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Abuelazm H, Elsayed OH, El-Mallakh RS. Evaluating lumateperone for its use in treating depressive episodes associated with bipolar I or II disorder in adults. Expert Rev Neurother 2023; 23:751-756. [PMID: 37458003 DOI: 10.1080/14737175.2023.2236795] [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: 06/05/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Lumateperone is a novel antipsychotic medication that has recently received approval by the United States Food and Drug Administration for treatment of major depressive episodes of type I and II bipolar disorder. It is approved for use as monotherapy or as an adjunctive treatment to lithium or valproic acid. AREAS COVERED Clinical trials performed with lumateperone for bipolar disorder were reviewed. Additionally, pharmacodynamic actions of lumateperone are reviewed. Lumateperone is superior to placebo whether used alone or in combination with a mood stabilizer in patients with type I or type II bipolar disorder. It achieves this effect with minimal dopamine blockade-related side effects due to less than 50% dopamine D2 receptor occupancy. While the pharmacodynamic profile of lumateperone is unique, the mechanism of action in bipolar depression remains obscure. EXPERT OPINION Lumateperone is an antipsychotic with full antagonist effects at the post-synaptic D2, and partial agonist effects at the presynaptic D2. This unique profile allows for both antipsychotic and antidepressant effects at the same dose, which does not produce dopamine-related side effects. Consequently, lumateperone is exceptionally well tolerated compared to other antidepressant-acting antipsychotic agents. It is now the only agent approved as an adjunct to the mood stabilizer for bipolar II depression.
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Affiliation(s)
- Hagar Abuelazm
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Omar H Elsayed
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Rif S El-Mallakh
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
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Mocci I, Casu MA, Sogos V, Liscia A, Angius R, Cadeddu F, Fanti M, Muroni P, Talani G, Diana A, Collu M, Setzu MD. Effects of memantine on mania-like phenotypes exhibited by Drosophila Shaker mutants. CNS Neurosci Ther 2023. [PMID: 36942502 DOI: 10.1111/cns.14145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Increased glutamate levels and electrolytic fluctuations have been observed in acutely manic patients. Despite some efficacy of the non-competitive NMDA receptor antagonist memantine (Mem), such as antidepressant-like and mood-stabilizer drugs in clinical studies, its specific mechanisms of action are still uncertain. The present study aims to better characterize the Drosophila melanogaster fly Shaker mutants (SH), as a translational model of manic episodes within bipolar disorder in humans, and to investigate the potential anti-manic properties of Mem. METHODS AND RESULTS Our findings showed typical behavioral abnormalities in SH, which mirrored with the overexpression of NMDAR-NR1 protein subunit, matched well to glutamate up-regulation. Such molecular features were associated to a significant reduction of SH brain volume in comparison to Wild Type strain flies (WT). Here we report on the ability of Mem treatment to ameliorate behavioral aberrations of SH (similar to that of Lithium), and its ability to reduce NMDAR-NR1 over-expression. CONCLUSIONS Our results show the involvement of the glutamatergic system in the SH, given the interaction between the Shaker channel and the NMDA receptor, suggesting this model as a promising tool for studying the neurobiology of bipolar disorders. Moreover, our results show Mem as a potential disease-modifying therapy, providing insight on new mechanisms of action.
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Affiliation(s)
- Ignazia Mocci
- Institute of Translational Pharmacology, National Research Council, Science and Technology Park of Sardinia, Cagliari, Italy
| | - Maria Antonietta Casu
- Institute of Translational Pharmacology, National Research Council, Science and Technology Park of Sardinia, Cagliari, Italy
| | - Valeria Sogos
- Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
| | - Anna Liscia
- Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
| | - Rossella Angius
- Unit of Biomedical Research Support, NMR Laboratory and Bioanalytical Technologies, Sardegna Ricerche, Science and Technology Park of Sardinia, Cagliari, Italy
| | - Francesca Cadeddu
- Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
| | - Maura Fanti
- Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
| | - Patrizia Muroni
- Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
| | - Giuseppe Talani
- Institute of Neuroscience, National Research Council, Monserrato, Italy
| | - Andrea Diana
- Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
| | - Maria Collu
- Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
| | - Maria Dolores Setzu
- Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
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De Berardis D, Fornaro M, Carmassi C. Editorial: Comorbidity in bipolar disorder, volume II. Front Psychiatry 2023; 14:1115357. [PMID: 36926462 PMCID: PMC10011613 DOI: 10.3389/fpsyt.2023.1115357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
Affiliation(s)
- Domenico De Berardis
- Department of Psychiatry, Azienda Sanitaria Locale 4, Teramo, Italy.,School of Nursing, University of L'Aquila, L'Aquila, Italy.,International Centre for Education and Research in Neuropsychiatry, Samara State Medical University, Samara, Russia
| | - Michele Fornaro
- School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Zou Y, Heyn C, Grigorian A, Tam F, Andreazza AC, Graham SJ, Maclntosh BJ, Goldstein BI. Measuring Brain Temperature in Youth Bipolar Disorder Using a Novel Magnetic Resonance Imaging Approach: A Proof-of-concept Study. Curr Neuropharmacol 2023; 21:1355-1366. [PMID: 36946483 PMCID: PMC10324328 DOI: 10.2174/1570159x21666230322090754] [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: 10/03/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND There is evidence of alterations in mitochondrial energy metabolism and cerebral blood flow (CBF) in adults and youth with bipolar disorder (BD). Brain thermoregulation is based on the balance of heat-producing metabolism and heat-dissipating mechanisms, including CBF. OBJECTIVE To examine brain temperature, and its relation to CBF, in relation to BD and mood symptom severity in youth. METHODS This study included 25 youth participants (age 17.4 ± 1.7 years; 13 BD, 12 control group (CG)). Magnetic resonance spectroscopy data were acquired to obtain brain temperature in the left anterior cingulate cortex (ACC) and the left precuneus. Regional estimates of CBF were provided by arterial spin labeling imaging. Analyses used general linear regression models, covarying for age, sex, and psychiatric medications. RESULTS Brain temperature was significantly higher in BD compared to CG in the precuneus. A higher ratio of brain temperature to CBF was significantly associated with greater depression symptom severity in both the ACC and precuneus within BD. Analyses examining the relationship of brain temperature or CBF with depression severity score did not reveal any significant finding in the ACC or the precuneus. CONCLUSION The current study provides preliminary evidence of increased brain temperature in youth with BD, in whom reduced thermoregulatory capacity is putatively associated with depression symptom severity. Evaluation of brain temperature and CBF in conjunction may provide valuable insight beyond what can be gleaned by either metric alone. Larger prospective studies are warranted to further evaluate brain temperature and its association with CBF concerning BD.
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Affiliation(s)
- Yi Zou
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Chinthaka Heyn
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Fred Tam
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Ana Cristina Andreazza
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, M5T 1R8, ON, Canada
| | - Simon J. Graham
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Bradley J. Maclntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Benjamin I. Goldstein
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, M5T 1R8, ON, Canada
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Insights into the Promising Prospect of G Protein and GPCR-Mediated Signaling in Neuropathophysiology and Its Therapeutic Regulation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:8425640. [PMID: 36187336 PMCID: PMC9519337 DOI: 10.1155/2022/8425640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/23/2022] [Indexed: 11/18/2022]
Abstract
G protein-coupled receptors (GPCRs) are intricately involved in the conversion of extracellular feedback to intracellular responses. These specialized receptors possess a crucial role in neurological and psychiatric disorders. Most nonsensory GPCRs are active in almost 90% of complex brain functions. At the time of receptor phosphorylation, a GPCR pathway is essentially activated through a G protein signaling mechanism via a G protein-coupled receptor kinase (GRK). Dopamine, an important neurotransmitter, is primarily involved in the pathophysiology of several CNS disorders; for instance, bipolar disorder, schizophrenia, Parkinson's disease, and ADHD. Since dopamine, acetylcholine, and glutamate are potent neuropharmacological targets, dopamine itself has potential therapeutic effects in several CNS disorders. GPCRs essentially regulate brain functions by modulating downstream signaling pathways. GPR6, GPR52, and GPR8 are termed orphan GPCRs because they colocalize with dopamine D1 and D2 receptors in neurons of the basal ganglia, either alone or with both receptors. Among the orphan GPCRs, the GPR52 is recognized for being an effective psychiatric receptor. Various antipsychotics like aripiprazole and quetiapine mainly target GPCRs to exert their actions. One of the most important parts of signal transduction is the regulation of G protein signaling (RGS). These substances inhibit the activation of the G protein that initiates GPCR signaling. Developing a combination of RGS inhibitors with GPCR agonists may prove to have promising therapeutic potential. Indeed, several recent studies have suggested that GPCRs represent potentially valuable therapeutic targets for various psychiatric disorders. Molecular biology and genetically modified animal model studies recommend that these enriched GPCRs may also act as potential therapeutic psychoreceptors. Neurotransmitter and neuropeptide GPCR malfunction in the frontal cortex and limbic-related regions, including the hippocampus, hypothalamus, and brainstem, is likely responsible for the complex clinical picture that includes cognitive, perceptual, emotional, and motor symptoms. G protein and GPCR-mediated signaling play a critical role in developing new treatment options for mental health issues, and this study is aimed at offering a thorough picture of that involvement. For patients who are resistant to current therapies, the development of new drugs that target GPCR signaling cascades remains an interesting possibility. These discoveries might serve as a fresh foundation for the creation of creative methods for pharmacologically useful modulation of GPCR function.
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Carta MG, Kalcev G, Fornaro M, Nardi AE. Novel experimental and early investigational drugs for the treatment of bipolar disorder. Expert Opin Investig Drugs 2021; 30:1081-1087. [PMID: 34844484 DOI: 10.1080/13543784.2021.2000965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The quest toward more effective treatments for bipolar disorder (BD) solicits novel drugs and further research on the underpinning neurobiology. The present review aims to critically appraise the existing evidence about the pharmacological treatment of BD toward the development of novel treatment avenues. AREAS COVERED The present review appraises animal and human studies concerning both the currently available psychotropic drugs, and the general medicine drugs which may represent a path toward the development of novel drugs for BD. PubMed and Scopus were last accessed on February 20th, 2021 for records indexed upon inception relevant to the pharmacological treatment of BD. Immune-modulating agents, anti-inflammatory agents, and glutamate antagonists represent the most intriguing potential targets for the development of new drugs for BD, thus receiving critical appraisal in the present text. EXPERT OPINION Regardless of the neurobiological pathways worthy of investigation toward the development of experimental drugs for BD, several unmet needs need to be addressed first. In particular, several biomarkers are altered in BD. However, it is the opinion herein expressed by the authors that it remains uncertain what comes first, that is peripheral changes or the disease.
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Affiliation(s)
- Mauro Giovanni Carta
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari Italy
| | - Goce Kalcev
- Department of Mechanical, Chemical and Materials Engineering, International Ph.D. In Innovation Sciences and Technologies, University of Cagliari, Cagliari Italy
| | - Michele Fornaro
- Department of Psychiatry, University of Federico II of Naples, Italy
| | - Antonio Egidio Nardi
- Laboratory Panic and Respiration, Institute of Psychiatry (Ipub), Federal University of Rio De Janeiro (Ufrj), Rio De Janeiro, Brazil
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Pereira AC, Oliveira J, Silva S, Madeira N, Pereira CMF, Cruz MT. Inflammation in Bipolar Disorder (BD): Identification of new therapeutic targets. Pharmacol Res 2020; 163:105325. [PMID: 33278569 DOI: 10.1016/j.phrs.2020.105325] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/21/2020] [Accepted: 11/21/2020] [Indexed: 02/06/2023]
Abstract
Bipolar disorder (BD) is a chronic and cyclic mental disorder, characterized by unusual mood swings between mania/hypomania and depression, raising concern in both scientific and medical communities due to its deleterious social and economic impact. Polypharmacy is the rule due to the partial effectiveness of available drugs. Disease course is often unremitting, resulting in frequent cognitive deficits over time. Despite all research efforts in identifying BD-associated molecular mechanisms, current knowledge remains limited. However, the involvement of inflammation in BD pathophysiology is increasingly consensual, with the immune system and neuroinflammation playing a key role in disease course. Evidence includes altered levels of cytokines and acute-phase proteins, pathological microglial activation, deregulation of Nrf2-Keap1 system and changes in biogenic amines neurotransmitters, whose expression is regulated by TNF-α, a pro-inflammatory cytokine highly involved in BD, pointing out inflammation as a novel and attractive therapeutic target for BD. As result, new therapeutic agents including non-steroidal anti-inflammatory drugs, N-acetylcysteine and GSK3 inhibitors have been incorporated in BD treatment. Taking into consideration the latest pre-clinical and clinical trials, in this review we discuss recent data regarding inflammation in BD, unveiling potential therapeutic approaches through direct or indirect modulation of inflammatory response.
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Affiliation(s)
- Ana Catarina Pereira
- University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Center for Neuroscience and Cell Biology (CNC), 3004-504, Coimbra, Portugal; University of Coimbra, Faculty of Medicine, 3000-548, Coimbra, Portugal.
| | - Joana Oliveira
- University of Coimbra, Faculty of Pharmacy, 3000-548, Coimbra, Portugal.
| | - Sónia Silva
- University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Center for Neuroscience and Cell Biology (CNC), 3004-504, Coimbra, Portugal; University of Coimbra, Faculty of Pharmacy, 3000-548, Coimbra, Portugal.
| | - Nuno Madeira
- University of Coimbra, Faculty of Medicine, 3000-548, Coimbra, Portugal; University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), 3000-548, Coimbra, Portugal; Centro Hospitalar e Universitário de Coimbra (CHUC), Department of Psychiatry, 3004-561, Coimbra, Portugal.
| | - Cláudia M F Pereira
- University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Center for Neuroscience and Cell Biology (CNC), 3004-504, Coimbra, Portugal; University of Coimbra, Faculty of Medicine, 3000-548, Coimbra, Portugal.
| | - Maria T Cruz
- University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Center for Neuroscience and Cell Biology (CNC), 3004-504, Coimbra, Portugal; University of Coimbra, Faculty of Pharmacy, 3000-548, Coimbra, Portugal.
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8
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Ferber SG, Namdar D, Hen-Shoval D, Eger G, Koltai H, Shoval G, Shbiro L, Weller A. The "Entourage Effect": Terpenes Coupled with Cannabinoids for the Treatment of Mood Disorders and Anxiety Disorders. Curr Neuropharmacol 2020; 18:87-96. [PMID: 31481004 PMCID: PMC7324885 DOI: 10.2174/1570159x17666190903103923] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 12/27/2022] Open
Abstract
Mood disorders are the most prevalent mental conditions encountered in psychiatric practice. Numerous patients suffering from mood disorders present with treatment-resistant forms of depression, co-morbid anxiety, other psychiatric disorders and bipolar disorders. Standardized essential oils (such as that of Lavender officinalis) have been shown to exert clinical efficacy in treating anxiety disorders. As endocannabinoids are suggested to play an important role in major depression, generalized anxiety and bipolar disorders, Cannabis sativa was suggested for their treatment. The endocannabinoid system is widely distributed throughout the body including the brain, modulating many functions. It is involved in mood and related disorders, and its activity may be modified by exogenous cannabinoids. CB1 and CB2 receptors primarily serve as the binding sites for endocannabinoids as well as for phytocannabinoids, produced by cannabis inflorescences. However, ‘cannabis’ is not a single compound product but is known for its complicated molecular profile, producing a plethora of phytocannabinoids alongside a vast array of terpenes. Thus, the “entourage effect” is the suggested positive contribution derived from the addition of terpenes to cannabinoids. Here, we review the literature on the effects of cannabinoids and discuss the possibility of enhancing cannabinoid activity on psychiatric symptoms by the addition of terpenes and terpenoids. Possible underlying mechanisms for the anti-depressant and anxiolytic effects are reviewed. These natural products may be an important potential source for new medications for the treatment of mood and anxiety disorders.
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Affiliation(s)
- Sari Goldstein Ferber
- Psychology Department, Bar-Ilan University, Ramat Gan, Israel.,Gonda Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
| | - Dvora Namdar
- ARO, Volcani Center, Rishon LeZion 7505101, Israel
| | - Danielle Hen-Shoval
- Psychology Department, Bar-Ilan University, Ramat Gan, Israel.,Gonda Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
| | - Gilad Eger
- Geha Mental Health Center, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Gal Shoval
- Geha Mental Health Center, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Shbiro
- Geha Mental Health Center, Petah Tiqva, Israel
| | - Aron Weller
- Psychology Department, Bar-Ilan University, Ramat Gan, Israel.,Gonda Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
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Tanaka M, Bohár Z, Vécsei L. Are Kynurenines Accomplices or Principal Villains in Dementia? Maintenance of Kynurenine Metabolism. Molecules 2020; 25:molecules25030564. [PMID: 32012948 PMCID: PMC7036975 DOI: 10.3390/molecules25030564] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 12/16/2022] Open
Abstract
Worldwide, 50 million people suffer from dementia, a group of symptoms affecting cognitive and social functions, progressing severely enough to interfere with daily life. Alzheimer’s disease (AD) accounts for most of the dementia cases. Pathological and clinical findings have led to proposing several hypotheses of AD pathogenesis, finding a presence of positive feedback loops and additionally observing the disturbance of a branch of tryptophan metabolism, the kynurenine (KYN) pathway. Either causative or resultant of dementia, elevated levels of neurotoxic KYN metabolites are observed, potentially upregulating multiple feedback loops of AD pathogenesis. Memantine is an N-methyl-D-aspartate glutamatergic receptor (NMDAR) antagonist, which belongs to one of only two classes of medications approved for clinical use, but other NMDAR modulators have been explored so far in vain. An endogenous KYN pathway metabolite, kynurenic acid (KYNA), likewise inhibits the excitotoxic NMDAR. Besides its anti-excitotoxicity, KYNA is a multitarget compound that triggers anti-inflammatory and antioxidant activities. Modifying the KYNA level is a potential multitarget strategy to normalize the disturbed KYN pathway and thus to alleviate juxtaposing AD pathogeneses. In this review, the maintenance of KYN metabolism by modifying the level of KYNA is proposed and discussed in search for a novel lead compound against the progression of dementia.
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Affiliation(s)
- Masaru Tanaka
- MTA-SZTE, Neuroscience Research Group, Semmelweis u. 6, H-6725 Szeged, Hungary
- Department of Neurology, Interdisciplinary Excellence Centre, Faculty of Medicine, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
| | - Zsuzsanna Bohár
- MTA-SZTE, Neuroscience Research Group, Semmelweis u. 6, H-6725 Szeged, Hungary
- Department of Neurology, Interdisciplinary Excellence Centre, Faculty of Medicine, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
| | - László Vécsei
- MTA-SZTE, Neuroscience Research Group, Semmelweis u. 6, H-6725 Szeged, Hungary
- Department of Neurology, Interdisciplinary Excellence Centre, Faculty of Medicine, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
- Correspondence: ; Tel.: +36-62-545-351
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Tomasetti C, Montemitro C, Fiengo AL, Santone C, Orsolini L, Valchera A, Carano A, Pompili M, Serafini G, Perna G, Vellante F, Martinotti G, Giannantonio MD, Kim YK, Nicola MD, Bellomo A, Ventriglio A, Fornaro M, Berardis DD. Novel Pathways in the Treatment of Major Depression: Focus on the Glutamatergic System. Curr Pharm Des 2019; 25:381-387. [DOI: 10.2174/1381612825666190312102444] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/06/2019] [Indexed: 12/28/2022]
Abstract
Depressive disorders represent protean psychiatric illnesses with heterogeneous clinical manifestations
and a multitude of comorbidities leading to severe disability. In spite of decades of research on the
pathophysiogenesis of these disorders, the wide variety of pharmacotherapies currently used to treat them is based
on the modulation of monoamines, whose alteration has been considered the neurobiological foundation of depression,
and consequently of its treatment. However, approximately one third to a half of patients respond partially
or become refractory to monoamine-based therapies, thereby jeopardizing the therapeutic effectiveness in
the real world of clinical practice. Recent scientific evidence has been pointing out the essential role of other
biological systems beyond monoamines in the pathophysiology of depressive disorders, in particular, the glutamatergic
neurotransmission. In the present review, we will discuss the most advanced knowledge on the involvement
of glutamatergic system in the molecular mechanisms at the basis of depression pathophysiology, as well as
the glutamate-based therapeutic strategies currently suggested to optimize depression treatment (e.g., ketamine).
Finally, we will mention further “neurobiological targeted” approaches, based on glutamate system, with the
purpose of promoting new avenues of investigation aiming at developing interventions that overstep the monoaminergic
boundaries to improve depressive disorders therapy.
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Affiliation(s)
- Carmine Tomasetti
- NHS, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment, Hospital “Maria SS dello Splendore”, Giulianova, Italy
| | - Chiara Montemitro
- Department of Neuroscience, Imaging and Clinical Science, University , Italy
| | - Annastasia L.C. Fiengo
- NHS, Department of Mental Health ASUR Marche AV5, Mental Health Unit, Ascoli Piceno, Italy
| | - Cristina Santone
- NHS, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment, Hospital “Maria SS dello Splendore”, Giulianova, Italy
| | | | | | - Alessandro Carano
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “Madonna Del Soccorso,” NHS, San Benedetto del Tronto, Ascoli Piceno, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giampaolo Perna
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, Albese con Cassano, Como, Italy
| | - Federica Vellante
- Department of Neuroscience, Imaging and Clinical Science, University , Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Science, University , Italy
| | | | - Yong-Ku Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Marco D. Nicola
- Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Michele Fornaro
- Department of Psychiatry, University Medical School “Federico II”, Naples, Italy
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Carta MG, Paribello P, Anastasia A, De Berardis D, Nardi AE, Fornaro M. Pharmacological management of depression in patients with multiple sclerosis. Expert Opin Pharmacother 2018; 19:1533-1540. [PMID: 30207800 DOI: 10.1080/14656566.2018.1516207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The pharmacotherapeutic management of depression in patients with multiple sclerosis (MS) is a matter of debate that cannot be decided from the evidence available in the current literature. Therefore, its management essentially relies on the clinical experience of the prescribing clinician rather than on evidence-based approaches. AREAS COVERED This review provides a clinically oriented critical perspective on the connection between MS and major depressive disorder (MDD) or depression associated with bipolar disorder (BD), focusing on its optimal pharmacotherapy. Both clinical and pharmacological considerations are accounted in order to promote rational pharmacotherapy, both in terms of efficacy and tolerability. EXPERT OPINION Despite its clinical burden and relatively frequent occurrence, the interplay of MS and depression still requires further controlled trials to better clarify the appropriate pharmacotherapy across varying 'diseases categories' of MS itself, as well as discriminating between depressive symptoms that do not necessarily reach the threshold of either MDD or BD. Additional insight into new mood-tolerated neurological pharmacotherapy for MS is likewise warranted toward a more effective, immune- and patient-tailored pharmacotherapy, while promoting innovation in drug design, with the ultimate goal of enhancing the overall quality life of the affected individual, his/her caregivers, and to reduce the associated economic and social burden.
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Affiliation(s)
- Mauro Giovanni Carta
- a Department of Health Sciences and Public Health , University of Cagliari , Cagliari , Italy
| | - Pasquale Paribello
- a Department of Health Sciences and Public Health , University of Cagliari , Cagliari , Italy
| | | | | | - Antonio Egidio Nardi
- d Medical School - Institute of Psychiatry , Federal University of Rio de Janeiro National Academy of Medicine , Rio de Janeiro , Brazil
| | - Michele Fornaro
- e Neuroscience, Reproductive Science and Odontostolmatology , Federico II University of Naples , Naples , Italy
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