Recent advances in understanding and treating social anxiety disorder

Environmental concentration of fluoxetine disturbs larvae behavior and increases the defense response at molecular level in zebrafish (Danio rerio)

Fluoxetine (FLX) is one of the main antidepressants used worldwide. After human use, FLX enters the aquatic ecosystems, where it has commonly detected in the high ng/L concentration range. Several investigations have shown that exposure to different concentrations of FLX caused different adverse effects towards a number of aquatic species. However, the information on the onset and the relationship between molecular and behavioral FLX-induced effects remains scant. The aim of this study was to assess the effects induced by two FLX concentrations, namely 50 ng/L and 500 ng/L, on swimming activity of zebrafish (Danio rerio) larvae at 96-h post-fertilization (hpf) and to investigate if such behavioral effects were related to modulation of the expression of oxidative stress-related (sod1, sod2, cat, gpxa, and gst), stress- and anxiety-related (oxtl, prl2, npy, and ucn3l) genes, and genes encoding for the transporters of the main neurotransmitters (slc6a3, slc6a4a, slc6a4b, slc6a11). Fluoxetine exposure altered the swimming behavior of larvae, as shown by the reduction of the distance traveled by treated larvae in response to an external stimulus. Such behavioral change was related, at molecular level, to an enhanced expression of sod1, cat, and gpxa, suggesting an overproduction of pro-oxidant molecules. In addition, FLX modulated the expression of oxtl, slc6a4a, slc6a4b, and slc6a11, suggesting its capability to affect anxiety- and neurotransmitter-related genes.

Anxiolytic effect of a novel 9,10-dihydrophenanthrene, juncuenin H, is associated with metabolic changes in cortical serotonin/dopamine levels in mice

Two novel phenanthrenoids, juncuenin H (1) and dijuncuenin B (2), together with eight known phenanthrenoids, effusol (3), dehydroeffusol (4), juncusol (5), dehydrojuncusol (6), juncuenin B (7), dehydrojuncuenin B (8), juncuenin A (9), and dehydrojuncuenin A (10), were isolated from the underground parts of Juncus setchuenensis. The structures of the compounds were determined by 1D and 2D NMR and mass spectroscopy. The anxiolytic activities of compounds 1, 6, 9, and 10 were evaluated. In order to explore the mechanisms underlying their anxiolytic activities, the levels of serotonin (5-HT), dopamine (DA), and their metabolites in the cerebral cortex and hippocampus of mice treated with compound 1 were determined by quantitative mass spectrometry. The mice treated with compound 1 had significantly lower levels of 5-HT, 3-methoxytyramine (3-MT), 5-hydroxyindole-3-acetic acid (5-HIAA), homovanillic acid (HVA), and 3, 4-dihydroxyphenylacetic acid (DOPAC) in the cerebral cortex than those of the vehicle control-treated mice. The levels of HVA and 5-HIAA in the hippocampus were also significantly lower in the mice treated with compound 1 than in the control group mice. These results suggest that the metabolic changes, reflected in the levels of DA and/or 5-HT, may contribute to the anxiolytic activity of the phenanthrenoids studied herein.

Behavioral and neurogenomic transcriptome changes in wild-derived zebrafish with fluoxetine treatment

Background

Stress and anxiety-related behaviors are seen in many organisms. Studies have shown that in humans and other animals, treatment with selective serotonin reuptake inhibitors (e.g. fluoxetine) can reduce anxiety and anxiety-related behaviors. The efficacies and side effects, however, can vary between individuals. Fluoxetine can modulate anxiety in a stereospecific manner or with equal efficacy regardless of stereoisomer depending on the mechanism of action (e.g. serotonergic or GABAergic effects). Zebrafish are an emerging and valuable translational model for understanding human health related issues such as anxiety. In this study we present data showing the behavioral and whole brain transcriptome changes with fluoxetine treatment in wild-derived zebrafish and suggest additional molecular mechanisms of this widely-prescribed drug.

Results

We used automated behavioral analyses to assess the effects of racemic and stereoisomeric fluoxetine on male wild-derived zebrafish. Both racemic and the individual isomers of fluoxetine reduced anxiety-related behaviors relative to controls and we did not observe stereospecific fluoxetine effects. Using RNA-sequencing of the whole brain, we identified 411 genes showing differential expression with racemic fluoxetine treatment. Several neuropeptides (neuropeptide Y, isotocin, urocortin 3, prolactin) showed consistent expression patterns with the alleviation of stress and anxiety when anxiety-related behavior was reduced with fluoxetine treatment. With gene ontology and KEGG pathway analyses, we identified lipid and amino acid metabolic processes, and steroid biosynthesis among other terms to be over-enriched.

Conclusion

Our results demonstrate that fluoxetine reduces anxiety-related behaviors in wild-derived zebrafish and alters their neurogenomic state. We identify two biological processes, lipid and amino acid metabolic synthesis that characterize differences in the fluoxetine treated fish. Fluoxetine may be acting on several different molecular pathways to reduce anxiety-related behaviors in wild-derived zebrafish. This study provides data that could help identify common molecular mechanisms of fluoxetine action across animal taxa.

Modest abuse-related subjective effects of zolpidem in drug-naive volunteers

Recent case reports suggest that the short-acting benzodiazepine-like hypnotic, zolpidem, may have abuse potential among individuals who have no personal history of abusing drugs or alcohol, particularly at doses higher than those recommended for treating insomnia. This study recruited drug-naive volunteers to assess the subjective effects of multiple doses of zolpidem (0, 5, 10, or 20 mg) administered in a within-subject double-blind design. Participants (n=11) answered computerized questionnaires (Addiction Research Center Inventory, visual analog scales, and a hypothetical Drug versus Money Choice) to address the hypothesis that a supratherapeutic dose (20 mg) would increase ratings of abuse-related subjective effects, while lower therapeutic doses (5 and 10 mg) would not. Although participants rated some effects as negative at 10 and 20 mg, the highest dose engendered predominantly positive abuse-like effects such as 'High', 'Like', and 'Good Effects'. However, no dose of zolpidem was chosen over money ($0.35-$10) when participants made hypothetical choices between them. Results suggest that although individuals without a drug abuse history are not inclined to choose zolpidem when presented with an alternative reinforcer such as money, it may possess moderate abuse potential that limits its clinical utility.

A pharmaco-epidemiological study of migraine and antidepressant medications: complete one year data from the Norwegian population

BACKGROUND

Migraine, depression and anxiety disorders have been associated with one another in several epidemiological studies. However, it is not known if or how these associations are reflected in the concurrent use of medications for migraine and depressive/anxiety disorders in the general population. The purpose of the present study was to identify groups of patients particularly likely to receive clinical treatment for both conditions.

METHODS

Data from the Norwegian Prescription Database for 2006 were analysed for the purpose of ascertaining concurrence of prescriptions for migraine and depression/anxiety disorders. Data were subjected to analysis testing deviation from unity for the OR performed by a chi-square test.

RESULTS

In the total Norwegian population (N=4,640,219) migraine drugs were prescribed to 81,225 persons (1.8% of the population), antidepressant drugs to 257,700 persons (5.6% of the population), and 11,269 persons were prescribed both types of drugs. The prescription of antidepressants was significantly increased in patients receiving a prescription for a medication used to treat migraine (OR=2.82 (95% CI=2.76-2.88); chi-square p<0.001), and this association was stronger for men than for women. Teenage women carried the highest risk for this co-morbid constellation (OR=3.89 CI=3.17-4.77); chi-square p<0.001).

CONCLUSION

This study revealed a strong positive association between the prescription of migraine and antidepressant medications, and this association was generally most pronounced in men. However, teenage girls carried the highest risk of receiving both kinds of prescriptions, suggesting particular attentiveness is required in the clinical management of these patients.

Neurosteroids as neuromodulators in the treatment of anxiety disorders

Anxiety disorders are the most common psychiatric disorders. They are frequently treated with benzodiazepines, which are fast acting highly effective anxiolytic agents. However, their long-term use is impaired by tolerance development and abuse liability. In contrast, antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are considered as first-line treatment but have a slow onset of action. Neurosteroids are powerful allosteric modulators of GABA(A) and glutamate receptors. However, they also modulate sigma receptors and they are modulated themselves by SSRIs. Both pre-clinical and clinical studies have shown that neurosteroid homeostasis is altered in depression and anxiety disorders and antidepressants may act in part through restoring neurosteroid disbalance. Moreover, novel drugs interfering with neurosteroidogenesis such as ligands of the translocator protein (18 kDa) may represent an attractive pharmacological option for novel anxiolytics which lack the unwarranted side effects of benzodiazepines. Thus, neurosteroids are important endogenous neuromodulators for the physiology and pathophysiology of anxiety and they may constitute a novel therapeutic approach in the treatment of these disorders.

Na+, K+ ATPase activity is reduced in amygdala of rats with chronic stress-induced anxiety-like behavior

In this study, we examined the effects of two chronic stress regimens upon anxiety-like behavior, Na(+), K(+)-ATPase activity and immunocontent, and oxidative stress parameters (antioxidant enzymes and reactive oxygen species production) in the amygdala. Male rats were subjected to chronic unpredictable and to chronic restraint stress for 40 days. Subsequently, anxiety-like behavior was examined. Both stressed groups presented increased anxiety-like behavior. Reduced amygdalal Na(+), K(+)-ATPase activity in the synaptic plasma membranes was also observed, without alterations in the amygdala immunocontent. In addition, when analyzing oxidative stress parameters, only superoxide dismutase activity was decreased in the amygdala of animals subjected to unpredictable stress. We conclude that both models of chronic stress lead to anxiety-like behavior and decreased amygdalal Na(+), K(+)-ATPase activity, which appears not to be related to oxidative imbalance. The relationship between this decreased activity and anxiety-like behavior remains to be studied.

Should an obsessive-compulsive spectrum grouping of disorders be included in DSM-V?

The obsessive-compulsive (OC) spectrum has been discussed in the literature for two decades. Proponents of this concept propose that certain disorders characterized by repetitive thoughts and/or behaviors are related to obsessive-compulsive disorder (OCD), and suggest that such disorders be grouped together in the same category (i.e. grouping, or "chapter") in DSM. This article addresses this topic and presents options and preliminary recommendations to be considered for DSM-V. The article builds upon and extends prior reviews of this topic that were prepared for and discussed at a DSM-V Research Planning Conference on Obsessive-Compulsive Spectrum Disorders held in 2006. Our preliminary recommendation is that an OC-spectrum grouping of disorders be included in DSM-V. Furthermore, we preliminarily recommend that consideration be given to including this group of disorders within a larger supraordinate category of "Anxiety and Obsessive-Compulsive Spectrum Disorders." These preliminary recommendations must be evaluated in light of recommendations for, and constraints upon, the overall structure of DSM-V.

Pregabalin in the treatment of alcohol and benzodiazepines dependence

We review all available studies on the use of the newer anticonvulsant drug pregabalin (PGB) in the treatment of both alcohol dependence (AD) and benzodiazepine dependence (BD). In AD, the available evidence includes one open-label and one double-blind randomized studies, whereas in BD, only a few case reports and one open-label study are as yet available. In both conditions, PGB was found efficacious with significant improvement in withdrawal symptoms at the dosage ranges of 150-450 mg/day (AD) and 225-900 mg/day (BD). Moreover, its side effects were mild and transient. Despite the limited quality of the studies design, their findings suggest that PGB might constitute a novel efficacious and safe option in the treatment of both AD and BD.

Comparison of the predictive validity of the mirror chamber and elevated plus maze tests in mice

The mirror chamber (MC) is a putative test of anxiety-like behavior in mice, and is increasingly popular. Nonetheless, it is unclear whether the observed behaviors rely on the presence of mirrored panels. If so, it is unclear whether the behaviors are sensitive to clinically effective anxiolytics, and how the test compares to the elevated plus maze (EPM) in terms of predictive validity. The present studies assessed anxiety-like behaviors in different mouse strains in the MC using mirrored and non-mirrored panels, under variable lighting conditions. We also assessed the pharmacological validity of the MC and EPM tests, and the locomotor properties of active test compounds. Seven mouse strains exhibited different levels of anxiety-like behaviors in the MC, and differential sensitivity to panel and light conditions. DBA/2J mice appeared most sensitive to the mirrored, versus black or white, panels and were therefore used in pharmacological MC studies. The mGlu5 receptor antagonist MPEP significantly decreased anxiety-like behaviors, similar to an intermediate dose of the benzodiazepine diazepam. The benzodiazepines chlordiazepoxide and alprazolam and the 5HT(1A) partial agonist buspirone had no effects on anxiety-like behaviors in the MC. None of the MC effects of active test compounds were attributable to non-specific/locomotor effects. The antidepressants fluoxetine and venlafaxine increased anxiety-like behaviors in the MC. By contrast, the anxiolytic-like effects of chlordiazepoxide, diazepam and MPEP were revealed in the EPM in C57Bl6/J mice. In conclusion, the EPM test exhibits superior predictive validity compared to the MC test, despite the sensitivity of the MC to mouse strain differences.