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Cheng X, Chen J, Zhang X, Wang T, Sun J, Zhou Y, Yang R, Xiao Y, Chen A, Song Z, Chen P, Yang C, QiuxiaWu, Lin T, Chen Y, Cao L, Wei X. Characterizing the temporal dynamics of intrinsic brain activities in depressed adolescents with prior suicide attempts. Eur Child Adolesc Psychiatry 2024; 33:1179-1191. [PMID: 37284850 PMCID: PMC11032277 DOI: 10.1007/s00787-023-02242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
Converging evidence has revealed disturbances in the corticostriatolimic system are associated with suicidal behaviors in adults with major depressive disorder. However, the neurobiological mechanism that confers suicidal vulnerability in depressed adolescents is largely unknown. A total of 86 depressed adolescents with and without prior suicide attempts (SA) and 47 healthy controls underwent resting-state functional imaging (R-fMRI) scans. The dynamic amplitude of low-frequency fluctuations (dALFF) was measured using sliding window approach. We identified SA-related alterations in dALFF variability primarily in the left middle temporal gyrus, inferior frontal gyrus, middle frontal gyrus (MFG), superior frontal gyrus (SFG), right SFG, supplementary motor area (SMA) and insula in depressed adolescents. Notably, dALFF variability in the left MFG and SMA was higher in depressed adolescents with recurrent suicide attempts than in those with a single suicide attempt. Moreover, dALFF variability was capable of generating better diagnostic and prediction models for suicidality than static ALFF. Our findings suggest that alterations in brain dynamics in regions involved in emotional processing, decision-making and response inhibition are associated with an increased risk of suicidal behaviors in depressed adolescents. Furthermore, dALFF variability could serve as a sensitive biomarker for revealing the neurobiological mechanisms underlying suicidal vulnerability.
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Affiliation(s)
- Xiaofang Cheng
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Jianshan Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Xiaofei Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Ting Wang
- The Second Affiliated Hospital, School of Medicine, South China University of Technology, 1 Panfu Road, Yuexiu district, Guangzhou, 510180, Guangdong, People's Republic of China
| | - Jiaqi Sun
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Ruilan Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Yeyu Xiao
- Guangzhou Integrated Traditional Chinese and Western Medicine, Guangzhou, 510800, Guangdong, People's Republic of China
| | - Amei Chen
- The Second Affiliated Hospital, School of Medicine, South China University of Technology, 1 Panfu Road, Yuexiu district, Guangzhou, 510180, Guangdong, People's Republic of China
| | - Ziyi Song
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Pinrui Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Chanjuan Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - QiuxiaWu
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Taifeng Lin
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Yingmei Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Liping Cao
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China.
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China.
| | - Xinhua Wei
- The Second Affiliated Hospital, School of Medicine, South China University of Technology, 1 Panfu Road, Yuexiu district, Guangzhou, 510180, Guangdong, People's Republic of China.
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Li S, Zhu Z, Lan T, Wu Y, Li Y, Wang C, Jian W, Yu SY. Levomilnacipran ameliorates lipopolysaccharide-induced depression-like behaviors and suppressed the TLR4/Ras signaling pathway. Int Immunopharmacol 2023; 122:110595. [PMID: 37413934 DOI: 10.1016/j.intimp.2023.110595] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Abstract
Levomilnacipran, a serotonin and norepinephrine reuptake inhibitor, has been reported to have anti-depressive effects. However, the detailed mechanisms underlying these effects are still unclear. This study aimed to investigate the antidepressant mechanisms of levomilnacipran to discover new perspectives on the treatment of depression in male rats. Intraperitoneal injection of lipopolysaccharide (LPS) was used to induce depressive behaviors in rats. Activation of microglia and apoptosis of neurons verified by immunofluorescence. Inflammatory related proteins and neurotrophic related proteins were verified by immunoblotting. The mRNA expression of apoptosis markers was verified by real-time quantitative PCR. Finally, electron microscopy analysis was used to observe the ultrastructural pathology of neuron. Here, we found that the anti-depression and anti-anxiety effects of levomilnacipran in the LPS-induced rat model of depression was resulted from the suppression of neuroinflammation and neuronal apoptosis within prefrontal cortex of rats. Furthermore, we found that levomilnacipran could decrease the number of microglia and suppress its activation in prefrontal cortex of rats. This effect may be mediated by suppressing the TLR4/NF-κB and Ras/p38 signaling pathways. In addition, levomilnacipran plays a neuroprotective role by increasing the expression of neurotrophic factors. Taken together, these results suggest that levomilnacipran exerts antidepressant effects by attenuating neuroinflammation to inhibit the damage in central nervous system and plays a neuroprotective role to improve depressive behaviors. These findings suggest that suppression of neuroinflammation in prefrontal cortex could ameliorate depressive behavioral disorder of rats induced by LPS, which provided a new perspective for the treatment of depression.
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Affiliation(s)
- Shuhan Li
- Department of Physiology, Shandong University, School of Basic Medical Sciences, Cheeloo College of Medicine, 44 Wenhuaxilu Road, Jinan, Shandong Province 250012, PR China
| | - Zhanpeng Zhu
- Department of Physiology, Shandong University, School of Basic Medical Sciences, Cheeloo College of Medicine, 44 Wenhuaxilu Road, Jinan, Shandong Province 250012, PR China
| | - Tian Lan
- Department of Physiology, Shandong University, School of Basic Medical Sciences, Cheeloo College of Medicine, 44 Wenhuaxilu Road, Jinan, Shandong Province 250012, PR China
| | - Yuhan Wu
- Department of Physiology, Shandong University, School of Basic Medical Sciences, Cheeloo College of Medicine, 44 Wenhuaxilu Road, Jinan, Shandong Province 250012, PR China
| | - Ye Li
- Department of Physiology, Shandong University, School of Basic Medical Sciences, Cheeloo College of Medicine, 44 Wenhuaxilu Road, Jinan, Shandong Province 250012, PR China
| | - Changmin Wang
- Department of Physiology, Shandong University, School of Basic Medical Sciences, Cheeloo College of Medicine, 44 Wenhuaxilu Road, Jinan, Shandong Province 250012, PR China
| | - Wencheng Jian
- Department of Radiology, Qilu Hospital of Shandong University, 107 Wenhuaxilu Road, Jinan, Shandong Province 250012, PR China.
| | - Shu Yan Yu
- Department of Physiology, Shandong University, School of Basic Medical Sciences, Cheeloo College of Medicine, 44 Wenhuaxilu Road, Jinan, Shandong Province 250012, PR China; Shandong Provincial Key Laboratory of Mental Disorders, School of Basic Medical Sciences, 44 Wenhuaxilu Road, Jinan, Shandong Province 250012, PR China.
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Vilazodone efficacy in subgroups of patients with major depressive disorder: a post-hoc analysis of four randomized, double-blind, placebo-controlled trials. Int Clin Psychopharmacol 2018; 33:217-223. [PMID: 29608461 PMCID: PMC5991171 DOI: 10.1097/yic.0000000000000217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The efficacy of antidepressants to treat major depressive disorder (MDD) varies by patient characteristics. This post-hoc analysis evaluated the effects of vilazodone across patient subgroups in adults with MDD. Data were pooled from four trials of vilazodone (NCT00285376, NCT00683592, NCT01473394, and NCT01473381). Mean change from baseline to week 8 in Montgomery-Åsberg Depression Rating Scale (MADRS) total score, MADRS response (≥50% total score improvement), and MADRS remission (total score≤10) were analyzed in the pooled intent-to-treat population (vilazodone=1254, placebo=964) and in subgroups of patients categorized by sex, age, MDD duration, recurrent episodes, baseline MADRS total score, and current episode duration. MADRS total score improvement was significantly greater with vilazodone versus placebo in the intent-to-treat population and in all patient subgroups (P<0.001). MADRS response and remission rates significantly separated from placebo (P<0.05) regardless of age, sex, MDD duration, recurrent MDD, and baseline symptom severity [except remission in patients with very severe baseline symptoms (MADRS score≥35)] and in patients with a shorter current episode duration (≤12 months). Despite the limitations associated with analyzing uncommon outcomes (e.g. MADRS remission) in small subgroups, vilazodone was an effective treatment in multiple patient populations, including those where reduced efficacy has previously been reported: males, older individuals, patients with a longer duration of MDD, and patients with recurrent depression.
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Abstract
This chapter covers antidepressants that fall into the class of serotonin (5-HT) and norepinephrine (NE) reuptake inhibitors. That is, they bind to the 5-HT and NE transporters with varying levels of potency and binding affinity ratios. Unlike the selective serotonin (5-HT) reuptake inhibitors (SSRIs), most of these antidepressants have an ascending rather than a flat dose-response curve. The chapter provides a brief review of the chemistry, pharmacology, metabolism, safety and adverse effects, clinical use, and therapeutic indications of each antidepressant. Venlafaxine, a phenylethylamine, is a relatively weak 5-HT and weaker NE uptake inhibitor with a 30-fold difference in binding of the two transporters. Therefore, the drug has a clear dose progression, with low doses predominantly binding to the 5-HT transporter and more binding of the NE transporter as the dose ascends. Venlafaxine is metabolized to the active metabolite O-desmethylvenlafaxine (ODV; desvenlafaxine) by CYP2D6, and it therefore is subject to significant inter-individual variation in blood levels and response dependent on variations in CYP2D6 metabolism. The half-life of venlafaxine is short at about 5 h, with the ODV metabolite being 12 h. Both parent compound and metabolite have low protein binding and neither inhibit CYP enzymes. Therefore, both venlafaxine and desvenlafaxine are potential options if drug-drug interactions are a concern, although venlafaxine may be subject to drug-drug interactions with CYP2D6 inhibitors. At low doses, the adverse effect profile is similar to an SSRI with nausea, diarrhea, fatigue or somnolence, and sexual side effects, while venlafaxine at higher doses can produce mild increases in blood pressure, diaphoresis, tachycardia, tremors, and anxiety. A disadvantage of venlafaxine relative to the SSRIs is the potential for dose-dependent blood pressure elevation, most likely due to the NE reuptake inhibition caused by higher doses; however, this adverse effect is infrequently observed at doses below 225 mg per day. Venlafaxine also has a number of potential advantages over the SSRIs, including an ascending dose-antidepressant response curve, with possibly greater overall efficacy at higher doses. Venlafaxine is approved for MDD as well as generalized anxiety disorder, social anxiety disorder, and panic disorder. Desvenlafaxine is the primary metabolite of venlafaxine, and it is also a relatively low-potency 5-HT and NE uptake inhibitor. Like venlafaxine it has a favorable drug-drug interaction profile. It is subject to CYP3A4 metabolism, and it is therefore vulnerable to enzyme inhibition or induction. However, the primary metabolic pathway is direct conjugation. It is approved in the narrow dose range of 50-100 mg per day. Duloxetine is a more potent 5-HT and NE reuptake inhibitor with a more balanced profile of binding at about 10:1 for 5HT and NE transporter binding. It is also a moderate inhibitor of CYP2D6, so that modest dose reductions and careful monitoring will be needed when prescribing duloxetine in combination with drugs that are preferentially metabolized by CYP2D6. The most common side effects identified in clinical trials are nausea, dry mouth, dizziness, constipation, insomnia, asthenia, and hypertension, consistent with its mechanisms of action. Clinical trials to date have demonstrated rates of response and remission in patients with major depression that are comparable to other marketed antidepressants reviewed in this book. In addition to approval for MDD, duloxetine is approved for diabetic peripheral neuropathic pain, fibromyalgia, and musculoskeletal pain. Milnacipran is marketed as an antidepressant in some countries, but not in the USA. It is approved in the USA and some other countries as a treatment for fibromyalgia. It has few pharmacokinetic and pharmacodynamic interactions with other drugs. Milnacipran has a half-life of about 10 h and therefore needs to be administered twice per day. It is metabolized by CYP3A4, but the major pathway for clearance is direct conjugation and renal elimination. As with other drugs in this class, dysuria is a common, troublesome, and dose-dependent adverse effect (occurring in up to 7% of patients). High-dose milnacipran has been reported to cause blood pressure and pulse elevations. Levomilnacipran is the levorotary enantiomer of milnacipran, and it is pharmacologically very similar to the racemic compound, although the side effects may be milder within the approved dosing range. As with other NE uptake inhibitors, it may increase blood pressure and pulse, although it appears to do so less than some other medications. All medications in the class can cause serotonin syndrome when combined with MAOIs.
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