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Inserra A, Piot A, De Gregorio D, Gobbi G. Lysergic Acid Diethylamide (LSD) for the Treatment of Anxiety Disorders: Preclinical and Clinical Evidence. CNS Drugs 2023; 37:733-754. [PMID: 37603260 DOI: 10.1007/s40263-023-01008-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 08/22/2023]
Abstract
Anxiety disorders (ADs) represent the sixth leading cause of disability worldwide, resulting in a significant global economic burden. Over 50% of individuals with ADs do not respond to standard therapies, making the identification of more effective anxiolytic drugs an ongoing research priority. In this work, we review the preclinical literature concerning the effects of lysergic acid diethylamide (LSD) on anxiety-like behaviors in preclinical models, and the clinical literature on anxiolytic effects of LSD in healthy volunteers and patients with ADs. Preclinical and clinical findings show that even if LSD may exacerbate anxiety acutely (both in "microdoses" and "full doses"), it induces long-lasting anxiolytic effects. Only two randomized controlled trials combining LSD and psychotherapy have been performed in patients with ADs with and without life-threatening conditions, showing a good safety profile and persisting decreases in anxiety outcomes. The effect of LSD on anxiety may be mediated by serotonin receptors (5-HT1A/1B, 5-HT2A/2C, and 5-HT7) and/or transporter in brain networks and circuits (default mode network, cortico-striato-thalamo-cortical circuit, and prefrontal cortex-amygdala circuit), involved in the modulation of anxiety. It remains unclear whether LSD can be an efficacious treatment alone or only when combined with psychotherapy, and if "microdosing" may elicit the same sustained anxiolytic effects as the "full doses". Further randomized controlled trials with larger sample size cohorts of patients with ADs are required to clearly define the effective regimens, safety profile, efficacy, and feasibility of LSD for the treatment of ADs.
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Affiliation(s)
- Antonio Inserra
- Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Avenue des Pins Ouest, Montreal, QC, H3A 1A1, Canada
| | - Alexandre Piot
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Danilo De Gregorio
- Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriella Gobbi
- Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Avenue des Pins Ouest, Montreal, QC, H3A 1A1, Canada.
- McGill University Health Center, Montreal, QC, Canada.
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Alarcan H, Schnell D, Rouleau S, Chachia A, Saint-Marcoux F, Mathieu O, Couderc S. Suivi thérapeutique pharmacologique de la cyamémazine : comment interpréter une concentration ? Une revue de la littérature. Therapie 2022; 77:603-609. [DOI: 10.1016/j.therap.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
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Spasov AA, Yakovlev DS, Brigadirova AA, Maltsev DV, Agatsarskaya YV. Novel Approaches to the Development of Antimigraine Drugs: A Focus on 5-HT2A Receptor Antagonists. RUSSIAN JOURNAL OF BIOORGANIC CHEMISTRY 2019. [DOI: 10.1134/s1068162019020146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Franc A, Kubová K, Elbl J, Muselík J, Vetchý D, Šaloun J, Opatřilová R. Diazepam filled hard capsules intended for detoxification of patients addicted to benzodiazepines and Z-drugs. Eur J Hosp Pharm 2017; 26:10-15. [PMID: 31157089 DOI: 10.1136/ejhpharm-2016-001163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 06/08/2017] [Accepted: 06/20/2017] [Indexed: 11/04/2022] Open
Abstract
Objectives The abuse of benzodiazepines and Z-drugs reduces the quality of life of millions of addicted people worldwide. They cannot be discontinued abruptly due to harmful withdrawal symptoms. Detoxification is usually based on replacement of short/middle acting benzodiazepines or Z-drugs by diazepam and tapering the dose over time. In order to enhance patient adherence to an individual withdrawal plan, suitable diazepam dosage forms have to be available. Hard capsules containing an exact and uniform dose could be used for the relief of symptoms caused by altering the plasma level and overcoming psychogenic stress from the dose reduction. Methods This work demonstrates that capsules with a content of diazepam ranging from 2.125mg to 0.492 mg (dose decreasing always by 15%) cannot be easily prepared by standard mortar technology in a pharmacy. To meet mass and content uniformity European Pharmacopoeia criteria, capsules were prepared by improved technology based on the preparation of binary blends of calcium phosphate anhydrous and diazepam in descending concentrations in a high-speed mixer (time 30 s) and densification of about 10% during filling of the capsules. Results All batches (n=20) prepared by improved technology met the requirement for content uniformity compared with only nine batches prepared by standard mortar blender technology. Based on the process capability index, none of the samples prepared by standard technology fitted pharmacopeia limits at the statistically acceptable level. On the other hand, all batches prepared by improved technology exhibited acceptable process capability index. Conclusions We have shown that at least 99.73% of batches prepared by our improved technology would meet the pharmacopoeia limits for content uniformity and are suitable for treatment of this type of addiction.
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Affiliation(s)
- Aleš Franc
- Department of Pharmaceutics, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
| | - Kateřina Kubová
- Department of Pharmaceutics, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
| | - Jan Elbl
- Department of Pharmaceutics, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
| | - Jan Muselík
- Department of Pharmaceutics, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
| | - David Vetchý
- Department of Pharmaceutics, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
| | - Jan Šaloun
- Department of Applied Pharmacy, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
| | - Radka Opatřilová
- Department of Chemical Drugs, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
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Bonnot O, Dufresne M, Herrera P, Michaud E, Pivette J, Chaslerie A, Sauvaget A, Vigneau C. Influence of socioeconomic status on antipsychotic prescriptions among youth in France. BMC Psychiatry 2017; 17:82. [PMID: 28241816 PMCID: PMC5330013 DOI: 10.1186/s12888-017-1232-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 02/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent studies analysing the trends in antipsychotic (AP) prescriptions for children and adolescents have raised concerns regarding the influence of socioeconomic status. Previous findings have also shown variable prescription rates for first-generation (FG) and second-generation (SG) APs. METHOD Our objectives were to assess the proportion of patients from low-income families receiving APs and the most commonly prescribed APs in France. We conducted a descriptive analysis of AP drugs dispensed during a 1-year period (July 1, 2013-June 30, 2014) in a northwestern region of France with 941,857 subjects less than 18 years old. All data were extracted from an exhaustive, individual and anonymous social security database. We obtained each subject's socioeconomic status (by identifying their affiliation with a specific social security program) and also collected sociodemographic data, drug type, prescribing and dispensing dates and amount, and prescriber type (e.g., hospital physician, general practitioner, psychiatrist, paediatrician). RESULTS There were two main novel findings. First, we found that the proportion of patients with AP prescriptions was nearly ten times higher in low-income families than in the general population: 35.9% of CMU-C patients compared to 3.7% in all of Pays de la Loire (X 2 = 7875.1, p < 0.001). Additionally, we found a higher rate of FGAP than SGAP prescriptions (65% vs. 57%). CONCLUSIONS Our study suggests two types of AP misuse that could provide interesting targets for public healthcare interventions. First, our results strongly suggest an over-representation of patients from low-income families. Low-income families primarily resided in areas with low physician density and appeared to receive drugs to treat their conditions more frequently than other individuals. This increased prescription rate is a public health issue, potentially requiring political action. Second, the use of FGAPs did not adhere to the latest recommendations for drug use in this population, and this discrepancy should be addressed with informational campaigns targeted to medical practitioners.
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Affiliation(s)
- Olivier Bonnot
- Department of Child and Adolescent Psychiatry, University Hospital of Nantes, Nantes, France. .,Department of Child and Adolescent Psychiatry, University of Nantes, CHU de Nantes, 55 rue St Jacques, 44 000, Nantes, France.
| | - Mélanie Dufresne
- 0000 0004 0472 0371grid.277151.7Department of Pharmacology, University Hospital of Nantes, Nantes, France
| | - Paula Herrera
- 0000 0004 0472 0371grid.277151.7Department of Child and Adolescent Psychiatry, University Hospital of Nantes, Nantes, France ,Medical Department, French National Health Insurance (DRSM), Nantes, France
| | - Emmanuelle Michaud
- 0000 0001 2205 5940grid.412191.eGrupo de Investigación en Neurociencias NeURos, Universidad del Rosario, Bogota, Colombia
| | - Jacques Pivette
- 0000 0001 2205 5940grid.412191.eGrupo de Investigación en Neurociencias NeURos, Universidad del Rosario, Bogota, Colombia
| | - Anicet Chaslerie
- 0000 0001 2205 5940grid.412191.eGrupo de Investigación en Neurociencias NeURos, Universidad del Rosario, Bogota, Colombia
| | - Anne Sauvaget
- 0000 0004 0472 0371grid.277151.7Department of Psychiatry, University Hospital of Nantes, Nantes, France
| | - Caroline Vigneau
- 0000 0004 0472 0371grid.277151.7Department of Pharmacology, University Hospital of Nantes, Nantes, France
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Nikmahzar E, Jahanshahi M, Ghaemi A, Naseri GR, Moharreri AR, Lotfinia AA. Hippocampal serotonin-2A receptor-immunoreactive neurons density increases after testosterone therapy in the gonadectomized male mice. Anat Cell Biol 2016; 49:259-272. [PMID: 28127501 PMCID: PMC5266105 DOI: 10.5115/acb.2016.49.4.259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/06/2016] [Accepted: 12/09/2016] [Indexed: 12/15/2022] Open
Abstract
The change of steroid levels may also exert different modulatory effects on the number and class of serotonin receptors present in the plasma membrane. The effects of chronic treatment of testosterone for anxiety were examined and expression of 5-HT2A serotonergic receptor, neuron, astrocyte, and dark neuron density in the hippocampus of gonadectomized male mice was determined. Thirty-six adult male NMRI mice were randomly divided into six groups: intact-no testosterone treatment (No T), gonadectomy (GDX)-No T, GDX-Vehicle, GDX-6.25 mg/kg testosterone (T), GDX-12.5 mg/kg T, and GDX-25 mg/kg T. Anxiety-related behavior was evaluated using elevated plus maze apparatus. The animals were anesthetized after 48 hours after behavioral testing, and decapitated and micron slices were prepared for immunohistochemical as well as histopathological assessment. Subcutaneous injection of testosterone (25 mg/kg) may induce anxiogenic-like behavior in male mice. In addition, immunohistochemical data reveal reduced expression of 5-HT2A serotonergic receptor after gonadectomy in all areas of the hippocampus. However, treatment with testosterone could increase the mean number of dark neurons as well as immunoreactive neurons in CA1 and CA3 area, dose dependently. The density of 5-HT2A receptor-immunoreactive neurons may play a crucial role in the induction of anxiety like behavior. As reduction in such receptor expression have shown to significantly enhance anxiety behaviors. However, replacement of testosterone dose dependently enhances the number of 5-HT2A receptor-immunoreactive neurons and interestingly also reduced anxiety like behaviors.
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Affiliation(s)
- Emsehgol Nikmahzar
- Neuroscience Research Center, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mehrdad Jahanshahi
- Department of Anatomy, Neuroscience Research Center, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Amir Ghaemi
- Shefa Neuroscience Research Center, Tehran, Iran
| | - Gholam Reza Naseri
- Department of Anatomy, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ali Reza Moharreri
- Department of Anatomy, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
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Khouri C, Lepelley M, Villier C, Bougerol T, Mallaret M. [Cyamemazine (Tercian ®): Exploration of extrapyramidal syndrome cases contained in the French pharmacovigilance database]. Therapie 2016; 72:345-350. [PMID: 27726885 DOI: 10.1016/j.therap.2016.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 06/29/2016] [Accepted: 07/19/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Cyamemazine (Tercian®) is currently the most widely prescribed neuroleptic in France. This widespread use is due to its anxiolytics properties and to a claimed good safety profile. Although, prescription of cyamemazine is not devoid of the risks associated with the use of neuroleptics: extrapyramidal syndromes. This study aims at describing extrapyramidal syndromes induced by cyamemazine registered in the French pharmacovigilance database. METHODS All spontaneous reports of extrapyramidal syndromes in the French pharmacovigilance database between 1st January 1985 and 31th December 2015 were described and analyzed. RESULTS During this period 132 cases following cyamemazine intake were reported in the French pharmacovigilance database. The extrapyramidal syndromes were considered as "serious" in 77% of cases. More than 80% of the cases were described with a dosage of cyamemazine under 100mg/day and no correlation between drug dose and seriousness of the cases were found. Thirty-six cases were described with a monotherapy of cyamemazine. CONCLUSION We should keep in mind that despite its widespread use in various indications (e.g. anxiolytic) cyamemazine remains a neuroleptic and could induce extrapyramidal syndromes even with low dosage. Careful monitoring should be performed when introducing and with long-term use of cyamemazine, mostly in elderly patients or patient already being treated with neuroleptics.
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Affiliation(s)
- Charles Khouri
- Centre régional de pharmacovigilance, CHU de Grenoble, pavillon E, CS 10217, 38043 Grenoble cedex 09, France.
| | - Marion Lepelley
- Centre régional de pharmacovigilance, CHU de Grenoble, pavillon E, CS 10217, 38043 Grenoble cedex 09, France
| | - Céline Villier
- Centre régional de pharmacovigilance, CHU de Grenoble, pavillon E, CS 10217, 38043 Grenoble cedex 09, France
| | - Thierry Bougerol
- Clinique de psychiatrie, pôle neurologie psychiatrie, CHU de Grenoble, 38043 Grenoble, France
| | - Michel Mallaret
- Centre régional de pharmacovigilance, CHU de Grenoble, pavillon E, CS 10217, 38043 Grenoble cedex 09, France
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The cytochrome P450-catalyzed metabolism of levomepromazine: a phenothiazine neuroleptic with a wide spectrum of clinical application. Biochem Pharmacol 2014; 90:188-95. [DOI: 10.1016/j.bcp.2014.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/08/2014] [Accepted: 05/09/2014] [Indexed: 11/18/2022]
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