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Fonseca NKO, Curtarelli VD, Bertoletti J, Azevedo K, Cardinal TM, Moreira JD, Antunes LC. Avoidant restrictive food intake disorder: recent advances in neurobiology and treatment. J Eat Disord 2024; 12:74. [PMID: 38849953 PMCID: PMC11157884 DOI: 10.1186/s40337-024-01021-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/14/2024] [Indexed: 06/09/2024] Open
Abstract
Avoidant restrictive food intake disorder (ARFID) is an eating disorder characterized by persistent insufficient nutritional and/or energy intake. ARFID, before referred to as "selective eating disorder", was introduced recently in the DSM-5 as a replacement for and expansion of the previous diagnosis. Individuals with ARFID may limit food variety and intake due to avoidance based on the sensory characteristics of the food or related to any adverse consequences of eating without the intention of losing weight and concerns of body image. The limited understanding of avoidant and restrictive eating poses challenges to effective treatment and management, impacting directly on the growth and development of children and adolescents. The ARFID neurobiological concept has not yet been clearly defined to clinical practice for nutritionists, thereby hindering screening and impeding the development of treatment recommendations. This narrative review provide useful practical information to consult the pathophysiology, the neurobiology, the clinical features, the assessment and the treatment for healthcare professionals seeking to enhance their clinical knowledge and management of this disorder.
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Affiliation(s)
- Natasha K O Fonseca
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil.
| | | | | | - Karla Azevedo
- Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Translational Nutritional Neuroscience Working Group, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Tiago M Cardinal
- Laboratory of Neuroscience and Eating Behavior, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Júlia D Moreira
- Department of Nutrition, Health Sciences Center, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Translational Nutritional Neuroscience Working Group, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Luciana C Antunes
- Laboratory of Neuroscience and Eating Behavior, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Department of Nutrition, Health Sciences Center, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Translational Nutritional Neuroscience Working Group, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
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Oricco S, Quintavalla C, Apolloni I, Crosara S. Bradyarrhythmia after treatment with atenolol and mirtazapine in a cat with hypertrophic cardiomyopathy. J Vet Cardiol 2024; 53:72-76. [PMID: 38735230 DOI: 10.1016/j.jvc.2024.03.003] [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: 11/10/2023] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 05/14/2024]
Abstract
A nine-year-old spayed female domestic shorthair cat with a previous diagnosis of hypertrophic cardiomyopathy and treated for one month with atenolol (6.25 mg q 12 h) was referred for respiratory distress and anorexia. The cat was diagnosed with pulmonary oedema secondary to obstructive hypertrophic cardiomyopathy. After stabilisation, she was discharged with furosemide (1 mg/kg q 12 h), clopidogrel (18.75 mg q 24 h), atenolol (6.25 mg q 12 h), and mirtazapine (2 mg/cat q 24 h) to increase appetite. At recheck, the cat was lethargic and presented with severe bradycardia with a junctional escape rhythm and ventriculoatrial conduction. The mirtazapine was discontinued due to its possible side-effects on cardiac rhythm. After three days, the atenolol was halved because the bradyarrhythmia was still present. After 10 days, the rhythm returned to sinus; atenolol was reintroduced twice daily with no further side-effects. The absence of a sinus rhythm with a junctional escape rhythm and P' retroconduction is compatible with a third-degree sinus block or a sinus standstill; the differentiation of these rhythm disturbances is impossible, based on the surface electrocardiogram (ECG). The sinus rhythm was restored after mirtazapine was withdrawn. However, it is not possible to rule out the role of the atenolol or the combined effect of the two drugs. The cat was affected by hypertrophic cardiomyopathy, and the role of myocardial remodelling cannot be excluded. This is the first time that a bradyarrhythmia consequent to the treatment with atenolol and mirtazapine was described in a cat.
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Affiliation(s)
- S Oricco
- Department of Veterinary Sciences, University of Parma, Via del Taglio 10, 43126 Parma, Italy
| | - C Quintavalla
- Department of Veterinary Sciences, University of Parma, Via del Taglio 10, 43126 Parma, Italy
| | - I Apolloni
- Department of Veterinary Sciences, University of Parma, Via del Taglio 10, 43126 Parma, Italy.
| | - S Crosara
- Department of Veterinary Sciences, University of Parma, Via del Taglio 10, 43126 Parma, Italy
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Zhu D, Lyu K. Anti-stigmatizing: a collaborative autoethnography on recovery from depression. Front Psychiatry 2024; 15:1360967. [PMID: 38690206 PMCID: PMC11059567 DOI: 10.3389/fpsyt.2024.1360967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/11/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Despite extensive research on clinical treatments for depression, there remains a significant gap in understanding of the lived experiences and recovery journeys of those with depression. This study sought to explore the recovery process through an "anti-stigmatizing" lens, emphasizing the cultural-psychological mechanisms at play and the importance of personal narratives in shaping the recovery trajectory. Methods Using a collaborative autoethnographic approach, this report focuses on the first author's journey of depression recovery. This research methodology allows for an in-depth exploration of subjective experiences, with a specific emphasis on the interaction between societal stigma, personal identity, and mental-health challenges. Results It is found that the depression-recovery experience can be divided into four stages from an anti-stigma perspective: (1) encountering the public stigma of emotions; (2) internalizing the stigma to a self-stigma; (3) "decriminalizing" the expected stigma of a "depressed" identity through diagnosis; and (4) being able to cope with and understanding the public stigma relating to depression when facing it again. Key factors that were found to contribute to recovery were self-awareness, community empowerment, and recognition and acceptance by close friends and family. Discussion We propose a reconceptualization of depression that incorporates a societal perspective on internalized stigma. Recovery from depression is not merely a medical process; it also pertains to how the patient frees themselves from public stigma. The results strongly indicate the need for a paradigm shift toward a more inclusive and empathetic approach to mental-health care, and we emphasize the importance of personal narratives in depression recovery.
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Affiliation(s)
- Danlei Zhu
- Institute of Vocational & Adult Education, East China Normal University, Shanghai, China
| | - Keyi Lyu
- Jing Hengyi School of Education, Hangzhou Normal University, Hangzhou, China
- Chinese Education Modernization Research Institute of Hangzhou Normal University, Hangzhou, China
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Piatkova Y, Doyen M, Heyer S, Tahmazov A, Frismand S, Hopes L, Imbert L, Verger A. Effects of medication on dopamine transporter imaging using [ 123I]I-FP-CIT SPECT in routine practice. Eur J Nucl Med Mol Imaging 2024; 51:1323-1332. [PMID: 38114618 DOI: 10.1007/s00259-023-06565-x] [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: 09/07/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Dopamine transporter (DAT) imaging is used to support the diagnosis of neurodegenerative parkinsonian disorders. Specific medications have been reported to confound the interpretation of [123I]I-FP-CIT SPECT scans, but there is limited data. The aim of the current study is to identify potential medication effects on the interpretation of [123I]I-FP-CIT SPECT scans in routine practice. MATERIALS AND METHODS Consecutive patients undergoing a [123I]I-FP-CIT SPECT/CT scan on a 360° CZT camera between September 2019 and December 2022 were included. An exhaustive review of patient medications (antidepressants, antipsychotics, anti-epileptics, anti-parkinsonians, benzodiazepines, lithium, opioids, and stimulants) was performed. Two experienced nuclear physicians, blinded to the medication reports, interpreted the [123I]I-FP-CIT SPECT scans visually and a semi-quantitative analysis was performed using a local normal database. RESULTS The study included 305 patients (71.0 ± 10.4, 135 women) and 145 (47.5%) visually interpreted normal scans. In normal scans, the striatum/occiput radioligand uptake ratio was decreased by noradrenergic and specific serotonergic antidepressants (NASSAs) (n = 15, z-score of - 0.93) and opioid medication (tramadol, n = 6, z-score of - 0.85) and was associated with a younger age in the multivariate analysis. In the overall population, the striatum/occiput ratio was influenced by NASSAs and associated with consensual visual analysis, age, sex, and anti-parkinsonian medications related to the status of the disease. CONCLUSION Our study confirms the potential impact of antidepressant (NASSA) and opioid (tramadol) medications on the semi-quantitative analysis of [123I]I-FP-CIT SPECT scans. However, when performing a visual analysis, only NASSAs significantly impacted the interpretation of [123I]I-FP-CIT SPECT scans.
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Affiliation(s)
- Yuliya Piatkova
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU Nancy, F-54000, Nancy, France
| | - Matthieu Doyen
- IADI, INSERM U1254, Université de Lorraine, F-54000, Nancy, France
| | - Sébastien Heyer
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU Nancy, F-54000, Nancy, France
| | - Ayaz Tahmazov
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU Nancy, F-54000, Nancy, France
| | - Solene Frismand
- Department of Neurology, Université de Lorraine, CHRU de Nancy, F-54000, Nancy, France
| | - Lucie Hopes
- Department of Neurology, Université de Lorraine, CHRU de Nancy, F-54000, Nancy, France
| | - Laetitia Imbert
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU Nancy, F-54000, Nancy, France
- IADI, INSERM U1254, Université de Lorraine, F-54000, Nancy, France
| | - Antoine Verger
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU Nancy, F-54000, Nancy, France.
- IADI, INSERM U1254, Université de Lorraine, F-54000, Nancy, France.
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Mrozek W, Socha J, Sidorowicz K, Skrok A, Syrytczyk A, Piątkowska-Chmiel I, Herbet M. Pathogenesis and treatment of depression: Role of diet in prevention and therapy. Nutrition 2023; 115:112143. [PMID: 37562078 PMCID: PMC10299949 DOI: 10.1016/j.nut.2023.112143] [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: 01/30/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 08/12/2023]
Abstract
In recent years, there has been a significant increase in depression, which is related to, among other things, the COVID-19 pandemic. Depression can be fatal if not treated or if treated inappropriately. Depression is the leading cause of suicide attempts. The disease is multifactorial, and pharmacotherapy often fails to bring satisfactory results. Therefore, increasingly more importance is attached to the natural healing substances and nutrients in food, which can significantly affect the therapy process and prevention of depressive disorders. A proper diet is vital to preventing depression and can be a valuable addition to psychological and pharmacologic treatment. An inadequate diet may reduce the effectiveness of antidepressants or increase their side effects, leading to life-threatening symptoms. This study aimed to review the literature on the pathogenesis of the development and treatment of depression, with particular emphasis on dietary supplements and the role of nutrition in the prevention and treatment of depressive disorders.
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Affiliation(s)
- Weronika Mrozek
- Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Lublin, Poland
| | - Justyna Socha
- Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Lublin, Poland
| | - Klara Sidorowicz
- Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Lublin, Poland
| | - Aleksandra Skrok
- Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Lublin, Poland
| | - Aleksandra Syrytczyk
- Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Lublin, Poland
| | | | - Mariola Herbet
- Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Lublin, Poland.
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Shirzadi M, Farshchian N, Nazarpour A, Eskandari S, Kahrari F, Abdollahpour Ranjbar H, Nazari S, Hekmati I, Farhang S. Escitalopram and progressive muscle relaxation training are both effective for the treatment of hot flashes in patients with breast cancer: a randomized controlled trial. J Psychosom Obstet Gynaecol 2022; 43:393-399. [PMID: 34647858 DOI: 10.1080/0167482x.2021.1985452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Available treatments for hot flashes in patients with breast cancer are not always tolerable or effective for all patients. METHODS Patients diagnosed to have primary breast cancer were randomly allocated to receive 10 mg of escitalopram, placebo, or progressive muscle relaxation therapy. Patients were asked to report the frequency and duration of hot flashes during day and night, at baseline and after ten weeks of treatment, and completed the menopause rating scale. RESULTS Eighty-two patients were randomly assigned to receive escitalopram (n = 26), PMRT (n = 28), and placebo (n = 28). PMRT and escitalopram could effectively decrease number and duration of diurnal and nocturnal HFs in patients with breast cancer, with a better effect observed from escitalopram. They could both decrease the total score of MRS. CONCLUSION Both escitalopram ad PMRT can reveal nocturnal and diurnal HFs in terms of frequency and duration in patients with breast cancer.
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Affiliation(s)
- Maryam Shirzadi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Negin Farshchian
- Department of Radiation Oncology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arash Nazarpour
- Department of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Soudabeh Eskandari
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fahimeh Kahrari
- Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Somayeh Nazari
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Sara Farhang
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, East Azerbaijan, Iran
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Han KM. Pharmacotherapy for late-life depression. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2022. [DOI: 10.5124/jkma.2022.65.3.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Late-life depression (LLD) is one of the most common psychiatric disorders. However, LLD is often undetected or inadequately treated by clinicians. This review summarizes the recent research on pharmacotherapy for LLD, updates information on monotherapy using recommended antidepressants, and discusses the clinical features and diagnostic criteria for LLD.Current Concepts: The diagnostic criteria for depression in both elderly and young adults are identical. Clinical features of the elderly with depression more likely include more comorbid medical conditions and cognitive impairment than those of young adults. Depression in the elderly tends to have a more chronic course with frequent recurrences or relapses.Discussion and Conclusion: The current pharmacological treatment guidelines for LLD recommend the use of selective serotonin reuptake inhibitor (SSRI), serotonin-norepinephrine reuptake inhibitor, bupropion, mirtazapine, and vortioxetine as first-line medications. SSRIs, among them, are recommended first because they present fewer serious adverse effects and more clinical evidence than those of other antidepressants. Before starting antidepressant treatment for LLD, clinicians should consider patients’ comorbid medical conditions, drug interactions, possible adverse effects of antidepressants, and polypharmacy. The starting dose of antidepressants for elderly patients should be half of that prescribed for young adults to minimize the adverse effects; however, most elderly patients need the same antidepressant doses as that prescribed for young patients. After remission, a 1-year maintenance treatment is required to prevent recurrence or relapse of LLD.
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Ito H, Tsuneki H, Sasaoka T, Toyooka N, Matsuo M, Yamazaki M. Suvorexant and mirtazapine improve chronic pain-related changes in parameters of sleep and voluntary physical performance in mice with sciatic nerve ligation. PLoS One 2022; 17:e0264386. [PMID: 35213655 PMCID: PMC8880854 DOI: 10.1371/journal.pone.0264386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/09/2022] [Indexed: 11/19/2022] Open
Abstract
Both chronic pain and sleep disorders are associated with a reduction in the quality of life. They can be both a cause and a consequence of each other, and should therefore be simultaneously treated. However, optimal treatments for chronic pain-related sleep disorders are not well established. Here, we aimed to investigate the effects of suvorexant, a novel sleep drug, and mirtazapine, a noradrenergic and specific serotonergic antidepressant, on pain-related changes in sleep parameters in a preclinical chronic pain mice model, by partial sciatic nerve ligation. We evaluated the quantity, duration, and depth of sleep by analyzing the electroencephalogram and voluntary activity by counting the number of wheel rotations to determine various symptoms of sleep disorders, including reduced total sleep time, fragmentation, low quality, and impaired activity in the daytime. Suvorexant and mirtazapine normalized the reduction in sleep time and fragmented sleep, further regaining the sleep depth at sleep onset in the chronic pain state in nerve-ligated mice. Mirtazapine also increased the percentage of rapid eye movement sleep in mice. Suvorexant decreased voluntary activity, which was prolonged after administration; however, mirtazapine did not decrease it. Although the effects of suvorexant and mirtazapine on sleep and activity are different, both suvorexant and mirtazapine could be potential therapeutic agents for chronic pain-related sleep disorders.
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Affiliation(s)
- Hisakatsu Ito
- Department of Anesthesiology, University of Toyama, Toyama, Japan
- * E-mail:
| | - Hiroshi Tsuneki
- Department of Clinical Pharmacology, University of Toyama, Toyama, Japan
| | - Toshiyasu Sasaoka
- Department of Clinical Pharmacology, University of Toyama, Toyama, Japan
| | - Naoki Toyooka
- Faculty of Engineering, University of Toyama, Toyama, Japan
| | - Mitsuhiro Matsuo
- Department of Anesthesiology, University of Toyama, Toyama, Japan
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Zhao Y, Wang N, Wen SW, Li M, Yuan Y, Retnakaran R, Hao W, Zhang R, Zhai D. Mirtazapine use may increase the risk of hypothyroxinaemia in patients affected by major depressive disorder. Br J Clin Pharmacol 2021; 88:214-225. [PMID: 34155670 DOI: 10.1111/bcp.14949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/29/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS Hypothyroxinaemia could be easily neglected if attention is paid only to patients with elevated thyroid-stimulating hormone. We aimed to assess the association between mirtazapine use and hypothyroxinaemia in patients affected by major depressive disorder. METHODS We conducted a retrospective cohort study in the Second Affiliated Hospital of Xinxiang Medical University between January 2016 and December 2018. Patients affected by major depression disorder and admitted to the hospital for treatment during the study period and who had thyroid tests at admission and after treatment were included. Mirtazapine use during hospitalization was the exposure measure and newly developed hypothyroxinaemia was as the primary outcome and structure parameters of thyroid homeostasis were the secondary outcomes of this study. Log-binomial model was used to estimate the association between mirtazapine use and hypothyroxinaemia, after adjusting for potential confounding factors. RESULTS A total of 220 eligible patients were included in the final analysis. The incidence of hypothyroxinaemia in patients who used mirtazapine was higher (37.5%) than those patients who did not use (19.7%). The relative risk of developing hypothyroxinaemia was 1.70 (95% confidence interval: 1.21-2.43) for mirtazapine use, after adjusting for confounding factors. The degree of reduction in thyroid feedback quantile-based index in mirtazapine group was significantly greater than that in nonmirtazapine group. CONCLUSION Mirtazapine use was associated with the increased risk of developing hypothyroxinaemia. The underlying mechanism may be involved the changed central set point of thyroid homeostasis, in which pituitary was in a possibly impaired sensitivity to the lower level of thyroid hormones.
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Affiliation(s)
- Ying Zhao
- The Second Affiliated Hospital, Xinxiang Medical University, Xinxiang, China.,School of Pharmacy, Xinxiang Medical University, Xinxiang, China.,Xinxiang Key Laboratory of Clinical psychopharmacology, Xinxiang, China
| | - Na Wang
- School of Pharmacy, Xinxiang Medical University, Xinxiang, China.,Xinxiang Key Laboratory of Clinical psychopharmacology, Xinxiang, China
| | - Shi Wu Wen
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Canada.,Department of Obstetrics, Gynecology, and Newborn Care, University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Mingcan Li
- School of Pharmacy, Xinxiang Medical University, Xinxiang, China.,Xinxiang Key Laboratory of Clinical psychopharmacology, Xinxiang, China
| | - Yuan Yuan
- School of Pharmacy, Xinxiang Medical University, Xinxiang, China.,Xinxiang Key Laboratory of Clinical psychopharmacology, Xinxiang, China
| | - Ravi Retnakaran
- Division of Endocrinology and Metabolism, University of Toronto, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Wei Hao
- The Second Affiliated Hospital, Xinxiang Medical University, Xinxiang, China
| | - Ruiling Zhang
- The Second Affiliated Hospital, Xinxiang Medical University, Xinxiang, China
| | - Desheng Zhai
- School of Public Health, Xinxiang Medical University, Xinxiang, China.,Henan International Joint Laboratory of non-Invasive Neuromodulation, Xinxiang Medical University, Xinxiang, China
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Nussbaumer-Streit B, Thaler K, Chapman A, Probst T, Winkler D, Sönnichsen A, Gaynes BN, Gartlehner G. Second-generation antidepressants for treatment of seasonal affective disorder. Cochrane Database Syst Rev 2021; 3:CD008591. [PMID: 33661528 PMCID: PMC8092631 DOI: 10.1002/14651858.cd008591.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Seasonal affective disorder (SAD) is a seasonal pattern of recurrent depressive episodes that is often treated with second-generation antidepressants (SGAs), light therapy, or psychotherapy. OBJECTIVES To assess the efficacy and safety of second-generation antidepressants (SGAs) for the treatment of seasonal affective disorder (SAD) in adults in comparison with placebo, light therapy, other SGAs, or psychotherapy. SEARCH METHODS This is an update of an earlier review first published in 2011. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 1) in the Cochrane Library (all years), Ovid MEDLINE, Embase, and PsycINFO (2011 to January 2020), together with the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) (all available years), for reports of randomised controlled trials (RCTs). We hand searched the reference lists of all included studies and other systematic reviews. We searched ClinicalTrials.gov for unpublished/ongoing trials. We ran a separate update search for reports of adverse events in the Ovid databases. SELECTION CRITERIA: For efficacy we included RCTs of SGAs compared with other SGAs, placebo, light therapy, or psychotherapy in adult participants with SAD. For adverse events we also included non-randomised studies. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts and full-text publications against the inclusion criteria. Data extraction and 'Risk of bias' assessment were conducted individually. We pooled data for meta-analysis where the participant groups were similar, and the studies assessed the same treatments with the same comparator and had similar definitions of outcome measures over a similar duration of treatment. MAIN RESULTS In this update we identified no new RCT on the effectiveness of SGAs in SAD patients. We included 2 additional single-arm observational studies that reported on adverse events of SGAs. For efficacy we included three RCTs of between five and eight weeks' duration with a total of 204 participants. For adverse events we included two RCTs and five observational (non-randomised) studies of five to eight weeks' duration with a total of 249 participants. All participants met the DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria for SAD. The average age ranged from 34 to 42 years, and the majority of participants were female (66% to 100%). Results from one trial with 68 participants showed that fluoxetine (20/36) was numerically superior to placebo (11/32) in achieving clinical response; however, the confidence interval (CI) included both a potential benefit as well as no benefit of fluoxetine (risk ratio (RR) 1.62, 95% CI 0.92 to 2.83, very low-certainty evidence). The number of adverse events was similar in both groups (very low-certainty evidence). Two trials involving a total of 136 participants compared fluoxetine versus light therapy. Meta-analysis showed fluoxetine and light therapy to be approximately equal in treating seasonal depression: RR of response 0.98 (95% CI 0.77 to 1.24, low-certainty evidence), RR of remission 0.81 (95% CI 0.39 to 1.71, very low-certainty evidence). The number of adverse events was similar in both groups (low-certainty evidence). We did not identify any eligible study comparing SGA with another SGA or with psychotherapy. Two RCTs and five non-randomised studies reported adverse event data on a total of 249 participants who received bupropion, fluoxetine, escitalopram, duloxetine, nefazodone, reboxetine, light therapy, or placebo. We were only able to obtain crude rates of adverse events, therefore caution is advised regarding interpretation of this information. Between 0% and 100% of participants who received an SGA suffered an adverse event, and between 0% and 25% of participants withdrew from the study due to adverse events. AUTHORS' CONCLUSIONS Evidence for the effectiveness of SGAs is limited to one small trial of fluoxetine compared with placebo showing a non-significant effect in favour of fluoxetine, and two small trials comparing fluoxetine against light therapy suggesting equivalence between the two interventions. The lack of available evidence precluded us from drawing any overall conclusions on the use of SGAs for SAD. Further, larger RCTs are required to expand and strengthen the evidence base on this topic, and should also include comparisons with psychotherapy and other SGAs. Data on adverse events were sparse, and a comparative analysis was not possible. The data we obtained on adverse events is therefore not robust, and our confidence in the data is limited. Overall, up to 25% of participants treated with SGAs for SAD withdrew from the study early due to adverse events.
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Affiliation(s)
- Barbara Nussbaumer-Streit
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Kylie Thaler
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Andrea Chapman
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Thomas Probst
- Department for Psychotherapy and Psychosocial Health, Danube University Krems, Krems, Austria
| | - Dietmar Winkler
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Sönnichsen
- Department of General Practice and Family Medicine, Medical University of Vienna, Vienna, Austria
| | - Bradley N Gaynes
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings Global School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gerald Gartlehner
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
- RTI International, Research Triangle Park, North Carolina, USA
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Effectiveness of Paroxetine for Poststroke Depression: A Meta-Analysis. J Stroke Cerebrovasc Dis 2020; 29:104664. [PMID: 32093988 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/02/2020] [Accepted: 01/11/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE The purpose of our study is to evaluate the efficacy of paroxetine in poststroke depression (PSD) patients by conducting a meta-analysis. METHODS We searched Web of Science (science and social science citation index), PubMed, the Cochrane Central Register of Controlled Trials, Embase up to August 2019. Randomized controlled trials that paroxetine compared to other antidepressants or control treatments as monotherapy for patients with PSD. RESULTS This review identified a total of 4 studies including 212 patients. This meta-analysis presented that paroxetine exhibits beneficial efficacy than routine treatment in PSD patients in terms of the reducing score of Hamilton Depression Scale (HAMD). Control treatment is more effective than paroxetine. No significant advantage was found with paroxetine. CONCLUSIONS The efficacy of paroxetine maybe not very significant compared to other pharmacological and nonpharmacological interventions. Further high quality and large sample size studies are needed to evaluate the efficacy and safety of paroxetine in treating PSD in future.
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Economos G, Lovell N, Johnston A, Higginson IJ. What is the evidence for mirtazapine in treating cancer-related symptomatology? A systematic review. Support Care Cancer 2020; 28:1597-1606. [PMID: 31858251 PMCID: PMC7036072 DOI: 10.1007/s00520-019-05229-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/05/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Cancer patients often experience multiple distressing symptoms which are challenging to manage. It would therefore be helpful to find a treatment that alleviates more than one symptom, to avoid polypharmacy: mirtazapine has been used in several studies for this purpose. The objective of this study was to assess the effectiveness and safety of mirtazapine in alleviating one or more frequently encountered cancer-related symptoms. METHODS Systematic review of clinical trials in English or French. Eight databases were searched. Included studies assessed the effectiveness of mirtazapine in alleviating one or more frequently encountered cancer-related symptoms. Comparator and validated assessment tools were required. Studies were independently appraised by two investigators before data synthesis. RESULTS The search yielded 1898 references, from which we identified 12 relevant articles evaluating highly heterogeneous outcomes. These were two randomised-controlled (RCTs), three non-randomised controlled, and seven non-randomised non-controlled trials. In total, 392 participants were included and 185 were in RCTs. No study assessed the effectiveness of mirtazapine in alleviating symptoms at the same time, but some considered more than one symptom. Overall, the data was of poor quality, limited by small sample size and bias. However, mirtazapine showed effectiveness in treating depression, anxiety, sleep disorders, emesis and neuropathic pain. Across all studies, mirtazapine is safe to use, with drowsiness and dizziness the most common side-effects. CONCLUSION Study design and small sample sizes limit the ability to interpret results. Trials to assess the impact of mirtazapine or other medicines in alleviating multiple symptoms would be valuable.
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Affiliation(s)
- Guillaume Economos
- Cicely Saunders Institut, Departement Palliative Care Policy and Rehabilitation, King’s College London, 10 Cutcombe Rd, Brixton, London, SE5 9PJ UK
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Palliative Care, 165 chemin du Grand Revoyet, 69310 Pierre-Bénite, France
| | - Natasha Lovell
- Cicely Saunders Institut, Departement Palliative Care Policy and Rehabilitation, King’s College London, 10 Cutcombe Rd, Brixton, London, SE5 9PJ UK
| | - Anna Johnston
- Cicely Saunders Institut, Departement Palliative Care Policy and Rehabilitation, King’s College London, 10 Cutcombe Rd, Brixton, London, SE5 9PJ UK
| | - Irene J. Higginson
- Cicely Saunders Institut, Departement Palliative Care Policy and Rehabilitation, King’s College London, 10 Cutcombe Rd, Brixton, London, SE5 9PJ UK
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Attenuation of auditory mismatch negativity in serotonin transporter knockout mice with anxiety-related behaviors. Behav Brain Res 2020; 379:112387. [PMID: 31783087 DOI: 10.1016/j.bbr.2019.112387] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 11/20/2022]
Abstract
As the first-line antidepressant drugs, selective serotonin reuptake inhibitors (SSRIs) have efficacy in controlling the symptoms of depression. However, adverse events such as anxiety and hearing disorders were usually observed in patients and even healthy volunteers during the initial phase of SSRI administration. Hearing disorders, including auditory hallucination and tinnitus, are not only highly comorbid with mental disorders but also acknowledged factors that induce psychiatric disorders. The pharmacological and neural mechanisms underlying SSRI-induced anxiety and hearing disorders are not clear. In particularly, the methods evaluating hearing disorders are not well established in animal models, limiting the pre-clinical research on its mechanism. In the present study, we examined the mismatch negativity (MMN), a cognitive component of auditory event-related potential (ERP), to evaluate the hearing process of auditory cortex in mice. Under the acute administration of citalopram, a widely used SSRI, the anxiety-related behaviors and reduced MMN were observed in mice. Serotonin transporter (SERT) is a potential target of SSRIs. The anxiety-related behaviors and reduced MMN were also observed in SERT knockout mice, implying the role of SERT in anxiety and hearing disorders induced by SSRIs. Meanwhile, the auditory brainstem response and initial components of auditory ERP were kept intact in SERT knockout mice, suggesting that hearing neural pathway is less affected by serotonergic system. Our study suggests that the SERT deficient mice might represent a useful animal model in the investigation of the anxiety and hearing disorders during the SSRI treatment.
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Gartlehner G, Nussbaumer‐Streit B, Gaynes BN, Forneris CA, Morgan LC, Greenblatt A, Wipplinger J, Lux LJ, Van Noord MG, Winkler D. Second-generation antidepressants for preventing seasonal affective disorder in adults. Cochrane Database Syst Rev 2019; 3:CD011268. [PMID: 30883669 PMCID: PMC6422318 DOI: 10.1002/14651858.cd011268.pub3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Seasonal affective disorder (SAD) is a seasonal pattern of recurrent major depressive episodes that most commonly occurs during autumn or winter and remits in spring. The prevalence of SAD ranges from 1.5% to 9%, depending on latitude. The predictable seasonal aspect of SAD provides a promising opportunity for prevention. This review - one of four reviews on efficacy and safety of interventions to prevent SAD - focuses on second-generation antidepressants (SGAs). OBJECTIVES To assess the efficacy and safety of SGAs (in comparison with other SGAs, placebo, light therapy, melatonin or agomelatine, psychological therapies or lifestyle interventions) in preventing SAD and improving patient-centred outcomes among adults with a history of SAD. SEARCH METHODS We searched Ovid MEDLINE (1950- ), Embase (1974- ), PsycINFO (1967- ) and the Cochrane Central Register of Controlled Trials (CENTRAL) to 19 June 2018. An earlier search of these databases was conducted via the Cochrane Common Mental Disorders Controlled Trial Register (CCMD-CTR) (all years to 11 August 2015). Furthermore, we searched the Cumulative Index to Nursing and Allied Health Literature, Web of Science, the Cochrane Library, the Allied and Complementary Medicine Database and international trial registers (to 19 June 2018). We also conducted a grey literature search and handsearched the reference lists of included studies and pertinent review articles. SELECTION CRITERIA For efficacy, we included randomised controlled trials (RCTs) on adults with a history of winter-type SAD who were free of symptoms at the beginning of the study. For adverse events, we planned to include non-randomised studies. Eligible studies compared a SGA versus another SGA, placebo, light therapy, psychological therapy, melatonin, agomelatine or lifestyle changes. We also intended to compare SGAs in combination with any of the comparator interventions versus placebo or the same comparator intervention as monotherapy. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts and full-text publications, extracted data and assessed risk of bias of included studies. When data were sufficient, we conducted random-effects (Mantel-Haenszel) meta-analyses. We assessed statistical heterogeneity by calculating the Chi2 statistic and the Cochran Q. We used the I2 statistic to estimate the magnitude of heterogeneity. We assessed publication bias by using funnel plots.We rated the strength of the evidence using the system developed by the GRADE Working Group. MAIN RESULTS We identified 3745 citations after de-duplication of search results and excluded 3619 records during title and abstract reviews. We assessed 126 full-text papers for inclusion in the review, of which four publications (on three RCTs) providing data from 1100 people met eligibility criteria for this review. All three RCTs had methodological limitations due to high attrition rates.Overall, moderate-quality evidence indicates that bupropion XL is an efficacious intervention for prevention of recurrence of depressive episodes in people with a history of SAD (risk ratio (RR) 0.56, 95% confidence interval (CI) 0.44 to 0.72; 3 RCTs, 1100 participants). However, bupropion XL leads to greater risk of headaches (moderate-quality evidence), insomnia and nausea (both low-quality evidence) when compared with placebo. Numbers needed to treat for additional beneficial outcomes (NNTBs) vary by baseline risks. For a population with a yearly recurrence rate of 30%, the NNTB is 8 (95% CI 6 to 12). For populations with yearly recurrence rates of 50% and 60%, NNTBs are 5 (95% CI 4 to 7) and 4 (95% CI 3 to 6), respectively.We could find no studies on other SGAs and no studies comparing SGAs with other interventions of interest, such as light therapy, psychological therapies, melatonin or agomelatine. AUTHORS' CONCLUSIONS Available evidence indicates that bupropion XL is an effective intervention for prevention of recurrence of SAD. Nevertheless, even in a high-risk population, three out of four people will not benefit from preventive treatment with bupropion XL and will be at risk for harm. Clinicians need to discuss with patients advantages and disadvantages of preventive SGA treatment, and might want to consider offering other potentially efficacious interventions, which might confer a lower risk of adverse events. Given the lack of comparative evidence, the decision for or against initiating preventive treatment of SAD and the treatment selected should be strongly based on patient preferences.Future researchers need to assess the effectiveness and risk of harms of SGAs other than bupropion for prevention of SAD. Investigators also need to compare benefits and harms of pharmacological and non-pharmacological interventions.
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Affiliation(s)
- Gerald Gartlehner
- Danube University KremsCochrane Austria, Department for Evidence‐based Medicine and Clinical EpidemiologyDr.‐Karl‐Dorrek‐Strasse 30KremsAustria3500
- RTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Barbara Nussbaumer‐Streit
- Danube University KremsCochrane Austria, Department for Evidence‐based Medicine and Clinical EpidemiologyDr.‐Karl‐Dorrek‐Strasse 30KremsAustria3500
| | - Bradley N Gaynes
- University of North Carolina at Chapel HillDepartment of PsychiatryCB# 7160Chapel HillNorth CarolinaUSA27599‐7160
| | - Catherine A Forneris
- University of North Carolina at Chapel HillDepartment of PsychiatryCB# 7160Chapel HillNorth CarolinaUSA27599‐7160
| | - Laura C Morgan
- IBM Watson Health15 Dartford CTChapel HillNorth CarolinaUSA27517
| | - Amy Greenblatt
- Emory UniversityNell Hodgson Woodruff School of NursingAtlantaGeorgiaUSA
| | - Jörg Wipplinger
- Danube University KremsDepartment for Evidence‐based Medicine and Clinical EpidemiologyDr.‐Karl‐Dorrek‐Straße 30KremsAustria3500
| | - Linda J Lux
- RTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Megan G Van Noord
- University of California DavisCarlson Health Sciences LibraryDavisCaliforniaUSA
| | - Dietmar Winkler
- Medical University of ViennaDepartment of Psychiatry and PsychotherapyWaehringer Guertel 18‐20ViennaAustria1090
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Venlafaxine-loaded sustained-release poly(hydroxyethyl methacrylate-co-itaconic acid) hydrogel composites: their synthesis and in vitro/in vivo attributes. IRANIAN POLYMER JOURNAL 2019. [DOI: 10.1007/s13726-019-00697-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Simon JA, Thorp J, Millheiser L. Flibanserin for Premenopausal Hypoactive Sexual Desire Disorder: Pooled Analysis of Clinical Trials. J Womens Health (Larchmt) 2019; 28:769-777. [PMID: 30707049 DOI: 10.1089/jwh.2018.7516] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Flibanserin, a 5-hydroxytryptamine 5-HT1A agonist and 5-HT2A antagonist, is indicated for the treatment of acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. This post hoc analysis assessed pooled efficacy and safety data for flibanserin in premenopausal women with HSDD. Materials and Methods: Data for flibanserin 100 mg once daily at bedtime (qhs) and placebo were pooled from three pivotal 24-week, randomized, placebo-controlled, multicenter studies (VIOLET, DAISY, and BEGONIA) of premenopausal women with HSDD. Pooled efficacy endpoints included the change from baseline to study end (i.e., 24 weeks) in the number of satisfying sexual events (SSEs) over 28 days, the Female Sexual Function Index desire domain (FSFI-d) score, and the Female Sexual Distress Scale-Revised Item 13 (FSDS-R-13) score. Results: The analysis included 2465 women (flibanserin, n = 1227; placebo, n = 1238) with a mean age of 36 years and a mean HSDD duration of 56.5 months. The mean ± standard error (SE) change from baseline to study end in SSEs over 28 days for flibanserin versus placebo was 2.1 ± 0.14 versus 1.2 ± 0.11, respectively (p < 0.0001). The least-squares mean ± SE changes from baseline to study end in FSFI desire domain score and FSDS-R-13 score were also significantly greater for flibanserin versus placebo (FSFI desire domain: 0.9 ± 0.04 vs. 0.6 ± 0.04, p < 0.0001; FSDS-R-13: -0.9 ± 0.04 vs. -0.6 ± 0.04, p < 0.0001). Patients in the flibanserin group generally had significantly greater improvements, compared with placebo, in SSEs, FSFI-d score, and FSDS-R-13 in subgroup analyses based on selected demographic and baseline clinical characteristics. Adverse events occurring in ≥10% of patients included dizziness and somnolence. Conclusions: This pooled analysis of three pivotal trials demonstrated that flibanserin 100 mg qhs was well tolerated, improved sexual desire, and reduced sexual distress associated with HSDD in premenopausal women, and these improvements were generally consistent across various subgroups based on demographic and baseline characteristics.
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Affiliation(s)
- James A Simon
- 1 Department of Obstetrics and Gynecology, George Washington University School of Medicine, Washington, District of Columbia
| | - John Thorp
- 2 Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Lovell N, Wilcock A, Bajwah S, Etkind SN, Jolley CJ, Maddocks M, Higginson IJ. Mirtazapine for chronic breathlessness? A review of mechanistic insights and therapeutic potential. Expert Rev Respir Med 2019; 13:173-180. [PMID: 30596298 DOI: 10.1080/17476348.2019.1563486] [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: 12/31/2022]
Abstract
INTRODUCTION Chronic breathlessness is a common and distressing symptom of advanced disease with few effective treatments. Central nervous system mechanisms are important in respiratory sensation and control. Consequently, drugs which may modify processing and perception of afferent information in the brain may have a role. Antidepressants have been proposed; however, current evidence is limited. Of potentially suitable antidepressants, mirtazapine is an attractive option given its tolerability profile, low cost, and wide availability, along with additional potential benefits. Areas covered: The paper provides an overview of the physiology of breathlessness, with an emphasis on central mechanisms, particularly the role of fear circuits and the associated neurotransmitters. It provides a potential rationale for how mirtazapine may improve chronic breathlessness and quality of life in patients with advanced disease. The evidence was identified by a literature search performed in PubMed through to October 2018. Expert opinion: Currently, there is insufficient evidence to support the routine use of antidepressants for chronic breathlessness in advanced disease. Mirtazapine is a promising candidate to pursue, with definitive randomized controlled trials required to determine its efficacy and safety in this setting.
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Affiliation(s)
- N Lovell
- a Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation , King's College London , London , UK
| | - A Wilcock
- b University of Nottingham, Palliative Medicine, Hayward House Specialist Palliative Care Unit , Nottingham University Hospitals NHS Trust , Nottingham , UK
| | - S Bajwah
- a Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation , King's College London , London , UK
| | - S N Etkind
- a Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation , King's College London , London , UK
| | - C J Jolley
- c Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine , King's College London , UK
| | - M Maddocks
- a Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation , King's College London , London , UK
| | - I J Higginson
- a Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation , King's College London , London , UK
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Abstract
BACKGROUND Fibromyalgia is a clinically defined chronic condition of unknown etiology characterised by chronic widespread pain, sleep disturbance, cognitive dysfunction, and fatigue. Many patients report high disability levels and poor quality of life. Drug therapy aims to reduce key symptoms, especially pain, and improve quality of life. The tetracyclic antidepressant, mirtazapine, may help by increasing serotonin and noradrenaline in the central nervous system (CNS). OBJECTIVES To assess the efficacy, tolerability and safety of the tetracyclic antidepressant, mirtazapine, compared with placebo or other active drug(s) in the treatment of fibromyalgia in adults. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, SCOPUS, the US National Institutes of Health, and the World Health Organization (WHO) International Clinical Trials Registry Platform for published and ongoing trials, and examined reference lists of reviewed articles, to 9 July 2018. SELECTION CRITERIA Randomised controlled trials (RCTs) of any formulation of mirtazapine against placebo, or any other active treatment of fibromyalgia, in adults. DATA COLLECTION AND ANALYSIS Two review authors independently extracted study characteristics, outcomes of efficacy, tolerability and safety, examined issues of study quality, and assessed risk of bias, resolving discrepancies by discussion. Primary outcomes were participant-reported pain relief (at least 50% or 30% pain reduction), Patient Global Impression of Change (PGIC; much or very much improved), safety (serious adverse events), and tolerability (adverse event withdrawal). Other outcomes were health-related quality of life (HRQoL) improved by 20% or more, fatigue, sleep problems, mean pain intensity, negative mood and particular adverse events. We used a random-effects model to calculate risk difference (RD), standardised mean difference (SMD), and numbers needed to treat. We assessed the evidence using GRADE and created a 'Summary of findings' table. MAIN RESULTS Three studies with 606 participants compared mirtazapine with placebo (but not other drugs) over seven to 13 weeks. Two studies were at unclear or high risk of bias in six or seven of eight domains. We judged the evidence for all outcomes to be low- or very low-quality because of poor study quality, indirectness, imprecision, risk of publication bias, and sometimes low numbers of events.There was no difference between mirtazapine and placebo for any primary outcome: participant-reported pain relief of 50% or greater (22% versus 16%; RD 0.05, 95% confidence interval (CI) -0.01 to 0.12; three studies with 591 participants; low-quality evidence); no data available for PGIC; only a single serious adverse event for evaluation of safety (RD -0.00, 95% CI -0.01 to 0.02; three studies with 606 participants; very low-quality evidence); and tolerability as frequency of dropouts due to adverse events (3% versus 2%; RD 0.00, 95% CI -0.02 to 0.03; three studies with 606 participants; low-quality evidence).Mirtazapine showed a clinically-relevant benefit compared to placebo for some secondary outcomes: participant-reported pain relief of 30% or greater (47% versus 34%; RD 0.13, 95% CI 0.05 to 0.21; number needed to treat for an additional beneficial outcome (NNTB) 8, 95% CI 5 to 20; three studies with 591 participants; low-quality evidence); participant-reported mean pain intensity (SMD -0.29, 95% CI -0.46 to -0.13; three studies with 591 participants; low-quality evidence); and participant-reported sleep problems (SMD -0.23, 95% CI -0.39 to -0.06; three studies with 573 participants; low-quality evidence). There was no benefit for improvement of participant-reported improvement of HRQoL of 20% or greater (58% versus 50%; RD 0.08, 95% CI -0.01 to 0.16; three studies with 586 participants; low-quality evidence); participant-reported fatigue (SMD -0.02, 95% CI -0.19 to 0.16; two studies with 533 participants; low-quality evidence); participant-reported negative mood (SMD -0.67, 95% CI -1.44 to 0.10; three studies with 588 participants; low-quality evidence); or withdrawals due to lack of efficacy (1.5% versus 0.1%; RD 0.01, 95% CI -0.01 to 0.02; three studies with 605 participants; very low-quality evidence).There was no difference between mirtazapine and placebo for participants reporting any adverse event (76% versus 59%; RD 0.12, 95 CI -0.01 to 0.26; three studies with 606 participants; low-quality evidence). There was a clinically-relevant harm with mirtazapine compared to placebo: in the number of participants with somnolence (42% versus 14%; RD 0.24, 95% CI 0.18 to 0.30; number needed to treat for an additional harmful outcome (NNTH) 5, 95% CI 3 to 6; three studies with 606 participants; low-quality evidence); weight gain (19% versus 1%; RD 0.17, 95% CI 0.11 to 0.23; NNTH 6, 95% CI 5 to 10; three studies with 606 participants; low-quality evidence); and elevated alanine aminotransferase (13% versus 2%; RD 0.13, 95% CI 0.04 to 0.22; NNTH 8, 95% CI 5 to 25; two studies with 566 participants; low-quality evidence). AUTHORS' CONCLUSIONS Studies demonstrated no benefit of mirtazapine over placebo for pain relief of 50% or greater, PGIC, improvement of HRQoL of 20% or greater, or reduction of fatigue or negative mood. Clinically-relevant benefits were shown for pain relief of 30% or greater, reduction of mean pain intensity, and sleep problems. Somnolence, weight gain, and elevated alanine aminotransferase were more frequent with mirtazapine than placebo. The quality of evidence was low or very low, with two of three studies of questionable quality and issues over indirectness and risk of publication bias. On balance, any potential benefits of mirtazapine in fibromyalgia were outweighed by its potential harms, though, a small minority of people with fibromyalgia might experience substantial symptom relief without clinically-relevant adverse events.
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Affiliation(s)
- Patrick Welsch
- Health Care Center for Pain Medicine and Mental Health, Saarbrücken, Germany
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Al-Majed A, Bakheit AH, Alharbi RM, Abdel Aziz HA. Mirtazapine. PROFILES OF DRUG SUBSTANCES, EXCIPIENTS, AND RELATED METHODOLOGY 2018; 43:209-254. [PMID: 29678261 DOI: 10.1016/bs.podrm.2018.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Mirtazapine is one of antidepression which is used mainly in the treatment of depression, moreover, it is sometimes used in the treatment of anxiety disorders, insomnia, nausea, and vomiting, and to produce weight gain when desirable. The action of mirtazapine is an antagonist of certain adrenergic and serotonin receptors, and, furthermore, the drug is used strong as antihistamine, and it is occasionally defined as a noradrenergic and specific serotonergic antidepressant (NaSSA). The comprehensive profile of mirtazapine gives more detailed information about nomenclature, formulae, elemental analysis, and appearance. In addition, the numerous methods of drug synthesis are summarized. Also the profile covers the physicochemical properties as: the value of pKa, drug solubility, melting point, X-ray powder diffraction, and analysis methods for example: (compendial, electrochemical, spectroscopic, and method of chromatographic). Besides that, the profile covered pharmacological profile and clinical pharmacokinetics in subtitle's (absorption, distribution, metabolism, and elimination). About 100 references were given as a proof of the above-mentioned studies.
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Affiliation(s)
| | - Ahmed H Bakheit
- College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia; Faculty of Sciences & Technology, Al-Neelain University, Khartoum, Sudan
| | - Raed M Alharbi
- College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Hatem A Abdel Aziz
- Centre of Excellence for Advanced Sciences, National Research Centre, Dokki, Cairo, Egypt
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Budău M, Hancu G, Rusu A, Cârcu-Dobrin M, Muntean DL. Chirality of Modern Antidepressants: An Overview. Adv Pharm Bull 2017; 7:495-500. [PMID: 29399539 PMCID: PMC5788204 DOI: 10.15171/apb.2017.061] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 11/30/2017] [Accepted: 12/05/2017] [Indexed: 01/01/2023] Open
Abstract
The majority of modern antidepressants (selective serotonin reuptake inhibitors and selective serotonin and norepinephrine reuptake inhibitors) have one or two centers of asymmetry in their structure; resulting in the formation of enantiomers which may exhibit different pharmacodynamic and pharmacokinetic properties. Recent developments in drug stereochemistry has led to understanding the role of chirality in modern therapy correlated with increased knowledge regarding the molecular structure of specific drug targets and towards the possible advantages of using pure enantiomers instead of racemic mixtures. The current review deals with chiral antidepressant drugs; presenting examples of stereoselectivity in the pharmacological actions of certain antidepressants and their metabolites and emphasizing the differences between pharmacological actions of the racemates and pure enantiomers.
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Affiliation(s)
- Monica Budău
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy from Tîrgu Mureş, Tîrgu Mureş, Romania
| | - Gabriel Hancu
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy from Tîrgu Mureş, Tîrgu Mureş, Romania
| | - Aura Rusu
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy from Tîrgu Mureş, Tîrgu Mureş, Romania
| | - Melania Cârcu-Dobrin
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy from Tîrgu Mureş, Tîrgu Mureş, Romania
| | - Daniela Lucia Muntean
- Department of Analytical Chemistry and Drug Analysis, Faculty of Pharmacy, University of Medicine and Pharmacy from Tîrgu Mureş, Tîrgu Mureş, Romania
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Shahzad D, Faisal M, Rauf A, Huang JH. Synthetic Story of a Blockbuster Drug: Reboxetine, a Potent Selective Norepinephrine Reuptake Inhibitor. Org Process Res Dev 2017. [DOI: 10.1021/acs.oprd.7b00265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Danish Shahzad
- Department
of Chemistry, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Muhammad Faisal
- Department
of Chemistry, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Ameema Rauf
- Department
of Chemistry, University of Wah, Wah Cantt, Pakistan
| | - Jian-hua Huang
- School
of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China
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Shen P, Hu Q, Dong M, Bai S, Liang Z, Chen Z, Li P, Hu Z, Zhong X, Zhu D, Wang H, Xie P. Venlafaxine exerts antidepressant effects possibly by activating MAPK-ERK1/2 and P13K-AKT pathways in the hippocampus. Behav Brain Res 2017; 335:63-70. [PMID: 28797602 DOI: 10.1016/j.bbr.2017.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/31/2017] [Accepted: 08/05/2017] [Indexed: 12/21/2022]
Abstract
Serotonin noradrenaline reuptake inhibitors are effective antidepressant drugs, which include venlafaxine and duloxetine. Venlafaxine is commonly used in a clinical context, but the molecular biological mechanisms behind its effects have not been fully determined. Here, we explored the potential biological effects of venlafaxine on mouse hippocampus. Mice were randomly divided into two groups and injected daily with 0.9% NaCl solution or venlafaxine. A GC-MS-based metabolomic approach was used to identify possible metabolic differences between these groups, and the key proteins involved in the relevant pathways were validated by western blotting. In our experiments, 27 hippocampal metabolites that distinguished the venlafaxine group from the control group were identified. These differential metabolites were subjected to Ingenuity Pathway Analysis, which revealed that they were strongly related to two metabolic pathways (MAPK-ERK1/2 and P13K-AKT signaling pathways). Six key proteins, BDNF, p-c-Raf, p-MAPK, p-MEK, p-AKT, and CREB, were verified by western blotting and the results were consistent with the differential metabolites identified by GC-MS. This study sheds light on the biological mechanisms underlying the effects of venlafaxine.
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Affiliation(s)
- Peng Shen
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Neurobiology, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China
| | - Qingchuan Hu
- Chongqing Key Laboratory of Neurobiology, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China; Key Laboratory of Laboratory Medical Diagnostics of Education, Department of Laboratory Medicine, Chongqing Medical University, Chongqing, China
| | - Meixue Dong
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Neurobiology, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China
| | - Shunjie Bai
- Chongqing Key Laboratory of Neurobiology, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China; Key Laboratory of Laboratory Medical Diagnostics of Education, Department of Laboratory Medicine, Chongqing Medical University, Chongqing, China
| | - Zihong Liang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Neurobiology, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China; Department of Neurology, The Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia, China
| | - Zhi Chen
- Chongqing Key Laboratory of Neurobiology, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China; Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Pengfei Li
- Chongqing Key Laboratory of Neurobiology, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China
| | - Zicheng Hu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Neurobiology, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China
| | - Xiaogang Zhong
- Chongqing Key Laboratory of Neurobiology, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China
| | - Dan Zhu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haiyang Wang
- Chongqing Key Laboratory of Neurobiology, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Neurobiology, Chongqing, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China; Key Laboratory of Laboratory Medical Diagnostics of Education, Department of Laboratory Medicine, Chongqing Medical University, Chongqing, China; Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China.
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Affiliation(s)
- Patrick Welsch
- Health Care Center for Pain Medicine and Mental Health; Saarbrücken Germany
| | - Kathrin Bernardy
- BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum; Department of Pain Medicine; Cample-de-la Bürk Platz 1 Bochum Germany 44789
| | - Sheena Derry
- University of Oxford; Pain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics); Pain Research Unit Churchill Hospital Oxford Oxfordshire UK OX3 7LE
| | - R Andrew Moore
- University of Oxford; Pain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics); Pain Research Unit Churchill Hospital Oxford Oxfordshire UK OX3 7LE
| | - Winfried Häuser
- Technische Universität München; Department of Psychosomatic Medicine and Psychotherapy; Langerstr. 3 München Germany D-81675
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Bai S, Hu Q, Chen Z, Liang Z, Wang W, Shen P, Wang T, Wang H, Xie P. Brain region-specific metabolite networks regulate antidepressant effects of venlafaxine. RSC Adv 2017. [DOI: 10.1039/c7ra08726h] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Administration of venlafaxine significantly altered the metabolic profiles of both the hippocampus and prefrontal cortex and the altered metabolites had significant brain region specificities.
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Affiliation(s)
- Shunjie Bai
- Department of Neurology
- Yongchuan Hospital
- Chongqing Medical University
- Chongqing 402460
- China
| | - Qingchuan Hu
- Chongqing Key Laboratory of Neurobiology
- Chongqing
- China
- Institute of Neuroscience and the Collaborative Innovation Center for Brain Science
- Chongqing Medical University
| | - Zhi Chen
- Department of Neurology
- Yongchuan Hospital
- Chongqing Medical University
- Chongqing 402460
- China
| | - Zihong Liang
- Chongqing Key Laboratory of Neurobiology
- Chongqing
- China
- Institute of Neuroscience and the Collaborative Innovation Center for Brain Science
- Chongqing Medical University
| | - Wei Wang
- Department of Neurology
- Yongchuan Hospital
- Chongqing Medical University
- Chongqing 402460
- China
| | - Peng Shen
- Chongqing Key Laboratory of Neurobiology
- Chongqing
- China
- Institute of Neuroscience and the Collaborative Innovation Center for Brain Science
- Chongqing Medical University
| | - Ting Wang
- Department of Neurology
- Yongchuan Hospital
- Chongqing Medical University
- Chongqing 402460
- China
| | - Haiyang Wang
- Chongqing Key Laboratory of Neurobiology
- Chongqing
- China
- Institute of Neuroscience and the Collaborative Innovation Center for Brain Science
- Chongqing Medical University
| | - Peng Xie
- Department of Neurology
- Yongchuan Hospital
- Chongqing Medical University
- Chongqing 402460
- China
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25
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Head shaking in the forced swim test: A robust but unexplored sex difference. Pharmacol Biochem Behav 2017; 152:90-96. [DOI: 10.1016/j.pbb.2016.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 05/04/2016] [Accepted: 05/12/2016] [Indexed: 01/02/2023]
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Lee N, Yu ML, Jun H, Ko SY. Extending the Synthetic Utilities of the Tandem Cyclic Sulfate Rearrangement-Opening Process: Synthesis of β-Hydroxy-γ-phenyl-γ-lactam. B KOREAN CHEM SOC 2016. [DOI: 10.1002/bkcs.11026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nagum Lee
- Department of Chemistry; Ewha Womans University; Seoul 120-750 Korea
| | - Min Lee Yu
- Department of Chemistry; Ewha Womans University; Seoul 120-750 Korea
| | - Hyeyeon Jun
- Department of Chemistry; Ewha Womans University; Seoul 120-750 Korea
| | - Soo Y. Ko
- Department of Chemistry; Ewha Womans University; Seoul 120-750 Korea
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Abstract
Psychotropic medications such as antidepressants, antipsychotics, stimulants, and benzodiazepines are widely prescribed. Most of these medications are thought to exert their effects through modulation of various monoamines as well as interactions with receptors such as histamine and muscarinic cholinergic receptors. Through these interactions, psychotropics can also have a significant impact on sleep physiology, resulting in both beneficial and adverse effects on sleep.
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Xu Z, Guo X, Yang Y, Tucker D, Lu Y, Xin N, Zhang G, Yang L, Li J, Du X, Zhang Q, Xu X. Low-Level Laser Irradiation Improves Depression-Like Behaviors in Mice. Mol Neurobiol 2016; 54:4551-4559. [PMID: 27379735 DOI: 10.1007/s12035-016-9983-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/14/2016] [Indexed: 12/28/2022]
Abstract
Major depressive disorder (MDD) is one of the leading forms of psychiatric disorders, characterized by aversion to mobility, neurotransmitter deficiency, and energy metabolic decline. Low-level laser therapy (LLLT) has been investigated in a variety of neurodegenerative disorders associated with mitochondrial dysfunction and functional impairments. The goal of this study was to examine the effect of LLLT on depression-like behaviors and to explore the potential mechanism by detecting mitochondrial function following LLLT. Depression models in space restriction mice and Abelson helper integration site-1 (Ahi1) knockout (KO) mice were employed in this work. Our results revealed that LLLT effectively improved depression-like behaviors, in the two depression mice models, by decreasing immobility duration in behavioral despair tests. In addition, ATP biosynthesis and the level of mitochondrial complex IV expression and activity were significantly elevated in prefrontal cortex (PFC) following LLLT. Intriguingly, LLLT has no effects on ATP content and mitochondrial complex I-IV levels in other tested brain regions, hippocampus and hypothalamus. As a whole, these findings shed light on a novel strategy of transcranial LLLT on depression improvement by ameliorating neurotransmitter abnormalities and promoting mitochondrial function in PFC. The present work provides concrete groundwork for further investigation of LLLT for depression treatment.
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Affiliation(s)
- Zhiqiang Xu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou City, Jiangsu, 215004, China.,Institute of Neuroscience, Soochow University, Suzhou City, Jiangsu, 215123, China
| | - Xiaobo Guo
- Institute of Neuroscience, Soochow University, Suzhou City, Jiangsu, 215123, China
| | - Yong Yang
- Department of Psychiatry, Guangji Hospital, Suzhou City, Jiangsu, 215000, China
| | - Donovan Tucker
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
| | - Yujiao Lu
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
| | - Ning Xin
- Department of Neurology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou City, Jiangsu, 215004, China
| | - Gaocai Zhang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou City, Jiangsu, 215004, China.,Institute of Neuroscience, Soochow University, Suzhou City, Jiangsu, 215123, China
| | - Lingli Yang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou City, Jiangsu, 215004, China
| | - Jizhen Li
- Department of Neurology, Suzhou Kowloon Hospital, Suzhou City, 215028, China
| | - Xiangdong Du
- Department of Psychiatry, Guangji Hospital, Suzhou City, Jiangsu, 215000, China
| | - Quanguang Zhang
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA, 30912, USA.
| | - Xingshun Xu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou City, Jiangsu, 215004, China. .,Institute of Neuroscience, Soochow University, Suzhou City, Jiangsu, 215123, China.
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Tian Y, Du J, Spagna A, Mackie MA, Gu X, Dong Y, Fan J, Wang K. Venlafaxine treatment reduces the deficit of executive control of attention in patients with major depressive disorder. Sci Rep 2016; 6:28028. [PMID: 27306061 PMCID: PMC4910055 DOI: 10.1038/srep28028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 05/23/2016] [Indexed: 01/03/2023] Open
Abstract
Attention plays an essential role in supporting other cognitive functions and behavior, and disturbance of attention is one of the most common symptoms in major depressive disorder (MDD). Although treatment with venlafaxine for MDD symptoms has been shown to reduce deficits in cognition and emotion regulation, it remains unclear whether venlafaxine improves specific attentional functions. We used the Attention Network Test to measure the attentional functions of alerting, orienting, and executive control before and after treatment with venlafaxine in patients with MDD compared to untreated healthy controls. Before treatment, the MDD group showed a selective impairment in alerting and executive control of attention, while there were no significant group differences in the orienting function. The interaction between group and session was significant for executive control, and after treatment with venlafaxine, the performance of the MDD group on executive control of attention was not significantly different from that of controls. Reported symptoms of MDD were also significantly reduced after treatment with venlafaxine. These results demonstrate that treatment with venlafaxine selectively normalizes the executive control function of attention in addition to improving clinical symptoms in MDD.
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Affiliation(s)
- Yanghua Tian
- Department of Neurology, the First Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Jing Du
- Department of Neurology, the Second Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Alfredo Spagna
- Department of Psychology, Queens College, the City University of New York, Flushing, NY, USA
| | - Melissa-Ann Mackie
- Department of Psychology, Queens College, the City University of New York, Flushing, NY, USA
| | - Xiaosi Gu
- Center for BrainHealth, School of Behavioral and Brain Sciences, the University of Texas at Dallas, Dallas, TX, 75235, USA
| | - Yi Dong
- Anhui Mental Health Center, Hefei, Anhui Province, China
| | - Jin Fan
- Department of Psychology, Queens College, the City University of New York, Flushing, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kai Wang
- Department of Neurology, the First Hospital of Anhui Medical University, Hefei, Anhui Province, China
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Involvement of mitochondrial dysfunction in nefazodone-induced hepatotoxicity. Food Chem Toxicol 2016; 94:148-58. [PMID: 27288927 DOI: 10.1016/j.fct.2016.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/10/2016] [Accepted: 06/03/2016] [Indexed: 12/17/2022]
Abstract
Nefazodone (NEF) is an antidepressive agent that was widely used in the treatment of depression until its withdrawal from the market, due to reports of liver injury and failure. NEF hepatotoxicity has been associated with mitochondrial impairment due to interference with the OXPHOS enzymatic activities, increased ROS generation and decreased antioxidant defenses. However, the mechanisms by which NEF induces mitochondrial dysfunction in hepatocytes are not completely understood. Here, we investigated the mitochondrial mechanisms affected upon NEF exposure and whether these might be linked to drug hepatotoxicity, in order to infer liabilities of future drug candidates. Two moderately hepatotoxic NEF concentrations (20 and 50 μM) were selected from dose-response growth curves performed in HepG2 cells. Cell viability, caspase activity, nuclear morphology, mitochondrial transmembrane potential, mitochondrial superoxide levels, and the expression of genes associated with different cellular pathways were evaluated at different time points. NEF treatment led to an increase in the expression of genes associated with DNA-damage response, antioxidant defense and apoptosis and a decreased expression of genes encoding proteins involved in oxidative phosphorylation, DNA repair, cell proliferation and cell cycle progression, which seem to constitute mechanisms underlying the observed mitochondrial and cell function impairment.
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Abstract
IntroductionMirtazapine is indicated in the treatment of major depressive disorder particularly in selective serotonin re-uptake inhibitors resistance. Its effect on hair loss is rare with no previous documented effect on hair colour.MethodReview of relevant literature and description of a case report of a 54-year-old male patient who developed alopecia and hair discoloration after initiation of mirtazapine treatment.ResultsUpon cessation of mirtazapine treatment full restoration of hair colour and regrowth of hair was attained within 10 weeks.DiscussionThere was clear temporal relationship between experiencing hair loss and commencing mirtazapine treatment. No other more likely medical reason to explain such experience was established. A noticeable restoration of the hair colour occurred following mirtazapine cessation.ConclusionMirtazapine is associated with hair discoloration and hair loss. The possibility of such distressing adverse effects needs to be conveyed to patients by clinicians and to be further explored by researchers.
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Lee TH, Kim K, Shin MS, Kim CJ, Lim BV. Treadmill exercise alleviates chronic mild stress-induced depression in rats. J Exerc Rehabil 2015; 11:303-10. [PMID: 26730380 PMCID: PMC4697778 DOI: 10.12965/jer.150265] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 12/13/2015] [Indexed: 11/22/2022] Open
Abstract
Depression is a major cause of disability and one of the most common public health problems. In the present study, antidepressive effect of treadmill exercise on chronic mild stress (CMS)-induced depression in rats was investigated. For this, sucrose intake test, immunohistochemistry for 5-bromo-2'-deoxyuridine, terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling staining, and Western blot analysis for brain-derived neurotrophic factor, cyclic adenosine monophosphate response element binding protein, and endothelial nitric oxide synthase were conducted. Following adaptation to the animal vivarium and two baseline fluid intake tests, the animals were divided into four groups: the control group, the CMS-induced depression group, the CMS-induced depression and exercise group, and the CMS-induced depression and fluoxetine-treated group. The animals in the CMS groups were exposed to the CMS conditions for 8 weeks and those in the control group were exposed to the control conditions for 8 weeks. After 4 weeks of CMS, the rats in the CMS-induced depression and exercise group were made to run on a motorized treadmill for 30 min once a day for 4 weeks. In the present results, treadmill exercise alleviated CMS-induced depressive symptoms. Treadmill exercise restored sucrose consumption, increased cell proliferation, and decreased apoptotic cell death. The present results suggest the possibility that exercise may improve symptoms of depression.
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Affiliation(s)
- Taeck-Hyun Lee
- Department of Family Medicine, Dae Dong Hospital, Busan, Korea
| | - Kijeong Kim
- School of Exercise & Sport Science, College of Natural Sciences, University of Ulsan, Ulsan, Korea
| | - Mal-Soon Shin
- Department of Physiology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Chang-Ju Kim
- Department of Physiology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Baek-Vin Lim
- Division of Leisure & Sports Science, Department of Exercise Prescription, Dongseo University, Busan, Korea
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Gartlehner G, Nussbaumer B, Gaynes BN, Forneris CA, Morgan LC, Kaminski-Hartenthaler A, Greenblatt A, Wipplinger J, Lux LJ, Sonis JH, Hofmann J, Van Noord MG, Winkler D. Second-generation antidepressants for preventing seasonal affective disorder in adults. Cochrane Database Syst Rev 2015:CD011268. [PMID: 26558418 DOI: 10.1002/14651858.cd011268.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Seasonal affective disorder (SAD) is a seasonal pattern of recurrent major depressive episodes that most commonly occurs during autumn or winter and remits in spring. The prevalence of SAD ranges from 1.5% to 9%, depending on latitude. The predictable seasonal aspect of SAD provides a promising opportunity for prevention. This review - one of four reviews on efficacy and safety of interventions to prevent SAD - focuses on second-generation antidepressants (SGAs). OBJECTIVES To assess the efficacy and safety of second-generation antidepressants (in comparison with other SGAs, placebo, light therapy, melatonin or agomelatine, psychological therapies or lifestyle interventions) in preventing SAD and improving patient-centred outcomes among adults with a history of SAD. SEARCH METHODS A search of the Specialised Register of the Cochrane Depression, Anxiety and Neuorosis Review Group (CCDANCTR) included all years to 11 August 2015. The CCDANCTR contains reports of randomised controlled trials derived from EMBASE (1974 to date), MEDLINE (1950 to date), PsycINFO (1967 to date) and the Cochrane Central Register of Controlled Trials (CENTRAL). Furthermore, we searched the Cumulative Index to Nursing and Allied Health Literature, Web of Knowledge, The Cochrane Library and the Allied and Complementary Medicine Database (to 26 May 2014). We also conducted a grey literature search and handsearched the reference lists of included studies and pertinent review articles. SELECTION CRITERIA For efficacy, we included randomised controlled trials on adults with a history of winter-type SAD who were free of symptoms at the beginning of the study. For adverse events, we planned to include non-randomised studies. Eligible studies compared an SGA versus another SGA, placebo, light therapy, psychological therapy, melatonin, agomelatine or lifestyle changes. We also intended to compare SGAs in combination with any of the comparator interventions versus the same comparator intervention as monotherapy. DATA COLLECTION AND ANALYSIS Two review authors screened abstracts and full-text publications and assigned risk of bias ratings based on the Cochrane 'Risk of bias' tool. We resolved disagreements by consensus or by consultation with a third party. Two review authors independently extracted data and assessed risk of bias of included studies. When data were sufficient, we conducted random-effects (Mantel-Haenszel) meta-analyses. We assessed statistical heterogeneity by calculating the Chi(2) statistic and the Cochran Q. We used the I(2) statistic to estimate the magnitude of heterogeneity and examined potential sources of heterogeneity using sensitivity analysis or analysis of subgroups. We assessed publication bias by using funnel plots. However, given the small number of component studies in our meta-analyses, these tests have low sensitivity to detect publication bias. We rated the strength of the evidence using the system developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group. MAIN RESULTS We identified 2986 citations after de-duplication of search results and excluded 2895 records during title and abstract reviews. We assessed 91 full-text papers for inclusion in the review, of which four publications (on three RCTs) providing data from 1100 people met eligibility criteria for this review. All three RCTs had methodological limitations due to high attrition rates.Overall moderate-quality evidence indicates that bupropion XL is an efficacious intervention for prevention of recurrence of depressive episodes in patients with a history of SAD (risk ratio (RR) 0.56, 95% confidence interval (CI) 0.44 to 0.72; three RCTs, 1100 participants). However, bupropion XL leads to greater risk of headaches (moderate-quality evidence), insomnia and nausea (both low-quality evidence) when compared with placebo. Numbers needed to treat for additional beneficial outcomes (NNTBs) vary by baseline risks. For a population with a yearly recurrence rate of 30%, the NNTB is 8 (95% CI 6 to 12). For populations with yearly recurrence rates of 40% and 50%, NNTBs are 6 (95% CI 5 to 9) and 5 (95% CI 4 to 7), respectively.We could find no studies on other SGAs and no studies comparing SGAs with other interventions of interest such as light therapy, psychological therapies, melatonin or agomelatine. AUTHORS' CONCLUSIONS Available evidence indicates that bupropion XL is an effective intervention for prevention of recurrence of SAD. Nevertheless, even in a high-risk population, four of five patients will not benefit from preventive treatment with bupropion XL and will be at risk for harm. Clinicians need to discuss with patients advantages and disadvantages of preventive SGA treatment and might want to consider offering other potentially efficacious interventions, which might confer lower risk of adverse events. Given the lack of comparative evidence, the decision for or against initiating preventive treatment of SAD and the treatment selected should be strongly based on patient preferences.Future researchers need to assess the effectiveness and risk of harms of SGAs other than bupropion for prevention of SAD. Investigators also need to compare benefits and harms of pharmacological and non-pharmacological interventions.
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Affiliation(s)
- Gerald Gartlehner
- Cochrane Austria, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, Krems, Austria, 3500
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Kurhe Y, Mahesh R. Mechanisms linking depression co-morbid with obesity: An approach for serotonergic type 3 receptor antagonist as novel therapeutic intervention. Asian J Psychiatr 2015; 17:3-9. [PMID: 26243683 DOI: 10.1016/j.ajp.2015.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 05/23/2015] [Accepted: 07/11/2015] [Indexed: 01/30/2023]
Abstract
Despite of the enormous research, therapeutic treatment for depression has always been a serious issue. Even though depression and obesity are individual abnormal health conditions, each act as a triggering factor for the other. Obese individuals are twice prone to develop depression than that of non-obese persons. The exact mechanism how obesity increases the risk for depression still remains an area of interest for research in neuropsychopharmacology. Depression and obesity share some common pathological pathways such as hyperactivity of hypothalamic-pituitary-adrenal (HPA) axis, dysregulation of oxidant/antioxidant system balance, higher level of inflammatory cytokines, leptin resistance, altered plasma glucose, insulin resistance, reduced neuronal brain derived neurotrophic factor (BDNF) and decreased serotonergic neurotransmission in various regions of brain. The antidepressant-like effect of 5-HT3 receptor antagonists through allosteric modulation of serotonergic pathways is well evident from several research investigations belonging to our and some in other laboratories. Furthermore, serotonin regulates diet intake, leptin, corticosterone, inflammatory mechanisms, altered plasma glucose, insulin resistance and BDNF concentration in brain. The present review deals with various biological mechanisms involved in depression co-morbid with obesity and 5-HT3 receptor antagonists by modulation of serotonergic system as a therapeutic target for such co-morbid disorder.
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Affiliation(s)
- Yeshwant Kurhe
- Department of Pharmacy, Birla Institute of Technology & Science, Pilani, Rajasthan 333031, India.
| | - Radhakrishnan Mahesh
- Department of Pharmacy, Birla Institute of Technology & Science, Pilani, Rajasthan 333031, India
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Donev R, Alawam K. Alterations in Gene Expression in Depression: Prospects for Personalize Patient Treatment. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2015; 101:97-124. [PMID: 26572977 DOI: 10.1016/bs.apcsb.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The number of people around the world suffering from depression has dramatically increased in last few decades. It has been predicted that by 2020 depression will become the second most common cause of disability. Furthermore, depression is often misdiagnosed and confused with other psychiatric disorders showing similar symptoms, i.e., anxiety and bipolar disorder, due to the fact that diagnosing is often carried out by medical workers who are not psychiatrically trained. These facts prompt us to prepare this review which focuses on alterations in gene expression in depression. We believe that an in-depth knowledge of molecular bases of behavior in depression and other mood disorders would be of a great benefit for the correct diagnosing of these disorders, as well as for prescribing a treatment that best suits each individual depending on expression alterations in depression-related genes. Therefore, the main aim of this review is to promote further translational research on the biochemistry of mood disorders and take the results further for the design of new targeted therapeutics that can be used for personalized treatment with minimal adverse effects.
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Affiliation(s)
| | - Khaled Alawam
- Forensic Medicine Department, Ministry of Interior, Kuwait City, Kuwait
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Motaghinejad M, Motevalian M, Ebrahimzadeh A, Larijani SF, Khajehamedi Z. Reduction of Methylphenidate Induced Anxiety, Depression and Cognition Impairment by Various doses of Venlafaxine in Rat. Int J Prev Med 2015; 6:52. [PMID: 26124949 PMCID: PMC4462776 DOI: 10.4103/2008-7802.158181] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/05/2015] [Indexed: 11/21/2022] Open
Abstract
Background: Methylphenidate (MPH) is a neural stimulant agent, which its neurochemical and behavioral effect remain unclear. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor antidepressant, which was used for management of depression and anxiety. In this study, protective effects of venlafaxine on MPH induced anxiety, depression and cognition impairment were investigated. Methods: Forty-eight adult male rats were divided randomly to 5 groups. Group 1, received normal saline (0.2 ml/rat) for 21 days and served as control group. Group 2, received MPH (10 mg/kg) for 21 days. Groups, 3, 4, 5 and 6 concurrently were treated by MPH (10 mg/kg) and venlafaxine at doses of 25, 50, 75 and 100 mg/kg respectively for 21 days. On day 22, elevated plus maze (EPM), open field test (OFT), forced swim test (FST) and tail suspension test (TST) were used to investigate the level of anxiety and depression in animals. In addition, between days 17 and 21, Morris water maze (MWM) was used to evaluate the effect of MPH on spatial learning and memory. Results: MPH caused depression and anxiety in a dose-dependent manner in FST, OFT, EPM and TST, which were significantly different compared with control group. Furthermore, MPH can significantly attenuate the motor activity in OFT. Venlafaxine in all doses can attenuate MPH induced anxiety, depression and motor activity alterations. MPH also can disturb learning and memory in MWM, but venlafaxine did not alter this effect of MPH. Conclusions: We conclude that venlafaxine can be protective in the brain against MPH induced anxiety and depression.
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Affiliation(s)
- Majid Motaghinejad
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Manijeh Motevalian
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Andia Ebrahimzadeh
- Department of Physiology, Faculty of Veterinary Medicine, Tehran University, Tehran, Iran
| | | | - Zohreh Khajehamedi
- Department of Clinical Biochemistry, School of Medicine, Hamadan University of Medical Sciences, Hamedan, Iran
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Helmreich I, Wagner S, König J, Kohnen R, Szegedi A, Hiemke C, Tadić A. Hamilton depression rating subscales to predict antidepressant treatment outcome in the early course of treatment. J Affect Disord 2015; 175:199-208. [PMID: 25638793 DOI: 10.1016/j.jad.2014.12.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 12/02/2014] [Accepted: 12/16/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hamilton depression rating scale (HAMD) subscales provide an economic alternative for the full scale; however, their ability to detect onset of improvement in the early course of treatment (EI) has not yet been researched. The present study investigated in patients with major depression (MD) whether the subscales are a comparable option to predict treatment remission in the early course of treatment. METHODS Based on data from 210 MD patients of a 6-week randomised, placebo-controlled trial comparing mirtazapine (MIR) and paroxetine (PAR), the discriminative and predictive validity of EI for (stable) remission at treatment end was evaluated for seven subscales and the HAMD17 in the total and in treatment subgroups (MIR vs. PAR). Receiver operating characteristics (ROC) curves (at week 2) and the Clinical Global Impression scales (CGI) (at study endpoint) were used to validate the 20% EI criterion for the subscales. RESULTS Only the Evans6 and Toronto7 subscale had almost the same predictive value as the HAMD17 (e.g., sensitivities stable remission Evans6/Toronto7: 96/95% vs. 96% HAMD17). The optimal cut-off for EI to predict remission was just below 20% for most subscales and slightly over 20% for stable remission. LIMITATIONS Study sample representativeness, non-independence of subscales, missing external validation criterion, lack of control group. CONCLUSIONS The Evans6 and Toronto7 subscales are valuable alternatives in situations, where economic aspects play a larger role. A sum score reduction of ≥20% as definition for EI seems also appropriate for the HAMD subscales, in the total as well as in the antidepressant subgroups.
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Affiliation(s)
- Isabella Helmreich
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany.
| | - Stefanie Wagner
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany
| | - Ralf Kohnen
- Psychology Department, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Armin Szegedi
- Employee of Merck, Rahway, NJ, USA (at the time of manuscript preparation)
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany
| | - André Tadić
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany
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Ferdousi M, Lalies M, Wasilewska A, Sączewski F, Hudson A. The effect of 7-fluoro-marsanidine, a novel α2-adrenoceptor agonist, on extracellular noradrenaline in rat frontal cortex: A microdialysis study. Neurosci Lett 2015; 590:47-51. [DOI: 10.1016/j.neulet.2015.01.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/22/2015] [Accepted: 01/23/2015] [Indexed: 10/24/2022]
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Efficacy and safety of flibanserin in postmenopausal women with hypoactive sexual desire disorder: results of the SNOWDROP trial. Menopause 2015; 21:633-40. [PMID: 24281236 DOI: 10.1097/gme.0000000000000134] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to assess the efficacy and safety of flibanserin, a serotonin receptor 1A agonist/serotonin receptor 2A antagonist, in postmenopausal women with hypoactive sexual desire disorder (HSDD). METHODS Naturally postmenopausal women with HSDD received flibanserin 100 mg once daily at bedtime (n = 468) or placebo (n = 481) for 24 weeks. Co-primary endpoints were changes from baseline to week 24 in the number of satisfying sexual events (SSEs) across 28 days and in the Female Sexual Function Index (FSFI) desire domain score. Secondary endpoints included change from baseline in Female Sexual Distress Scale-Revised (FSDS-R) Item 13 score (which assesses distress due to low sexual desire), FSDS-R total score, and FSFI total score. The Patient Benefit Evaluation was asked on treatment discontinuation. RESULTS There were significant improvements with flibanserin versus placebo in the mean (SE) changes in the number of SSEs (1.0 [0.1] vs 0.6 [0.1]), FSFI desire domain score (0.7 [0.1] vs 0.4 [0.1]), FSDS-R Item 13 score (-0.8 [0.1] vs -0.6 [0.1]), FSDS-R total score (-8.3 [0.6] vs -6.3 [0.6]), and FSFI total score (4.2 [0.4] vs 2.7 [0.4]; all P < 0.01). More women on flibanserin (37.6%) than women on placebo (28.0%) reported experiencing meaningful benefits from the study medication on treatment discontinuation. The most frequent adverse events associated with flibanserin were dizziness, somnolence, nausea, and headache. CONCLUSIONS In naturally postmenopausal women with HSDD, flibanserin, compared with placebo, has been associated with improvement in sexual desire, improvement in the number of SSEs, and reduced distress associated with low sexual desire, and is well tolerated.
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Gartlehner G, Nussbaumer B, Gaynes BN, Forneris CA, Morgan LC, Kaminski-Hartenthaler A, Greenblatt A, Wipplinger J, Lux LJ, Sonis JH, Hofmann J, Van Noord MG, Winkler D. Second-generation antidepressants for preventing seasonal affective disorder. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Interaction of 5-HTT and HTR1A gene polymorphisms in treatment responses to mirtazapine in patients with major depressive disorder. J Clin Psychopharmacol 2014; 34:446-54. [PMID: 24911443 DOI: 10.1097/jcp.0000000000000143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We tested for the association of HTR1A and 5-HTT genetic polymorphisms with treatment response to mirtazapine and evaluated the interactive effect between the polymorphisms in 283 patients with major depressive disorder. Korean subjects with diagnosis of major depressive disorder using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I disorders were recruited. Clinical symptoms were evaluated using the 17-item Hamilton Depression Rating (HAMD-17) Scale at baseline and after 1, 2, 4, 8, and 12 weeks of treatment with mirtazapine. The genetic association of 5-HTTLPR and HTR1A+272G>A with treatment response was analyzed. We found a significant association of the 12.12-repeat genotype of 5-HTT various number tandem repeat (VNTR) with a large percentage decline in HAMD-17 Scale score after 4, 8, and 12 weeks of treatment with mirtazapine. We also found that the frequency of the 12.12-repeat genotype was higher in responders than in nonresponders at week 8. The HTR1A+272GG genotype was significantly associated with a large percentage decline in HAMD-17 Scale score at 4, 8, and 12 weeks, although the genotypic frequencies were comparable between responders and nonresponders during the study period. Patients with the 12.12-repeat 5-HTT VNTR and GG of HTR1A+272G>A showed the highest HAMD-17 Scale percentage reduction during the study period and a better treatment response status after 4 weeks. These results suggest that the interaction between HTR1A+272G>A and 5-HTT VNTR is involved in the response to mirtazapine treatment and that a combination of these may be a useful marker for predicting treatment response to mirtazapine.
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Gupta D, Radhakrishnan M, Thangaraj D, Kurhe Y. Antidepressant and anti-anxiety like effects of 4i (N-(3-chloro-2-methylphenyl) quinoxalin-2-carboxamide), a novel 5-HT3 receptor antagonist in acute and chronic neurobehavioral rodent models. Eur J Pharmacol 2014; 735:59-67. [PMID: 24747753 DOI: 10.1016/j.ejphar.2014.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 01/11/2014] [Accepted: 04/08/2014] [Indexed: 11/16/2022]
Abstract
Depression and anxiety are the most debilitating mood disorders with poor therapeutic recovery rates. In the last decades, 5-HT3 receptor antagonists have been identified as potential agents for mood disorders. The current investigation focuses on evaluating the, antidepressant and anti-anxiety like effects of a novel 5-HT3 antagonist, 4i (N-(3-chloro-2-methylphenyl) quinoxalin-2-carboxamide). Preliminary, in vitro 5-HT3 receptor binding affinity was performed in isolated longitudinal muscle-myenteric plexus from the guinea pig ileum. Consequently, neurobehavioral effects of 4i in acute and chronic rodent models were evaluated. In addition, involvement of serotonergic system in the postulated effects of the compound was analyzed by in vivo assay. in vitro, 4i demonstrated high 5-HT3 receptor antagonistic activity (pA2, 7.6). in vivo acute study, 4i exhibited decreased duration of immobility in forced swim and tail suspension tests, and increased exploratory parameters as number and duration of nose-poking in hole board test and latency and time spent in aversive brightly illuminated light chamber in light-dark model. Moreover, in chronic model of depression, i.e., olfactory bulbectomy with behavioral deficits, 4i reversed depressive anhedonia in sucrose preference test and anxious hyperactive behavior in open field test in rats. Furthermore, synergistic effect of 4i with fluoxetine (a selective serotonin reuptake inhibitor) and inhibitory effect of 1-(m-chlorophenyl)-biguanide (a 5-HT3 receptor agonist) revealed serotonergic modulation by 4i mediated 5-HT3 receptor antagonism, which was further confirmed by potentiation of 5-hydroxytryptophan (a serotonin synthesis precursor) induced head twitch response. These findings suggest the potential antidepressant and anti-anxiety like effects of 4i, which may be related to the modulation of serotonergic system.
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Affiliation(s)
- Deepali Gupta
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani, Rajasthan 333031, India.
| | - Mahesh Radhakrishnan
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani, Rajasthan 333031, India.
| | - Devadoss Thangaraj
- KVSR Siddhartha College of Pharmaceutical Sciences, Vijaywada, Andhra Pradesh 520001, India.
| | - Yeshwant Kurhe
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani, Rajasthan 333031, India.
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Kimmel RJ, Seibert J. Is antidepressant-associated mania always an evidence of a bipolar spectrum disorder? A case report and review of the literature. Gen Hosp Psychiatry 2013; 35:577.e1-2. [PMID: 23363702 DOI: 10.1016/j.genhosppsych.2012.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 12/19/2012] [Accepted: 12/31/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The authors consider the clinical implications of characterizing every case of antidepressant-induced mania as evidence of an underlying bipolar diathesis. METHOD The authors report the case of a 45-year-old man, with no personal or family history of bipolar symptoms, who developed manic symptoms after sertraline initiation for a first lifetime depressive episode. RESULTS The patient's manic symptoms resolved rapidly with cessation of sertraline. His depressive symptoms responded to mirtazapine, and he had no further mood episodes during 2-year follow-up. DISCUSSION It may not always be appropriate to identify selective serotonin reuptake inhibitor-induced manic symptoms as pathognomonic for the bipolar diathesis, particularly as the bipolar formulation has distinct implications for future pharmacologic choices.
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Affiliation(s)
- Ryan J Kimmel
- Department of Psychiatry and Behavioral Sciences, University of Washington, Box 356073, Seattle, WA 98195-6073, USA.
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Bauer M, Pfennig A, Severus E, Whybrow PC, Angst J, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 1: update 2013 on the acute and continuation treatment of unipolar depressive disorders. World J Biol Psychiatry 2013; 14:334-85. [PMID: 23879318 DOI: 10.3109/15622975.2013.804195] [Citation(s) in RCA: 381] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This 2013 update of the practice guidelines for the biological treatment of unipolar depressive disorders was developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal has been to systematically review all available evidence pertaining to the treatment of unipolar depressive disorders, and to produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. The guidelines are intended for use by all physicians seeing and treating patients with these conditions. METHODS The 2013 update was conducted by a systematic update literature search and appraisal. All recommendations were approved by the Guidelines Task Force. RESULTS This first part of the guidelines (Part 1) covers disease definition, classification, epidemiology, and course of unipolar depressive disorders, as well as the management of the acute and continuation phase treatment. It is primarily concerned with the biological treatment (including antidepressants, other psychopharmacological medications, electroconvulsive therapy, light therapy, adjunctive and novel therapeutic strategies) of adults. CONCLUSIONS To date, there is a variety of evidence-based antidepressant treatment options available. Nevertheless there is still a substantial proportion of patients not achieving full remission. In addition, somatic and psychiatric comorbidities and other special circumstances need to be more thoroughly investigated. Therefore, further high-quality informative randomized controlled trials are urgently needed.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
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Yeephu S, Suthisisang C, Suttiruksa S, Prateepavanich P, Limampai P, Russell IJ. Efficacy and safety of mirtazapine in fibromyalgia syndrome patients: a randomized placebo-controlled pilot study. Ann Pharmacother 2013; 47:921-32. [PMID: 23737510 DOI: 10.1345/aph.1r725] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Data from an open-label trial suggest that mirtazapine might prove useful in treatment of fibromyalgia syndrome (FMS). OBJECTIVE To obtain preliminary efficacy data of mirtazapine for estimation of sample size requirements for a Phase 2 clinical trial in FMS. METHODS This 13-week randomized controlled trial compared the effects of mirtazapine 15 mg/day, mirtazapine 30 mg/day, and placebo in 40 patients with FMS. The primary outcomes were change in Pain Visual Analog Scale (PVAS) and proportion of pain responders (≥30% PVAS reduction). Secondary outcomes included scores from the Jenkins Sleep Scale (JSS), Patient Global Impression of Change (PGIC), Fibromyalgia Impact Questionnaire (FIQ), Hamilton Depression Rating Scale (HAM-D), Patient Global Assessment, and self-reported adverse events. RESULTS Significant within-group PVAS reductions from baseline were observed in all 3 groups, with the greatest improvement in the mirtazapine 30-mg group (p < 0.005); between-group difference was not significant. The proportion of pain responders did not meet significance criteria (66.67% for mirtazapine 30 mg, 50% for mirtazapine 15 mg, 41.67% for placebo). Significant within-group improvement in JSS scores was seen for mirtazapine 30 mg (p < 0.01) and mirtazapine 15 mg (p < 0.05). Between-group comparison achieved significance for JSS item 3, waking several times per night (p < 0.05). On the PGIC, 72.73% felt better with both mirtazapine dosages compared with 50% for placebo. Within-group FIQ responses indicated improvement in only mirtazapine-treated groups, whereas within-group improvement for HAM-D and Patient Global Assessment was observed in all groups. Based on our findings, the sample size requirement (80% power, 5% type I error) should be 83 per group to detect PVAS change difference between mirtazapine 30 mg and placebo. Common mirtazapine-related adverse events were increased appetite and weight gain. CONCLUSIONS Patients with FMS taking mirtazapine exhibited within-group significant improvement in most of the measured outcomes. Between-group analysis was predictably compromised by the small sample size. Mirtazapine was well tolerated. Further study with a larger sample size is likely to be useful.
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Affiliation(s)
- Suwimon Yeephu
- Faculty of Pharmacy, Department of Pharmacology, Mahidol University, Rajthevee, Bangkok, Thailand
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Katz M, DeRogatis LR, Ackerman R, Hedges P, Lesko L, Garcia M, Sand M. Efficacy of flibanserin in women with hypoactive sexual desire disorder: results from the BEGONIA trial. J Sex Med 2013; 10:1807-15. [PMID: 23672269 DOI: 10.1111/jsm.12189] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Hypoactive Sexual Desire Disorder (HSDD) is characterized by low sexual desire that causes marked distress or interpersonal difficulty. AIM The aim of this study was to assess the efficacy and safety of the 5-HT1A agonist/5-HT2A antagonist flibanserin in premenopausal women with HSDD. METHODS This was a randomized, placebo-controlled trial in which premenopausal women with HSDD (mean age: 36.6 years) were treated with flibanserin 100 mg once daily at bedtime (qhs) (n = 542) or placebo (n = 545) for 24 weeks. MAIN OUTCOME MEASURES Coprimary end points were the change from baseline to study end in Female Sexual Function Index (FSFI) desire domain score and in number of satisfying sexual events (SSE) over 28 days. Secondary end points included the change from baseline in FSFI total score, Female Sexual Distress Scale-Revised (FSDS-R) total score, and FSDS-R Item 13 score. RESULTS Compared with placebo, flibanserin led to increases in mean (standard deviation) SSE of 2.5 (4.6) vs. 1.5 (4.5), mean (standard error [SE]) FSFI desire domain score of 1.0 (0.1) vs. 0.7 (0.1), and mean (SE) FSFI total score of 5.3 (0.3) vs. 3.5 (0.3); and decreases in mean (SE) FSDS-R Item 13 score of -1.0 (0.1) vs. -0.7 (0.1) and mean (SE) FSDS-R total score of -9.4 (0.6) vs. -6.1 (0.6); all P ≤ 0.0001. The most frequently reported adverse events in the flibanserin group were somnolence, dizziness, and nausea, with adverse events leading to discontinuation in 9.6% of women receiving flibanserin vs. 3.7% on placebo. CONCLUSION In premenopausal women with HSDD, flibanserin 100 mg qhs resulted in significant improvements in the number of SSE and sexual desire (FSFI desire domain score) vs. placebo. Flibanserin was associated with significant reductions in distress associated with sexual dysfunction (FSDS-R total score) and distress associated with low sexual desire (FSDS-R Item 13) vs. placebo. There were no significant safety concerns associated with the use of flibanserin for 24 weeks.
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Affiliation(s)
- Molly Katz
- Katz and Kade, Cincinnati, OH 45219, USA.
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Maniadakis N, Kourlaba G, Mougiakos T, Chatzimanolis I, Jonsson L. Economic evaluation of agomelatine relative to other antidepressants for treatment of major depressive disorders in Greece. BMC Health Serv Res 2013; 13:173. [PMID: 23663281 PMCID: PMC3654993 DOI: 10.1186/1472-6963-13-173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 05/01/2013] [Indexed: 12/01/2022] Open
Abstract
Background Major depressive disorder (MDD) constitutes an important public health problem, as it is highly prevalent in the industrialized world and it is associated with substantial economic consequences for patients, health care providers, insurance and social security organizations and employers. To conduct an economic evaluation comparing agomelatine with other commonly used alternatives for treating patients with major depressive disorder (MDD) in Greece. Methods An existing international Markov model designed to evaluate the cost-effectiveness of agomelatine was adapted to the Greek setting. It reflects six different health states, in which patients may move on a monthly basis. The analysis was undertaken from a societal perspective. Transition probabilities, utilities and costs assigned to each health state were extracted from the published literature, government sources and expert opinion. Data reflects the year 2012 and was discounted using a rate of 3.5%. Probabilistic analysis was undertaken to deal with uncertainty. Results Base case analyses revealed that agomelatine is a dominant therapy for MDD relative to escitalopram, fluoxetine and sertraline, and it appeared to be cost-effective compared to venlafaxine (ICER: €547/QALY). Agomelatine remained a dominant treatment against generic sertraline and fluoxetine, and it appeared to be a cost-effective alternative compared to generic venlafaxine and escitalopram (ICER: €1,446/QALY and €3,303/QALY, respectively). Excluding the indirect cost from the analysis, agomelatine remained a cost-effective alternative over all comparators. In the probabilistic sensitivity analysis agomelatine was dominant in 44.5%, 89.6%, 70.6% and 84.6% of simulated samples against branded venlafaxine, escitalopram, fluoxetine and sertraline, respectively. Conclusion The present evaluation indicates that agomelatine is either a dominant or a cost-effective alternative relative to branded or generic alternatives, in Greece.
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Affiliation(s)
- Nikos Maniadakis
- Department of Health Services Organization & Management, National School of Public Health, 196 Alexandras Avenue, Athens 11521, Greece
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Investigating the psychopharmacology of cognitive affective bias in rats using an affective tone discrimination task. Psychopharmacology (Berl) 2013; 226:601-13. [PMID: 23239131 DOI: 10.1007/s00213-012-2932-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
Abstract
RATIONALE Affective states are known to influence behaviour in humans resulting in cognitive affective biases, which may play an important role in the development and treatment of mood disorders. Similar biases have recently been shown in animals, including the rat, providing an opportunity to investigate these processes in non-human species. OBJECTIVE This study sought to investigate the psychopharmacology of cognitive affective bias in rats using systemic treatments with anxiolytic (diazepam) and antidepressant drugs (reboxetine or fluoxetine). METHODS Lister hooded rats were trained to discriminate two distinct tones and respond on the appropriate lever to either obtain reward (food) or avoid punishment (mild foot shock). Cognitive affective bias, following acute or chronic drug treatment, was investigated using test sessions where both reference tones and intermediate ambiguous tones were included. RESULTS Rats exhibited a negative judgement bias under vehicle conditions which was not significantly attenuated by any of the acute drug treatments, diazepam (0.3, 1.0 mg/kg), reboxetine (0.3-3.0 mg/kg) or fluoxetine 0.1-1.0 mg/kg). Acute reboxetine induced a significant and dose-dependent decrease in the anticipation of reward. Chronic treatment with fluoxetine tended to reduce the negative bias observed in the rats after 1 week of treatment although no significant main effect of treatment was observed. CONCLUSIONS The results from these initial psychopharmacological studies show that drug treatments can differentially affect motivation to respond to cues associated with reward versus punishment. Our data also suggest that cognitive affective bias, quantified using this method, may be sensitive to chronic but not acute antidepressant treatment.
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