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Arai K, Nonaka M, Shimada S, Nakamura M. Vortioxetine as a potential alternative for patients with escitalopram-induced jitteriness/anxiety syndrome: A report of three cases. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e158. [PMID: 38868737 PMCID: PMC11114283 DOI: 10.1002/pcn5.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 06/14/2024]
Abstract
Background Jitteriness/anxiety syndrome is a recognized adverse effect observed during the initiation or change of dose in antidepressant treatment. Managing patients who develop this syndrome remains a challenge. While escitalopram is a widely used antidepressant known to cause these symptoms, this report explores vortioxetine as a therapeutic alternative. Case Presentation Three distinct clinical scenarios were observed in patients who manifested jitteriness/anxiety syndrome while on escitalopram treatment for depression. Patient A was initiated on escitalopram and experienced an initial alleviation in depressive symptoms, but 3 months later displayed mood elevation, talkativeness, and increased activity, which disturbed his daily life. A transition to vortioxetine subsequently resolved the mood elevation. Patient B exhibited elevated mood, hyperactivity, irritability, and talkativeness just 6 days post-initiation of treatment with escitalopram. After the discontinuation of escitalopram and unsuccessful trials with aripiprazole, lurasidone, and lamotrigine, her depressive mood intensified, culminating in suicidal ideation. Starting vortioxetine led to a consistent improvement of her symptoms, and she resumed work and was emotionally stable. Patient C was initially diagnosed with bipolar disorder and faced a relapse into depression despite undergoing various treatments. After 2 weeks on escitalopram, she exhibited irritability and self-harm urges. Three months later, after being re-diagnosed with depressive disorders with anxious distress, vortioxetine was administered, which significantly reduced her depressive symptoms and allowed her to continue her education. Conclusion Vortioxetine presents as a promising therapeutic alternative that is worth considering for patients with escitalopram-induced jitteriness/anxiety syndrome.
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Affiliation(s)
- Kaoru Arai
- Department of PsychiatryKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Mari Nonaka
- Department of PsychiatryKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Shoko Shimada
- Department of PsychiatryKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Masayuki Nakamura
- Department of PsychiatryKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
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de Sousa TR, Dt C, Novais F. Exploring the Hypothesis of a Schizophrenia and Bipolar Disorder Continuum: Biological, Genetic and Pharmacologic Data. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2023; 22:161-171. [PMID: 34477537 DOI: 10.2174/1871527320666210902164235] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/19/2021] [Accepted: 08/08/2021] [Indexed: 12/16/2022]
Abstract
Present time nosology has its roots in Kraepelin's demarcation of schizophrenia and bipolar disorder. However, accumulating evidence has shed light on several commonalities between the two disorders, and some authors have advocated for the consideration of a disease continuum. Here, we review previous genetic, biological and pharmacological findings that provide the basis for this conceptualization. There is a cross-disease heritability, and they share single-nucleotide polymorphisms in some common genes. EEG and imaging patterns have a number of similarities, namely reduced white matter integrity and abnormal connectivity. Dopamine, serotonin, GABA and glutamate systems have dysfunctional features, some of which are identical among the disorders. Finally, cellular calcium regulation and mitochondrial function are, also, impaired in the two.
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Affiliation(s)
- Teresa Reynolds de Sousa
- Department of Neurosciences and Mental Health, Centro Hospitalar Universitário Lisboa Norte (CHULN), Hospital de Santa Maria, Lisbon, Portugal
| | - Correia Dt
- Department of Neurosciences and Mental Health, Centro Hospitalar Universitário Lisboa Norte (CHULN), Hospital de Santa Maria, Lisbon, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- ISAMB - Instituto de Saúde Ambiental, Lisboa, Portugal
| | - Filipa Novais
- Department of Neurosciences and Mental Health, Centro Hospitalar Universitário Lisboa Norte (CHULN), Hospital de Santa Maria, Lisbon, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- ISAMB - Instituto de Saúde Ambiental, Lisboa, Portugal
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3
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Kato T. Current understanding of bipolar disorder: Toward integration of biological basis and treatment strategies. Psychiatry Clin Neurosci 2019; 73:526-540. [PMID: 31021488 DOI: 10.1111/pcn.12852] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 12/18/2022]
Abstract
Biological studies of bipolar disorder initially focused on the mechanism of action for antidepressants and antipsychotic drugs, and the roles of monoamines (e.g., serotonin, dopamine) have been extensively studied. Thereafter, based on the mechanism of action of lithium, intracellular signal transduction systems, including inositol metabolism and intracellular calcium signaling, have drawn attention. Involvement of intracellular calcium signaling has been supported by genetics and cellular studies. Elucidation of the neural circuits affected by calcium signaling abnormalities is critical, and our previous study suggested a role of the paraventricular thalamic nucleus. The genetic vulnerability of mitochondria causes calcium dysregulation and results in the hyperexcitability of serotonergic neurons, which are suggested to be susceptible to oxidative stress. Efficacy of anticonvulsants, animal studies of candidate genes, and studies using induced pluripotent stem cell-derived neurons have suggested a relation between bipolar disorder and the hyperexcitability of neurons. Recent genetic findings suggest the roles of polyunsaturated acids. At the systems level, social rhythm therapy targets circadian rhythm abnormalities, and cognitive behavioral therapy may target emotion/cognition (E/C) imbalance. In the future, pharmacological and psychosocial treatments may be combined and optimized based on the biological basis of each patient, which will realize individualized treatment.
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Affiliation(s)
- Tadafumi Kato
- Laboratory for Molecular Dynamics of Mental Disorders, RIKEN Center for Brain Science, Wako, Japan
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Manchia M, Carpiniello B, Valtorta F, Comai S. Serotonin Dysfunction, Aggressive Behavior, and Mental Illness: Exploring the Link Using a Dimensional Approach. ACS Chem Neurosci 2017; 8:961-972. [PMID: 28378993 DOI: 10.1021/acschemneuro.6b00427] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aggressive individuals have higher rates of mental illness compared to non-aggressive individuals. Multiple factors, including psychosocial, genetic, and neurobiological determinants modulate the liability to both aggressive behavior and mental illness. Concerning the latter factors, multiple lines of evidence have shown a dysfunction in the serotonin (5-HT) system occurring in aggressive and in mentally ill individuals. In particular, reduced 5-HT activity has been associated with depression as well as with aggressive behavior, especially with impulsive aggression. Consistently, psychopharmacological interventions aimed at boosting the 5-HT system (e.g., with selective serotonin reuptake inhibitors) have demonstrated therapeutic efficacy in a high percentage of patients with either or both pathological conditions. Current knowledge does not yet allow to clearly disentangle whether 5-HT dysfunction, most often a 5-HT deficiency, is the cause or the consequence of the aggressive/violent behavior, of the underlying mental disease/s, or the expression of the comorbidity. Future studies are thus needed to clarify the association between changes in 5-HT levels, altered activity of 5-HT receptors and their intracellular signaling cascades, and modifications of 5-HT genes, and in particular the neurobiological link between the altered 5-HT machinery and aggressive behavior in the context or in the absence of mental illness. In this Review, we employ a dimensional approach to discuss the trivariate relationship among the 5-HT system, aggressive behavior, and mental illness, focusing our attention on 5-HT levels, 5-HT receptors, metabolic enzymes, and their genes. Emphasis is given to controversial findings, still unanswered questions, and future perspectives.
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Affiliation(s)
- Mirko Manchia
- Section of Psychiatry,
Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Bernardo Carpiniello
- Section of Psychiatry,
Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
| | - Flavia Valtorta
- San Raffaele Scientific Institute and Vita Salute University, Via Olgettina 58, 20132 Milano, Italy
| | - Stefano Comai
- San Raffaele Scientific Institute and Vita Salute University, Via Olgettina 58, 20132 Milano, Italy
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Davis MT, Holmes SE, Pietrzak RH, Esterlis I. Neurobiology of Chronic Stress-Related Psychiatric Disorders: Evidence from Molecular Imaging Studies. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2017; 1:2470547017710916. [PMID: 29862379 PMCID: PMC5976254 DOI: 10.1177/2470547017710916] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/30/2017] [Accepted: 05/01/2017] [Indexed: 01/12/2023]
Abstract
Chronic stress accounts for billions of dollars of economic loss annually in the United States alone, and is recognized as a major source of disability and mortality worldwide. Robust evidence suggests that chronic stress plays a significant role in the onset of severe and impairing psychiatric conditions, including major depressive disorder, bipolar disorder, and posttraumatic stress disorder. Application of molecular imaging techniques such as positron emission tomography and single photon emission computed tomography in recent years has begun to provide insight into the molecular mechanisms by which chronic stress confers risk for these disorders. The present paper provides a comprehensive review and synthesis of all positron emission tomography and single photon emission computed tomography imaging publications focused on the examination of molecular targets in individuals with major depressive disorder, posttraumatic stress disorder, or bipolar disorder to date. Critical discussion of discrepant findings and broad strengths and weaknesses of the current body of literature is provided. Recommended future directions for the field of molecular imaging to further elucidate the neurobiological substrates of chronic stress-related disorders are also discussed. This article is part of the inaugural issue for the journal focused on various aspects of chronic stress.
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Affiliation(s)
- Margaret T. Davis
- Department of Psychiatry, Yale School of
Medicine, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical
Imaging, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Sophie E. Holmes
- Department of Psychiatry, Yale School of
Medicine, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical
Imaging, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Robert H. Pietrzak
- Department of Psychiatry, Yale School of
Medicine, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical
Imaging, Yale School of Medicine, Yale University, New Haven, CT, USA
- US Department of Veterans Affairs National
Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT,
USA
| | - Irina Esterlis
- Department of Psychiatry, Yale School of
Medicine, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical
Imaging, Yale School of Medicine, Yale University, New Haven, CT, USA
- US Department of Veterans Affairs National
Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT,
USA
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6
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Aging-induced changes in brain regional serotonin receptor binding: Effect of Carnosine. Neuroscience 2016; 319:79-91. [DOI: 10.1016/j.neuroscience.2016.01.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 01/14/2016] [Indexed: 12/11/2022]
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Mirzakhani H, van Noorden MS, Swen J, Nozari A, Guchelaar HJ. Pharmacogenetics in electroconvulsive therapy and adjunctive medications. Pharmacogenomics 2015; 16:1015-31. [DOI: 10.2217/pgs.15.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Electroconvulsive therapy (ECT) has shown apparent efficacy in treatment of patients with depression and other mental illnesses who do not respond to psychotropic medications or need urgent control of their symptoms. Pharmacogenetics contributes to an individual's sensitivity and response to a variety of drugs. Clinical insights into pharmacogenetics of ECT and adjunctive medications not only improves its safety and efficacy in the indicated patients, but can also lead to the identification of novel treatments in psychiatric disorders through understanding of potential molecular and biological mechanisms involved. In this review, we explore the indications of pharmacogenetics role in safety and efficacy of ECT and present the evidence for its role in patients with psychiatric disorders undergoing ECT.
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Affiliation(s)
- Hooman Mirzakhani
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
- Division of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Martijn S van Noorden
- Department of Psychiatry, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Jesse Swen
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Ala Nozari
- Department of Anesthesia, Orthopedic Anesthesia Division, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
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George N, Gean EG, Nandi A, Frolov B, Zaidi E, Lee H, Brašić JR, Wong DF. Advances in CNS Imaging Agents: Focus on PET and SPECT Tracers in Experimental and Clinical Use. CNS Drugs 2015; 29:313-30. [PMID: 25948171 DOI: 10.1007/s40263-015-0237-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The physiological functioning of the brain is not well-known in current day medicine and the pathologies of many neuropsychiatric disorders are still not yet fully understood. With our aging population and better life expectancies, it has become imperative to find better biomarkers for disease progression as well as receptor target engagements. In the last decade, these major advances in the field of molecular CNS imaging have been made available with tools such as functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS), single photon emission computed tomography (SPECT), and neuroreceptor-targeted positron emission tomography (PET). These tools have given researchers, pharmaceutical companies, and clinical physicians a better method of understanding CNS dysfunctions, and the ability to employ improved therapeutic agents. This review is intended to provide an update on brain imaging agents that are currently used in clinical and translational research toward treatment of CNS disorders. The review begins with amyloid and tau imaging, the former of which has at least three [(18)F] agents that have been recently approved and will soon be available for clinical use for specific indications in the USA and elsewhere. Other prevalent PET and SPECT neurotransmitter system agents, including those newly US FDA-approved imaging agents related to the dopaminergic system, are included. A review of both mature and potentially growing PET imaging agents, including those targeting serotonin and opiate receptor systems, is also provided.
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Affiliation(s)
- Noble George
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Johns Hopkins Medical Institutions, 601 N. Caroline St., JHOC Room 3245, Baltimore, MD, 21287-0807, USA
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Kometer M, Schmidt A, Bachmann R, Studerus E, Seifritz E, Vollenweider FX. Psilocybin biases facial recognition, goal-directed behavior, and mood state toward positive relative to negative emotions through different serotonergic subreceptors. Biol Psychiatry 2012; 72:898-906. [PMID: 22578254 DOI: 10.1016/j.biopsych.2012.04.005] [Citation(s) in RCA: 185] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 04/03/2012] [Accepted: 04/04/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Serotonin (5-HT) 1A and 2A receptors have been associated with dysfunctional emotional processing biases in mood disorders. These receptors further predominantly mediate the subjective and behavioral effects of psilocybin and might be important for its recently suggested antidepressive effects. However, the effect of psilocybin on emotional processing biases and the specific contribution of 5-HT2A receptors across different emotional domains is unknown. METHODS In a randomized, double-blind study, 17 healthy human subjects received on 4 separate days placebo, psilocybin (215 μg/kg), the preferential 5-HT2A antagonist ketanserin (50 mg), or psilocybin plus ketanserin. Mood states were assessed by self-report ratings, and behavioral and event-related potential measurements were used to quantify facial emotional recognition and goal-directed behavior toward emotional cues. RESULTS Psilocybin enhanced positive mood and attenuated recognition of negative facial expression. Furthermore, psilocybin increased goal-directed behavior toward positive compared with negative cues, facilitated positive but inhibited negative sequential emotional effects, and valence-dependently attenuated the P300 component. Ketanserin alone had no effects but blocked the psilocybin-induced mood enhancement and decreased recognition of negative facial expression. CONCLUSIONS This study shows that psilocybin shifts the emotional bias across various psychological domains and that activation of 5-HT2A receptors is central in mood regulation and emotional face recognition in healthy subjects. These findings may not only have implications for the pathophysiology of dysfunctional emotional biases but may also provide a framework to delineate the mechanisms underlying psylocybin's putative antidepressant effects.
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Affiliation(s)
- Michael Kometer
- Neuropsychopharmacology and Brain Imaging, and Heffter Research Center, Clinic of Affective Disorders and General Psychiatry, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland.
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10
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Nikolaus S, Hautzel H, Heinzel A, Müller HW. Key players in major and bipolar depression--a retrospective analysis of in vivo imaging studies. Behav Brain Res 2012; 232:358-90. [PMID: 22483788 DOI: 10.1016/j.bbr.2012.03.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 03/13/2012] [Accepted: 03/17/2012] [Indexed: 11/30/2022]
Abstract
In the present study, we evaluated the contribution of the individual synaptic constituents of all assessed neurotransmitter systems by subjecting all available in vivo imaging studies on patients with unipolar major depressive disorder (MDD) and bipolar depression (BD) to a retrospective analysis. In acute MDD, findings revealed significant increases of prefrontal and frontal DA synthesis, decreases of thalamic and midbrain SERT, increases of insular SERT, decreases of midbrain 5-HT(1A) receptors and decreases of prefrontal, frontal, occipital and cingulate 5-HT(2A) receptors, whereas, in remission, decreases of striatal D₂ receptors, midbrain SERT, frontal, parietal, temporal, occipital and cingulate 5-HT(1A) receptors and parietal 5-HT(2A) receptors were observed. In BD, findings indicated a trend towards increased striatal D₂ receptors in depression and mania, decreased striatal DA synthesis in remission and decreased frontal D₁ receptors in all three conditions. Additionally, there is some evidence that ventrostriatal and hippocampal SERT may be decreased in depression, whereas in remission and mania elevations of thalamic and midbrain SERT, respectively, were observed. Moreover, in depression, limbic 5-HT(1A) receptors were elevated, whereas in mania a decrease of both cortical and limbic 5-HT(2A) receptor binding was observed. Furthermore, in depression, prefrontal, frontal, occipital and cingulate M2 receptor binding was found to be reduced. From this, a complex pattern of dysregulations within and between neurotransmitter systems may be derived, which is likely to be causally linked not only with the subtype and duration of disease but also with the predominance of individual symptoms and with the kind and duration of pharmacological treatment(s).
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Affiliation(s)
- Susanne Nikolaus
- Clinic of Nuclear Medicine, University Hospital Düsseldorf, Heinrich-Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany.
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Chen Q, Liu W, Li H, Zhang H, Tian M. Molecular imaging in patients with mood disorders: a review of PET findings. Eur J Nucl Med Mol Imaging 2011; 38:1367-80. [DOI: 10.1007/s00259-011-1779-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 02/11/2011] [Indexed: 01/08/2023]
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12
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Walderhaug E, Varga M, Pedro MS, Hu J, Neumeister A. The role of the aminergic systems in the pathophysiology of bipolar disorder. Curr Top Behav Neurosci 2011; 5:107-126. [PMID: 25236552 DOI: 10.1007/7854_2010_72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Bipolar disorder (BPD) is a major medical and social burden, but little is known about the specific pathophysiology of BPD. The key biogenic amines in the aminergic system include serotonin (5-HT), norepinephrine (NE), dopamine (DA), and acetylcholine (ACh). By analyzing these neurotransmitters, this chapter highlights three hypotheses in the pathophysiology of BPD: the biogenic amine hypothesis, the cholinergic-aminergic balance hypothesis, and the permissive hypothesis. Evidence from select studies of cerebrospinal fluid, postmortem subjects, neuroimaging, genetic factors, and pharmacological agents will be used to reconcile these hypotheses. Possible explanations for discrepancies in these hypotheses are given, and directions for future studies are suggested.
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Affiliation(s)
- Espen Walderhaug
- Department of Psychology, University of Oslo, 1094, Blindern, 0317, Oslo, Norway,
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