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Tomasetti C, Autullo G, Ballerini A, de Bartolomeis A, Dell'Osso B, Fiorentini A, Tonioni F, Villari V, De Berardis D. Treating depression in patients with borderline personality disorder: clinical clues on the use of antidepressants. Ann Gen Psychiatry 2024; 23:21. [PMID: 38816843 PMCID: PMC11140967 DOI: 10.1186/s12991-024-00507-z] [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: 01/28/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024] Open
Abstract
Personality disorders (PD) are described as enduring patterns of markedly deviant and pervasive inner experiences and behaviors, with onset in adolescence, which lead to severe distress or impairment. Patients suffering from major depressive disorder (MDD) display higher rates of comorbidity with personality disorders, often complicating the treatment, and worsening the outcomes. Borderline personality disorder (BPD) is the most common of PD and is frequently associated with MDD, with which shares several features. The most part of research agrees on the fact that comorbid BPD in MDD patients quite doubles the poor response to treatments. Moreover, no treatment strategy stands out currently to emerge as more effective in these cases, thus urging the call for the need of new approaches. Herein, we revise the current literature on BPD, its neurobiology and comorbidity with MDD, as well as the more recent treatment strategies used. Then, based on its pharmacology, we propose a possible role of trazodone as a valuable tool to approach comorbid BPD-MDD.
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Affiliation(s)
- Carmine Tomasetti
- Department of Mental Health, Alzheimer Center of Giulianova, Hospital "Maria SS dello Splendore", ASL Teramo, Giulianova (TE), Italy.
| | - G Autullo
- Psychiatry and Psychology Institute, Catholic University of Sacred Heart of Rome, Rome, Italy
| | - A Ballerini
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, Florence, 50134, Italy
| | - A de Bartolomeis
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Dentistry, University of Naples "Federico II", Naples, Italy
| | - B Dell'Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - A Fiorentini
- Department of Neurosciences and Mental Health, Ca' Granda Ospedale Maggiore Policlinico, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), University of Milan, Milan, Italy
| | - F Tonioni
- Psychiatric Emergency Service, Department of Neuroscience and Mental Health, A.O.U. "Città della Salute e della Scienza", Turin, Italy
| | - V Villari
- Psychiatry and Psychology Institute, Catholic University of Sacred Heart of Rome, Rome, Italy
| | - D De Berardis
- Department of Mental Health, Mental Health Center of Giulianova, ASL Teramo, Teramo, Italy
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Cowen PJ. SSRIs in the Treatment of Depression: A Pharmacological CUL-DE-SAC? Curr Top Behav Neurosci 2024; 66:1-19. [PMID: 37922101 DOI: 10.1007/7854_2023_447] [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] [Indexed: 11/05/2023]
Abstract
The widespread adoption of selective serotonin reuptake inhibitors (SSRIs) as first-line pharmacological treatments in the management of clinical depression transformed the landscape of drug therapy for this condition. SSRIs are safer and better tolerated than the tricyclic antidepressants (TCAs) that they replaced. However, they have limitations that may have placed a ceiling on the expectations of first-line pharmacological treatment. Notable problems with SSRIs include induction of anxiety on treatment initiation, delayed onset of significant therapeutic effect, sexual dysfunction, sleep disturbance and overall modest efficacy. The latter is linked with an inability of SSRIs to effectively treat syndromes of anhedonia and cognitive impairment. Combined serotonin and noradrenaline reuptake inhibitors (SNRIs), such as venlafaxine, have produced some limited improvements over SSRIs in efficacy, at the cost of a greater side-effect burden. Attempts to supplement serotonin reuptake activity with actions at serotonin receptor sub-types have not yet yielded substantial benefits; however, vortioxetine may provide more utility in the management of cognitive impairment. Future advances might come from the development of SNRIs, which more closely mimic the actions of effective TCAs. There may also be possible benefits to be derived from combining SSRIs with 5-HT4 receptor agonists and 5-HT7 receptor antagonists.
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Affiliation(s)
- Philip J Cowen
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
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3
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Albert U, Tomasetti C, Marra C, Neviani F, Pirani A, Taddeo D, Zanetti O, Maina G. Treating depression in clinical practice: new insights on the multidisciplinary use of trazodone. Front Psychiatry 2023; 14:1207621. [PMID: 37654988 PMCID: PMC10466041 DOI: 10.3389/fpsyt.2023.1207621] [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: 04/17/2023] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
Depression is estimated to be a leading contributor to the global mental health-related burden. The determinants of this huge prevalence lie in the fact that depressive symptoms may be comorbid in a wide variety of disorders, thus complicating and exacerbating their clinical framework. This makes the treatment of depressive symptoms difficult, since many pharmacological interactions should be considered by physicians planning therapy. Hence, depression still represents a challenge for both psychiatrists and other clinicians, in terms of its high rates of relapse and resistance despite well-established protocols. It is also complicated by the well-known latency in its complete response to current antidepressant treatments. In this context, the search for new strategies regarding antidepressant treatment is mandatory. Revising the use of "old" pharmacotherapies by considering their specific features may help to perfecting the treatment of depression, both in its standalone psychiatric manifestation and in the framework of other clinical conditions. Using a nominal group technique approach, the results of a consensus of expert physicians regarding the possible use of trazodone as a valuable strategy for addressing the "real world" unmet needs of depression treatment in different fields (psychiatry, primary care, neurology and geriatrics) is herein provided. This idea is based on the unique characteristics of this drug which delivers a more rapid antidepressant action as compared to other selective serotonin reuptake inhibitors. It also has pharmacodynamic malleability (i.e., the possibility of exerting different effects on depressive symptoms at different dosages) and pharmacokinetic tolerability (i.e., the possibility of being used as an add-on to other antidepressants with scarce interaction and achieving complimentary effects) when used in the milieu of other drugs in treating comorbid depressive symptoms. Moreover, the large number of formulations available permits finite dosage adjustments, and the use of trazodone for specific pathologies, such as dysphagia. Therefore, although additional studies exploring the real-world conditions of antidepressant treatment are warranted, experts agree on the idea that depressive disorder, in both its standalone and its comorbid manifestations, may surely take advantage of the particular characteristics of trazodone, thus attempting to reach the greatest effectiveness in different contexts.
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Affiliation(s)
- Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- Azienda Sanitaria Integrata Giuliano-Isontina—ASUGI, UCO Clinica Psichiatrica, Trieste, Italy
| | - Carmine Tomasetti
- ASL Teramo, Department of Mental Health of Teramo, Alzheimer Centre of Giulianova, Teramo, Italy
| | - Camillo Marra
- Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Neviani
- Center for Cognitive Disorders and Dementia, Chair of Geriatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Pirani
- Center for Cognitive Disorders and Dementia, Health County of Ferrara, Ferrara, Italy
- Alzheimer’s Association “Francesco Mazzuca”, Ferrara, Italy
| | - Daiana Taddeo
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Orazio Zanetti
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giuseppe Maina
- San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Turin, Italy
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Shad MU. Recent Developments in Pharmacotherapy of Depression: Bench to Bedside. J Pers Med 2023; 13:jpm13050773. [PMID: 37240943 DOI: 10.3390/jpm13050773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
For the last 70 years, we did not move beyond the monoamine hypothesis of depression until the approval of the S-enantiomer of ketamine, an N-methyl-D-aspartate (NMDA) receptor blocker and the first non-monoaminergic antidepressant characterized by rapid antidepressant and antisuicidal effects. A similar profile has been reported with another NMDA receptor antagonist, dextromethorphan, which has also been approved to manage depression in combination with bupropion. More recently, the approval of a positive allosteric modulator of GABA-A receptors, brexanolone, has added to the list of recent breakthroughs with the relatively rapid onset of antidepressant efficacy. However, multiple factors have compromised the clinical utility of these exciting discoveries in the general population, including high drug acquisition costs, mandatory monitoring requirements, parenteral drug administration, lack of insurance coverage, indirect COVID-19 effects on healthcare systems, and training gaps in psychopharmacology. This narrative review aims to analyze the clinical pharmacology of recently approved antidepressants and discuss potential barriers to the bench-to-bedside transfer of knowledge and clinical application of exciting recent discoveries. Overall, clinically meaningful advances in the treatment of depression have not reached a large proportion of depressed patients, including those with treatment-resistant depression, who might benefit the most from the novel antidepressants.
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Affiliation(s)
- Mujeeb U Shad
- Valley Health System (VHS), Las Vegas, NV 89118, USA
- The Department of Psychiatry, University of Nevada, Las Vegas, School of Medicine, The Touro University of Nevada College of Osteopathic Medicine (TUNCOM), Henderson, NV 89014, USA
- The University of Nevada, Las Vegas, NV 89154, USA
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Prakash A, Borkotoky S, Dubey VK. Targeting two potential sites of SARS-CoV-2 main protease through computational drug repurposing. J Biomol Struct Dyn 2022; 41:3014-3024. [PMID: 35266856 DOI: 10.1080/07391102.2022.2044907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Before the rise of SARS-CoV-2, emergence of different coronaviruses such as SARS-CoV and MERS-CoV has been reported that indicates possibility of the future novel pathogen from the coronavirus family at a pandemic level. In this context, explicit studies on identifying inhibitors focused on the coronavirus life cycle, are immensely important. The main protease is critical for the life cycle of coronaviruses. Majority of the work done on the inhibitor studies on the catalytically active dimeric SARS-CoV-2 main protease (Mpro), primarily focussed on the catalytic site of a single protomer, with a few targeting the dimeric site. In this study, we have exploited the FDA-approved drugs, for a computational drug repurposing study against the Mpro. A virtual screening approach was employed with docking and molecular dynamics (MD) methods. Out of 1576, FDA-approved compounds, our study suggests three compounds: netupitant, paliperidone and vilazodone as possible inhibitors with a potential to inhibit both sites (monomeric and dimeric) of the Mpro. These compounds were found to be stable during the MD simulations and their post simulation binding energies were also correlated for both the targeted sites, suggesting equal binding capacity. This unique efficiency of the reported compounds might support further experimental studies on developing inhibitors against SARS-CoV-2 main protease.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Archisha Prakash
- Department of Zoology, Banaras Hindu University (BHU), Varanasi, Uttar Pradesh, India
| | - Subhomoi Borkotoky
- School of Biochemical Engineering, Indian Institute of Technology (BHU), Varanasi, Uttar Pradesh, India
| | - Vikash Kumar Dubey
- School of Biochemical Engineering, Indian Institute of Technology (BHU), Varanasi, Uttar Pradesh, India
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Chauhan M, Parry R, Bobo WV. Vilazodone for Major Depression in Adults: Pharmacological Profile and an Updated Review for Clinical Practice. Neuropsychiatr Dis Treat 2022; 18:1175-1193. [PMID: 35726313 PMCID: PMC9206504 DOI: 10.2147/ndt.s279342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/08/2022] [Indexed: 12/16/2022] Open
Abstract
This article provides an updated review of the pharmacological profile and available efficacy and tolerability/safety data for vilazodone, one of the most recent antidepressant drugs to be approved in the USA for the treatment of major depressive disorder (MDD) in adults. The efficacy of vilazodone for MDD in adults is supported by four positive short-term (8-10 weeks), randomized, placebo-controlled trials. Beyond these pivotal trials, we review updated research findings pertaining to the clinical effects of vilazodone for MDD including the results of switch studies, small comparative efficacy trials, key pooled and secondary data analyses focused on important depressive subtypes (anxious depression) and predictors of treatment outcome, and safety studies including direct studies of sexual side-effects. Despite these additional research efforts and use for over a decade, important gaps in the clinical evidence base remain with vilazodone. Hypothesized differences in efficacy and adverse effects between other antidepressants and vilazodone based on its multimodal mechanism of action (combining serotonin reuptake inhibition with serotonin 5-HT1A partial agonist effects) have not been comprehensively demonstrated in clinical studies and its effectiveness as a continuation- or maintenance-phase therapeutic is not yet established. Questions remain regarding its reproductive and lactational safety profiles and its efficacy as a potential next-step therapeutic for patients with MDD who do not respond to first-line antidepressants such as selective serotonin reuptake inhibitors. Suggestions for clinical use of vilazodone and discussion of its place among the broad range of pharmacotherapies for adults with MDD are provided.
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Affiliation(s)
- Mohit Chauhan
- Department of Psychiatry & Psychology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Rebecca Parry
- Department of Psychiatry & Psychology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - William V Bobo
- Department of Psychiatry & Psychology, Mayo Clinic Florida, Jacksonville, FL, USA.,Center for Individualized Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
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Early response to trazodone once-a-day in major depressive disorder: review of the clinical data and putative mechanism for faster onset of action. CNS Spectr 2021; 26:232-242. [PMID: 33731232 DOI: 10.1017/s1092852921000304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Most antidepressants have a delayed onset of action and must be administered for several weeks to generate therapeutic effects. Trazodone is a serotonin antagonist and reuptake inhibitor approved for the treatment of major depressive disorder. The once-a-day (OAD) formulation of trazodone has an improved tolerability profile compared to its conventional formulations. In this study, we systematically reviewed the evidence available for the antidepressant efficacy and early improvement in depressive symptoms with trazodone OAD treatment. METHOD We conducted a PubMed database search for randomized controlled trials published from 2005 to 2020. RESULTS Two studies, a placebo-controlled and an active-comparator (venlafaxine extended-release or XR) study were found. Both the studies demonstrated that trazodone exhibits antidepressant activity at a starting dose of 150 mg/day and results in statistically significant greater reduction in Hamilton Depression Rating Scale (HAM-D17) scores within 1 week of starting treatment compared to placebo or venlafaxine XR (P < .05). Trazodone also resulted in significant early improvement in the HAM-D17 sleep disturbance factor compared to placebo or venlafaxine XR at day 7 (P < .05). This clinical effect is supported by in vitro proprietary data for the affinity of trazodone for different target receptors. Activity at these receptors may underlie trazodone's fast antidepressant action. CONCLUSIONS Trazodone, if properly dosed, can be an effective antidepressant with early onset of action and good tolerability. Future studies designed to specifically evaluate onset and timing of improvement of depressive symptoms remain necessary to confirm and extend these results.
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"Novel Psychopharmacology for Depressive Disorders". ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1305:449-461. [PMID: 33834412 DOI: 10.1007/978-981-33-6044-0_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Major depressive disorder carries a significant burden and a high risk for suicide. The need for more effective, safer, and faster-acting drugs is, therefore, compelling. The present chapter briefly assesses the most promising agents, focusing on non-monoamine-targeting compounds, namely, the glutamate antagonist ketamine and its enantiomer esketamine. A critical overview of the evidence and the pitfalls associated with current antidepressant drug development is likewise provided in the following text.
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9
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Delre P, Caporuscio F, Saviano M, Mangiatordi GF. Repurposing Known Drugs as Covalent and Non-covalent Inhibitors of the SARS-CoV-2 Papain-Like Protease. Front Chem 2020; 8:594009. [PMID: 33304884 PMCID: PMC7701290 DOI: 10.3389/fchem.2020.594009] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022] Open
Abstract
In the absence of an approved vaccine, developing effective severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antivirals is essential to tackle the current pandemic health crisis due to the coronavirus disease 2019 (COVID-19) spread. As any traditional drug discovery program is a time-consuming and costly process requiring more than one decade to be completed, in silico repurposing of existing drugs is the preferred way for rapidly selecting promising clinical candidates. We present a virtual screening campaign to identify covalent and non-covalent inhibitors of the SARS-CoV-2 papain-like protease (PLpro) showing potential multitarget activities (i.e., a desirable polypharmacology profile) for the COVID-19 treatment. A dataset including 688 phase III and 1,702 phase IV clinical trial drugs was downloaded from ChEMBL (version 27.1) and docked to the recently released crystal structure of PLpro in complex with a covalently bound peptide inhibitor. The obtained results were analyzed by combining protein-ligand interaction fingerprint similarities, conventional docking scores, and MM-GBSA-binding free energies and allowed the identification of some interesting candidates for further in vitro testing. To the best of our knowledge, this study represents the first attempt to repurpose drugs for a covalent inhibition of PLpro and could pave the way for new therapeutic strategies against COVID-19.
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Affiliation(s)
- Pietro Delre
- Department of Chemistry, University of Bari “Aldo Moro”, Bari, Italy
- National Research Council (CNR) – Institute of Crystallography, Bari, Italy
| | - Fabiana Caporuscio
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Michele Saviano
- National Research Council (CNR) – Institute of Crystallography, Bari, Italy
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Abstract
Introduction: Vilazodone is a novel antidepressant approved for the treatment of major depressive disorder. It acts as a serotonin reuptake inhibitor and 5-HT1A partial agonist. It may lead to a more rapid rise in serotonin concentration in the synaptic cleft than selective serotonin reuptake inhibitors (SSRIs), which could potentially cause more severe toxicity in overdose.Methods: We performed a systematic review of the medical literature to identify all available peer reviewed evidence regarding vilazodone poisoning.Results: We identified nine unique articles describing vilazodone poisoning. These included eleven unique case reports of vilazodone poisoning, three reviews of data from the National Poison Data System, and one review of data from the Toxicology Investigators Consortium. Children were frequently symptomatic, and many developed seizures and/or serotonin syndrome. Adults and adolescents also developed serotonin syndrome after single-substance ingestion of vilazodone. ICU admission, endotracheal intubation, and parenteral benodiazepines were frequently required.Discussion: Vilazodone, unlike SSRIs, may frequently cause serotonin syndrome in single-substance ingestions. Children ingesting as little as the minimum daily dose of vilazodone, 10 mg, suffered major clinical toxicity.Conclusion: Vilazodone poisoning may produce serious clinical effects, including serotonin syndrome and seizures. Young children are at particularly high risk and may become critically ill after ingestion of very small amounts of vilazodone. Admission of poisoned children to a monitored setting and prolonged clinical observation of poisoned adults may be reasonable.
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Affiliation(s)
- Kevin Baumgartner
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Evan Schwarz
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
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11
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Byun TH, Chaliki SS, Poole KG. New Treatment Options for Depression: A Primer for Internists. Am J Med 2019; 132:678-684. [PMID: 30710538 DOI: 10.1016/j.amjmed.2019.01.012] [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: 12/27/2018] [Revised: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Abstract
Depression continues to be a challenging condition to treat despite the myriad treatment options available. Primary care providers are increasingly tasked with providing second- and third-line treatments for major depressive disorder, and thus, should be familiar with newer medication therapies that are available. In this article, we aim to provide the general internist and other providers who treat depression in their practice with a succinct review of recent developments in the treatment of depression.
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Affiliation(s)
- Tina H Byun
- Division of Community Internal Medicine, Mayo Clinic, Scottsdale, Ariz.
| | - Swarna S Chaliki
- Division of Community Internal Medicine, Mayo Clinic, Scottsdale, Ariz
| | - Kenneth G Poole
- Division of Community Internal Medicine, Mayo Clinic, Scottsdale, Ariz
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Villas Boas GR, Boerngen de Lacerda R, Paes MM, Gubert P, Almeida WLDC, Rescia VC, de Carvalho PMG, de Carvalho AAV, Oesterreich SA. Molecular aspects of depression: A review from neurobiology to treatment. Eur J Pharmacol 2019; 851:99-121. [PMID: 30776369 DOI: 10.1016/j.ejphar.2019.02.024] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 12/14/2022]
Abstract
Major depressive disorder (MDD), also known as unipolar depression, is one of the leading causes of disability and disease worldwide. The signs and symptoms are low self‑esteem, anhedonia, feeling of worthlessness, sense of rejection and guilt, suicidal thoughts, among others. This review focuses on studies with molecular-based approaches involving MDD to obtain an integrated, more detailed and comprehensive view of the brain changes produced by this disorder and its treatment and how the Central Nervous System (CNS) produces neuroplasticity to orchestrate adaptive defensive behaviors. This article integrates affective neuroscience, psychopharmacology, neuroanatomy and molecular biology data. In addition, there are two problems with current MDD treatments, namely: 1) Low rates of responsiveness to antidepressants and too slow onset of therapeutic effect; 2) Increased stress vulnerability and autonomy, which reduces the responses of currently available treatments. In the present review, we encourage the prospection of new bioactive agents for the development of treatments with post-transduction mechanisms, neurogenesis and pharmacogenetics inducers that bring greater benefits, with reduced risks and maximized access to patients, stimulating the field of research on mood disorders in order to use the potential of preclinical studies. For this purpose, improved animal models that incorporate the molecular and anatomical tools currently available can be applied. Besides, we encourage the study of drugs that do not present "classical application" as antidepressants, (e.g., the dissociative anesthetic ketamine and dextromethorphan) and drugs that have dual action mechanisms since they represent potential targets for novel drug development more useful for the treatment of MDD.
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Affiliation(s)
- Gustavo Roberto Villas Boas
- Research Group on Development of Pharmaceutical Products (P&DProFar), Center for Biological and Health Sciences, Federal University of Western Bahia, Rua Bertioga, 892, Morada Nobre II, CEP 47810-059, Barreiras, Bahia, Brazil; Faculty of Health Sciences, Federal University of Grande Dourados, Dourados Rodovia Dourados, Itahum Km 12, Cidade Universitaria, Caixa. postal 364, CEP 79804-970, Dourados, Mato Grosso do Sul, Brazil.
| | - Roseli Boerngen de Lacerda
- Department of Pharmacology of the Biological Sciences Center, Federal University of Paraná, Jardim das Américas, Caixa. postal 19031, CEP 81531-990, Curitiba, Paraná, Brazil.
| | - Marina Meirelles Paes
- Research Group on Development of Pharmaceutical Products (P&DProFar), Center for Biological and Health Sciences, Federal University of Western Bahia, Rua Bertioga, 892, Morada Nobre II, CEP 47810-059, Barreiras, Bahia, Brazil.
| | - Priscila Gubert
- Center for Biological and Health Sciences, Federal University of Western Bahia, Rua Bertioga, 892, Morada Nobre II, CEP 47810-059, Barreiras, Bahia, Brazil.
| | - Wagner Luis da Cruz Almeida
- Research Group on Development of Pharmaceutical Products (P&DProFar), Center for Biological and Health Sciences, Federal University of Western Bahia, Rua Bertioga, 892, Morada Nobre II, CEP 47810-059, Barreiras, Bahia, Brazil.
| | - Vanessa Cristina Rescia
- Research Group on Development of Pharmaceutical Products (P&DProFar), Center for Biological and Health Sciences, Federal University of Western Bahia, Rua Bertioga, 892, Morada Nobre II, CEP 47810-059, Barreiras, Bahia, Brazil.
| | - Pablinny Moreira Galdino de Carvalho
- Center for Biological and Health Sciences, Federal University of Western Bahia, Rua Bertioga, 892, Morada Nobre II, CEP 47810-059, Barreiras, Bahia, Brazil.
| | - Adryano Augustto Valladao de Carvalho
- Center for Biological and Health Sciences, Federal University of Western Bahia, Rua Bertioga, 892, Morada Nobre II, CEP 47810-059, Barreiras, Bahia, Brazil.
| | - Silvia Aparecida Oesterreich
- Faculty of Health Sciences, Federal University of Grande Dourados, Dourados Rodovia Dourados, Itahum Km 12, Cidade Universitaria, Caixa. postal 364, CEP 79804-970, Dourados, Mato Grosso do Sul, Brazil.
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Stuivenga M, Giltay EJ, Cools O, Roosens L, Neels H, Sabbe B. Evaluation of vilazodone for the treatment of depressive and anxiety disorders. Expert Opin Pharmacother 2018; 20:251-260. [PMID: 30475091 DOI: 10.1080/14656566.2018.1549542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Major Depressive Disorder (MDD) and General Anxiety Disorder (GAD) significantly contribute to the global burden of disease. Vilazodone, a combined serotonin reuptake inhibitor and 5-HT1A partial agonist, is an approved therapy for the treatment of MDD and which has been further investigated for GAD. Areas covered: This article covers the pharmacokinetics and pharmacodynamics of vilazodone and provides an evaluation of the clinical usefulness of vilazodone for the treatment of MDD and anxiety disorders. A literature search was performed using PubMed/MEDLINE, Web of Science and the Cochrane Library. Expert opinion: Studies have shown that vilazodone is significantly superior to placebo. However, vilazodone cannot as yet be recommended as a first-line treatment option for MDD as it is unclear whether the drug's dual mechanism of action provides greater efficacy than prevailing treatment options. Moreover, more phase IV studies are needed to establish its efficacy and long-term safety in larger and more diverse populations. Although vilazodone may have an additional advantage for the treatment of anxiety symptoms in MDD, here also additional studies are required to confirm its efficacy over and above SSRI alternatives and other antidepressant treatments. Therefore, presently, vilazodone should be considered as a second- or third-line treatment option for MDD and GAD.
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Affiliation(s)
- Mirella Stuivenga
- a Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences , University of Antwerp, Belgium; University Psychiatric Hospital Duffel , Duffel , Belgium
| | - Erik J Giltay
- a Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences , University of Antwerp, Belgium; University Psychiatric Hospital Duffel , Duffel , Belgium.,b Department of Psychiatry , Leiden University Medical Center (LUMC) , Leiden , The Netherlands
| | - Olivia Cools
- a Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences , University of Antwerp, Belgium; University Psychiatric Hospital Duffel , Duffel , Belgium
| | - Laurence Roosens
- c Toxicological Center, Department of Pharmaceutical Sciences , University of Antwerp , Antwerp , Belgium
| | - Hugo Neels
- c Toxicological Center, Department of Pharmaceutical Sciences , University of Antwerp , Antwerp , Belgium
| | - Bernard Sabbe
- a Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences , University of Antwerp, Belgium; University Psychiatric Hospital Duffel , Duffel , Belgium
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14
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Wang H, Zhang W, Gao Q, Cao X, Li Y, Li X, Min Z, Yu Y, Guo Y, Shuai L. Extractive from Hypericum ascyron L promotes serotonergic neuronal differentiation in vitro. Stem Cell Res 2018; 31:42-50. [PMID: 30015171 DOI: 10.1016/j.scr.2018.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/29/2018] [Accepted: 07/05/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Plant natural products have many different biological activities but the precise mechanisms underlying these activities remain largely unknown. Hypericum longistylum has long been recorded in Chinese medicine as a cure for depression and related disorders, but how it repairs neural lineages has not been addressed. METHODS We extracted compounds from Hypericum longistylum and determined their effect on neural differentiation of embryonic stem cells (ESCs) in vitro by using the Pax6-GFP reporter system. The amount of serotonin released during differentiation was measured by HPLC. The tail suspension test and forced swimming test was performed for determining the effect of compounds on depression-like behaviors in mice. RESULTS We found that one of the phloroglucinol derivatives not only facilitated differentiation of neural progenitor cells, but also increased the efficiency of differentiation into serotonergic neurons. This compound also improved the behaviors of mice placed in a stressful environment and reduced signs of depression. CONCLUSIONS This is the first use of Chinese herb derived-natural products to promote neurogenesis of ESCs, including the generation of serotonergic neurons, and the first attempt to identify the active compound in Hypericum longistylum responsible for its beneficial effects on depressive diseases.
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Affiliation(s)
- Haisong Wang
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, Tianjin 300350, China.
| | - Wenhao Zhang
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, Tianjin 300350, China.
| | - Qian Gao
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, Tianjin 300350, China; Department of Gynecology and Obstetrics, Peking University Third Hospital, Beijing 100191, China.
| | - Xiangrong Cao
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, Tianjin 300350, China
| | - Yanni Li
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, Tianjin 300350, China.
| | - Xu Li
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, Tianjin 300350, China.
| | - Zheying Min
- Department of Gynecology and Obstetrics, Peking University Third Hospital, Beijing 100191, China
| | - Yang Yu
- Department of Gynecology and Obstetrics, Peking University Third Hospital, Beijing 100191, China.
| | - Yuanqiang Guo
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, Tianjin 300350, China.
| | - Ling Shuai
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, Tianjin 300350, China; Key Laboratory of Immune Microenvironment and Disease (Ministry of Education), Tianjin Medical University, Tianjin 300070, China.
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15
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Abstract
Vilazodone hydrochloride is the first member in a new class of antidepressants called indolealkylamines and was approved for use in the United States in 2011 for major depressive disorder. It has a combined mechanism of action of a selective serotonin reuptake inhibitor and a partial agonist of serotonin 5-HT1A receptors. It has not been approved for use in the pediatric population, and toxicity from exploratory vilazodone ingestion has been rarely described to date. We describe 2 children with laboratory-confirmed vilazodone ingestions that led to significant toxicity including refractory status epilepticus in 1 patient and likely transient seizure activity in the other. Both patients required multiple doses of benzodiazepines; in the more severe case, barbiturates were added to control seizure activity. These children returned to baseline and had no prolonged neurologic complications. Pediatric experience with vilazodone is limited; however, the literature demonstrates 3 additional case reports of children experiencing seizure after vilazodone ingestion. With the 2 new cases presented here, it seems prudent to educate prescribers and families of the potential dangers of ingestion of vilazodone tablets by young children.
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16
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Schneier FR, Moskow DM, Choo TH, Galfalvy H, Campeas R, Sanchez-Lacay A. A randomized controlled pilot trial of vilazodone for adult separation anxiety disorder. Depress Anxiety 2017; 34:1085-1095. [PMID: 29071764 DOI: 10.1002/da.22693] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Separation anxiety disorder was recently recognized by fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as a diagnosis in adults, but no publications to date have characterized a sample of patients seeking treatment for adult separation anxiety disorder (ASAD) or assessed treatment efficacy. We hypothesized that vilazodone, a selective serotonin reuptake inhibitor (SSRI) and serotonin 1a (5HT1a ) receptor partial agonist, would have efficacy in ASAD, because SSRIs have appeared efficacious in children with mixed diagnoses including separation anxiety disorder and in animal models of separation anxiety. METHODS In this pilot study, 24 adults (ages 18-60) with a principal diagnosis of ASAD were randomized to 12 weeks of double-blind treatment with vilazodone (n = 13) or placebo (n = 11). Outcome was assessed by an independent evaluator and self-ratings, and analyzed with mixed effect models. RESULTS This sample was predominantly female (67%), with comorbid psychiatric disorders (58%), and adult onset of separation anxiety disorder (62%). Response rates at week 12 did not differ significantly between groups. Across all time points, the vilazodone group evidenced greater improvement on the Structured Clinical Interview for Separation Anxiety Symptoms (P = .026) and the Quality of Life Enjoyment and Satisfaction Questionnaire (P = .011), and trends toward greater improvement on the Adult Separation Anxiety Questionnaire (P = .054) and the Clinical Global Impression-Change Scale (P = .086), all with large between-group effect sizes. CONCLUSIONS Findings demonstrate feasibility of a clinical trial in ASAD, and they suggest that vilazodone may have efficacy in the treatment of ASAD and warrants further study.
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Affiliation(s)
- Franklin R Schneier
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Danielle M Moskow
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
| | - Tse-Hwei Choo
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Raphael Campeas
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Arturo Sanchez-Lacay
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
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17
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Paolucci S. Advances in antidepressants for treating post-stroke depression. Expert Opin Pharmacother 2017; 18:1011-1017. [PMID: 28535081 DOI: 10.1080/14656566.2017.1334765] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Post-stroke depression (PSD) is a common and serious complication after stroke, occurring in nearly one third of stroke survivors, and affecting mortality rate, functional outcome, rehabilitation results and quality of life. However, in the common clinical practice only a minority of patients are properly treated. A relatively small number of scientific reports are available on clinical usefulness and safety of antidepressants (ADs) in PSD. Areas covered: This report provides an updated review about pharmacological state of art of PSD, including efficacy and safety of different drugs and their role on prevention, treatment and functional outcome. Expert opinion: Even if currently an antidepressant treatment can improve depressive symptoms, neither the optimal drug nor the optimal lengths of treatment, have been identified. Serotonergic drugs are preferable because of their better safety profile, but in the recent years there has been an important debate on possible association between selective serotonin reuptake inhibitor use and increased mortality. Another issue is the potential role of ADs for improving functional recovery. Newer ADs have interesting properties, in particular vortioxetine, due to its properties of enhancing cognitive functions, but further research is needed to clarify its/their role in treatment of PSD.
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Affiliation(s)
- Stefano Paolucci
- a Department of Neurorehabilitation , Fondazione I.R.C.C.S. Santa Lucia , Rome , Italy
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18
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Zhang LM, Wang XY, Zhao N, Wang YL, Hu XX, Ran YH, Liu YQ, Zhang YZ, Yang RF, Li YF. Neurochemical and behavioural effects of hypidone hydrochloride (YL-0919): a novel combined selective 5-HT reuptake inhibitor and partial 5-HT 1A agonist. Br J Pharmacol 2017; 174:769-780. [PMID: 27882537 DOI: 10.1111/bph.13675] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 11/14/2016] [Accepted: 11/19/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Our previous studies revealed that hypidone hydrochloride (YL-0919), which acts as a selective 5-HT (serotonin) reuptake inhibitor (SSRI) and displays partial 5-HT1A receptor agonist properties, exerts a significant antidepressant effect in various animal models. The aim of present research was to further investigate the pharmacology of YL-0919. EXPERIMENTAL APPROACH We first investigated the target profile of YL-0919 using [35 S]-GTPγS binding and microdialysis. To determine whether the 5-HT or noradrenergic systems are involved in the antidepressant-like effect of YL-0919, the 5-hydroxytryptophan (5-HTP)-induced head-twitch test and antagonism with a high dose of apomorphine were performed. Using the learned helplessness paradigm, the novelty suppressed feeding test, the Vogel-type conflict and elevated plus-maze test, we further verified the antidepressant-like and anxiolytic-like effects of YL-0919. The effects of YL-0919 on hippocampal long-term potentiation (LTP) and sexual behaviour were also evaluated. KEY RESULTS Data from the present study demonstrated that YL-0919 displays partial 5-HT1A receptor agonist properties, producing a greater impact on extracellular 5-HT levels than a conventional SSRI (fluoxetine), as well as significant antidepressant and anxiolytic effects. Furthermore, YL-0919 treatment rapidly influenced the synaptic plasticity (enhancing LTP) of rats. Finally, at doses close to those producing antidepressant-like effects, YL-0919 did not result in a marked inhibition of sexual function. CONCLUSIONS AND IMPLICATIONS These data suggest that YL-0919 is probably a fast-onset potent antidepressant with few side effects.
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Affiliation(s)
- Li-Ming Zhang
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Xiao-Yun Wang
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, Beijing, China.,Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Nan Zhao
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Yu-Lu Wang
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, Beijing, China.,College of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiao-Xu Hu
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Yu-Hua Ran
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Yan-Qin Liu
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - You-Zhi Zhang
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Ri-Fang Yang
- Department of Medicinal Chemistry, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Yun-Feng Li
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, Beijing, China
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19
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Wang SM, Han C, Lee SJ, Patkar AA, Masand PS, Pae CU. Vilazodone for the Treatment of Depression: An Update. Chonnam Med J 2016; 52:91-100. [PMID: 27231672 PMCID: PMC4880584 DOI: 10.4068/cmj.2016.52.2.91] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/02/2016] [Accepted: 03/06/2016] [Indexed: 12/28/2022] Open
Abstract
Vilazodone is a novel antidepressant having a selective serotonin (5-HT) reuptake inhibitor and 5-HT1A receptor partial agonist profile, so it has been regarded as a serotonin partial agonist-reuptake inhibitor (SPARI). We aimed to provide Vilazodone's clinical implications mainly by reviewing published clinical trials. Vilazodone has been speculated to have three potential benefits including faster onset of action, greater efficacy, and better tolerability owning to its SPARI properties. However, no studies conducted so far have directly proven the above speculations. Five initial phase II trials failed to distinguish vilazodone from placebo in the treatment of MDD, but 4 randomized clinical trials (RCT), 3 post-hoc or pooled analysis, 1 long-term open label study, and a meta-analysis showed vilazodone's superior efficacy over placebo. The studies also showed vilazodone is generally safe and tolerable. However, diarrhea, nausea, headache, dizziness, dry mouth, and insomnia warrant close attention in clinical practice because they have been constantly noted throughout the clinical studies. 2 RCTs recently documented the efficacy and safety of vilazodone in patients with generalized anxiety disorder, which could be a start of broadening vilazodone's usage or FDA approval in diverse anxiety disorders.
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Affiliation(s)
- Sheng-Min Wang
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea.; International Health Care Center, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Changsu Han
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea
| | - Soo-Jung Lee
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ashwin A Patkar
- Department of Psychiatry and Behavioural Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Chi-Un Pae
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea.; Department of Psychiatry and Behavioural Sciences, Duke University Medical Center, Durham, NC, USA
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20
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Culpepper L, Muskin PR, Stahl SM. Major Depressive Disorder: Understanding the Significance of Residual Symptoms and Balancing Efficacy with Tolerability. Am J Med 2015; 128:S1-S15. [PMID: 26337210 DOI: 10.1016/j.amjmed.2015.07.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Major depressive disorder is a complex and frequent psychiatric condition that poses significant challenges to both the patients who experience it and the physicians who treat them. The goal of therapy is for patients to achieve remission, which requires identifying and measuring symptoms at the outset and throughout treatment to document both response and resistance to treatment. A number of validated instruments are available both for diagnosis of and response to treatment. Many factors affect a patient's ability to achieve remission, but although many patients do achieve remission, a significant number continue to have residual symptoms that cause functional impairment. METHODS Review of the literature for treatment of major depression, including mechanisms of action, individualized treatment optimization, residual symptom reduction, and minimization of side effects. RESULTS For sustained remission, all symptoms must be treated until they are undetectable. Patients who do not achieve remission after adequate treatment trials should be evaluated for adherence to treatment, as well as comorbid psychiatric and medical disorders. In these cases, consideration should be given to changing therapy by switching, combining, or augmenting initial therapy, as well as referring some patients to a psychiatrist for treatment with specialized modalities. Linking symptoms with malfunctioning brain circuits and neurotransmitters provides a targeted approach for achieving sustained remission. Neurobiology also provides a rational basis for combination therapy in patients with treatment-resistant depression, because it can aid selection of different drugs with different mechanisms of action or of multifunctional/multimodal antidepressant drugs that target more than 1 molecular mechanism. DISCUSSION Recent advances and better understanding of neurobiology provide a rational basis for individualizing treatment of patients with major depression.
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Affiliation(s)
- Larry Culpepper
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Mass.
| | - Philip R Muskin
- Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Stephen M Stahl
- Department of Psychiatry, University of California San Diego, San Diego; Neuroscience Education Institute, Carlsbad, Calif; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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21
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Deardorff WJ, Grossberg GT. The Pharmacology and Clinical Use of the Antidepressants Vilazodone, Levomilnacipran, and Vortioxetine for Depression in the Elderly. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-015-0140-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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22
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Hellerstein DJ, Flaxer J. Vilazodone for the treatment of major depressive disorder: an evidence-based review of its place in therapy. CORE EVIDENCE 2015; 10:49-62. [PMID: 25945081 PMCID: PMC4408952 DOI: 10.2147/ce.s54075] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION It has clearly been demonstrated that depressive disorders constitute a major worldwide public health problem, with massive economic and quality-of-life consequences. Existing pharmacological treatments have limited efficacy, with only about a third of patients achieving remission on any one medication. Delayed onset of action and variable tolerability contribute to this limited efficacy. Vilazodone, introduced in the US in 2011, has been described as the first member of the serotonin partial agonist-reuptake inhibitor (SPARI) class of medications, combining serotonin-reuptake inhibition with 5-HT1A partial agonism. This agent could potentially have benefits for subgroups of depressed patients, including depressed patients with comorbid anxiety and patients with anxiety disorders, and might have fewer sexual side effects than selective serotonin-reuptake inhibitors (SSRIs). AIMS We reviewed existing clinical trials that assess the benefits of vilazodone for treatment of major depression. EVIDENCE REVIEW In clinical trials, including two Phase III studies and two Phase IV studies, vilazodone has been shown to have efficacy greater than placebo on the Montgomery-Åsberg Depression Rating Scale, comparable efficacy to citalopram, and continued benefit after 52 weeks of treatment. The safety profile for vilazodone is comparable to other SSRI medications, and tolerability also appears generally comparable to other SSRI medications. PLACE IN THERAPY Vilazodone, which has been described as the first-of-class SPARI medication, may potentially have benefits for subgroups of patients, particularly those depressed individuals with coexisting anxiety symptoms or anxiety disorders. However, convincing evidence for these benefits has as yet not been published.
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Affiliation(s)
- David J Hellerstein
- Department of Psychiatry, Columbia University, New York, NY, USA ; New York State Psychiatric Institute, New York, NY, USA
| | - Joseph Flaxer
- Department of Psychiatry, Columbia University, New York, NY, USA
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