1
|
Gammoh O, Ibrahim A, Yehya A, Alqudah A, Qnais E, Altaber S, Alrob OA, Aljabali AAA, Tambuwala MM. Exploring the Roles of Vitamins C and D and Etifoxine in Combination with Citalopram in Depression/Anxiety Model: A Focus on ICAM-1, SIRT1 and Nitric Oxide. Int J Mol Sci 2024; 25:1960. [PMID: 38396638 PMCID: PMC10889164 DOI: 10.3390/ijms25041960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/17/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
The study of intercellular adhesion molecule-1 (ICAM-1) and SIRT1, a member of the sirtuin family with nitric oxide (NO), is emerging in depression and anxiety. As with all antidepressants, the efficacy is delayed and inconsistent. Ascorbic acid (AA) and vitamin D (D) showed antidepressant properties, while etifoxine (Etx), a GABAA agonist, alleviates anxiety symptoms. The present study aimed to investigate the potential augmentation of citalopram using AA, D and Etx and related the antidepressant effect to brain and serum ICAM-1, SIRT1 and NO in an animal model. BALB/c mice were divided into naive, control, citalopram, citalopram + etx, citalopram + AA, citalopram + D and citalopram + etx + AA + D for 7 days. On the 8th day, the mice were restrained for 8 h, followed by a forced swim test and marble burying test before scarification. Whole-brain and serum expression of ICAM-1, Sirt1 and NO were determined. Citalopram's antidepressant and sedative effects were potentiated by ascorbic acid, vitamin D and etifoxine alone and in combination (p < 0.05), as shown by the decreased floating time and rearing frequency. Brain NO increased significantly (p < 0.05) in depression and anxiety and was associated with an ICAM-1 increase versus naive (p < 0.05) and a Sirt1 decrease (p < 0.05) versus naive. Both ICAM-1 and Sirt1 were modulated by antidepressants through a non-NO-dependent pathway. Serum NO expression was unrelated to serum ICAM-1 and Sirt1. Brain ICAM-1, Sirt1 and NO are implicated in depression and are modulated by antidepressants.
Collapse
Affiliation(s)
- Omar Gammoh
- Department of Clinical Pharmacy and Pharmacy, Faculty of Pharmacy, Yarmouk University, Irbid 21163, Jordan; (A.Y.); (O.A.A.)
| | - Aseel Ibrahim
- Faculty of Sciences, Yarmouk University, Irbid 21163, Jordan;
| | - Ala Yehya
- Department of Clinical Pharmacy and Pharmacy, Faculty of Pharmacy, Yarmouk University, Irbid 21163, Jordan; (A.Y.); (O.A.A.)
| | - Abdelrahim Alqudah
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa 13133, Jordan;
| | - Esam Qnais
- Department of Biology and Biotechnology, Faculty of Science, The Hashemite University, Zarqa 13133, Jordan; (E.Q.); (S.A.)
| | - Sara Altaber
- Department of Biology and Biotechnology, Faculty of Science, The Hashemite University, Zarqa 13133, Jordan; (E.Q.); (S.A.)
| | - Osama Abo Alrob
- Department of Clinical Pharmacy and Pharmacy, Faculty of Pharmacy, Yarmouk University, Irbid 21163, Jordan; (A.Y.); (O.A.A.)
| | - Alaa A. A. Aljabali
- Department of Pharmaceutics and Pharmaceutical Technology, Yarmouk University, Irbid 21163, Jordan;
| | - Murtaza M. Tambuwala
- Lincoln Medical School, Brayford Pool Campus, University of Lincoln, Lincoln LN6 7TS, UK;
| |
Collapse
|
2
|
Treatment-Resistant Depression in Poland—Epidemiology and Treatment. J Clin Med 2022; 11:jcm11030480. [PMID: 35159935 PMCID: PMC8837165 DOI: 10.3390/jcm11030480] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders worldwide. Although several antidepressant drugs have been developed, up to 30% of patients fail to achieve remission, and acute remission rates decrease with the number of treatment steps required. The aim of the current project was to estimate and describe the population of treatment-resistant depression (TRD) patients in outpatient clinics in Poland. (2) Methods: The project involved a representative sample of psychiatrists working in outpatient clinics, chosen through a process of quota random sampling. The doctors completed two questionnaires on a consecutive series of patients with MDD, which captured the patients’ demographics, comorbidities, and medical histories. TRD was defined as no improvement seen after a minimum of two different antidepressant drug therapies applied in sufficient doses for a minimum of 4 weeks each. The data were weighted and extrapolated to the population of TRD outpatients in Poland. (3) Results: A total of 76 psychiatrists described 1781 MDD patients, out of which 396 fulfilled the criteria of TRD. The TRD patients constituted 25.2% of all MDD patients, which led to the number of TRD outpatients in Poland being estimated at 34,800. The demographics, comorbidities, medical histories, and histories of treatment of Polish TRD patients were described. In our sample of the TRD population (mean age: 45.6 ± 13.1 years; female: 64%), the patients had experienced 2.1 ± 1.6 depressive episodes (including the current one), and the mean duration of the current episode was 4.8 ± 4.4 months. In terms of treatment strategies, most patients (around 70%) received monotherapy during the first three therapies, while combination antidepressant drugs (ADs) were applied more often from the fourth line of treatment. The use of additional medications and augmentation was reported in only up to one third of the TRD patients. During all of the treatment steps, patients most often received a selective serotonin reuptake inhibitor (SSRI) and a serotonin norepinephrine reuptake inhibitor (SNRI). (4) Conclusions: TRD is a serious problem, affecting approximately one fourth of all depressive patients and nearly 35,000 Poles.
Collapse
|
3
|
Clinical guidelines for the management of treatment-resistant depression: French recommendations from experts, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental. BMC Psychiatry 2019; 19:262. [PMID: 31455302 PMCID: PMC6712810 DOI: 10.1186/s12888-019-2237-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/12/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Clear guidance for successive antidepressant pharmacological treatments for non-responders in major depression is not well established. METHOD Based on the RAND/UCLA Appropriateness Method, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental developed expert consensus guidelines for the management of treatment-resistant depression. The expert guidelines combine scientific evidence and expert clinicians' opinions to produce recommendations for treatment-resistant depression. A written survey comprising 118 questions related to highly-detailed clinical presentations was completed on a risk-benefit scale ranging from 0 to 9 by 36 psychiatrist experts in the field of major depression and its treatments. Key-recommendations are provided by the scientific committee after data analysis and interpretation of the results of the survey. RESULTS The scope of these guidelines encompasses the assessment of pharmacological resistance and situations at risk of resistance, as well as the pharmacological and psychological strategies in major depression. CONCLUSION The expert consensus guidelines will contribute to facilitate treatment decisions for clinicians involved in the daily assessment and management of treatment-resistant depression across a number of common and complex clinical situations.
Collapse
|
4
|
Abstract
SummarySequenced (stepped) treatment approaches are widely endorsed in the management of depression. Combining antidepressants is a recognised step for those failing to respond to monotherapy. Despite the limited evidence base, this strategy is widely used by clinicians in practice. Not every combination used clinically has a sound neuropharmacological rationale and the use of such combinations may increase the side-effect burden without any additional advantage to the patient. Efficacy of various antidepressant combinations along with the data on side-effect profile and toxicity of such combined treatments are reviewed here. The different combinations are considered by each class of antidepressant available in the UK.
Collapse
|
5
|
Antidepressant use in suicides: a case-control study from the Friuli Venezia Giulia Region, Italy, 2005-2014. Eur J Clin Pharmacol 2017; 73:883-890. [PMID: 28342066 PMCID: PMC5486927 DOI: 10.1007/s00228-017-2236-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/08/2017] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare the use of antidepressant (AD) classes and compounds in individuals who committed suicide and in controls from the general population and to assess to what extent adherence and current use of different AD classes can affect the risk of committing suicide. METHODS Individual data on suicide, diagnoses and AD use in Friuli Venezia Giulia from 2005 to 2014 were obtained from the Regional Social and Health Information System. All suicides that had at least one prescription of AD in the 730 days before death (N = 876) were included as cases. Each case was matched with regard to age and sex with five controls from the general population. The association between suicide and AD use was assessed using conditional logistic regression analysis. RESULTS Almost 70% of all suicides occurring in the10-year period had been prescribed AD. Selective serotonin reuptake inhibitors (SSRIs) accounted for more than the 90% of the prescriptions, with paroxetine the most prescribed AD. All AD compounds and classes were not associated with a higher suicide risk, with the exception of SSRI (OR = 1.6). A decreasing trend in suicide risk was observed when adherent subjects or current AD users were compared to the others. CONCLUSIONS AD treatment is an important factor for preventing suicide, since the use of AD at adequate dosage and for a proper duration was associated with a lower suicide risk. The proper use of AD should be ascertained by physicians, particularly in a primary care context.
Collapse
|
6
|
Charpeaud T, Moliere F, Bubrovszky M, Haesebaert F, Allaïli N, Bation R, Nieto I, Richieri R, Saba G, Bellivier F, Bennabi D, Holtzmann J, Camus V, Courtet P, Courvoisier P, d'Amato T, Doumy O, Garnier M, Bougerol T, Lançon C, Haffen E, Leboyer M, Llorca PM, Vaiva G, El-Hage W, Aouizerate B. [Switching and combining strategies of antidepressant medications]. Presse Med 2016; 45:329-37. [PMID: 26995511 DOI: 10.1016/j.lpm.2016.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Switching antidepressant medication may be helpful in depressed patients having no benefit from the initial antidepressant treatment. Before considering switching strategy, the initial antidepressant treatment should produce no therapeutic effect after at least 4 weeks of administration at adequate dosage. Choosing an antidepressant of pharmacologically distinct profile fails to consistently demonstrate a significant superiority in terms of effectiveness over the switching to another antidepressant within the same pharmacological class. Augmenting SSRI/SNRIs with mirtazapine/mianserin has become the most recommended strategy of antidepressant combinations. Augmenting SSRI with tricyclic drugs is now a less recommended strategy of antidepressant combinations given the increased risk for the occurrence of pharmacokinetic drug-drug interactions and adverse effects.
Collapse
Affiliation(s)
- Thomas Charpeaud
- CHU de Clermont-Ferrand, centre expert dépression résistante fondamental, service de psychiatrie de l'adulte B, 63003 Clermont-Ferrand, France.
| | - Fanny Moliere
- CHRU Lapeyronie, centre expert dépression résistante fondamental, département des urgences et post-urgences psychiatrique, 34295 Montpellier cedex 5, France
| | - Maxime Bubrovszky
- CHRU de Lille, hôpital Fontan 1, centre expert dépression résistante fondamental, service de psychiatrie adulte, 59037 Lille cedex, France
| | - Frédéric Haesebaert
- Centre hospitalier Le-Vinatier, centre expert dépression résistante fondamental, service universitaire de psychiatrie adulte, BP 300 39, 69678 Bron cedex, France
| | - Najib Allaïli
- Hôpital Fernand-Widal, centre expert dépression résistante fondamental, service de psychiatrie adulte, 75010 Paris, France
| | - Rémy Bation
- Centre hospitalier Le-Vinatier, centre expert dépression résistante fondamental, service universitaire de psychiatrie adulte, BP 300 39, 69678 Bron cedex, France
| | - Isabel Nieto
- Hôpital Fernand-Widal, centre expert dépression résistante fondamental, service de psychiatrie adulte, 75010 Paris, France
| | - Raphaëlle Richieri
- CHU La-Conception, pôle psychiatrie centre, centre expert dépression résistante fondamental, 13005 Marseille, France
| | - Ghassen Saba
- Hôpital Chenevier, Henri-Mondor, pôle de psychiatrie des hôpitaux universitaires, centre expert dépression résistante fondamental, 94000 Créteil, France
| | - Frank Bellivier
- Hôpital Fernand-Widal, centre expert dépression résistante fondamental, service de psychiatrie adulte, 75010 Paris, France
| | - Djamila Bennabi
- CHU de Besançon, centre expert dépression résistante fondamental, service de psychiatrie de l'adulte, 25030 Besançon cedex, France
| | - Jérôme Holtzmann
- CHU de Grenoble, hôpital Nord, centre expert dépression résistante fondamental, service de psychiatrie de l'adulte, CS 10217, 38043 Grenoble cedex 9, France
| | - Vincent Camus
- CHU de Tours, clinique psychiatrique universitaire, centre expert dépression résistante fondamental, 37044 Tours cedex 9, France
| | - Philippe Courtet
- CHRU Lapeyronie, centre expert dépression résistante fondamental, département des urgences et post-urgences psychiatrique, 34295 Montpellier cedex 5, France
| | - Pierre Courvoisier
- CHU de Grenoble, hôpital Nord, centre expert dépression résistante fondamental, service de psychiatrie de l'adulte, CS 10217, 38043 Grenoble cedex 9, France
| | - Thierry d'Amato
- Centre hospitalier Le-Vinatier, centre expert dépression résistante fondamental, service universitaire de psychiatrie adulte, BP 300 39, 69678 Bron cedex, France
| | - Olivier Doumy
- CH Charles-Perrens, pôle de psychiatrie générale et universitaire, centre expert dépression résistante fondamental, 33076 Bordeaux cedex, France
| | - Marion Garnier
- CHU de Clermont-Ferrand, centre expert dépression résistante fondamental, service de psychiatrie de l'adulte B, 63003 Clermont-Ferrand, France
| | - Thierry Bougerol
- CHU de Grenoble, hôpital Nord, centre expert dépression résistante fondamental, service de psychiatrie de l'adulte, CS 10217, 38043 Grenoble cedex 9, France
| | - Christophe Lançon
- CHU La-Conception, pôle psychiatrie centre, centre expert dépression résistante fondamental, 13005 Marseille, France
| | - Emmanuel Haffen
- CHU de Besançon, centre expert dépression résistante fondamental, service de psychiatrie de l'adulte, 25030 Besançon cedex, France
| | - Marion Leboyer
- Hôpital Chenevier, Henri-Mondor, pôle de psychiatrie des hôpitaux universitaires, centre expert dépression résistante fondamental, 94000 Créteil, France
| | - Pierre-Michel Llorca
- CHU de Clermont-Ferrand, centre expert dépression résistante fondamental, service de psychiatrie de l'adulte B, 63003 Clermont-Ferrand, France
| | - Guillaume Vaiva
- CHRU de Lille, hôpital Fontan 1, centre expert dépression résistante fondamental, service de psychiatrie adulte, 59037 Lille cedex, France
| | - Wissam El-Hage
- CHU de Tours, clinique psychiatrique universitaire, centre expert dépression résistante fondamental, 37044 Tours cedex 9, France
| | - Bruno Aouizerate
- CH Charles-Perrens, pôle de psychiatrie générale et universitaire, centre expert dépression résistante fondamental, 33076 Bordeaux cedex, France
| |
Collapse
|
7
|
Ivanets NN, Kinkulkina MA, Avdeeva TI, Tikhonova YG, Luk’ianova AV. An increase in the efficacy of psychopharmacotherapy of late-onset depressions: combination and substitution of antidepressants. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:43-51. [DOI: 10.17116/jnevro20161165143-51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
8
|
Cleare A, Pariante CM, Young AH, Anderson IM, Christmas D, Cowen PJ, Dickens C, Ferrier IN, Geddes J, Gilbody S, Haddad PM, Katona C, Lewis G, Malizia A, McAllister-Williams RH, Ramchandani P, Scott J, Taylor D, Uher R. Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol 2015; 29:459-525. [PMID: 25969470 DOI: 10.1177/0269881115581093] [Citation(s) in RCA: 407] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A revision of the 2008 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken in order to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in September 2012. Key areas in treating depression were reviewed and the strength of evidence and clinical implications were considered. The guidelines were then revised after extensive feedback from participants and interested parties. A literature review is provided which identifies the quality of evidence upon which the recommendations are made. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse and stopping treatment. Significant changes since the last guidelines were published in 2008 include the availability of new antidepressant treatment options, improved evidence supporting certain augmentation strategies (drug and non-drug), management of potential long-term side effects, updated guidance for prescribing in elderly and adolescent populations and updated guidance for optimal prescribing. Suggestions for future research priorities are also made.
Collapse
Affiliation(s)
- Anthony Cleare
- Professor of Psychopharmacology & Affective Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - C M Pariante
- Professor of Biological Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - A H Young
- Professor of Psychiatry and Chair of Mood Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - I M Anderson
- Professor and Honorary Consultant Psychiatrist, University of Manchester Department of Psychiatry, University of Manchester, Manchester, UK
| | - D Christmas
- Consultant Psychiatrist, Advanced Interventions Service, Ninewells Hospital & Medical School, Dundee, UK
| | - P J Cowen
- Professor of Psychopharmacology, Psychopharmacology Research Unit, Neurosciences Building, University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - C Dickens
- Professor of Psychological Medicine, University of Exeter Medical School and Devon Partnership Trust, Exeter, UK
| | - I N Ferrier
- Professor of Psychiatry, Honorary Consultant Psychiatrist, School of Neurology, Neurobiology & Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - J Geddes
- Head, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - S Gilbody
- Director of the Mental Health and Addictions Research Group (MHARG), The Hull York Medical School, Department of Health Sciences, University of York, York, UK
| | - P M Haddad
- Consultant Psychiatrist, Cromwell House, Greater Manchester West Mental Health NHS Foundation Trust, Salford, UK
| | - C Katona
- Division of Psychiatry, University College London, London, UK
| | - G Lewis
- Division of Psychiatry, University College London, London, UK
| | - A Malizia
- Consultant in Neuropsychopharmacology and Neuromodulation, North Bristol NHS Trust, Rosa Burden Centre, Southmead Hospital, Bristol, UK
| | - R H McAllister-Williams
- Reader in Clinical Psychopharmacology, Institute of Neuroscience, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - P Ramchandani
- Reader in Child and Adolescent Psychiatry, Centre for Mental Health, Imperial College London, London, UK
| | - J Scott
- Professor of Psychological Medicine, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - D Taylor
- Professor of Psychopharmacology, King's College London, London, UK
| | - R Uher
- Associate Professor, Canada Research Chair in Early Interventions, Dalhousie University, Department of Psychiatry, Halifax, NS, Canada
| | | |
Collapse
|
9
|
Abstract
A total of 17 years after its introduction, bupropion remains a safe and effective antidepressant, suitable for first-line use. Bupropion undergoes metabolic transformation to an active metabolite, 4-hydroxybupropion, through hepatic cytochrome P450-2B6 (CYP2B6) and has inhibitory effects on cytochrome P450-2D6 (CYP2D6), thus raising concern for clinically-relevant drug interactions. Common side effects are nervousness and insomnia. Nausea appears slightly less common than with the SSRI drugs and sexual dysfunction is probably the least of any antidepressant. Bupropion is relatively safe in overdose with seizures being the predominant concern. The mechanism of action of bupropion is still uncertain but may be related to inhibition of presynaptic dopamine and norepinephrine reuptake transporters. The activity of vesicular monoamine transporter-2, the transporter pumping dopamine, norepinephrine and serotonin from the cytosol into presynaptic vesicles, is increased by bupropion and may be a component of its mechanism of action. Bupropion is approved for use in major depression and seasonal affective disorder and has demonstrated comparable efficacy to other antidepressants in clinical trials. Bupropion is also useful in augmenting a partial response to selective serotonin reuptake inhibitor antidepressants, although bupropion should not be combined with monoamine oxidase inhibitors. It may be less likely to provoke mania than antidepressants with prominent serotonergic effects. Bupropion is effective in helping people quit tobacco smoking. Anecdotal reports indicate bupropion may lower inflammatory mediators such as tumor necrosis factor-alpha, may lower fatigue in cancer and may help reduce concentration problems.
Collapse
Affiliation(s)
- Kevin F Foley
- University of Vermont, Department of Medical Laboratory and Radiation Sciences Burlington, 302 Rowell Building, VT 05405, USA.
| | | | | |
Collapse
|
10
|
Woo YS, Bahk WM, Jeong JH, Lee SH, Sung HM, Pae CU, Koo BH, Kim W. Tianeptine combination for partial or non-response to selective serotonin re-uptake inhibitor monotherapy. Psychiatry Clin Neurosci 2013; 67:219-27. [PMID: 23683152 DOI: 10.1111/pcn.12042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 04/26/2012] [Accepted: 05/30/2012] [Indexed: 11/29/2022]
Abstract
AIMS The goal of this study was to assess the efficacy and tolerability of tianeptine in combination with selective serotonin re-uptake inhibitor (SSRI) in partial responders or non-responders to SSRI monotherapy. METHODS In this prospective, open-label, 6-week study, 150 patients with major depressive disorder who had previously not responded or partially responded to SSRI monotherapy were recruited. Tianeptine was given in combination with an SSRI for 6 weeks. RESULTS Significant improvements were observed in the mean scores of the Hamilton Depression Rating Scale (HDRS), Montgomery-Åsberg Depression Rating Scale (MADRS), and Clinical Global Impression-Severity (CGI-S). The change in the mean HDRS, MADRS, and CGI-S scores was significant from week 1. The response rates were 64.7% (HDRS) and 68.7% (MADRS), and the remission rates were 34.0% (HDRS) and 42.0% (MADRS) at week 6. Thirty-six patients (24.0%) reported adverse events that were determined by the investigator to be related to one of the study drugs. The tianeptine and SSRI combination was generally well-tolerated. CONCLUSIONS A combination strategy with tianeptine may be an effective and well-tolerated tool for patients who have failed to adequately respond to SSRI monotherapy.
Collapse
Affiliation(s)
- Young Sup Woo
- Department of Psychiatry, Yeouido St Mary's Hospital, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Yamauchi M, Imanishi T, Koyama T. A combination of mirtazapine and milnacipran augments the extracellular levels of monoamines in the rat brain. Neuropharmacology 2012; 62:2278-87. [PMID: 22342987 DOI: 10.1016/j.neuropharm.2012.01.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 01/26/2012] [Accepted: 01/30/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Miki Yamauchi
- Pharmaceutical Research Center, Meiji Seika Pharma Co., Ltd., 760 Morooka-cho, Kohoku-ku, Yokohama 222-8567, Japan.
| | | | | |
Collapse
|
12
|
Hudson AL, Lalies MD, Silverstone P. Venlafaxine enhances the effect of bupropion on extracellular dopamine in rat frontal cortex. Can J Physiol Pharmacol 2012; 90:803-9. [DOI: 10.1139/y2012-045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Venlafaxine is recognised as an effective treatment for depression and is known to inhibit the reuptake of serotonin (5-HT) and noradrenaline (NA). Another antidepressant, bupropion, acts to inhibit dopamine (DA) and NA reuptake and is commonly co-administered with other antidepressants to improve the efficacy of the antidepressant effect. The present study was designed to investigate the acute effect of combining the 2 drugs on extracellular levels of 5-HT, DA, and NA in rat frontal cortex using brain microdialysis, with the drugs being administered by intraperitoneal injection (i.p). Bupropion (10 mg/kg body mass, i.p.) alone had no effect on extracellular 5-HT levels, whereas venlafaxine (10 mg/kg, i.p.) alone significantly elevated extracellular 5-HT over basal values. As expected, bupropion alone elevated extracellular dopamine above basal values at 40 min post-drug administration, and this effect lasted for a further 2 h. Venlafaxine alone did not statistically elevate extracellular dopamine. The co-administration of venlafaxine with bupropion resulted in a dramatic increase in extracellular dopamine, and this effect was significantly greater than that seen with bupropion alone. In the frontal cortex, NA was elevated by bupropion alone and venlafaxine alone, relative to the control animals. The combination of bupropion and venlafaxine resulted in a marked elevation of NA.
Collapse
Affiliation(s)
- Alan L. Hudson
- Department of Pharmacology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Maggie D. Lalies
- Department of Pharmacology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Peter Silverstone
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| |
Collapse
|
13
|
Moreira R. The Efficacy and Tolerability of Bupropion in the Treatment of Major Depressive Disorder. Clin Drug Investig 2011; 31 Suppl 1:5-17. [DOI: 10.2165/1159616-s0-000000000-00000] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
14
|
The strategy of combining antidepressants in the treatment of major depression: clinical experience in spanish outpatients. DEPRESSION RESEARCH AND TREATMENT 2011; 2011:140194. [PMID: 21738865 PMCID: PMC3124138 DOI: 10.1155/2011/140194] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 04/03/2011] [Accepted: 04/14/2011] [Indexed: 11/18/2022]
Abstract
Introduction. The combination of antidepressants is a useful tool in the treatment of major depression, especially in cases where there is a partial response to antidepressant monotherapy. However, the use of this strategy is a matter of controversy, and its frequency of use in clinical practice is not clear. The aim of our study is to assess the use of antidepressants combination in Spain by reviewing three databases used between 1997 and 2001. Methods. Databases pertain to patients who are study subjects of major depression treatment. These databases are a result of studies performed in Spain and in which 550 psychiatrists participated. The total studied sample was comprised of N = 2, 842 patients, aged over 18, fitting DSM-IV criteria for Major Depressive Episode. The percentage of patients who received more than one antidepressant and the types of combinations used was described. Subsequently, a comparative study between the group which received a combination of antidepressants (N = 64) and the group which received antidepressant monotherapy (N = 775) was performed. Results. 27.1% of patients were on antidepressive monotherapy treatment, and 2.2% were on combination therapy. In the comparison of patients on combination therapy and monotherapy, there were significant differences only in episode duration (P = 0.001). The most frequent combinations are SSRIs and tricyclic antidepressants. The active principle most widely combined is fluoxetine. Conclusions. The prevalence of use of antidepressant combination therapy is 2.2% of the global sample and 8.3% of treated patients. Other than duration of the depressive episode, no clinical characteristics exclusive to patients who received combination rather than monotherapy were found. Our study found that the most frequent combination is SSRIs + TCAs, also being the most studied.
Collapse
|
15
|
Seguí J, López-Muñoz F, Alamo C, Camarasa X, García-García P, Pardo A. Effects of adjunctive reboxetine in patients with duloxetine-resistant depression: a 12-week prospective study. J Psychopharmacol 2010; 24:1201-7. [PMID: 19282423 DOI: 10.1177/0269881109102641] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The efficacy of the combination therapy with two antidepressants from different pharmacological families in patients with treatment-resistant depression has been reported in multiple studies. In this prospective 12-weeks open-label study, we assessed the effectiveness of the addition of reboxetine to 79 depressive outpatients diagnosed with major depressive disorder (MDD) according to the DSM-IV criteria who had previously not responded, or had done so only in a partial way, over 8 weeks of conventional treatment, in monotherapy, with duloxetine. Efficacy was assessed using the 21-item Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impression-Improvement (CGI-I). Safety was evaluated by recording spontaneously reported adverse events. Data were analysed on an intent-to-treat basis, using the last-observation-carried-forward method. Mean HDRS reduction was 65.5% (P < 0.0001). The percentages of responders (>or=50% reduction in HDRS) and patients considered benefiting from complete remission (HDRS <or= 10 points) at week 12 were 76% and 69.3%, respectively. By the end of the treatment, the score of CGI-I decreased 68.5% (P < 0.0001). Percentage of patient improving (CGI < 4 points) was 95.8%. The most common non-serious adverse events were dry mouth, increased sweating, constipation and difficulty passing urine. The results of this study suggest that the combination strategy with reboxetine may be an effective and well-tolerated tool in duloxetine-resistant patients.
Collapse
Affiliation(s)
- J Seguí
- Service of Psychiatry, Sagrat Cor University Hospital, Barcelona, Spain
| | | | | | | | | | | |
Collapse
|
16
|
Abstract
OBJECTIVE Non-response to treatment with antidepressants (AD) is a clinical problem. METHOD The algorithm for pharmacological treatment of the Dutch multidisciplinary guideline for depression is compared with four other algorithms. RESULTS The Dutch algorithm consists of five subsequent steps. Treatment is started with one out of many optional ADs (step 1); in case of non-response after 4-10 weeks, best evidence is for switching to another AD (step 2); next step is augmentation with lithium as the best option (step 3); the next step is a monoamine oxidase inhibitor (MAOI) (step 4); and finally electroconvulsive therapy (step 5). There are major differences with other algorithms regarding timing of augmentation step, best agents for augmentation and role of MAOI. CONCLUSION Algorithms for AD treatment vary according to national and local preferences. Although the evidence for most of the treatment strategies is rather meagre, an AD algorithm appears to be an useful instrument in clinical practice.
Collapse
Affiliation(s)
- J Spijker
- De Gelderse Roos, Mental Health Care, Ede, the Netherlands.
| | | |
Collapse
|
17
|
Lai CH. Mirtazapine and Bupropion Combined Treatment in Treatment-resistant Depression. Tzu Chi Med J 2009. [DOI: 10.1016/s1016-3190(09)60071-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
18
|
Preti A, Rucci P, Gigantesco A, Santone G, Picardi A, Miglio R, de Girolamo G. Patterns of care in patients discharged from acute psychiatric inpatient facilities: a national survey in Italy. Soc Psychiatry Psychiatr Epidemiol 2009; 44:767-76. [PMID: 19212696 DOI: 10.1007/s00127-009-0498-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 01/13/2009] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To analyze the characteristics of patients scheduled for discharge from acute psychiatric inpatient facilities in Italy, and their pattern of care. METHODS Socio-demographic and clinical characteristics, and patterns of care of 1,330 patients discharged from public and private inpatient facilities in Italy were assessed with a standardized methodology during an index period in the year 2004. RESULTS About one half of the sample had schizophrenia or bipolar disorder. However, the case-mix differed between public and private facilities, where in-patients had more frequently mood and anxiety disorders. The use of two or more drugs was very common, involving more than 90% of patients and including typically benzodiazepines and antipsychotics. Structured psychosocial treatments were rarely initiated during the hospital stay. Increasing age, male gender, long stay in the facility (>60 days), personality disorder and type of facility were associated with a higher likelihood of being discharged to a community residential facility. Predictors of discharge to another psychiatric facility were increasing age, being single, schizophrenia, personality disorder and organic mental disorder. Families were not involved in decisions about patients' discharge in a significant proportion of cases. University psychiatric clinics and private facilities were less coordinated with the community system of care than General Hospital Psychiatric Units. Referral of patients with substance use disorder to drug addiction services occurred in just 30% of subjects. CONCLUSIONS This study provides information on the characteristics and the pattern of care of patients discharged from inpatient facilities in a country that has closed down all its mental hospitals. This information may be relevant for those countries that are affording now the downsizing of MHs, and the expansion of community-based models of care.
Collapse
Affiliation(s)
- Antonio Preti
- Dept. of Psychology, University of Cagliari, Cagliari, Italy
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Millan MJ. Dual- and triple-acting agents for treating core and co-morbid symptoms of major depression: novel concepts, new drugs. Neurotherapeutics 2009; 6:53-77. [PMID: 19110199 PMCID: PMC5084256 DOI: 10.1016/j.nurt.2008.10.039] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The past decade of efforts to find improved treatment for major depression has been dominated by genome-driven programs of rational drug discovery directed toward highly selective ligands for nonmonoaminergic agents. Selective drugs may prove beneficial for specific symptoms, for certain patient subpopulations, or both. However, network analyses of the brain and its dysfunction suggest that agents with multiple and complementary modes of action are more likely to show broad-based efficacy against core and comorbid symptoms of depression. Strategies for improved multitarget exploitation of monoaminergic mechanisms include triple inhibitors of dopamine, serotonin (5-HT) and noradrenaline reuptake, and drugs interfering with feedback actions of monoamines at inhibitory 5-HT(1A), 5-HT(1B) and possibly 5-HT(5A) and 5-HT(7) receptors. Specific subsets of postsynaptic 5-HT receptors mediating antidepressant actions are under study (e.g., 5-HT(4) and 5-HT(6)). Association of a clinically characterized antidepressant mechanism with a nonmonoaminergic component of activity is an attractive strategy. For example, agomelatine (a melatonin agonist/5-HT(2C) antagonist) has clinically proven activity in major depression. Dual neurokinin(1) antagonists/5-HT reuptake inhibitors (SRIs) and melanocortin(4) antagonists/SRIs should display advantages over their selective counterparts, and histamine H(3) antagonists/SRIs, GABA(B) antagonists/SRIs, glutamatergic/SRIs, and cholinergic agents/SRIs may counter the compromised cognitive function of depression. Finally, drugs that suppress 5-HT reuptake and blunt hypothalamo-pituitary-adrenocorticotrophic axis overdrive, or that act at intracellular proteins such as GSK-3beta, may abrogate the negative effects of chronic stress on mood and neuronal integrity. This review discusses the discovery and development of dual- and triple-acting antidepressants, focusing on novel concepts and new drugs disclosed over the last 2 to 3 years.
Collapse
Affiliation(s)
- Mark J Millan
- Psychopharmacology Department, Institut du Recherches Servier, Centre de Recherches de Croissy, Paris, France.
| |
Collapse
|
20
|
Lambert M, Naber D, Huber CG. Management of incomplete remission and treatment resistance in first-episode psychosis. Expert Opin Pharmacother 2008; 9:2039-51. [PMID: 18671460 DOI: 10.1517/14656566.9.12.2039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
21
|
Anderson IM, Ferrier IN, Baldwin RC, Cowen PJ, Howard L, Lewis G, Matthews K, McAllister-Williams RH, Peveler RC, Scott J, Tylee A. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology guidelines. J Psychopharmacol 2008; 22:343-96. [PMID: 18413657 DOI: 10.1177/0269881107088441] [Citation(s) in RCA: 335] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A revision of the 2000 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in May 2006. Key areas in treating depression were reviewed, and the strength of evidence and clinical implications were considered. The guidelines were drawn up after extensive feedback from participants and interested parties. A literature review is provided, which identifies the quality of evidence to inform the recommendations, the strength of which are based on the level of evidence. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse, and stopping treatment.
Collapse
Affiliation(s)
- I M Anderson
- Senior Lecturer and Honorary Consultant Psychiatrist, Neuroscience and Psychiatry Unit, University of Manchester, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Malhi GS, Ng F, Berk M. Dual-dual action? Combining venlafaxine and mirtazapine in the treatment of depression. Aust N Z J Psychiatry 2008; 42:346-9. [PMID: 18330778 DOI: 10.1080/00048670701881587] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Venlafaxine and mirtazapine in combination are increasingly used in clinical practice to treat treatment-refractory depression. Putative efficacy for this combination of antidepressants, beyond that of monotherapy, stems from their synergistic actions. This paper describes a prospective case series that examined the efficacy of the venlafaxine-mirtazapine combination in the treatment of depressed patients who had failed at least one antidepressant trial. METHOD Twenty-two depressed patients with major depression were treated with venlafaxine and mirtazapine in combination for an average of just under 8 weeks. Baseline ratings on the 17-item Hamilton Depression Rating Scale (HAM-D(17)), Montgomery-Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression-Severity Scale (CGI-S) were repeated at end-point, determined by the naturalistic termination of the depressive treatment episode or the discontinuation of the combination treatment due to adverse effects. The length of treatment until end-point was documented for each patient. Descriptive statistics were used on the collated data. RESULTS At baseline, mean scores were 28.8 (SD=3.8) for HAM-D(17), 30.1 (SD=5.8) for MADRS, and 4.5 (SD=0.5) for CGI-S, reflecting a cohort at the moderate to severe end of the spectrum. At end-point, mean absolute scores were 10.2 (SD=4.7) for HAM-D(17), 10.8 (SD=4.6) for MADRS, and 2.3 (SD=0.6) for CGI-S. Mean change from baseline was 18.6 (SD=6.4) for HAM-D(17), 19.3 (SD=6.8) for MADRS, and 2.3 (SD=0.6) for CGI-S. Mean duration of treatment was approximately 8 weeks, producing a response rate of 81.8% and a remission rate of 27.3%. Only one patient was unable to tolerate the combination although nearly half (10) had significant side-effects during treatment. CONCLUSION This study demonstrates relatively high response and remission rates that are encouraging and contribute to the efficacy database for this antidepressant combination. Further studies using randomized controlled designs are needed.
Collapse
Affiliation(s)
- Gin S Malhi
- Discipline of Psychological Medicine, University of Sydney, Sydney, New South Wales, Australia.
| | | | | |
Collapse
|
23
|
Álamo C, López-Muñoz F, Rubio G, García-García P, Pardo A. Combined treatment with reboxetine in depressed patients with no response to venlafaxine: a 6-week follow-up study. Acta Neuropsychiatr 2007; 19:291-6. [PMID: 26952941 DOI: 10.1111/j.1601-5215.2007.00187.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of present study was to evaluate the efficacy of the addition of reboxetine in patients that had not previously responded, or had done so only partially, over 6 weeks of conventional pharmacological treatment with venlafaxine. METHODS This open-label, prospective and multicentric study included 40 outpatients diagnosed with major depressive disorder according to the DSM-IV criteria. Efficacy was assessed using the 21-item Hamilton Depression Rating Scale (HAMD) and the Clinical Global Impression-Improvement (CGI-I). Safety was evaluated by recording spontaneously reported adverse events. Data were analysed on an intent-to-treat basis, using the last-observation-carried-forward method. RESULTS Mean HAMD reduction was 34.9% (P < 0.0001). The percentages of responders (≥50% reduction in HAMD) and patients considered as benefiting from complete remission (HAMD ≤ 10 points) at week 6 were 27.5 and 12.5%, respectively. By the end of the treatment, the score of CGI-I decreased 24.8% (P < 0.0001). Percentage of patient improving (CGI < 4 points) was 47.5%. The most common non-serious adverse events were constipation, nervousness, anxiety and insomnia. CONCLUSION These findings suggest that the combined treatment of reboxetine and venlafaxine, in venlafaxine-resistant patients, may be an effective and well-tolerated strategy.
Collapse
Affiliation(s)
- Cecilio Álamo
- 1Pharmacology Department, Faculty of Medicine, University of Alcalá, Madrid, Spain
| | | | - Gabriel Rubio
- 2Retiro Mental Health Services, Department of Psychiatry, Complutense University, Madrid, Spain
| | - Pilar García-García
- 1Pharmacology Department, Faculty of Medicine, University of Alcalá, Madrid, Spain
| | - Antonio Pardo
- 3Department of Social Psychology and Methodology, Faculty of Psychology, Autonome University, Madrid, Spain
| |
Collapse
|
24
|
López-Muñoz F, Rubio G, Alamo C, García-García P, Pardo A. Reboxetine addition in patients with mirtazapine-resistant depression: a case series. Clin Neuropharmacol 2006; 29:192-6. [PMID: 16855420 DOI: 10.1097/01.wnf.0000228211.19818.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Treatment-resistant depression is a common occurrence in clinical practice as well as combination treatment with 2 different antidepressants. In the present case series, we study the effectiveness of the addition of reboxetine, during 12 weeks, to 14 outpatients diagnosed with major depressive disorder, according to Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria, who had previously failed to respond or who had only responded partially, over a period of 6 weeks, to conventional treatment with mirtazapine. METHODS Evaluation of antidepressant efficacy was carried out through the application of the 21-item Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impressions-Global Improvement Scale (CGI-I). RESULTS The percentages of responders (HDRS>or=50%), patients in remission (HDRS<or=10), and improving (CGI-I absolute value<4) were 35.7%, 28.6%, and 64.3%, respectively. No serious side effects were observed during combination therapy, being more frequent dry mouth (2 cases). CONCLUSIONS The initial findings of our study show that reboxetine and mirtazapine may constitute an effective and low side effects combination.
Collapse
Affiliation(s)
- Francisco López-Muñoz
- Department of Pharmacology, Faculty of Medicine, University of Alcalá, Madrid, Spain.
| | | | | | | | | |
Collapse
|