10.1080/15504263.2015.1100471] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Depression among methamphetamine users is more prevalent in females than males, but gender-specific treatment options for this comorbidity have not been described. Reduced brain phosphocreatine levels have been shown to be lower in female methamphetamine users compared to males, and, of relevance, studies have demonstrated an association between treatment-resistant depression and reduced brain phosphocreatine concentrations. The nutritional supplement creatine monohydrate has been reported to reduce symptoms of depression in female adolescents and adults taking antidepressants, as well as to increase brain phosphocreatine in healthy volunteers. Therefore, the purpose of this pilot study was to investigate creatine monohydrate as a treatment for depression in female methamphetamine users. METHODS Fourteen females with depression and comorbid methamphetamine dependence were enrolled in an 8-week open label trial of 5 g of daily creatine monohydrate and of these 14, 11 females completed the study. Depression was measured using the Hamilton Depression Rating Scale (HAMD) and brain phosphocreatine levels were measured using phosphorus magnetic resonance spectroscopy pre- and post-creatine treatment. Secondary outcome measures included anxiety symptoms, measured with the Beck Anxiety Inventory (BAI), as well as methamphetamine use, monitored by twice weekly urine drug screens and self-reported use. RESULTS The results of a linear mixed effects repeated measures model showed significantly reduced HAMD and BAI scores as early as week 2 when compared to baseline scores. This improvement was maintained through study completion. Brain phosphocreatine concentrations were higher at the second phosphorus magnetic resonance spectroscopy scan compared to the baseline scan; Mbaseline = 0.223 (SD = 0.013) vs. Mpost-treatment = 0.233 (SD = 0.009), t (9) = 2.905, p <.01, suggesting that creatine increased phosphocreatine levels. Also, a reduction in methamphetamine positive urine drug screens of greater than 50% was observed by week 6. Finally, creatine was well tolerated and adverse events that were related to gastrointestinal symptoms and muscle cramping were determined as possibly related to creatine. CONCLUSIONS The current study suggests that creatine treatment may be a promising therapeutic approach for females with depression and comorbid methamphetamine dependence. This study is registered on clinicaltrials.gov (NCT01514630).
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Affiliation(s)
- Tracy L Hellem
- a The Brain Institute, University of Utah , Salt Lake City , Utah , USA.,b The College of Nursing, University of Utah , Salt Lake City , Utah , USA
| | - Young-Hoon Sung
- a The Brain Institute, University of Utah , Salt Lake City , Utah , USA
| | - Xian-Feng Shi
- a The Brain Institute, University of Utah , Salt Lake City , Utah , USA.,c The Department of Psychiatry , University of Utah , Salt Lake City , Utah , USA
| | - Marjorie A Pett
- b The College of Nursing, University of Utah , Salt Lake City , Utah , USA
| | - Gwen Latendresse
- b The College of Nursing, University of Utah , Salt Lake City , Utah , USA
| | - Jubel Morgan
- a The Brain Institute, University of Utah , Salt Lake City , Utah , USA.,c The Department of Psychiatry , University of Utah , Salt Lake City , Utah , USA
| | - Rebekah S Huber
- a The Brain Institute, University of Utah , Salt Lake City , Utah , USA
| | | | - Kelly J Lundberg
- c The Department of Psychiatry , University of Utah , Salt Lake City , Utah , USA
| | - Perry F Renshaw
- a The Brain Institute, University of Utah , Salt Lake City , Utah , USA.,c The Department of Psychiatry , University of Utah , Salt Lake City , Utah , USA.,d VISN 19 MIRECC , Salt Lake City , Utah , USA
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Hellem TL, Lundberg KJ, Renshaw PF. A review of treatment options for co-occurring methamphetamine use disorders and depression. J Addict Nurs 2015; 26:14-23; quiz E1. [PMID: 25761159 PMCID: PMC5510330 DOI: 10.1097/jan.0000000000000058] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Co-occurring methamphetamine use and depression interferes with treatment outcomes. Female methamphetamine users are known to have higher rates of depression than male methamphetamine users, although this is also true for the general population. There are limited treatment options for the management of depression among methamphetamine users. In this integrative review, we summarize data on treatment strategies for co-occurring depression and methamphetamine use disorders. English-language articles were identified from PsychINFO, CINAHL, PubMed, and Medline as well as from reference lists of key articles. Search terms included "methamphetamine," "depression," and "treatment." Research articles describing psychological (n = 3), pharmacological (n = 6), nutritional supplement (n = 1), and psychological combined with pharmacological (n = 3) approaches for the treatment of methamphetamine use or withdrawal and/or depression are included in this review. Psychological and combination of psychological with pharmacological approaches have not been shown to be effective in treating these co-occurring conditions. Antidepressants have been determined to be ineffective and/or to introduce side effects. Gender differences with response to treatment were examined in only one of the published studies. There is a large gap in knowledge regarding treatment of co-occurring methamphetamine use disorders and depression. Considering that female methamphetamine users experience higher rates of depression than men, a focus on gender-specific treatment approaches is warranted.
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Affiliation(s)
- Tracy L Hellem
- Tracy L. Hellem, PhD, RN, College of Nursing and The Brain Institute, University of Utah, Salt Lake City. Kelly J. Lundberg, PhD, Department of Psychiatry, University of Utah, Salt Lake City. Perry F. Renshaw, MD, PhD, MBA, The Brain Institute and Department of Psychiatry, University of Utah, and VISN 19 MIRECC, Salt Lake City
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Qian Y, Ding Q, Li Y, Zou Z, Yan B, Ou L. Phosphorylation of uridine and cytidine by uridine–cytidine kinase. J Biotechnol 2014; 188:81-7. [DOI: 10.1016/j.jbiotec.2014.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 08/10/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
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New perspectives on using brain imaging to study CNS stimulants. Neuropharmacology 2014; 87:104-14. [PMID: 25080072 DOI: 10.1016/j.neuropharm.2014.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/26/2014] [Accepted: 07/07/2014] [Indexed: 11/23/2022]
Abstract
While the recent application of brain imaging to study CNS stimulants has offered new insights into the fundamental factors that contribute to their use and abuse, many gaps remain. Brain circuits that mediate pleasure, dependence, craving and relapse are anatomically, neurophysiologically and neurochemically distinct from one another, which has guided the search for correlates of stimulant-seeking and taking behavior. However, unlike other drugs of abuse, metrics for tolerance and physical dependence on stimulants are not obvious. The dopamine theory of stimulant abuse does not sufficiently explain this disorder as serotonergic, GABAergic and glutamagergic circuits are clearly involved in stimulant pharmacology and so tracking the source of the "addictive" processes must adopt a more multimodal, multidisciplinary approach. To this end, both anatomical and functional magnetic resonance imaging (MRI), MR spectroscopy (MRS) and positron emission tomography (PET) are complementary and have equally contributed to our understanding of how stimulants affect the brain and behavior. New vistas in this area include nanotechnology approaches to deliver small molecules to receptors and use MRI to resolve receptor dynamics. Anatomical and blood flow imaging has yielded data showing that cognitive enhancers might be useful adjuncts in treating CNS stimulant dependence, while MRS has opened opportunities to examine the brain's readiness to accept treatment as GABA tone normalizes after detoxification. A desired outcome of the above approaches is being able to offer evidence-based rationales for treatment approaches that can be implemented in a more broad geographic area, where access to brain imaging facilities may be limited. This article is part of the Special Issue entitled 'CNS Stimulants'.
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Wignall ND, Brown ES. Citicoline in addictive disorders: a review of the literature. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 40:262-8. [PMID: 24950234 PMCID: PMC4139283 DOI: 10.3109/00952990.2014.925467] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 05/07/2014] [Accepted: 05/12/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND Citicoline is a dietary supplement that has been used as a neuroprotective agent for neurological disorders such as stroke and dementia. Citicoline influences acetylcholine, dopamine, and glutamate neurotransmitter systems; serves as an intermediate in phospholipid metabolism; and enhances the integrity of neuronal membranes. Interest has grown in citicoline as a treatment for addiction since it may have beneficial effects on craving, withdrawal symptoms, and cognitive functioning, as well as the ability to attenuate the neurotoxic effects of drugs of abuse. OBJECTIVES To review the literature on citicoline's use in addictive disorders. METHODS Using PubMed we conducted a narrative review of the clinical literature on citicoline related to addictive disorders from the years 1900-2013 using the following keywords: citicoline, CDP-choline, addiction, cocaine, alcohol, substance abuse, and substance dependence. Out of approximately 900 first hits, nine clinical studies have been included in this review. RESULTS Most addiction research investigated citicoline for cocaine use. The findings suggest that it is safe and well tolerated. Furthermore, citicoline appears to decrease craving and is associated with a reduction in cocaine use, at least at high doses in patients with both bipolar disorder and cocaine dependence. Limited data suggest citicoline may also hold promise for alcohol and cannabis dependence and in reducing food consumption. CONCLUSIONS Currently, there is limited research on the efficacy of citicoline for addictive disorders, but the available literature suggests promising results. Future research should employ larger sample sizes, increased dosing, and more complex study designs.
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Affiliation(s)
- Nicholas D. Wignall
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX
| | - E. Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX
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Rakofsky JJ, Dunlop BW. Review of nutritional supplements for the treatment of bipolar depression. Depress Anxiety 2014; 31:379-90. [PMID: 24353094 DOI: 10.1002/da.22220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 10/26/2013] [Accepted: 11/02/2013] [Indexed: 11/10/2022] Open
Abstract
Many patients view psychotropics with skepticism and fear and view nutritional supplements as more consistent with their values and beliefs. The purpose of this review was to critically evaluate the evidence base for nutritional supplements in the treatment of bipolar depression (BD). A literature search for all randomized, controlled clinical trials using nutritional supplements in the treatment of BD was conducted via PubMed and Ovid MEDLINE computerized database. The studies were organized into essential nutrients/minerals, nonessential nutrients, and combinations of nutritional products. Among essential nutrients/minerals, omega-3-fatty acids (O3FAs) have the strongest evidence of efficacy for bipolar depression, although some studies failed to find positive effects from O3FAs. Weak evidence supports efficacy of vitamin C whereas no data support the usefulness of folic acid and choline. Among nonessential nutrients, cytidine is the least supported treatment. Studies of N-acetylcysteine have not resolved its efficacy in treating acute depressive episodes relative to placebo. However, one study demonstrates its potential to improve depressive symptoms over time and the other, though nonsignificant, suggests it has a prophylactic effect. Studies of inositol have been mostly negative, except for 1 study. Those that were negative were underpowered but demonstrated numerically positive effects for inositol. There is no evidence that citicholine is efficacious for uncomplicated BD depression, though it may have value for comorbid substance abuse among BD patients. Finally, combination O3FA-cytidine lacks evidence of efficacy. The findings of this review do not support the routine use of nutritional supplements in the treatment or prophylaxis of BD depression. Studies with more rigorous designs are required before definitive conclusions can be made. Despite the inadequacy of the existing data, clinicians should remain open to the value of nutritional supplements: after all, lithium is a mineral too.
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Affiliation(s)
- Jeffrey J Rakofsky
- Mood and Anxiety Disorders Program/Bipolar Disorders Clinic, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
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