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Lee KH, Won SJ, Oyinloye P, Shi L. Unlocking the Potential of High-Quality Dopamine Transporter Pharmacological Data: Advancing Robust Machine Learning-Based QSAR Modeling. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.06.583803. [PMID: 38558976 PMCID: PMC10979915 DOI: 10.1101/2024.03.06.583803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The dopamine transporter (DAT) plays a critical role in the central nervous system and has been implicated in numerous psychiatric disorders. The ligand-based approaches are instrumental to decipher the structure-activity relationship (SAR) of DAT ligands, especially the quantitative SAR (QSAR) modeling. By gathering and analyzing data from literature and databases, we systematically assemble a diverse range of ligands binding to DAT, aiming to discern the general features of DAT ligands and uncover the chemical space for potential novel DAT ligand scaffolds. The aggregation of DAT pharmacological activity data, particularly from databases like ChEMBL, provides a foundation for constructing robust QSAR models. The compilation and meticulous filtering of these data, establishing high-quality training datasets with specific divisions of pharmacological assays and data types, along with the application of QSAR modeling, prove to be a promising strategy for navigating the pertinent chemical space. Through a systematic comparison of DAT QSAR models using training datasets from various ChEMBL releases, we underscore the positive impact of enhanced data set quality and increased data set size on the predictive power of DAT QSAR models.
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Affiliation(s)
- Kuo Hao Lee
- Computational Chemistry and Molecular Biophysics Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse – Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
| | - Sung Joon Won
- Computational Chemistry and Molecular Biophysics Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse – Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
| | - Precious Oyinloye
- Computational Chemistry and Molecular Biophysics Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse – Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
| | - Lei Shi
- Computational Chemistry and Molecular Biophysics Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse – Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
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2
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Chrétien B, Jourdan JP, Davis A, Fedrizzi S, Bureau R, Sassier M, Rochais C, Alexandre J, Lelong-Boulouard V, Dolladille C, Dallemagne P. Disproportionality analysis in VigiBase as a drug repositioning method for the discovery of potentially useful drugs in Alzheimer's disease. Br J Clin Pharmacol 2020; 87:2830-2837. [PMID: 33274491 DOI: 10.1111/bcp.14690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/09/2020] [Accepted: 11/28/2020] [Indexed: 12/12/2022] Open
Abstract
Drug repositioning aims to propose new indications for marketed drugs. Although several methods exist, the utility of pharmacovigilance databases for this purpose is unclear. We conducted a disproportionality analysis in the World Health Organization pharmacovigilance database VigiBase to identify potential anticholinesterase drug candidates for repositioning in Alzheimer's disease (AD). METHODS Disproportionality analysis is a validated method for detecting significant associations between drugs and adverse events (AEs) in pharmacovigilance databases. We applied this approach in VigiBase to establish the safety profile displayed by the anticholinesterase drugs used in AD and searched the database for drugs with similar safety profiles. The detected drugs with potential activity against acetylcholinesterase and butyrylcholinesterases (BuChEs) were then evaluated to confirm their anticholinesterase potential. RESULTS We identified 22 drugs with safety profiles similar to AD medicines. Among these drugs, 4 (clozapine, aripiprazole, sertraline and S-duloxetine) showed a human BuChE inhibition rate of over 70% at 10-5 M. Their human BuChE half maximal inhibitory concentration values were compatible with clinical anticholinesterase action in humans at their normal doses. The most active human BuChE inhibitor in our study was S-duloxetine, with a half maximal inhibitory concentration of 1.2 μM. Combined with its ability to inhibit serotonin (5-HT) reuptake, the use of this drug could represent a novel multitarget directed ligand therapeutic strategy for AD. CONCLUSION We identified 4 drugs with repositioning potential in AD using drug safety profiles derived from a pharmacovigilance database. This method could be useful for future drug repositioning efforts.
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Affiliation(s)
- Basile Chrétien
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France.,Pharmacovigilance Regional Center, Caen University Hospital, Caen, F-14000, France
| | - Jean-Pierre Jourdan
- Department of Pharmacy, Caen University Hospital, Caen, F-14000, France.,Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN), Normandie Univ, UNICAEN, Caen, F-14000, France
| | - Audrey Davis
- Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN), Normandie Univ, UNICAEN, Caen, F-14000, France
| | - Sophie Fedrizzi
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France.,Pharmacovigilance Regional Center, Caen University Hospital, Caen, F-14000, France
| | - Ronan Bureau
- Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN), Normandie Univ, UNICAEN, Caen, F-14000, France
| | - Marion Sassier
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France.,Pharmacovigilance Regional Center, Caen University Hospital, Caen, F-14000, France
| | - Christophe Rochais
- Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN), Normandie Univ, UNICAEN, Caen, F-14000, France
| | - Joachim Alexandre
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France.,Pharmacovigilance Regional Center, Caen University Hospital, Caen, F-14000, France.,EA4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Normandie Univ, UNICAEN, Caen, 14000, France
| | - Véronique Lelong-Boulouard
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France.,INSERM UMR 1075, COMETE-MOBILITES "Vieillissement, Pathologie, Santé", Normandie Univ, UNICAEN, Caen, 14000, France
| | - Charles Dolladille
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France.,EA4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Normandie Univ, UNICAEN, Caen, 14000, France
| | - Patrick Dallemagne
- Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN), Normandie Univ, UNICAEN, Caen, F-14000, France
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3
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The anti-inflammatory role of SSRI and SNRI in the treatment of depression: a review of human and rodent research studies. Inflammopharmacology 2020; 29:75-90. [PMID: 33164143 DOI: 10.1007/s10787-020-00777-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/31/2020] [Indexed: 12/15/2022]
Abstract
RATIONALE Depression has the topmost prevalence of all psychiatric diseases. It is characterized by a high recurrence rate, disability, and numerous and mostly unclear pathogenic mechanisms. Besides the monoamine or the neurotrophic hypothesis of depression, the inflammatory mechanism has begun to be supported by more and more evidence. At the same time, the current knowledge about the standard treatment of choice, the selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs), is expanding rapidly, adding more features to the initial ones. OBJECTIVES This review summarizes the in vivo anti-inflammatory effects of SSRIs and SNRIs in the treatment of depression and outlines the particular mechanisms of these effects for each drug separately. In addition, we provide an overview of the inflammation-related theory of depression and the underlying mechanisms. RESULTS SSRIs and SNRIs decrease the neuroinflammation through multiple mechanisms including the reduction of blood or tissue cytokines or regulating complex inflammatory pathways: nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), inflammasomes, Toll-like receptor 4 (TLR4), peroxisome proliferator-activated receptor gamma (PPARγ). Also, SSRIs and SNRIs show these effects in association with an antidepressant action. CONCLUSIONS SSRIs and SNRIs have an anti-neuroinflammatory role which might contribute the antidepressant effect.
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4
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Lozovskiy SV, Vasilyev AV. Catalyst‐Free Preparation of Perfluoroalkyl‐Phosphoryl Substituted Furans from 1‐Perfluoroalkyl 1,3‐Diketones in Two Steps. Adv Synth Catal 2020. [DOI: 10.1002/adsc.202000534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Stanislav V. Lozovskiy
- Department of Organic Chemistry, Institute of ChemistrySaint Petersburg State University Universitetskaya nab., 7/9 Saint Petersburg 199034 Russia
| | - Aleksander V. Vasilyev
- Department of Organic Chemistry, Institute of ChemistrySaint Petersburg State University Universitetskaya nab., 7/9 Saint Petersburg 199034 Russia
- Department of ChemistrySaint Petersburg State Forest Technical University Institutsky per., 5 Saint Petersburg 194021 Russia
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5
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Kious BM, Bakian AV. Evidence of new-onset depression among persons with migraine after discontinuing antidepressants. Psychiatry Res 2020; 288:112990. [PMID: 32353695 DOI: 10.1016/j.psychres.2020.112990] [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: 03/13/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
Antidepressants have been hypothesized to cause tardive dysphoria-the delayed development of negative emotional symptoms. We assessed the risk of tardive dysphoria in a cohort of persons with migraine taking anti-migraine antidepressants with no known diagnosis of any mood or anxiety disorder. We included all outpatient encounters in a university hospital system for migraine from January 2008 through October 2018, excluding subjects with prior psychiatric diagnoses. Kaplan-Meier survival curves and multivariable Cox proportional hazards analyses were conducted. 13,048 subjects were included; 1191 took an antidepressant; 402 discontinued an antidepressant. In multivariable analyses examining the first year after exposure, antidepressant use was not significantly associated with risk of a depression, any mood disorder (including depression, mania, and other mood disorders), or anxiety. Antidepressant discontinuation was significantly associated with increased risk of depression, but not any mood disorder or anxiety. Among persons with migraine with no known psychiatric diagnosis, antidepressants did not appear to be associated with indicators of tardive dysphoria. Antidepressant discontinuation, however, was associated with increased risk of a depression diagnosis.
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Affiliation(s)
- Brent M Kious
- Department of Psychiatry, University of Utah, Salt Lake City, Utah, United States.
| | - Amanda V Bakian
- Department of Psychiatry, University of Utah, Salt Lake City, Utah, United States
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6
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Kumar R, Sinha VR, Dahiya L, Singh G, Sarwal A. Impact of cyclodextrin derivatives on systemic release of duloxetine HCl via buccal route. Drug Dev Ind Pharm 2020; 46:931-945. [PMID: 32420753 DOI: 10.1080/03639045.2020.1764019] [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: 10/24/2022]
Abstract
Aim: The aim of this work was to develop buccoadhesive tablets for the systemic delivery of duloxetine HCl (DXT) using more soluble derivatives of β-cyclodextrin, i.e. hydroxypropyl-β-cyclodextrin (HPβCD) and sulfobutylether-β-cyclodextrin (SBEβCD) and to investigate enhanced cellular uptake of inclusion complexed drug.Materials and methods: Freeze dried and spray dried complexes of both cyclodextrin derivatives with DXT (1:1 molar) were prepared and characterized with DSC, FTIR, and PXRD techniques. C971 and PC, on the basis of swelling behavior, erosion and in vitro residence time, were selected for further study at different levels (-1, 0, +1) to optimize the formulation in terms of enhanced drug release and ex vivo permeation.Results: SBEβCD based complexes show more aqueous solubility of DXT (0.782 and 0.958 mM) and more complexation efficiency compared to HPβCD at 25 °C and 37 °C, respectively. Apparent stability constant was reported to be higher (1109.94 and 1693.25 M-1) for DXT-SBEβCD at 25 °C and 37 °C, respectively, than the corresponding values for DXT-HPβCD systems. Enhanced cellular uptake using fibroblast cells was revealed for complexed drug compared to free drug .Conclusion: Both cyclodextrin derivatives are able to enhance drug release and permeation in vitro and ex vivo.
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Affiliation(s)
- Rajiv Kumar
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - V R Sinha
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Lalita Dahiya
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Gurpal Singh
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Amita Sarwal
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
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7
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Molecular docking utilising the OliveNet™ library reveals novel phenolic compounds which may potentially target key proteins associated with major depressive disorder. Comput Biol Chem 2020; 86:107234. [PMID: 32220809 DOI: 10.1016/j.compbiolchem.2020.107234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/31/2020] [Accepted: 02/10/2020] [Indexed: 11/21/2022]
Abstract
The antidepressant medications that are currently prescribed to patients suffering from major depressive disorder (MDD) have limitations and as a result, there is an urgent need to increase the options that are available. A number of studies have found that natural polyphenols have neuroprotective properties and there is evidence to suggest that they modulate neurotransmitter systems. There are more than 200 phenolic compounds that have been identified in Olea europaea, many of which have not yet been investigated for their potential biological effects. In this study, in silico methods were used to screen the phenolic library from the OliveNet™ database and identify novel lead compounds for proteins implicated in the pathophysiology of MDD. The molecular docking results revealed that the monoamine oxidase enzyme isoforms (MAO-A/MAO-B) had binding specificities for certain phenolic subclasses. The lead ligands that were identified from these subclasses were positioned near the flavin adenine dinucleotide (FAD) cofactor, interacting in a similar manner as known inhibitors. In addition to the MAO enzymes, several phenolic compounds were docked to neurotransmitter transporters and postsynaptic receptors, as well as proteins involved in neuroinflammation, oxidative stress and the endocannabinoid system. Based on the binding affinity, position, orientation and interactions of the lead phenolic compounds identified in this study, it is predicted that they may have antidepressant properties. The results should be validated further using molecular dynamics (MD) simulations, as well as in vivo and in vitro techniques.
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8
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Rodrigues-Amorim D, Olivares JM, Spuch C, Rivera-Baltanás T. A Systematic Review of Efficacy, Safety, and Tolerability of Duloxetine. Front Psychiatry 2020; 11:554899. [PMID: 33192668 PMCID: PMC7644852 DOI: 10.3389/fpsyt.2020.554899] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022] Open
Abstract
Duloxetine is a serotonin-norepinephrine reuptake inhibitor approved for the treatment of patients affected by major depressive disorder (MDD), generalized anxiety disorder (GAD), neuropathic pain (NP), fibromyalgia (FMS), and stress incontinence urinary (SUI). These conditions share parallel pathophysiological pathways, and duloxetine treatment might be an effective and safe alternative. Thus, a systematic review was conducted following the 2009 Preferred Reporting Items (PRISMA) recommendations and Joanna Briggs Institute Critical (JBI) Appraisals guidelines. Eighty-five studies focused on efficacy, safety, and tolerability of duloxetine were included in our systematic review. Studies were subdivided by clinical condition and evaluated individually. Thus, 32 studies of MDD, 11 studies of GAD, 19 studies of NP, 9 studies of FMS, and 14 studies of SUI demonstrated that the measured outcomes indicate the suitability of duloxetine in the treatment of these clinical conditions. This systematic review confirms that the dual mechanism of duloxetine benefits the treatment of comorbid clinical conditions, and supports the efficacy, safety, and tolerability of duloxetine in short- and long-term treatments.
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Affiliation(s)
- Daniela Rodrigues-Amorim
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), University of Vigo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain
| | - José Manuel Olivares
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), University of Vigo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain.,Head of Department of Psychiatry, Health Area of Vigo, Servizo Galego de Saúde (SERGAS), Vigo, Spain.,Director Neuroscience Area, Galicia Sur Health Research Institute (IISGS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain
| | - Carlos Spuch
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), University of Vigo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain
| | - Tania Rivera-Baltanás
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain
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9
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Rizea-Savu S, Duna SN, Ghita A, Iordachescu A, Chirila M. The Effect of Food on the Single-Dose Bioavailability and Tolerability of the Highest Marketed Strength of Duloxetine. Clin Pharmacol Drug Dev 2019; 9:797-804. [PMID: 31793229 PMCID: PMC7586977 DOI: 10.1002/cpdd.759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/11/2019] [Indexed: 11/10/2022]
Abstract
Duloxetine is a combined serotonin and norepinephrine reuptake inhibitor indicated in adults for the treatment of major depressive disorder, diabetic peripheral neuropathic pain, and generalized anxiety disorder. The aim of these studies was to evaluate the effect of food on the pharmacokinetics and safety of duloxetine 60‐mg gastroresistant hard capsules following single‐dose administration. The data were obtained from 2 phase 1 bioequivalence studies, 1 in a fasting state and the other under fed conditions. Both studies have shown that, when administered as a single dose in the same prandial state, the test and reference duloxetine treatments were bioequivalent and exhibited similar safety profiles. The mean fed and fasting pharmacokinetic parameters and drug‐related adverse events from the 2 studies were compared in order to assess the effect of food on the duloxetine bioavailability and respectively, tolerability. Administration of duloxetine in fed conditions increased peak plasma concentration by up to 30% and delayed mean time to peak concentration by an average of 1.15 hours while having an insignificant effect on extent of absorption (area under the plasma concentration–time curve in fed state within ±6% as compared with fasting conditions). Even though peak plasma levels were substantially higher in the fed state, there was no negative impact on the drug's safety profile. Actually, administration with food resulted in a lower average number of adverse events per single dose exposure. The negligible variation in overall systemic exposure suggests that efficacy remains unchanged irrespective of administration conditions; however, a better tolerability of the 60‐mg dose is expected when the drug is taken with food.
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Affiliation(s)
| | | | - Adrian Ghita
- 3S-Pharmacological Consultation & Res. SRL, Bucharest, Romania
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10
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Muscatello MRA, Zoccali RA, Pandolfo G, Mangano P, Lorusso S, Cedro C, Battaglia F, Spina E, Bruno A. Duloxetine in Psychiatric Disorders: Expansions Beyond Major Depression and Generalized Anxiety Disorder. Front Psychiatry 2019; 10:772. [PMID: 31749717 PMCID: PMC6844294 DOI: 10.3389/fpsyt.2019.00772] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 09/25/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Duloxetine hydrochloride (DUL) is an antidepressant included in the pharmacological class of serotonin-norepinephrine reuptake inhibitors approved for the treatment of major depressive disorder, generalized anxiety disorder, diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain. The aim of this review was to elucidate current evidences on the use of DUL in the treatment of a variety of psychiatric disorders. Methods: This systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed database was searched from January 1, 2003, to September 30, 2018, using 11 key terms related to psychiatric disorders ("persistent depressive disorder," "dysthymic disorder," "bipolar disorder," "seasonal affective disorder," "obsessive-compulsive disorder," "social phobia," "panic disorder," "posttraumatic stress disorder," "schizophrenia," "eating disorders," "sexual disorders," "personality disorders") and one key term related to duloxetine ("duloxetine hydrochloride"). Article titles and abstracts were scanned to determine relevance to the topic. For additional studies, the authors also examined the reference lists of several of the included papers. Results: Duloxetine may be an effective treatment for mood spectrum disorders, panic disorder, several symptom clusters of borderline personality, and as add-on drug in schizophrenia. Modest or conflicting results have been found for the efficacy of duloxetine in obsessive-compulsive disorder, posttraumatic stress disorder, eating, and sexual disorders. Conclusion: Major limitations of the reviewed studies were short trial duration, small sample sizes, and the lack of control groups. Defining the potential role of DUL in the treatment of psychiatric disorders other than major depressive disorder and generalized anxiety disorder needs further randomized, placebo-controlled studies.
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Affiliation(s)
| | - Rocco A Zoccali
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Gianluca Pandolfo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Paolo Mangano
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Simona Lorusso
- Department of Clinical Neurosciences, Villa San Benedetto Menni, Italy
| | - Clemente Cedro
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Fortunato Battaglia
- Department of Medical Sciences, Neurology and Psychiatry, Hackensack Meridian School of Medicine, Seton Hall University, United States
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Antonio Bruno
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
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11
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Nanclares C, Gameiro-Ros I, Méndez-López I, Martínez-Ramírez C, Padín-Nogueira JF, Colmena I, Baraibar AM, Gandía L, García AG. Dual Antidepressant Duloxetine Blocks Nicotinic Receptor Currents, Calcium Signals and Exocytosis in Chromaffin Cells Stimulated with Acetylcholine. J Pharmacol Exp Ther 2018; 367:28-39. [PMID: 30006476 DOI: 10.1124/jpet.118.250969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 07/12/2018] [Indexed: 01/09/2023] Open
Abstract
The inhibition of nicotinic acetylcholine receptors (nAChRs) has been proposed as a potential strategy to develop new antidepressant drugs. This is based on the observation that antidepressants that selectively block noradrenaline (NA) or serotonin (5-HT) reuptake also inhibit nAChRs. Dual antidepressants blocking both NA and 5-HT reuptake were proposed to shorten the delay in exerting their clinical effects; whether duloxetine, a prototype of dual antidepressants, also blocks nAChRs is unknown. Here we explored this question in bovine chromaffin cells (BCCs) that express native α3, α5, and α7 nAChRs and in cell lines expressing human α7, α3β4, or α4β2 nAChRs. We have found that duloxetine fully blocked the acetylcholine (ACh)-elicited nicotinic currents in BCCs with an IC50 of 0.86 µM. Such blockade seemed to be noncompetitive, voltage dependent, and partially use dependent. The ACh-elicited membrane depolarization, the elevation of cytosolic calcium ([Ca2+]c), and catecholamine release in BCCs were also blocked by duloxetine. This blockade developed slowly, and the recovery of secretion was also slow and gradual. Duloxetine did not affect Na+ or Ca2+ channel currents neither the high-K+-elicited [Ca2+]c transients and secretion. Of interest was that in cell lines expressing human α7, α3β4, and α4β2 nAChRs, duloxetine blocked nicotinic currents with IC50 values of 0.1, 0.56, and 0.85 µM, respectively. Thus, in blocking α7 receptors, which are abundantly expressed in the brain, duloxetine exhibited approximately 10-fold to 100- fold higher potency with respect to reported IC50 values for various antidepressant drugs. This may contribute to the antidepressant effect of duloxetine.
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Affiliation(s)
- Carmen Nanclares
- Instituto Teófilo Hernando and Departamento de Farmacología, Facultad de Medicina (C.N., I.G.-R., I.M.-L., C.M.-R., J.F.P.-N., I.C., A.M.B., L.G., A.G.G.) and Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa (A.G.G.), Universidad Autónoma de Madrid, Madrid, Spain; and Departamento de Ciencias Médicas, Facultad de Medicina, Universidad Castilla La Mancha (UCLM), Ciudad Real, Spain (J.F.P.-N.)
| | - Isabel Gameiro-Ros
- Instituto Teófilo Hernando and Departamento de Farmacología, Facultad de Medicina (C.N., I.G.-R., I.M.-L., C.M.-R., J.F.P.-N., I.C., A.M.B., L.G., A.G.G.) and Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa (A.G.G.), Universidad Autónoma de Madrid, Madrid, Spain; and Departamento de Ciencias Médicas, Facultad de Medicina, Universidad Castilla La Mancha (UCLM), Ciudad Real, Spain (J.F.P.-N.)
| | - Iago Méndez-López
- Instituto Teófilo Hernando and Departamento de Farmacología, Facultad de Medicina (C.N., I.G.-R., I.M.-L., C.M.-R., J.F.P.-N., I.C., A.M.B., L.G., A.G.G.) and Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa (A.G.G.), Universidad Autónoma de Madrid, Madrid, Spain; and Departamento de Ciencias Médicas, Facultad de Medicina, Universidad Castilla La Mancha (UCLM), Ciudad Real, Spain (J.F.P.-N.)
| | - Carmen Martínez-Ramírez
- Instituto Teófilo Hernando and Departamento de Farmacología, Facultad de Medicina (C.N., I.G.-R., I.M.-L., C.M.-R., J.F.P.-N., I.C., A.M.B., L.G., A.G.G.) and Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa (A.G.G.), Universidad Autónoma de Madrid, Madrid, Spain; and Departamento de Ciencias Médicas, Facultad de Medicina, Universidad Castilla La Mancha (UCLM), Ciudad Real, Spain (J.F.P.-N.)
| | - J Fernando Padín-Nogueira
- Instituto Teófilo Hernando and Departamento de Farmacología, Facultad de Medicina (C.N., I.G.-R., I.M.-L., C.M.-R., J.F.P.-N., I.C., A.M.B., L.G., A.G.G.) and Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa (A.G.G.), Universidad Autónoma de Madrid, Madrid, Spain; and Departamento de Ciencias Médicas, Facultad de Medicina, Universidad Castilla La Mancha (UCLM), Ciudad Real, Spain (J.F.P.-N.)
| | - Inés Colmena
- Instituto Teófilo Hernando and Departamento de Farmacología, Facultad de Medicina (C.N., I.G.-R., I.M.-L., C.M.-R., J.F.P.-N., I.C., A.M.B., L.G., A.G.G.) and Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa (A.G.G.), Universidad Autónoma de Madrid, Madrid, Spain; and Departamento de Ciencias Médicas, Facultad de Medicina, Universidad Castilla La Mancha (UCLM), Ciudad Real, Spain (J.F.P.-N.)
| | - Andrés M Baraibar
- Instituto Teófilo Hernando and Departamento de Farmacología, Facultad de Medicina (C.N., I.G.-R., I.M.-L., C.M.-R., J.F.P.-N., I.C., A.M.B., L.G., A.G.G.) and Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa (A.G.G.), Universidad Autónoma de Madrid, Madrid, Spain; and Departamento de Ciencias Médicas, Facultad de Medicina, Universidad Castilla La Mancha (UCLM), Ciudad Real, Spain (J.F.P.-N.)
| | - Luis Gandía
- Instituto Teófilo Hernando and Departamento de Farmacología, Facultad de Medicina (C.N., I.G.-R., I.M.-L., C.M.-R., J.F.P.-N., I.C., A.M.B., L.G., A.G.G.) and Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa (A.G.G.), Universidad Autónoma de Madrid, Madrid, Spain; and Departamento de Ciencias Médicas, Facultad de Medicina, Universidad Castilla La Mancha (UCLM), Ciudad Real, Spain (J.F.P.-N.)
| | - Antonio G García
- Instituto Teófilo Hernando and Departamento de Farmacología, Facultad de Medicina (C.N., I.G.-R., I.M.-L., C.M.-R., J.F.P.-N., I.C., A.M.B., L.G., A.G.G.) and Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa (A.G.G.), Universidad Autónoma de Madrid, Madrid, Spain; and Departamento de Ciencias Médicas, Facultad de Medicina, Universidad Castilla La Mancha (UCLM), Ciudad Real, Spain (J.F.P.-N.)
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Xu X, Wei Y, Guo Q, Zhao S, Liu Z, Xiao T, Liu Y, Qiu Y, Hou Y, Zhang G, Wang K. Pharmacological Characterization of H05, a Novel Serotonin and Noradrenaline Reuptake Inhibitor with Moderate 5-HT 2A Antagonist Activity for the Treatment of Depression. J Pharmacol Exp Ther 2018; 365:624-635. [PMID: 29615471 DOI: 10.1124/jpet.118.248351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/28/2018] [Indexed: 01/16/2023] Open
Abstract
Multitarget antidepressants selectively inhibiting monoaminergic transporters and 5-hydroxytryptamine (5-HT) 2A receptor have demonstrated higher efficacy and fewer side effects than selective serotonin reuptake inhibitors. In the present study, we synthesized a series of novel 3-(benzo[d][1,3]dioxol-4-yloxy)-3-arylpropyl amine derivatives, among which compound H05 was identified as a lead, exhibiting potent inhibitory effects on both serotonin (Ki = 4.81 nM) and norepinephrine (NE) (Ki = 6.72 nM) transporters and moderate 5-HT2A antagonist activity (IC50 = 60.37 nM). H05 was able to dose-dependently reduce the immobility duration in mouse forced swimming test and tail suspension test, with the minimal effective doses lower than those of duloxetine, and showed no stimulatory effect on locomotor activity. The administration of H05 (5, 10, and 20 mg/kg, by mouth) significantly shortened the immobility time of adrenocorticotropin-treated rats that serve as a model of treatment-resistant depression, whereas imipramine (30 mg/kg, by mouth) and duloxetine (30 mg/kg, by mouth) showed no obvious effects. Chronic treatment with H05 reversed the depressive-like behaviors in a rat model of chronic unpredictable mild stress and a mouse model of corticosterone-induced depression. Microdialysis analysis revealed that the administration of H05 at either 10 or 20 mg/kg increased the release of 5-HT and NE from the frontal cortex. The pharmacokinetic (PK) and brain penetration analyses suggest that H05 has favorable PK properties with good blood-brain penetration ability. Therefore, it can be concluded that H05, a novel serotonin and NE reuptake inhibitor with 5-HT2A antagonist activity, possesses efficacious activity in the preclinical models of depression and treatment-resistant depression, and it may warrant further evaluation for clinical development.
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Affiliation(s)
- Xiangqing Xu
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Yaqin Wei
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Qiang Guo
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Song Zhao
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Zhiqiang Liu
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Ting Xiao
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Yani Liu
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Yinli Qiu
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Yuanyuan Hou
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Guisen Zhang
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - KeWei Wang
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
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Alev L, Fujikoshi S, Yoshikawa A, Enomoto H, Ishida M, Tsuji T, Ogawa K, Konno S. Duloxetine 60 mg for chronic low back pain: post hoc responder analysis of double-blind, placebo-controlled trials. J Pain Res 2017; 10:1723-1731. [PMID: 28769588 PMCID: PMC5533563 DOI: 10.2147/jpr.s138297] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Duloxetine has demonstrated efficacy in chronic low back pain (CLBP). We examined the predictors of response to duloxetine for CLBP. Patients and methods This was a post hoc analysis of pooled data from 4 double-blind, ran-domized, placebo-controlled trials of duloxetine (60 mg/day for 12–14 weeks) in adult patients with CLBP. Primary outcome was proportion of patients with ≥30% reduction in Brief Pain Inventory (BPI) average pain (“pain reduction”) at 12–14 weeks. The proportion of patients with ≥30% and ≥50% (secondary outcome) pain reduction in duloxetine and placebo groups was compared. Variables for responder analyses were early improvement (≥15% pain reduction at Week 2), sex, age, baseline BPI average pain score, duration of CLBP, and number of painful body sites according to the Michigan Body Map (≥2 vs 1 [isolated CLBP]; 1 trial); relative risk (RR) and 95% confidence interval (CI) were calculated. Results Compared with placebo (n = 653), a greater proportion of duloxetine-treated patients (n = 642) achieved ≥30% (59.7% vs 47.8%; P < 0.001) and ≥50% pain reduction (48.6% vs 35.1%; P < 0.001). Among duloxetine-treated patients, early improvement was associated with greater likelihood of ≥30% (RR [95% CI], 2.91 [2.30–3.67]) or ≥50% (3.24 [2.44–4.31]) pain reduction. Women were slightly more likely than men to achieve ≥30% (RR [95% CI], 1.14 [1.00–1.30]) or ≥50% (1.17 [0.99–1.38]) pain reduction. Response rates were similar between age, CLBP duration, and baseline BPI average pain score subgroups. Patients with ≥2 painful sites were more likely to respond to duloxetine 60 mg relative to placebo than patients with isolated CLBP (RR, duloxetine vs placebo [95% CI]: ≥30% reduction, ≥2 painful sites 1.40 [1.18–1.66], isolated CLBP 1.07 [0.78–1.48]; ≥50% reduction, ≥2 painful sites 1.51 [1.20–1.89], isolated CLBP 1.23 [0.81–1.88]). Conclusion Early pain reduction was indicative of overall response. Patients with multiple painful sites had more benefit from duloxetine than patients with isolated CLBP.
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Affiliation(s)
| | | | - Aki Yoshikawa
- Scientific Communications, Medicines Development Unit, Eli Lilly Japan K.K., Kobe
| | | | | | | | | | - Shinichi Konno
- Department of Orthopedic Surgery, Fukushima Medical University, Fukushima, Japan
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14
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Mowla A, Dastgheib SA, Razeghian Jahromi L. Comparing the Effects of Sertraline with Duloxetine for Depression Severity and Symptoms: A Double-Blind, Randomized Controlled Trial. Clin Drug Investig 2016; 36:539-43. [PMID: 27071759 DOI: 10.1007/s40261-016-0399-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Selecting the most effective treatment for major depressive disorder (MDD) is a challenge for clinicians. The aim of this study was to compare the effects of sertraline with duloxetine on major depression signs and symptoms. METHODS The trial was a 6-week, randomized, controlled, double-blind study. Sixty-three patients with diagnosis of MDD according to DSM-IV-TR criteria were randomly assigned to receive either duloxetine (31 patients) or sertraline (32 patients). The mean dosage of duloxetine was 55 mg/day (range 40-60 mg/day) and the mean dosage of sertraline was 146 mg/day (range 50-200 mg/day). Subjects were assessed at baseline, and at the end of week 6. Depression severity and symptoms were assessed by 21-item Hamilton Depression Rating Scale (HAM-D). RESULTS Of 63 patients who were randomized to treatment, 54 patients including 28 in the sertraline group and 26 in the duloxetine group completed the trial. The HAM-D total score for both groups was significantly reduced at the end of the trial period without significant difference from each other (p = 0.463). Of the symptoms studied, psychomotor retardation, general somatic symptoms and sexual problems improved more in the duloxetine group. On the other hand, agitation, anxiety symptoms and hypochondriasis ameliorated better in the sertraline group. There was no difference between the two groups regarding the other symptoms. CONCLUSIONS Our study shows that the antidepressant mechanism of action has influence on its effects on different signs and symptoms. Clinician awareness of an antidepressant's special effects can help in selecting appropriate medicine.
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Affiliation(s)
- Arash Mowla
- Department of Psychiatry, Substance Abuse and Mental Health Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Seyed Ali Dastgheib
- Department of Psychiatry, Substance Abuse and Mental Health Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Razeghian Jahromi
- Department of Psychiatry, Substance Abuse and Mental Health Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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15
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Zhang X, Wang Q, Wang Y, Hu J, Jiang H, Cheng W, Ma Y, Liu M, Sun A, Zhang X, Li X. Duloxetine prevents the effects of prenatal stress on depressive‐like and anxiety‐like behavior and hippocampal expression of pro‐inflammatory cytokines in adult male offspring rats. Int J Dev Neurosci 2016; 55:41-48. [PMID: 27637928 DOI: 10.1016/j.ijdevneu.2016.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/03/2016] [Accepted: 09/12/2016] [Indexed: 12/22/2022] Open
Affiliation(s)
- Xiaosong Zhang
- College of Humanities and Social Sciences, Applied Psychology, China Medical UniversityPR China
| | - Qi Wang
- Department of Psychiatrythe First Affiliated Hospital of China Medical UniversityPR China
| | - Yan Wang
- Department of Psychiatrythe First Affiliated Hospital of China Medical UniversityPR China
| | - Jingmin Hu
- Essential Qualities Oriented Education College, Liaoning Finance Vocational CollegePR China
| | - Han Jiang
- Department of Psychiatrythe First Affiliated Hospital of China Medical UniversityPR China
| | - Wenwen Cheng
- College of Humanities and Social Sciences, Applied Psychology, China Medical UniversityPR China
| | - Yuchao Ma
- College of Humanities and Social Sciences, Applied Psychology, China Medical UniversityPR China
| | - Mengxi Liu
- Department of Psychiatrythe First Affiliated Hospital of China Medical UniversityPR China
| | - Anji Sun
- Department of Psychiatrythe First Affiliated Hospital of China Medical UniversityPR China
| | - Xinxin Zhang
- Department of Psychiatrythe First Affiliated Hospital of China Medical UniversityPR China
| | - Xiaobai Li
- Department of Psychiatrythe First Affiliated Hospital of China Medical UniversityPR China
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16
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Tokuoka H, Takahashi H, Ozeki A, Kuga A, Yoshikawa A, Tsuji T, Wohlreich MM. Trajectories of depression symptom improvement and associated predictor analysis: An analysis of duloxetine in double-blind placebo-controlled trials. J Affect Disord 2016; 196:171-80. [PMID: 26922146 DOI: 10.1016/j.jad.2016.02.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 01/14/2016] [Accepted: 02/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND In the treatment of major depressive disorder (MDD), it is not fully understood how individual symptoms improve over time (trajectory) in remitters. This study compared symptom improvement trajectories, as measured with the 17-item Hamilton Depression Rating Scale (HAM-D17), in remitters and nonremitters. METHODS This analysis is based on 10 placebo-controlled, randomized, double-blind trials of duloxetine (40-60mg/day) for treatment of MDD from baseline up to week 8. Remission was defined as a HAM-D17 total score ≤7 at week 8 (last observation carried forward). Trajectories of HAM-D17 items were assessed by mixed model repeated measures analysis for treatment and remitter-nonremitter comparisons. Grouping of the trajectories was performed by factor analysis. Predictor analysis using HAM-D17 items was conducted by logistic regression. RESULTS There were 1555 patients in the duloxetine group (489 [31.4%] remitters) and 1206 patients in the placebo group (290 [24.0%] remitters; P<.0001). For most items, the difference in trajectories between remitters and nonremitters appeared at early time points and increased over time. Treatment response trajectories were very similar for duloxetine and placebo remitters, while duloxetine nonremitters improved more than placebo nonremitters. For duloxetine remitters, we found 3 trajectory groups of HAM-D17 items. The predictor analysis showed that improvement in 6 individual items at week 1 or 2 was significantly associated with remission at week 8. LIMITATIONS Generalizability of these results may be limited by the relatively short observation period used to define remission. CONCLUSIONS Early monitoring of some symptoms of depression may prove useful in guiding treatment decisions.
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Affiliation(s)
- Hirofumi Tokuoka
- Eli Lilly Japan K.K., Neuroscience and Pain Products, Bio-Medicines, Medicines Development Unit Japan, Kobe, Hyogo, Japan.
| | - Hitoshi Takahashi
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Akichika Ozeki
- Eli Lilly Japan K.K., Statistical Science, Medicines Development Unit Japan, Kobe, Hyogo, Japan
| | - Atsushi Kuga
- Eli Lilly Japan K.K., Neuroscience and Pain Products, Bio-Medicines, Medicines Development Unit Japan, Kobe, Hyogo, Japan
| | - Aki Yoshikawa
- Eli Lilly Japan K.K., Scientific Communications, Medicines Development Unit Japan, Kobe, Hyogo, Japan
| | - Toshinaga Tsuji
- Medical Affairs Department, Shionogi & Co., Ltd., Osaka, Osaka, Japan
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Harada E, Tokuoka H, Fujikoshi S, Funai J, Wohlreich MM, Ossipov MH, Iwata N. Is duloxetine's effect on painful physical symptoms in depression an indirect result of improvement of depressive symptoms? Pooled analyses of three randomized controlled trials. Pain 2016; 157:577-584. [PMID: 26882344 PMCID: PMC4751744 DOI: 10.1097/j.pain.0000000000000406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/06/2015] [Accepted: 10/27/2015] [Indexed: 11/26/2022]
Abstract
In treating Major Depressive Disorder with associated painful physical symptoms (PPS), the effect of duloxetine on PPS has been shown to decompose into a direct effect on PPS and an indirect effect on PPS via depressive symptoms (DS) improvement. To evaluate the changes in relative contributions of the direct and indirect effects over time, we analyzed pooled data from 3 randomized double-blind studies comparing duloxetine 60 mg/d with placebo in patients with major depressive disorder and PPS. Changes from baseline in Montgomery-Åsberg Depression Rating Scale total and Brief Pain Inventory-Short Form average pain score were assessed over 8 weeks. Path analysis examined the (1) direct effect of treatment on PPS and/or indirect effect on PPS via DS improvement and (2) direct effect of treatment on DS and/or indirect effect on DS via PPS improvement. At week 1, the direct effect of duloxetine on PPS (75.3%) was greater than the indirect effect through DS improvement (24.7%) but became less (22.6%) than the indirect effect (77.4%) by week 8. Initially, the direct effect of duloxetine on PPS was markedly greater than its indirect effect, whereas later the indirect effect predominated. Conversely, at week 1, the direct effect of treatment on DS (46.4%) was less than the indirect effect (53.6%), and by week 8 it superseded (62.6%) the indirect effect (37.4%). Thus, duloxetine would relieve PPS directly in the initial phase and indirectly via improving DS in the later phase.
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Affiliation(s)
- Eiji Harada
- Medical Science, Eli Lilly Japan K.K., Kobe, Hyogo, Japan
| | | | | | - Jumpei Funai
- Science Communications, Eli Lilly Japan K.K., Kobe, Hyogo, Japan
| | | | | | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Onuţu AH. Duloxetine, an antidepressant with analgesic properties - a preliminary analysis. Rom J Anaesth Intensive Care 2015; 22:123-128. [PMID: 28913467 PMCID: PMC5505372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Serotonin and norepinephrine reuptake inhibitors are second-line antidepressants largely used because of their good tolerance and their reduced side effects. Two of these drugs, duloxetine and venlafaxine, are used also in chronic pain management. In this review we present recent data regarding duloxetine's effects on the central nervous system, linked to acute pain management, and their efficiency in reducing postoperative chronic pain. The drug's efficacy results from its modulating effect on the descending inhibitory pain pathways and the inhibition of the nociceptive input. There are already several studies in favor of the analgesic properties of duloxetine. However, further and larger randomized studies are necessary in order to clarify duloxetine efficiency in acute postoperative settings, and thereafter on persistent chronic postoperative pain.
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Affiliation(s)
- Adela Hilda Onuţu
- Orthopaedic and Trauma Clinic, Emergency County Hospital Cluj-Napoca, Romania
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19
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Harada E, Kato M, Fujikoshi S, Wohlreich MM, Berggren L, Tokuoka H. Changes in energy during treatment of depression: an analysis of duloxetine in double-blind placebo-controlled trials. Int J Clin Pract 2015; 69:1139-48. [PMID: 25980552 PMCID: PMC4682452 DOI: 10.1111/ijcp.12658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS The aim of this study was to assess how quickly and effectively duloxetine improves energy compared with placebo in patients with major depressive disorder (MDD). METHODS Data from 10 randomised, double-blind, placebo-controlled clinical trials examining duloxetine (40-60 mg/day) vs. placebo in patients diagnosed with MDD were analysed. Change from baseline at Week 1 through Week 8 in Hamilton Depression Rating Scale (HAM-D) retardation subscale score (Item 1 - depressed mood, Item 7 - work and activities, Item 8 - retardation and Item 14 - genital symptoms) was assessed with mixed model repeated measures analysis. Positive predictive values and negative predictive values were calculated for predictor analysis. RESULTS Patients treated with duloxetine (N = 1522) experienced statistically significantly (p ≤ 0.05) greater reductions in HAM-D retardation subscale scores vs. placebo (N = 1180) starting at Week 1 throughout Week 8 of treatment. Of the patients with early energy improvement (≥ 20% reduction in HAM-D retardation subscale scores) at Week 1, 48% achieved remission (HAM-D total score ≤ 7) at Week 8; 48% and 46% of patients who experienced early energy improvement at Weeks 2 and 4, respectively, achieved remission at Week 8. DISCUSSION We demonstrated that treatment with duloxetine, quickly and with increasing magnitude over treatment time, improves low energy symptoms. As early as 1 week after starting treatment with duloxetine, improvement of low energy may serve as a predictor of remission at end-point. CONCLUSIONS Treatment with duloxetine improves energy in patients with MDD and early response in retardation may serve as a modest predictor of remission at end-point. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov. Study Identifiers: NCT00036335; NCT00073411; NCT00406848 and NCT00536471. Studies HMAQa, HMAQb, HMATa, HMATb, HMBHa and HMBHb predate the registration requirement. DATA POSTING ClinicalTrials.gov. Study Identifiers: NCT00406848; NCT00536471.
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Affiliation(s)
- E Harada
- Medical Science, Eli Lilly Japan K.K.Hyogo, Japan
| | - M Kato
- Department of Neuropsychiatry, Kansai Medical UniversityOsaka, Japan
| | - S Fujikoshi
- Statistical Science, Eli Lilly Japan K.K.Hyogo, Japan
| | - M M Wohlreich
- Neuroscience, Eli Lilly and CompanyIndianapolis, IN, USA
| | - L Berggren
- Global Statistical Sciences, Eli Lilly and CompanyBad Homburg, Germany
| | - H Tokuoka
- Medical Science, Eli Lilly Japan K.K.Hyogo, Japan
- Correspondence to:
, Hirofumi Tokuoka, Lilly Research Laboratories Japan, Eli Lilly Japan K.K., 6510086, Kobe, Japan, Tel.: + 81 3 5574 9234, Fax: +81 3 5574 9979,
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Reversal of age-associated cognitive deficits is accompanied by increased plasticity-related gene expression after chronic antidepressant administration in middle-aged mice. Pharmacol Biochem Behav 2015; 135:70-82. [DOI: 10.1016/j.pbb.2015.05.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/07/2015] [Accepted: 05/22/2015] [Indexed: 12/22/2022]
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Bilodeau M, Simon T, Beauchamp MH, Lespérance P, Dubreucq S, Dorée JP, Tourjman SV. Duloxetine in adults with ADHD: a randomized, placebo-controlled pilot study. J Atten Disord 2014; 18:169-75. [PMID: 22582349 DOI: 10.1177/1087054712443157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the effect of duloxetine on ADHD in adults. METHOD In a 6-week double-blind trial, 30 adults with ADHD received placebo or duloxetine 60 mg daily. The Conners' Adult ADHD Rating Scale (CAARS) and the Clinical Global Impression Scales (CGI) were used to assess symptom severity and clinical improvement. The Hamilton Anxiety Rating Scale (HARS) and the Hamilton Depression Rating Scale (HDRS) were used to measure the effect on anxiety and depressive symptoms. RESULTS The Duloxetine group showed lower score on CGI-Severity at Week 6 (3.00 vs. 4.07 for placebo, p < .001), greater improvement on CGI-Improvement (2.89 vs. 4.00 at Week 6, p < .001), and greater decreases on five of eight subscales of the CAARS. There was no treatment group effect on HDRS or HARS scores. CONCLUSION Duloxetine may be a therapeutic option for adults with ADHD, but further studies are required to replicate these findings in larger samples.
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Dhillon S. Duloxetine: a review of its use in the management of major depressive disorder in older adults. Drugs Aging 2014; 30:59-79. [PMID: 23239363 DOI: 10.1007/s40266-012-0040-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Duloxetine (Cymbalta(®)) is a selective serotonin norepinephrine reuptake inhibitor indicated for the treatment of major depressive disorder (MDD). This article reviews the therapeutic efficacy and tolerability of duloxetine in older adults with MDD and summarizes its pharmacological properties. Treatment with duloxetine significantly improved several measures of cognition, depression, anxiety, pain and health-related quality-of-life (HR-QOL) in older adults with MDD in two 8-week, double-blind, placebo-controlled trials. However, no significant improvements in measures of depression were observed at week 12 (primary endpoint) of a 24-week, double-blind trial, although symptoms of depression did improve significantly at earlier timepoints. Benefit of treatment was also observed during continued therapy in the 24-week study (i.e. after the 12-week primary endpoint) and in an open-label, 52-week study, with improvements being observed in some measures of depression, pain and HR-QOL. Duloxetine was generally well tolerated in these studies, with nausea, dizziness and adverse events reflecting noradrenergic activity (e.g. dry mouth, constipation) being the most common treatment-emergent adverse events during treatment for up to 52 weeks. Duloxetine therapy had little effect on cardiovascular parameters and bodyweight. Although further well designed and long-term studies in this patient population are required to confirm the efficacy of duloxetine and to compare it with that of other antidepressants, current evidence suggests that treatment with duloxetine may be beneficial in older adults with MDD.
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Affiliation(s)
- Sohita Dhillon
- Adis, 41 Centorian Drive, Mairangi Bay, Private Bag 65901, North Shore, Auckland, New Zealand.
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Engel D, Zomkowski ADE, Lieberknecht V, Rodrigues AL, Gabilan NH. Chronic administration of duloxetine and mirtazapine downregulates proapoptotic proteins and upregulates neurotrophin gene expression in the hippocampus and cerebral cortex of mice. J Psychiatr Res 2013; 47:802-8. [PMID: 23522402 DOI: 10.1016/j.jpsychires.2013.02.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 02/24/2013] [Indexed: 01/16/2023]
Abstract
Structural alterations in the limbic system, neuronal cell loss, and low levels of neurotrophins have been implicated in the pathogenesis of depression. While it is generally accepted that increasing monoamine levels in the brain can effectively alleviate depression, the precise neurobiological mechanisms involved are unclear. In the present study, we examined the effects of two antidepressants, duloxetine and mirtazapine, on the expression of apoptotic and neurotrophic proteins in the cerebral cortex and hippocampus of mice. Duloxetine (10 mg/kg) and mirtazapine (3 mg/kg) were chronically administered for 21 days, and qRT-PCR analysis was carried for the following: neurotrophins (BDNF, NGF, FGF-2, and NT-3); anti-apoptotic proteins (Bcl-2 and Bcl-xL) and pro-apoptotic proteins (Bax, Bad, and p53). Both duloxetine and mirtazapine produced antidepressant activity in the forced swimming test and induced increased cortical and hippocampal mRNA expression of BDNF. Duloxetine also increased Bcl-2, Bcl-xL, FGF-2, and NT-3 expression in the cerebral cortex, and FGF-2 expression in the hippocampus. Moreover, duloxetine reduced Bax and p53 expression in the hippocampus, and Bad expression in the cerebral cortex. Mirtazapine decreased Bcl-xL and Bax expression in the hippocampus, and Bad and p53 expression in both the hippocampus and cerebral cortex. Mirtazapine also increased the expression of neurotrophins, NGF and NT-3, in the cerebral cortex. These results suggest that duloxetine and mirtazapine could elicit their therapeutic effect by modulating the activity of apoptotic and neurotrophic pathways, thus enhancing plasticity and cell survival in depressive patients.
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Affiliation(s)
- Daiane Engel
- Departamento de Bioquímica, CCB, Universidade Federal de Santa Catarina, 88040-900, Florianópolis, SC, Brazil
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Fornaro M, Bandini F, Ogliastro C, Cordano C, Martino M, Cestari L, Escelsior A, Rocchi G, Colicchio S, Perugi G. Electroretinographic assessment in major depressed patients receiving duloxetine: might differences between responders and non-responders indicate a differential biological background? J Affect Disord 2011; 135:154-9. [PMID: 21820182 DOI: 10.1016/j.jad.2011.07.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 07/13/2011] [Accepted: 07/14/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Despite intense research efforts, still too little is known about the biological determinants of depression, thus soliciting diverse study approaches. Among others, the electroretinography (ERG) has been proposed even as a putative proxy (retinal) measurement of central dopaminergic activity for Major Depressive Disorder (MDD) both in drug-naïve patients and subjects receiving antidepressant treatments. Nonetheless, current evidences are merely preliminary, essentially considering just older classes of antidepressants, thus requiring confirmation studies even with newer agents as duloxetine. METHOD Twenty MDD subjects and 20 matched controls received duloxetine 60 mg/day for 12 weeks, being monitored both by standard ERG recording and by administration of the Hamilton scales for Depression and Anxiety and the Young Mania Rating Scale at baseline and week 12 (end of the study). RESULTS ERG mean rod b-wave amplitude significantly reduced from baseline to week 12 in those depressed subjects achieving final response (p=.024), decreasing from the highest rank values to the ones, substantially unmodified, seen among non-responders and controls. LIMITATIONS Small sample size and lack of multiple assessments. CONCLUSIONS At least some MDD patients responding to duloxetine might exhibit a peculiar ERG pattern, hypothetically indicating a specific biological background. If confirmed by larger-sampled studies, these results might shed further light in the understanding of the biological determinants of different subtypes of depression, ideally showing alternative patterns of response upon different treatment interventions.
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Affiliation(s)
- Michele Fornaro
- Department of Neurosciences, Ophthalmology and Genetics - Section of Psychiatry, University of Genova, Italy.
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Dolder C, Nelson M, Stump A. Pharmacological and clinical profile of newer antidepressants: implications for the treatment of elderly patients. Drugs Aging 2010; 27:625-40. [PMID: 20658791 DOI: 10.2165/11537140-000000000-00000] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The pharmacological treatment of older adults with major depressive disorder presents a variety of challenges, including a relative lack of high quality studies designed to measure the efficacy and safety of antidepressants specific to this patient population. Gaining a clear understanding of how to use antidepressants in elderly patients with depression, especially new and widely used agents, would provide valuable insight to clinicians. The purpose of the current article is to review the pharmacology, efficacy and safety of newer antidepressants (i.e. escitalopram, duloxetine and desvenlafaxine) in the treatment of late-life depression. To accomplish this goal, a MEDLINE and PubMed search (1966 - February 2010) was conducted for relevant articles. Animal and human studies have clearly demonstrated the effects of desvenlafaxine, duloxetine and escitalopram on monoamine reuptake transporters. The serotonergic and noradrenergic actions of desvenlafaxine and duloxetine may provide for a faster onset of antidepressant activity in the elderly, but more definitive data are needed and the clinical effects of the possible faster onset of action need to be elucidated. Duloxetine and escitalopram are extensively metabolized via cytochrome P450 (CYP) enzymes and the decreased hepatic metabolism present in many older adults should be taken into account when prescribing these medications. Duloxetine possesses the greatest likelihood of producing clinically relevant drug-drug interactions because of its inhibition of CYP2D6. All three agents must also be used cautiously in older adults with poor renal function. In terms of clinical efficacy, 14 prospective published trials involving escitalopram (n = 8) and duloxetine (n = 6) in the treatment of older adults with major depressive disorder were identified. No such studies involving desvenlafaxine were found. Of the five randomized, double-blind, controlled trials, 46% and 37% of antidepressant-treated patients were considered responders and remitters, respectively. In contrast to escitalopram, duloxetine-treated patients experienced improvements in depressive symptoms that more consistently differentiated themselves from the symptoms of placebo-treated patients. Escitalopram and duloxetine were generally well tolerated, but 5-20% and 10-27% of patients, respectively, dropped out because of medication-related adverse effects. Adverse effects experienced by older adults were generally similar to those experienced by younger adults, although indirect comparisons suggest that older adults are more likely to experience dry mouth and constipation with duloxetine and escitalopram, while orthostasis may be more common in older adults prescribed desvenlafaxine. Overall, duloxetine and escitalopram represent modestly effective treatments for late-life depression that are generally well tolerated but do produce a variety of adverse effects. Conclusions regarding desvenlafaxine cannot be made at this time because of a lack of geriatric-specific data.
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Affiliation(s)
- Christian Dolder
- Wingate University School of Pharmacy, North Carolina 28174, USA.
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Abstract
Duloxetine (Cymbalta(R)) is a potent serotonin and noradrenaline (norepinephrine) reuptake inhibitor (SNRI) in the CNS. It is indicated for the treatment of generalized anxiety disorder (GAD) as well as other indications. In patients with GAD of at least moderate severity, oral duloxetine 60-120 mg once daily was effective with regard to improvement from baseline in assessments of anxiety and functional impairment, and numerous other clinical endpoints. Longer-term duloxetine 60-120 mg once daily also demonstrated efficacy in preventing or delaying relapse in responders among patients with GAD. In addition, duloxetine was generally well tolerated, with most adverse events being of mild to moderate severity in patients with GAD in short- and longer-term trials. Additional comparative and pharmacoeconomic studies are required to position duloxetine among other selective serotonin reuptake inhibitors and SNRIs. However, available clinical data, and current treatment guidelines, indicate that duloxetine is an effective first-line treatment option for the management of GAD. Duloxetine is a potent and selective inhibitor of serotonin and noradrenaline transporters, and a weak inhibitor of dopamine transporters. It has a low affinity for neuronal receptors, such as alpha(1)- and alpha(2)-adrenergic, dopamine D(2), histamine H(1), muscarinic, opioid and serotonin receptors, as well as ion channel binding sites and other neurotransmitter transporters, such as choline and GABA transporters. It does not inhibit monoamine oxidase types A or B. The pharmacokinetics of duloxetine in healthy volunteers were dose proportional over the range of 40-120 mg once daily. Steady state was typically reached by day 3 of administration. Duloxetine may be administered without regard to food or time of day. Duloxetine is highly protein bound and is widely distributed throughout tissues. It is rapidly and extensively metabolized in the liver by cytochrome P450 (CYP) 1A2 and 2D6, and its numerous metabolites, which are inactive, are mainly excreted in the urine. The mean elimination half-life of duloxetine is approximately 12 hours. Duloxetine is a substrate for CYP1A2 and CYP2D6 and a moderate inhibitor of CYP2D6. Concomitant use of duloxetine and potent CYP1A2 inhibitors should be avoided and duloxetine should be used with caution in patients receiving drugs that are extensively metabolized by CYP2D6, particularly those with a narrow therapeutic index. Duloxetine was effective in the short-term treatment of patients with primary GAD of at least moderate severity. In four randomized, double-blind, placebo-controlled, multicentre, phase III trials, duloxetine 60-120 mg once daily for 9 or 10 weeks was significantly more effective than placebo with regard to the primary endpoint of mean change in Hamilton Anxiety Rating Scale (HAM-A) total score from baseline to study endpoint. In addition, all other endpoints were generally improved from baseline to a greater extent with duloxetine 60-120 mg once daily than with placebo. Duloxetine also improved patient role functioning (assessed using Sheehan Disability Scale global impairment functioning scores), health-related quality of life and patient well-being compared with placebo. Duloxetine was effective in patients with GAD who were aged >/=65 years. Pooled results of data from the two short-term efficacy trials that also included an active comparator arm showed that the mean change in HAM-A scores with duloxetine relative to placebo were of the same magnitude as those with venlafaxine extended release versus placebo. Duloxetine 60-120 mg once daily was also more effective than placebo in preventing or delaying relapse in responders to duloxetine in a longer-term study. In this study, patients with GAD received duloxetine during a 26-week, open-label, acute treatment phase and responders were then randomized to continue on duloxetine or receive placebo during a 26-week, double-blind, continuation phase. Time to relapse was significantly longer in duloxetine recipients than in placebo recipients. In addition, significantly fewer duloxetine recipients than placebo recipients relapsed during the double-blind phase of the trial and more duloxetine recipients achieved remission. Short- (9-10 weeks) and longer-term (52 weeks) treatment with duloxetine 60-120 mg once daily was generally well tolerated in patients with GAD, with the majority of adverse events being of mild to moderate severity. Nausea, dry mouth, headache, constipation, dizziness and fatigue were among the most common treatment-emergent adverse events. The adverse event profile of duloxetine did not differ with dose or treatment duration. Significantly more patients receiving short-term duloxetine than placebo discontinued treatment because of an adverse event, with nausea being the only event that resulted in significantly more treatment discontinuations in duloxetine recipients than in placebo recipients. Serious adverse events were uncommon with both short- and longer-term duloxetine treatment. Two episodes of attempted suicide and one episode of completed suicide occurred in duloxetine recipients during the 24-week open-label phase of a longer-term trial. No deaths or suicides were reported in any of the short-term trials. Discontinuation-emergent adverse events, most commonly nausea and dizziness, occurred in up to one-third of duloxetine recipients in the short-term trials.
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Affiliation(s)
- Natalie J Carter
- Wolters Kluwer Health mid R: Adis, Auckland, New Zealand, an editorial office of Wolters Kluwer Health, Philadelphia, Pennsylvania, USA.
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Carvalho LA, Gorenstein C, Moreno R, Pariante C, Markus RP. Effect of antidepressants on melatonin metabolite in depressed patients. J Psychopharmacol 2009; 23:315-21. [PMID: 18562432 DOI: 10.1177/0269881108089871] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antidepressants increase melatonin levels, but it is still unclear whether this effect is related to the improvement of depressive symptoms or to unrelated pharmacological action of antidepressants. To answer this question, the effect of antidepressants on 6-sulphatoxymelatonin (aMT6s), the main melatonin urinary metabolite, was examined in drug-free depressed patients - most of them antidepressant-naive. aMT6s was evaluated in 34 depressed patients, before and after 8 weeks of placebo (n = 12) or antidepressant (n = 22; fluoxetine, duloxetine or Hypericum perforatum). Both groups showed an improvement of depressive symptoms after treatment compared to baseline (Hamilton Depression scores): 17.0 +/- 1.4 vs. 9.0 +/- 2.8, P = 0.007 for placebo, and 18.6 +/- 1.1 vs. 11.8 +/- 1.6, P < 0.001 for antidepressants). After treatment, aMT6s levels increased after antidepressants (P < 0.01), but not after placebo (P > 0.05). As depressive symptoms improved both in patients taking antidepressant and in those taking placebo, but an effect of antidepressants could only be seen in those taking antidepressants, we suggest that melatonin changes after antidepressants are more likely due to a pharmacological action of these drugs on melatonin secretion.
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Affiliation(s)
- Livia A Carvalho
- Department of Psychological Medicine, Section and Laboratory of Stress Psychiatry and Immunology, Institute of Psychiatry, Kings College London, London, UK.
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Khan AY, Macaluso M. Duloxetine for the treatment of generalized anxiety disorder: a review. Neuropsychiatr Dis Treat 2009; 5:23-31. [PMID: 19557096 PMCID: PMC2695226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Approximately 16 million people in the United States suffer from anxiety disorders alone, while another 12 million experience both anxiety and at least one other psychiatric condition. Generalized anxiety disorder (GAD) has lifetime prevalence rates between 5% and 6%. Treatment of GAD is aimed primarily at symptom reduction. Duloxetine, a serotonin norepinephrine reuptake inhibitor (SNRI), received Food and Drug Administration (FDA) approval for the treatment of GAD in 2007. This article reviews the pharmacologic profile and seminal clinical trials associated with the FDA indication of duloxetine for GAD. A literature search performed using PubMed with the keywords "duloxetine", "gad", "generalized anxiety disorder", and "venlafaxine XR" yielded 27 articles. We also focused on papers that pooled data from these seminal studies. Data on file from Eli Lilly were also reviewed, including data from the Eli Lilly website. Based on this search, duloxetine was found to be an FDA-approved treatment option for GAD that has been studied in several double-blind, placebo-controlled clinical trials. This review of duloxetine will help physicians to interpret clinical studies properly and also help them to make an informed decision about which patients are the most appropriate candidates for a trial of duloxetine.
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Affiliation(s)
- Ahsan Y Khan
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
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Design of Monoamine Reuptake Inhibitors: SSRIs, SNRIs and NRIs. TOPICS IN MEDICINAL CHEMISTRY 2008. [DOI: 10.1007/7355_2008_028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
Duloxetine (Cymbalta) is an orally administered, selective serotonin and noradrenaline reuptake inhibitor (SNRI) that has been approved for the treatment of major depressive disorder (MDD). Based on a considerable body of evidence, duloxetine at dosages ranging from 40 to 120 mg/day was effective in the short- and long-term treatment of MDD. Significant improvements versus placebo in core emotional symptoms as well as painful physical symptoms associated with depression, were seen in most, but not all, appropriately designed studies; results of meta-analyses suggested that improvements in these efficacy measures were apparent after 1-2 weeks' treatment with the highest recommended dosage of 60 mg once daily. Short-term (< or =15 weeks) administration of duloxetine at fixed or flexible dosages between 60 and 120 mg/day was noninferior to paroxetine 20 mg once daily, noninferior or inferior to escitalopram 10-20mg once daily, and had a similar global benefit-risk (GBR) profile to that of venlafaxine extended-release (XR) 150-225 mg/day in the treatment of MDD. Longer-term (6-8 months) treatment with duloxetine was similar in efficacy to paroxetine and escitalopram. Duloxetine is generally well tolerated, although it may be appropriate to avoid initiating treatment with the 60 mg/day dosage, as this has been associated with a higher discontinuation rate due to adverse events in some (but not all) comparative studies with escitalopram and venlafaxine XR. Definitive comparisons are awaited, although duloxetine seemingly provides a useful alternative to SSRIs and other SNRIs for the treatment of MDD. It also appears to be an attractive option for MDD patients presenting with painful physical symptoms.
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Sánchez C, Brennum LT, Stórustovu SÍ, Kreilgård M, Mørk A. Depression and poor sleep: the effect of monoaminergic antidepressants in a pre-clinical model in rats. Pharmacol Biochem Behav 2007; 86:468-76. [PMID: 17303232 DOI: 10.1016/j.pbb.2007.01.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Revised: 12/27/2006] [Accepted: 01/10/2007] [Indexed: 10/23/2022]
Abstract
The effects of five antidepressants (escitalopram, paroxetine, duloxetine, venlafaxine, and reboxetine) on the sleep architecture were investigated in freely moving rats in the light phase of a 12:12 h light:dark cycle following a single i.p. dose of antidepressant. Overall, paroxetine and escitalopram exhibited the least sleep disruptive profiles, whereas duloxetine, venlafaxine, and reboxetine increased the time spent awake and suppressed paradoxical sleep. Analysis of the EEG at 1 h intervals revealed only subtle differences from the overall picture. The effect of venlafaxine on disruption of sleep architecture could not be readily explained by its in vitro serotonin (5-HT) and noradrenaline (NA) reuptake inhibitory potencies. In vivo microdialysis experiments in the ventral hippocampus of freely moving rats revealed that venlafaxine affected the 5-HT and NA systems equally at the doses tested. Duloxetine (7.7 mg/kg) induced maximal blockade of the 5-HT transporter and duloxetine 7.7 mg/kg also modulated the noradrenaline system. Thus, in this animal model, the enhancement of noradrenergic activity is more disruptive on the sleep architecture than enhancement of serotonergic activity.
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Affiliation(s)
- Connie Sánchez
- Neuroscience, Lundbeck Research USA Inc, Paramus, NJ 07652-1431, USA.
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Gould GG, Javors MA, Frazer A. Effect of chronic administration of duloxetine on serotonin and norepinephrine transporter binding sites in rat brain. Biol Psychiatry 2007; 61:210-5. [PMID: 16650830 DOI: 10.1016/j.biopsych.2006.02.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Revised: 02/28/2006] [Accepted: 03/06/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic treatment of rats with certain selective serotonin or norepinephrine reuptake inhibitors produces significant decreases, respectively, in serotonin and norepinephrine transporter binding sites in brain. Duloxetine may be a dual serotonin/norepinephrine reuptake inhibitor, as it is only a slightly more potent inhibitor of serotonin than norepinephrine uptake in vitro. Consequently, we hypothesized that chronic duloxetine treatment, at doses producing serum levels within its therapeutic range, would affect both monoamine transporters dose-dependently, with a higher dose causing greater reductions of binding sites for both transporters. METHODS Rats were treated with either 4 or 8 mg/kg/d of duloxetine, paroxetine, desipramine, or vehicle via subcutaneous osmotic minipumps for 21 days. Binding sites for serotonin and norepinephrine transporters were measured in amygdala and hippocampus using quantitative autoradiography. RESULTS Both doses of duloxetine and paroxetine produced equivalent and significant decreases in [3H] cyanoimipramine binding to serotonin transporters, but only desipramine treatment significantly reduced [3H] nisoxetine binding to norepinephrine transporters. CONCLUSIONS At doses producing rat serum concentrations in the range achieved in patients at recommended daily doses of the drug, duloxetine behaves in vivo more as a selective serotonin reuptake inhibitor than a dual reuptake inhibitor in its capacity to selectively reduce serotonin transporter density.
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Affiliation(s)
- Georgianna G Gould
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.
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Raskin J, Wang F, Pritchett YL, Goldstein DJ. Duloxetine for patients with diabetic peripheral neuropathic pain: a 6-month open-label safety study. PAIN MEDICINE 2006; 7:373-85. [PMID: 17014595 DOI: 10.1111/j.1526-4637.2006.00207.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Duloxetine is a relatively balanced and potent reuptake inhibitor of both serotonin and norepinephrine. Because these neurotransmitters play a role in pain inhibition, duloxetine was considered a possible treatment for diabetic peripheral neuropathic pain (DPNP). This study assessed the 6-month safety and tolerability of duloxetine in patients with DPNP; evaluation of efficacy was a secondary objective. DESIGN In this 28-week, open-label study, in the clinical setting, 449 patients with DPNP were randomized (3:1) to receive duloxetine 60 mg twice daily (BID) (N = 334) or duloxetine 120 mg once daily (QD) (N = 115). Comprehensive safety evaluations including laboratory analyses and electrocardiograms were performed for all patients. Efficacy measures included the Brief Pain Inventory (BPI) and Clinical Global Impression of Severity (CGI-S) scales. RESULTS Protocol completion rates were 63.8% and 62.6% for the 60 mg BID and 120 mg QD groups, respectively (P = 0.823). Discontinuations were primarily due to adverse events, 20.1% for 60 mg BID and 27.0% for 120 mg QD (P = 0.149). Heart rate increased slightly in both treatment groups (P </= 0.02 in both groups). Systolic blood pressure was unaffected, while diastolic blood pressure decreased slightly in the 120 mg QD group (P = 0.04). Sustained elevation in blood pressure was reported for 18 (5.5%) patients in the 60 mg BID group and six (5.4%) in the 120 mg QD group. Duloxetine treatment was not associated with significant QTc prolongation. There was significant improvement at endpoint on all subscales of the BPI and CGI-S (P < 0.001 in both groups). CONCLUSIONS In this study, duloxetine 60 mg BID and 120 mg QD were safely administered and well tolerated in patients with DPNP for up to 28 weeks. There were few differences in safety or tolerability between the two dosages. At both doses, duloxetine provided clinically significant pain relief.
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Affiliation(s)
- Joel Raskin
- Lilly Research Laboratories, Eli Lilly Canada, Toronto, Canada.
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Jonathan Fray M, Bish G, Brown AD, Fish PV, Stobie A, Wakenhut F, Whitlock GA. N-(1,2-diphenylethyl)piperazines: a new class of dual serotonin/noradrenaline reuptake inhibitor. Bioorg Med Chem Lett 2006; 16:4345-8. [PMID: 16750359 DOI: 10.1016/j.bmcl.2006.05.051] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Revised: 05/16/2006] [Accepted: 05/16/2006] [Indexed: 11/18/2022]
Abstract
The synthesis and structure-activity relationships of a novel series of piperazine derivatives as dual inhibitors of serotonin and noradrenaline reuptake is described. Two compounds possessed comparable in vitro profiles to the dual reuptake inhibitor duloxetine.
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Affiliation(s)
- M Jonathan Fray
- Sandwich Chemistry, Pfizer Global Research and Development, Sandwich, UK.
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Abstract
Neuropathic pain develops as a result of damage to either the peripheral or central nervous system. It is characterised by spontaneous burning pain and/or ongoing pain with accompanying hyperalgesia and allodynia. Neuropathic pain is difficult to treat as it is often refractory to conventional analgesic treatments, with most patients obtaining only partial relief. At present, there are four major medication categories that are considered first-line treatment for neuropathic pain: antidepressants, anticonvulsants, local anaesthetic/topical agents and opioids. The efficacy of these treatments in neuropathic pain, excepting opioids, has been discovered serendipitously. However, responder rates and overall efficacy is poor with these agents and tolerability or side effects are often limiting. This update will review existing treatment options for neuropathic pain, and highlight more recent advances in the development of novel analgesics to treat this chronic disorder.
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Affiliation(s)
- Susanne D Collins
- GlaxoSmithKline, Neurology & Gastrointestinal Centre of Excellence for Drug Discovery, New Frontiers Science Park, Third Avenue, Harlow, Essex, CM19 5AW, UK.
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Troelsen KB, Nielsen EØ, Mirza NR. Chronic treatment with duloxetine is necessary for an anxiolytic-like response in the mouse zero maze: the role of the serotonin transporter. Psychopharmacology (Berl) 2005; 181:741-50. [PMID: 16032412 DOI: 10.1007/s00213-005-0032-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Accepted: 04/11/2005] [Indexed: 10/25/2022]
Abstract
RATIONALE Monoamine transporter inhibitor antidepressants have anxiolytic efficacy in man. However, preclinical data poorly reflect this, either because (1) few studies assess chronic antidepressant treatment in animal models, (2) antidepressants are anxiogenic after acute treatment; and (3) animal models of anxiety are insensitive to antidepressants. OBJECTIVE We address issues (1) and (2) and ascertain potential mechanisms mediating anxiolytic effects demonstrated. METHODS The effect of acute treatment with seven antidepressants covering the classes selective serotonin reuptake inhibitors, serotonin-noradrenaline reuptake inhibitors, noradrenaline reuptake inhibitors and tricyclic antidepressants were compared with the benzodiazepine, chlordiazepoxide, on the mouse zero maze, an unconditioned model of anxiety. Furthermore, citalopram, duloxetine, reboxetine and amitriptyline were assessed after chronic administration (10 mg/kg p.o., 21 days, twice daily) in this model. In mice treated chronically, (a) the hypothermic response to serotonin (5-HT)1A and 5-HT1B receptor ligands, 8-hydroxy-2-(di-n-propylamino)tetralin (8-OHDPAT) and m-chlorophenyl piperazine (mCPP), respectively, was assessed and (b) serotonin transporter (SERT) and noradrenaline transporter (NET) densities in the cortex and hippocampus, respectively, were determined. RESULTS None of the antidepressants were anxiolytic after acute treatment, although reboxetine, duloxetine and amitriptyline were anxiogenic. Only chronic treatment with duloxetine induced an anxiolytic effect, which was dissociable from nonspecific motor effects. Duloxetine reduced SERT density in the cortex by approximately 75% compared to control, with no effect on NET density in the hippocampus. Citalopram and amitriptyline significantly reduced SERT density by approximately 20%, whereas reboxetine selectively reduced NET density. All drugs reduced the hypothermic response to 8-OHDPAT and mCPP. CONCLUSION Duloxetine was anxiolytic after chronic but not acute treatment, reflecting clinical experience with antidepressants in general. Duloxetine's anxiolytic-like profile may be ascribed to the considerable reduction in the density of the SERT in the cortex.
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Affiliation(s)
- K B Troelsen
- NeuroSearch A/S, 93 Pederstrupvej, Ballerup, 2750, Denmark
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Hunziker ME, Suehs BT, Bettinger TL, Crismon ML. Duloxetine hydrochloride: A new dual-acting medication for the treatment of major depressive disorder. Clin Ther 2005; 27:1126-43. [PMID: 16199241 DOI: 10.1016/j.clinthera.2005.08.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Duloxetine hydrochloride has recently been approved by the US Food and Drug Administration for the treatment of major depressive disorder (MDD). Duloxetine is a potent inhibitor of serotonin and norepinephrine reuptake, with weak effects on dopamine reuptake. OBJECTIVE This article reviews the literature on duloxetine with regard to its pharmacodynamics, pharmacokinetics, clinical efficacy, and tolerability. METHODS A comprehensive search of MEDLINE was performed using the terms duloxetine, Cymbalta, and major depressive disorder, with no restriction on year. The Eli Lilly and Company clinical trial registry, and abstracts and posters from recent American Psychiatric Association meetings were also reviewed. RESULTS Duloxetine exhibits linear, dose-dependent pharmacokinetics across the approved oral dosage range of 40 to 60 mg/d. No dose adjustment appears to be needed based on age. Duloxetine has shown efficacy in reducing depressive symptoms compared with placebo, and duloxetine recipients have shown significant improvements in global functioning compared with placebo (both, P < 0.05). Response and remission rates have been comparable to or greater than those seen with fluoxetine or paroxetine. Duloxetine is generally well tolerated, with nausea, dry mouth, and fatigue being the most common treatment-emergent adverse effects. Cardiovascular adverse effects do not appear to result in sustained blood pressure elevations, QTc-interval prolongation, or other electrocardiographic changes. CONCLUSIONS Based on the available evidence, duloxetine is a well-tolerated and effective treatment for MDD in adults. Randomized head-to-head comparisons against established antidepressants are needed to determine the relative safety and efficacy of duloxetine.
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Bomholt SF, Mikkelsen JD, Blackburn-Munro G. Antinociceptive effects of the antidepressants amitriptyline, duloxetine, mirtazapine and citalopram in animal models of acute, persistent and neuropathic pain. Neuropharmacology 2005; 48:252-63. [PMID: 15695164 DOI: 10.1016/j.neuropharm.2004.09.012] [Citation(s) in RCA: 162] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2004] [Revised: 07/05/2004] [Accepted: 09/16/2004] [Indexed: 11/28/2022]
Abstract
The effects of acute, systemic administration of amitriptyline, duloxetine and mirtazapine (antidepressant drugs that variously affect extracellular noradrenaline and serotonin levels) and the selective serotonin reuptake inhibitor (SSRI) citalopram were compared in rat models of experimental pain. None of the drugs (all 3-30 mg/kg, i.p.) affected acute nociceptive responses as measured in the tail flick test. In the hot plate test, duloxetine and mirtazapine significantly increased (P<0.05) the nociceptive response latency, whereas amitriptyline and citalopram were ineffective. In the formalin test, duloxetine and citalopram significantly attenuated, whereas amitriptyline and mirtazapine increased, second phase flinching behaviour (all P<0.05). However, amitriptyline and mirtazapine reduced second phase licking behaviour. In the chronic constriction injury model of neuropathic pain, thermal hyperalgesia of the injured hindpaw was significantly attenuated by all four drugs (P<0.05); only amitriptyline and duloxetine fully reversed thermal hypersensitivity. None of the drugs tested attenuated mechanical allodynia. In contrast amitriptyline, duloxetine and mirtazapine significantly reduced mechanical hyperalgesia (P<0.05); citalopram was ineffective. No drug-related effects on motor performance in the rotarod test were observed. These results (a) highlight the difficulty in correlating antinociceptive effects of drugs from different antidepressant classes across a range of animal pain models and (b) suggest that antidepressants that variously affect both noradrenaline and serotonin levels have more potent and efficacious antinociceptive effects than SSRIs (as exemplified by citalopram), against a range of pain-like behaviours in an animal model of neuropathic pain.
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Affiliation(s)
- Signe F Bomholt
- Department of Pharmacology, NeuroSearch A/S, 93 Pederstrupvej, DK-2750, Ballerup, Denmark.
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Abstract
The antidepressant compound, morpholine, 2-[(2-ethoxyphenoxy)phenylmethyl]-,methanesulfonate, or reboxetine, is a selective noradrenergic reuptake inhibitor that acts by binding to the norepinephrine (NE) transporter and blocking reuptake of extracellular NE back into terminals. This compound has low affinity for other transporters and receptors. The development of reboxetine as a potential antidepressant stems from the prior demonstration that blockade of the NE transporter imparts antidepressant activity. Desipramine, lofepramine, and nortryptiline are examples of tricyclic antidepressant (TCA) compounds from the first generation of antidepressants that exert their effects by blockade of NE reuptake. Maprotiline, a non-tricyclic compound, is also a NE selective reuptake inhibitor. Unfortunately, these antidepressants are also associated with interactions with muscarinic, histaminergic, and adrenergic receptors, which are known to contribute to a variety of untoward side effects. Despite the positive pharmacological profile of reboxetine, i.e., selectivity and specificity, with relatively fewer side effects, its use as an antidepressant is currently limited to Europe. Reboxetine is marketed as Edronax in the UK, Norebox in Italy, and as Irenor in Spain. It is registered in Germany, Sweden, Denmark, Ireland, Austria and Finland. Based on studies conducted primarily outside the US, the FDA granted a preliminary letter of approval in 1999. However, more recent clinical studies conducted in the US and Canada, prompted by the FDA, resulted in a letter of non-approval. To date, it is unclear why the further development of reboxetine as an antidepressant in the US has been halted. Despite this setback, reboxetine has been a valuable pharmacological tool to assess the role of the noradrenergic system in preclinical studies of depressive disorder.
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Affiliation(s)
- Michelle E Page
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA 19129, USA.
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Effective Recognition and Treatment of Generalized Anxiety Disorder in Primary Care. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2004; 6:35-41. [PMID: 15486599 PMCID: PMC427612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
This Academic Highlights section of The Primary Care Companion to The Journal of Clinical Psychiatry presents the highlights of the planning roundtable "Effective Recognition and Treatment of Generalized Anxiety Disorder (GAD) in the Primary Care Setting," held December 11, 2003, in Pittsburgh, Pa. The planning roundtable and this Academic Highlights were supported by an unrestricted educational grant from Pfizer. The planning roundtable was chaired by Larry Culpepper, M.D., M.P.H., Boston University School of Medicine, Boston, Mass. The faculty member was Kathryn M. Connor, M.D., Duke University Medical Center, Durham, N.C.
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