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Zhai SY, Gu HW, Wang C, Li YS, Tang HB. Gynura procumbens and selected metabolites: Amelioration of depressive-like behaviors in mice and risperidone-induced hyperprolactinemia in rats. Biomed Pharmacother 2024; 173:116361. [PMID: 38428310 DOI: 10.1016/j.biopha.2024.116361] [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: 12/27/2023] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024] Open
Abstract
Gynura procumbens (Lour.) Merr., utilized in traditional Chinese medicine, is known for its liver-protective, liver-soothing, and depression-alleviating properties. This research examines the antidepressant and anti-hyperprolactinemia potentials of an ethanol extract from G. procumbens stems (EEGS) and specific metabolites. To model depression and hyperprolactinemia, chronic unpredictable mild stress (CUMS) was induced in mice and risperidone was administered to rats, respectively. Treatments involved administering low (5 mg/kg), medium (25 mg/kg), and high (125 mg/kg) doses of EEGS and certain metabolites to both models. Behavioral assessments were conducted in the CUMS-induced mice, while the CA3 neuronal damage in mice and histopathological alterations in rat mammary glands were evaluated using Nissl and Hematoxylin & Eosin staining techniques, respectively. EEGS decreased immobility times in the forced swimming and tail suspension tests in mice, enhancing their exploration of the central zone. It elevated the serum levels of 5-hydroxytryptamine, norepinephrine, estradiol, luteinizing hormone (LH), and testosterone in mice. Moreover, EEGS restored the neuronal cell arrangement in the CA3 area, reduced interleukin-1beta mRNA production, and increased the expression of interleukin-10 and beta-catenin mRNA. In the context of risperidone-induced hyperprolactinemia, EEGS lowered blood prolactin levels, reduced the dimensions of rat nipples, and enhanced LH, progesterone, and dopamine levels, alongside mitigating mammary hyperplasia. Among the EEGS selected metabolites, the combined effect of chlorogenic acid and trans-p-coumaric acid was found to be more effective than the action of each compound in isolation. Collectively, the findings indicate that EEGS and its selected metabolites offer promising antidepressant benefits while counteracting hyperprolactinemia.
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Affiliation(s)
- Si-Yu Zhai
- Lab of Hepatopharmacology and Ethnopharmacology, School of Pharmaceutical Sciences, South-central Minzu University, No. 182, Minyuan Road, Wuhan 430074, China
| | - Hong-Wei Gu
- Department of Pharmacy, Wuhan Mental Health Center, NO. 89, Gongnongbing Road, Jiang'an District, Wuhan 430012, China
| | - Cong Wang
- Lab of Hepatopharmacology and Ethnopharmacology, School of Pharmaceutical Sciences, South-central Minzu University, No. 182, Minyuan Road, Wuhan 430074, China
| | - Yu-Sang Li
- Lab of Hepatopharmacology and Ethnopharmacology, School of Pharmaceutical Sciences, South-central Minzu University, No. 182, Minyuan Road, Wuhan 430074, China.
| | - He-Bin Tang
- Lab of Hepatopharmacology and Ethnopharmacology, School of Pharmaceutical Sciences, South-central Minzu University, No. 182, Minyuan Road, Wuhan 430074, China.
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Domingues RR, Wiltbank MC, Hernandez LL. The antidepressant fluoxetine (Prozac®) modulates estrogen signaling in the uterus and alters estrous cycles in mice. Mol Cell Endocrinol 2023; 559:111783. [PMID: 36198363 PMCID: PMC10038119 DOI: 10.1016/j.mce.2022.111783] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 02/03/2023]
Abstract
Selective serotonin reuptake inhibitors (SSRI) are the most used antidepressants. However, up to 80% of women taking SSRI suffer from sexual dysfunction. We investigated the effects of fluoxetine (Prozac®) (low and high dose, n = 6-7/group) on reproductive function and the regulation of the estrous cycle. All mice treated with high dose of fluoxetine had interruption of estrous cycles within a few days after onset of treatment. When treated for 14 days, mice in the high dose group had fewer CL, often lack of any CL, and antral follicles. Uterine expression of estrogen receptor alpha, G-protein coupled estrogen receptor, and steroidogenesis enzymes were upregulated in the high dose group. Nevertheless, decreased expression of connexin 43 and alkaline phosphatase and increased expression of insulin-like growth factor-binding protein 3 and monoamine oxidase A are consistent with decreased estrogen signaling and the decreased uterine weight. Taken together, fluoxetine modulates estrogen synthesis/signaling and dysregulates estrous cycles.
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Affiliation(s)
- Rafael R Domingues
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, USA; Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Milo C Wiltbank
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, USA; Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Laura L Hernandez
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, USA; Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, USA.
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Vortioxetine-Induced Amenorrhea: A Case Report. Clin Neuropharmacol 2022; 45:7-8. [PMID: 35029863 DOI: 10.1097/wnf.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vortioxetine is a novel multimodal antidepressant for the treatment of major depressive disorders and is widely used in clinical practice. Vortioxetine has a safe profile. However, there are case reports of other adverse effects in the literature. In this article, a case of amenorrhea due to vortioxetine is presented. CASE The patient is 36 years old, married, female, and is an anesthesiologist. She applied to the psychiatric outpatient clinic with symptoms of major depression. Vortioxetine was initiated at 10 mg/d and then gradually increased to 20 mg/d. She had regular menstruation until now. However, she did not menstruate after taking vortioxetine. The patient used vortioxetine for 3 months and never had a period. Pregnancy test and other tests to investigate organic etiology were normal. Two weeks after discontinuation of vortioxetine, the patient had a menstrual period. CONCLUSIONS Further research is needed on the relationship and possible mechanisms between vortioxetine and amenorrhea.
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Masoudi M, Ansari S, Kashani L, Tavolinejad H, Hossein Rashidi B, Esalatmanesh S, Ghazizadeh-Hashemi M, Noorbala AA, Akhondzadeh S. Effect of sertraline on depression severity and prolactin levels in women with polycystic ovary syndrome: a placebo-controlled randomized trial. Int Clin Psychopharmacol 2021; 36:238-243. [PMID: 34030169 DOI: 10.1097/yic.0000000000000367] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is a paucity of data regarding the safety and efficacy of antidepressant therapy in women with polycystic ovary syndrome and depression. The effect of antidepressant medications on circulating prolactin levels is of concern in this patient population. We aimed to evaluate the effect of sertraline on depression severity and serum prolactin levels in women with polycystic ovary syndrome and mild-to-moderate depression. In a parallel-design, two-center, randomized controlled trial, we stratified participants according to their baseline prolactin level into normal (<25 ng/mL) and high (≥25 ng/mL) prolactin groups. Each group was randomized to receive 50 mg daily sertraline (up-titrated after 25 mg daily for 1 week) or placebo. The enrolling physicians, outcome assessors, and study subjects were all blind to the treatment. Depression severity was assessed by the Hamilton depression rating scale at baseline, the third, and the sixth weeks. The primary efficacy outcome was a change in depression severity. Prolactin levels were checked at baseline and after 6 weeks, and the safety outcome was the alteration in prolactin levels. Overall, 513 women were screened for eligibility in two outpatient clinics. Ultimately, 74 (38 normal prolactin and 36 high prolactin level) individuals were randomized. After 6 weeks of follow-up, depression severity was significantly reduced among patients who received sertraline regardless of the baseline prolactin levels (all between subjects P < 0.001). Furthermore, there was no difference in prolactin levels between the sertraline and placebo arms in normal (P = 0.80) or high prolactin (P = 0.21) groups. Sertraline is a well-tolerated and effective choice for treating depression in women with polycystic ovary syndrome. Future studies with longer follow-up periods are required to draw more robust conclusions.
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Affiliation(s)
- Maryam Masoudi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital
| | | | | | | | | | | | - Maryam Ghazizadeh-Hashemi
- Mental Health Research Center, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Galactorrhea during antipsychotic treatment: results from AMSP, a drug surveillance program, between 1993 and 2015. Eur Arch Psychiatry Clin Neurosci 2021; 271:1425-1435. [PMID: 33768297 PMCID: PMC8563638 DOI: 10.1007/s00406-021-01241-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/12/2021] [Indexed: 11/25/2022]
Abstract
Galactorrhea is a well-known adverse drug reaction (ADR) of numerous antipsychotic drugs (APD) and is often distressing for those affected. Methodological problems in the existing literature make it difficult to determine the prevalence of symptomatic hyperprolactinemia in persons treated with APDs. Consequently, a large sample of patients exposed to APDs is needed for more extensive evaluation. Data on APD utilization and reports of galactorrhea caused by APDs were analyzed using data from an observational pharmacovigilance program in German-speaking countries-Arzneimittelsicherheit in der Psychiatrie (AMSP)-from 1993 to 2015. 320,383 patients (175,884 female inpatients) under surveillance were treated with APDs for schizophrenia and other indications. A total of 170 events of galactorrhea caused by APDs were identified (0.97 cases in 1000 female inpatient admissions). Most cases occurred during the reproductive age with the highest incidence among patients between 16 and 30 years (3.81 cases in 1000 inpatients). The APDs that were most frequently imputed alone for inducing galactorrhea were risperidone (52 cases and 0.19% of all exposed inpatients), amisulpride (30 resp. 0.48%), and olanzapine (13 resp. 0.05%). In three cases, quetiapine had a prominent role as a probable cause for galactorrhea. High dosages of the imputed APDs correlated with higher rates of galactorrhea. Galactorrhea is a severe and underestimated condition in psychopharmacology. While some APDs are more likely to cause galactorrhea, we identified a few unusual cases. This highlights the importance of alertness in clinical practice and of taking a patient's individual situation into consideration.
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Nebhinani N, Suthar N, Modi S. Fluoxetine-induced pseudocyesis in a patient with obsessive-compulsive disorder: A case report. Indian J Psychiatry 2018; 60:370-371. [PMID: 30405270 PMCID: PMC6201658 DOI: 10.4103/psychiatry.indianjpsychiatry_405_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Naresh Nebhinani
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India. E-mail:
| | - Navratan Suthar
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India. E-mail:
| | - Shruti Modi
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India. E-mail:
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Abstract
The concept of the ovarian continuum can be understood as a process that occurs during a woman's lifetime and begins during intrauterine life with fertilization. Women start their reproductive years with approximately five hundred thousand follicles containing oocytes, of which only around five hundred will be released during ovulation. Ovulation has been recognized as an event linked with reproduction; however, recent evidence supports the role of ovulation as a sign of health. The use of biomarkers that help women recognize ovulation enables them to identify their health status. This knowledge helps medical healthcare providers in the prevention, diagnosis, and treatment of different pathologies related with endocrine disorders, gynecological abnormalities, autoimmune, genetic, and neoplastic diseases, as well as pregnancy-related issues. The knowledge of the ovarian continuum and the use of biomarkers to recognize ovulation should be considered a powerful tool for women and medical professionals. Summary The ovarian continuum is a process that occurs during a woman's lifetime. It begins during intrauterine life with fertilization and ends with menopause. This process can be greatly affected by different conditions such as changes in hormonal levels and illnesses. Therefore, understanding and promoting the knowledge and use of biomarkers of ovulation in women is a key aspect to consider when evaluating their health status. The knowledge and education about the ovarian continuum should be taken into account as a powerful tool for women and medical professionals.
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Affiliation(s)
- Pilar Vigil
- Biomedical Division, Reproductive Health Research Institute (RHRI), Santiago, Chile.,Pontificia Universidad Católica de Chile, Vicerrectoría de Comunicaciones, Santiago, Chile
| | - Carolina Lyon
- Biomedical Division, Reproductive Health Research Institute (RHRI), Santiago, Chile
| | - Betsi Flores
- Biomedical Division, Reproductive Health Research Institute (RHRI), Santiago, Chile
| | - Hernán Rioseco
- Biomedical Division, Reproductive Health Research Institute (RHRI), Santiago, Chile
| | - Felipe Serrano
- Biomedical Division, Reproductive Health Research Institute (RHRI), Santiago, Chile
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Carvalho AF, Sharma MS, Brunoni AR, Vieta E, Fava GA. The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 85:270-88. [PMID: 27508501 DOI: 10.1159/000447034] [Citation(s) in RCA: 348] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/24/2016] [Indexed: 11/19/2022]
Abstract
Newer generation antidepressant drugs (ADs) are widely used as the first line of treatment for major depressive disorders and are considered to be safer than tricyclic agents. In this critical review, we evaluated the literature on adverse events, tolerability and safety of selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, bupropion, mirtazapine, trazodone, agomelatine, vilazodone, levomilnacipran and vortioxetine. Several side effects are transient and may disappear after a few weeks following treatment initiation, but potentially serious adverse events may persist or ensue later. They encompass gastrointestinal symptoms (nausea, diarrhea, gastric bleeding, dyspepsia), hepatotoxicity, weight gain and metabolic abnormalities, cardiovascular disturbances (heart rate, QT interval prolongation, hypertension, orthostatic hypotension), genitourinary symptoms (urinary retention, incontinence), sexual dysfunction, hyponatremia, osteoporosis and risk of fractures, bleeding, central nervous system disturbances (lowering of seizure threshold, extrapyramidal side effects, cognitive disturbances), sweating, sleep disturbances, affective disturbances (apathy, switches, paradoxical effects), ophthalmic manifestations (glaucoma, cataract) and hyperprolactinemia. At times, such adverse events may persist after drug discontinuation, yielding iatrogenic comorbidity. Other areas of concern involve suicidality, safety in overdose, discontinuation syndromes, risks during pregnancy and breast feeding, as well as risk of malignancies. Thus, the rational selection of ADs should consider the potential benefits and risks, likelihood of responsiveness to the treatment option and vulnerability to adverse events. The findings of this review should alert the physician to carefully review the appropriateness of AD prescription on an individual basis and to consider alternative treatments if available.
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Affiliation(s)
- André F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
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Galactorrhea After Selective Serotonin Reuptake Inhibitor Use in an Adolescent Girl: A Case Report. J Clin Psychopharmacol 2017; 37:374-376. [PMID: 28383361 DOI: 10.1097/jcp.0000000000000709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Selvaraj V, Hour S, Gunasekar P, Gray C, Smith JF. Escitalopram-Induced Amenorrhea and False Positive Urine Pregnancy Test. Korean J Fam Med 2017; 38:40-42. [PMID: 28197332 PMCID: PMC5305664 DOI: 10.4082/kjfm.2017.38.1.40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 05/10/2016] [Accepted: 05/13/2016] [Indexed: 11/12/2022] Open
Abstract
Escitalopram is a selective serotonin reuptake inhibitor antidepressant approved by the Food and Drug Administration for the treatment of major depressive disorder and generalized anxiety disorder. A 34-year-old female patient with major depressive disorder developed amenorrhea and had a false-positive urine pregnancy test after initiation of escitalopram treatment. To our knowledge, no published case report of amenorrhea and false-positive urine pregnancy tests in women taking escitalopram exists. This case report suggests that women of child-bearing age should be carefully monitored for amenorrhea while they are on an antidepressant treatment regimen.
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Affiliation(s)
- Vithyalakshmi Selvaraj
- Department of Psychiatry, Creighton University School of Medicine, Omaha, USA.; Department of Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, USA
| | - Siv Hour
- Department of Psychiatry, Creighton University School of Medicine, Omaha, USA
| | - Palanikumar Gunasekar
- Department of Biomedical Sciences, Creighton University School of Medicine, Omaha, USA
| | - Caron Gray
- Department of Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, USA
| | - James F Smith
- Department of Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, USA
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Kukreti P, Ali W, Jiloha RC. Rising Trend of Use of Antidepressants Induced Non- Puerperal Lactation: A Case Report. J Clin Diagn Res 2016; 10:VD01-VD02. [PMID: 27504388 DOI: 10.7860/jcdr/2016/19266.7928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/06/2016] [Indexed: 11/24/2022]
Abstract
Non puerperal lactation or galactorrhea is a well known side effect of antipsychotic drugs but has been infrequently described with the use of antidepressants. In past few decades, there have been emerging trend of isolated case reports of selective serotonin reuptake inhibitors induced non puerperal lactation. We report a case of non puerperal lactation following usage of second generation tricyclic antidepressant, nortriptyline and resolution on withdrawing the drug. Literature review has been done for antidepressant induced galactorrhea to understand the current trends, putative mechanism as different from one implicated for antipsychotics and its clinical utility.
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Affiliation(s)
- Prerna Kukreti
- Assistant Professor, Department of Psychiatry, Hamdard Institute of Medical Science & Research (HIMSR) , Jamia Hamdard, Delhi, India
| | - Wazid Ali
- Pharmacovigilance Technical Associate, IPC Ghaziabad, MoH & FW, Govt. of India, posted at Hamdard Institute of Medical Science & Research (HIMSR), Jamia Hamdard, Delhi, India
| | - R C Jiloha
- Professor and Head, Department of Psychiatry & Rehabilitation Sciences, Hamdard Institute of Medical Science & Research (HIMSR) , Jamia Hamdard, Delhi, India
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Zhou B, Xie S, Hu J, Sun X, Guan H, Deng Y. Paroxetine Increased the Serum Estrogen in Postmenopausal Women with Depressive and Anxiety Symptoms. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojd.2014.35022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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