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Havlik JL, Wahid S, Teopiz KM, McIntyre RS, Krystal JH, Rhee TG. Recent Advances in the Treatment of Treatment-Resistant Depression: A Narrative Review of Literature Published from 2018 to 2023. Curr Psychiatry Rep 2024; 26:176-213. [PMID: 38386251 DOI: 10.1007/s11920-024-01494-4] [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] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE OF REVIEW We review recent advances in the treatment of treatment-resistant depression (TRD), a disorder with very limited treatment options until recently. We examine advances in psychotherapeutic, psychopharmacologic, and interventional psychiatry approaches to treatment of TRD. We also highlight various definitions of TRD in recent scientific literature. RECENT FINDINGS Recent evidence suggests some forms of psychotherapy can be effective as adjunctive treatments for TRD, but not as monotherapies alone. Little recent evidence supports the use of adjunctive non-antidepressant pharmacotherapies such as buprenorphine and antipsychotics for the treatment of TRD; side effects and increased medication discontinuation rates may outweigh the benefits of these adjunctive pharmacotherapies. Finally, a wealth of recent evidence supports the use of interventional approaches such as electroconvulsive therapy, ketamine/esketamine, and transcranial magnetic stimulation for TRD. Recent advances in our understanding of how to treat TRD have largely expanded our knowledge of best practices in, and efficacy of, interventional psychiatric approaches. Recent research has used a variety of TRD definitions for study inclusion criteria; research on TRD should adhere to inclusion criteria based on internationally defined guidelines for more meaningfully generalizable results.
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Affiliation(s)
- John L Havlik
- Yale University School of Medicine, New Haven, CT, USA
| | - Syed Wahid
- The University of Chicago, Chicago, IL, USA
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Pharmacology, University of Toronto, Toronto, Canada
| | - John H Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- Department of Public Health Sciences, University of Connecticut, Farmington, CT, USA.
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2
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Wu G, Xu H. A synopsis of multitarget therapeutic effects of anesthetics on depression. Eur J Pharmacol 2023; 957:176032. [PMID: 37660970 DOI: 10.1016/j.ejphar.2023.176032] [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: 07/04/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023]
Abstract
Depression is a profound mental disorder that dampens the mood and undermines volition, which exhibited an increased incidence over the years. Although drug-based interventions remain the primary approach for depression treatment, the available medications still can't satisfy the patients. In recent years, the newly discovered therapeutic targets such as N-methyl-D-aspartate (NMDA) receptor, α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA) receptor, and tyrosine kinase B (TrkB) have brought new breakthroughs in the development of antidepressant drugs. Moreover, it has come to light that certain anesthetics possess pharmacological mechanisms intricately linked to the aforementioned therapeutic targets for depression. At present, numerous preclinical and clinical studies have explored the therapeutic effects of anesthetic drugs such as ketamine, isoflurane, N2O, and propofol, on depression. These investigations suggested that these drugs can swiftly ameliorate patients' depression symptoms and engender long-term effects. In this paper, we provide a comprehensive review of the research progress and potential molecular mechanisms of various anesthetic drugs for depression treatment. By shedding light on this subject, we aim to facilitate the development and clinical implementation of new antidepressant drugs based on anesthetic medications.
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Affiliation(s)
- Guowei Wu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China
| | - Hongwei Xu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China.
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3
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Blaszczyk AT, Mathys M, Le J. A Review of Therapeutics for Treatment-Resistant Depression in the Older Adult. Drugs Aging 2023; 40:785-813. [PMID: 37596380 DOI: 10.1007/s40266-023-01051-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 08/20/2023]
Abstract
One-third of older adults with depression meet criteria for treatment resistance, typically defined as a lack of response to two or more adequate trials of an antidepressant. Treatment resistance contributes to an unfavorable prognosis, compromised medical outcomes, heightened disability, accelerated cognitive decline, and an elevated risk of developing dementia. Despite this significant morbidity, evidence is sparse for how to proceed with treatment in this population. Non-pharmacologic therapy (e.g., diet, psychotherapy) can be utilized as adjunctive therapy, despite little published evidence of benefit, given that the risks are low. Pharmacotherapy trials in the treatment-resistant late-life depression population lack strong methods and external validity; however, the use of venlafaxine as monotherapy and add-on therapy, as well as lithium, bupropion, or aripiprazole as add-on therapy to standard antidepressant therapy, have enough evidence that a trial with appropriate monitoring is a prudent strategy. Electroconvulsive therapy remains a well-studied safe therapy, especially when used as maintenance treatment once an initial cycle is completed but is traditionally underutilized in the treatment-resistant late-life depression population. Ensuring non-pharmacologic and pharmacologic strategies are optimized and given a sufficient trial in those with treatment-resistant late-life depression is the best we can do for this vulnerable population.
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Affiliation(s)
- Amie Taggart Blaszczyk
- Department of Pharmacy Practice, Texas Tech University HSC School of Pharmacy-Dallas/Fort Worth, 5920 Forest Park Rd, Dallas, TX, USA.
| | - Monica Mathys
- Department of Pharmacy Practice, Texas Tech University HSC School of Pharmacy-Dallas/Fort Worth, 5920 Forest Park Rd, Dallas, TX, USA
| | - Jennifer Le
- Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
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Riblet NB, Young-Xu Y, Shiner B, Schnurr PP, Watts BV. The efficacy and safety of buprenorphine for the treatment of depression: A systematic review and meta-analysis. J Psychiatr Res 2023; 161:393-401. [PMID: 37019069 PMCID: PMC10149594 DOI: 10.1016/j.jpsychires.2023.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/01/2023] [Accepted: 03/27/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Depressive disorders are common. Many patients with major depression do not achieve remission with available treatments. Buprenorphine has been raised as a potential treatment for depression as well as suicidal behavior but may pose certain risks. METHODS A meta-analysis comparing the efficacy, tolerability, and safety of buprenorphine (or combinations such as buprenorphine/samidorphan) versus control in improving symptoms in patients with depression. Medline, Cochrane Database, PsycINFO, Excerpta Medica Database and The Cumulative Index to Nursing and Allied Health Literature were searched from inception through January 2, 2022. Depressive symptoms were pooled using Hedge's g with 95% Confidence Intervals (CI). Tolerability, safety, suicide outcomes were summarized qualitatively. RESULTS 11 studies (N = 1699) met inclusion criteria. Buprenorphine had a small effect on depressive symptoms (Hedges' g 0.17, 95%CI: 0.05-0.29). Results were driven by six trials of buprenorphine/samidorphan (N = 1,343, Hedges's g 0.17, 95%CI: 0.04-0.29). One study reported significant improvement in suicidal thoughts (Least Squares Mean Change: -7.1, 95%CI: -12.0 - 2.3). Most studies found buprenorphine was well-tolerated with no evidence of abuse behavior or dependency. CONCLUSIONS Buprenorphine may have a small benefit for depressive symptoms. Future research should clarify the dose response relationship between buprenorphine and depression.
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Affiliation(s)
- Natalie B Riblet
- Veterans Affairs Medical Center, Mental Health Service, 215 North Main Street, White River Junction, VT, 05009, USA; Geisel School of Medicine at Dartmouth, Department of Psychiatry and Dartmouth Institute, 1 Rope Ferry Road, Hanover, NH, 03755, USA.
| | - Yinong Young-Xu
- Veterans Affairs Medical Center, Mental Health Service, 215 North Main Street, White River Junction, VT, 05009, USA; Geisel School of Medicine at Dartmouth, Department of Psychiatry, 1 Rope Ferry Road, Hanover, NH, 03755, USA
| | - Brian Shiner
- Veterans Affairs Medical Center, Mental Health Service, 215 North Main Street, White River Junction, VT, 05009, USA; Geisel School of Medicine at Dartmouth, Department of Psychiatry and Dartmouth Institute, 1 Rope Ferry Road, Hanover, NH, 03755, USA; National Center for PTSD, 215 North Main Street, White River Junction, VT, 05009, USA
| | - Paula P Schnurr
- Geisel School of Medicine at Dartmouth, Department of Psychiatry, 1 Rope Ferry Road, Hanover, NH, 03755, USA; National Center for PTSD, 215 North Main Street, White River Junction, VT, 05009, USA
| | - Bradley V Watts
- Veterans Affairs Medical Center, Mental Health Service, 215 North Main Street, White River Junction, VT, 05009, USA; Geisel School of Medicine at Dartmouth, Department of Psychiatry, 1 Rope Ferry Road, Hanover, NH, 03755, USA; Veterans Rural Health Resource Center, White River Junction VA Medical Center, White River Junction, VT, 05009, USA
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Correll CU, Solmi M, Cortese S, Fava M, Højlund M, Kraemer HC, McIntyre RS, Pine DS, Schneider LS, Kane JM. The future of psychopharmacology: a critical appraisal of ongoing phase 2/3 trials, and of some current trends aiming to de-risk trial programmes of novel agents. World Psychiatry 2023; 22:48-74. [PMID: 36640403 PMCID: PMC9840514 DOI: 10.1002/wps.21056] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 01/15/2023] Open
Abstract
Despite considerable progress in pharmacotherapy over the past seven decades, many mental disorders remain insufficiently treated. This situation is in part due to the limited knowledge of the pathophysiology of these disorders and the lack of biological markers to stratify and individualize patient selection, but also to a still restricted number of mechanisms of action being targeted in monotherapy or combination/augmentation treatment, as well as to a variety of challenges threatening the successful development and testing of new drugs. In this paper, we first provide an overview of the most promising drugs with innovative mechanisms of action that are undergoing phase 2 or 3 testing for schizophrenia, bipolar disorder, major depressive disorder, anxiety and trauma-related disorders, substance use disorders, and dementia. Promising repurposing of established medications for new psychiatric indications, as well as variations in the modulation of dopamine, noradrenaline and serotonin receptor functioning, are also considered. We then critically discuss the clinical trial parameters that need to be considered in depth when developing and testing new pharmacological agents for the treatment of mental disorders. Hurdles and perils threatening success of new drug development and testing include inadequacy and imprecision of inclusion/exclusion criteria and ratings, sub-optimally suited clinical trial participants, multiple factors contributing to a large/increasing placebo effect, and problems with statistical analyses. This information should be considered in order to de-risk trial programmes of novel agents or known agents for novel psychiatric indications, increasing their chances of success.
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Affiliation(s)
- Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Marco Solmi
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mikkel Højlund
- Department of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
- Mental Health Services in the Region of Southern Denmark, Department of Psychiatry Aabenraa, Aabenraa, Denmark
| | - Helena C Kraemer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Cupertino, CA, USA
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Daniel S Pine
- Section on Developmental Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
| | - Lon S Schneider
- Department of Psychiatry and Behavioral Sciences, and Department of Neurology, Keck School of Medicine, and L. Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - John M Kane
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
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Yao L, Tarpey T. A Single Index Model for Longitudinal Outcomes to Optimize Individual Treatment Decision Rules. Stat (Int Stat Inst) 2022; 11:e493. [PMID: 38770026 PMCID: PMC11105108 DOI: 10.1002/sta4.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 08/04/2022] [Indexed: 11/07/2022]
Abstract
A pressing challenge in medical research is to identify optimal treatments for individual patients. This is particularly challenging in mental health settings where mean responses are often similar across multiple treatments. For example, the mean longitudinal trajectories for patients treated with an active drug and placebo may be very similar but different treatments may exhibit distinctly different individual trajectory shapes. Most precision medicine approaches using longitudinal data often ignore information from the longitudinal data structure. This paper investigates a powerful precision medicine approach by examining the impact of baseline covariates on longitudinal outcome trajectories to guide treatment decisions instead of traditional scalar outcome measures derived from longitudinal data, such as a change score. We introduce a method of estimating "biosignatures" defined as linear combinations of baseline characteristics (i.e., a single index) that optimally separate longitudinal trajectories among different treatment groups. The criterion used is to maximize the Kullback-Leibler Divergence between different treatment outcome distributions. The approach is illustrated via simulation studies and a depression clinical trial. The approach is also contrasted with more traditional methods and compares performance in the presence of missing data.
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Affiliation(s)
- Lanqiu Yao
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, NY, USA
| | - Thaddeus Tarpey
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, NY, USA
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7
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Hasin DS, Shmulewitz D, Stohl M, Greenstein E, Aharonovich E, Petronis KR, Von Korff M, Datta S, Sonty N, Ross S, Inturrisi C, Weinberger ML, Scodes J, Wall MM. Diagnosing Prescription Opioid Use Disorder in Patients Using Prescribed Opioids for Chronic Pain. Am J Psychiatry 2022; 179:715-725. [PMID: 35702830 DOI: 10.1176/appi.ajp.21070721] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The diagnostic criteria for opioid use disorder, originally developed for heroin, did not anticipate the surge in prescription opioid use and the resulting complexities in diagnosing prescription opioid use disorder (POUD), including differentiation of pain relief (therapeutic intent) from more common drug use motives, such as to get high or to cope with negative affect. The authors examined the validity of the Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 opioid version, an instrument designed to make this differentiation. METHODS Patients (N=606) from pain clinics and inpatient substance treatment who ever received a ≥30-day opioid prescription for chronic pain were evaluated for DSM-5 POUD (i.e., withdrawal and tolerance were not considered positive if patients used opioids only as prescribed, per DSM-5 guidelines) and pain-adjusted POUD (behavioral/subjective criteria were not considered positive if pain relief [therapeutic intent] was the sole motive). Bivariate correlated-outcome regression models indicated associations of 10 validators with DSM-5 and pain-adjusted POUD measures, using mean ratios for dimensional measures and odds ratios for binary measures. RESULTS The prevalences of DSM-5 and pain-adjusted POUD, respectively, were 44.4% and 30.4% at the ≥2-criteria threshold and 29.5% and 25.3% at the ≥4-criteria threshold. Pain adjustment had little effect on prevalence among substance treatment patients but resulted in substantially lower prevalence among pain treatment patients. All validators had significantly stronger associations with pain-adjusted than with DSM-5 dimensional POUD measures (ratios of mean ratios, 1.22-2.31). For most validators, pain-adjusted binary POUD had larger odds ratios than DSM-5 measures. CONCLUSIONS Adapting POUD measures for pain relief (therapeutic intent) improved validity. Studies should investigate the clinical utility of differentiating between therapeutic and nontherapeutic intent in evaluating POUD diagnostic criteria.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Dvora Shmulewitz
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Malka Stohl
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Eliana Greenstein
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Kenneth R Petronis
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Michael Von Korff
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Samyadev Datta
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Nomita Sonty
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Stephen Ross
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Charles Inturrisi
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Michael L Weinberger
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Jennifer Scodes
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Medical Center (Hasin, Shmulewitz, Aharonovich, Scodes, Wall) and New York State Psychiatric Institute (Hasin, Shmulewitz, Stohl, Greenstein, Aharonovich, Scodes, Wall), New York; Epidemiology, Pfizer, Inc., New York (Petronis); Kaiser Permanente Washington Health Research Institute, Seattle (Von Korff); Department of Anesthesiology, Rutgers University, Newark, N.J. (Datta); Department of Anesthesiology, Columbia University Medical Center, New York (Sonty, Weinberger); Department of Psychiatry, New York University, New York (Ross); Cornell University Medical College, New York (Inturrisi)
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8
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Coluzzi F, Rullo L, Scerpa MS, Losapio LM, Rocco M, Billeci D, Candeletti S, Romualdi P. Current and Future Therapeutic Options in Pain Management: Multi-mechanistic Opioids Involving Both MOR and NOP Receptor Activation. CNS Drugs 2022; 36:617-632. [PMID: 35616826 PMCID: PMC9166888 DOI: 10.1007/s40263-022-00924-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 12/24/2022]
Abstract
Opioids are widely used in chronic pain management, despite major concerns about their risk of adverse events, particularly abuse, misuse, and respiratory depression from overdose. Multi-mechanistic opioids, such as tapentadol and buprenorphine, have been widely studied as a valid alternative to traditional opioids for their safer profile. Special interest was focused on the role of the nociceptin opioid peptide (NOP) receptor in terms of analgesia and improved tolerability. Nociceptin opioid peptide receptor agonists were shown to reinforce the antinociceptive effect of mu opioid receptor (MOR) agonists and modulate some of their adverse effects. Therefore, multi-mechanistic opioids involving both MOR and NOP receptor activation became a major field of pharmaceutical and clinical investigations. Buprenorphine was re-discovered in a new perspective, as an atypical analgesic and as a substitution therapy for opioid use disorders; and buprenorphine derivatives have been tested in animal models of nociceptive and neuropathic pain. Similarly, cebranopadol, a full MOR/NOP receptor agonist, has been clinically evaluated for its potent analgesic efficacy and better tolerability profile, compared with traditional opioids. This review overviews pharmacological mechanisms of the NOP receptor system, including its role in pain management and in the development of opioid tolerance. Clinical data on buprenorphine suggest its role as a safer alternative to traditional opioids, particularly in patients with non-cancer pain; while data on cebranopadol still require phase III study results to approve its introduction on the market. Other bifunctional MOR/NOP receptor ligands, such as BU08028, BU10038, and AT-121, are currently under pharmacological investigations and could represent promising analgesic agents for the future.
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Affiliation(s)
- Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Latina, Italy
- Unit Anesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, Rome, Italy
| | - Laura Rullo
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum - University of Bologna, Irnerio 48, Bologna, 40126, Italy
| | - Maria Sole Scerpa
- Unit Anesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, Rome, Italy
| | - Loredana Maria Losapio
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum - University of Bologna, Irnerio 48, Bologna, 40126, Italy
| | - Monica Rocco
- Department of Surgical and Medical Science and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Sanzio Candeletti
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum - University of Bologna, Irnerio 48, Bologna, 40126, Italy.
| | - Patrizia Romualdi
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum - University of Bologna, Irnerio 48, Bologna, 40126, Italy
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Faden J, Serdenes R, Citrome L. Olanzapine-samidorphan combination tablets for the treatment of schizophrenia and bipolar I disorder - what is it, and will it be used? Expert Rev Neurother 2022; 22:365-376. [PMID: 35354374 DOI: 10.1080/14737175.2022.2060742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : Although olanzapine remains one of the most efficacious antipsychotic medications for the treatment of schizophrenia, there are significant tolerability concerns related to its weight and metabolic profile. Olanzapine-samidorphan combination tablets (OLZ/SAM), branded as Lybalvi, is a newly FDA approved formulation aimed at attenuating antipsychotic induced weight gain via modulation of the endogenous opioid system with samidorphan, while retaining the robust antipsychotic efficacy of olanzapine. AREAS COVERED : We reviewed the published literature of OLZ/SAM for the management of schizophrenia using the US National Library of Medicine's PubMed.gov resource. Topics covered in this narrative review include the pharmacokinetics, pharmacodynamics, tolerability, and efficacy of OLZ/SAM. EXPERT OPINION : OLZ/SAM is an effective and well tolerated pharmacologic option in mitigating olanzapine induced weight gain while retaining olanzapine's efficacy. It has a limited effect on metabolic laboratory parameters and cumulatively tends to limit weight gain rather than promote weight loss. Additional research will be needed to determine its effectiveness compared to alternative strategies to attenuate antipsychotic induced weight gain.
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Affiliation(s)
- Justin Faden
- Lewis Katz School of Medicine at Temple University, Philadelphia PA 19125, USA
| | - Ryan Serdenes
- Lewis Katz School of Medicine at Temple University, Philadelphia PA 19125, USA
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Yavi M, Henter ID, Park LT, Zarate C. Key considerations in the pharmacological management of treatment-resistant depression. Expert Opin Pharmacother 2021; 22:2405-2415. [PMID: 34252320 PMCID: PMC8648908 DOI: 10.1080/14656566.2021.1951225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
Introduction: Treatment-resistant depression (TRD) is a complex, multifactorial, and biologically heterogeneous disorder with debilitating outcomes. Understanding individual reasons why patients do not respond to treatment is necessary for improving clinical recommendations regarding medication regimens, augmentation strategies, and alternative treatments.Areas covered: This manuscript reviews evidence-based treatment strategies for the clinical management of TRD. Current developments in the field and potential future recommendations for personalized treatment of TRD are also discussed.Expert opinion: Treatment guidelines for TRD are limited by the heterogeneous nature of the disorder. Furthermore, current strategies reflect this heterogeneity by emphasizing disease characteristics as well as drug trial response or failure. Developing robust biomarkers that could one day be integrated into clinical practice has the potential to advance specific treatment targets and ultimately improve treatment and remission outcomes.
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Affiliation(s)
- Mani Yavi
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental HealthNational Institutes of Health Bethesda, MD, USA
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Davoudi M, Allame Z, Niya RT, Taheri AA, Ahmadi SM. The synergistic effect of vitamin D supplement and mindfulness training on pain severity, pain-related disability and neuropathy-specific quality of life dimensions in painful diabetic neuropathy: a randomized clinical trial with placebo-controlled. J Diabetes Metab Disord 2021; 20:49-58. [PMID: 34222059 DOI: 10.1007/s40200-020-00700-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/22/2020] [Indexed: 12/13/2022]
Abstract
Purpose This study aimed to examine the synergistic effect of Vitamin D (VD) Supplement and mindfulness on neuropathic pain severity, Pain-Related Disability and Neuropathy-Specific Quality of Life (QOL) dimensions in painful diabetic neuropathy. Methods In this randomized controlled trial, 225 patients with painful diabetic neuropathy were randomly allocated to five groups: (1) mindfulness and placebo, (2) placebo, (3) mindfulness, (4) VD, and (5) mindfulness and VD. Mindfulness training includes twelve sessions, and VD patients received a daily four thousand IU oral dosage (four capsules) with 28,000 IU vitamin D weekly for 12 weeks. Laboratory analyses, Sun exposure time, Vitamin D intake, BMI and physical activity were measured in pre-test and post-test. Pain-Related Disability measured with The Pain Disability Index (PDI). For other outcome variables, Neuropathy, a Specific QOL questionnaire and Neuropathic pain severity scale were utilized. Data were analyzed using one-way repeated-measures analysis of variance (ANOVA), Scheffe Post-hoc test and paired sample t-test. Results In baseline, measures were not different among the groups. At the end-of-treatment, results showed improvement in all groups except the "placebo only" group for outcome variables. There was no difference between VD and mindfulness groups (within and not combined with placebo) in posttest. However, "VD + mindfulness" has a greater improvement rather than VD and mindfulness groups (P < 0.05). Moreover, both protocols have no significant effects on FBS, BMI and energy intakes (P > 0.05). Conclusion Combining VD and mindfulness can reduce pain severity and pain-related disability, so with these changes, patients experience improve in their quality of life.
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Affiliation(s)
- Mohammadreza Davoudi
- Department of clinical psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Zahra Allame
- Department of clinical psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Amir Abbas Taheri
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyyed Mojtaba Ahmadi
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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