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Saadatmand S, Zohroudi F, Tangestani H. The Effect of Oral Chamomile on Anxiety: A Systematic Review of Clinical Trials. Clin Nutr Res 2024; 13:139-147. [PMID: 38784853 PMCID: PMC11109927 DOI: 10.7762/cnr.2024.13.2.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/07/2024] [Accepted: 04/11/2024] [Indexed: 05/25/2024] Open
Abstract
Anxiety disorder is a prevalent psychiatric issue that affects 4.05% of the global population. As complementary and alternative medicine gains popularity, many individuals with anxiety symptoms seek herbal remedies. This systematic review aims to explore the sedative efficacy of chamomile as an herbal medicine for anxiety treatment. Our search was conducted in PubMed, Google Scholar, and Scopus databases until August 2023. Among 389 papers found, after removing duplicates and irrelevant papers, 10 clinical trials investigating the effect of oral consumption of chamomile on anxiety were included. Two researchers independently completed all steps, including the screening process and data extraction. Out of the 10 articles selected, 9 studies have concluded that chamomile is effective in reducing anxiety. Even though, the exact mechanism of chamomile's anxiolytic action is not well understood, evidence suggests that its active compounds, including apigenin, may modulate the function of the hypothalamic-pituitary-adrenocortical axis by affecting neurotransmitter pathways. This systematic review showed that chamomile potentially has an anxiolytic effect. In addition, due to the side effects of drugs used to treat anxiety disorders, the use of chamomile seems to be effective and less dangerous.
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Affiliation(s)
- Sogand Saadatmand
- Student Research and Technology Committee, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr 7514633341, Iran
| | - Foad Zohroudi
- Student Research and Technology Committee, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr 7514633341, Iran
| | - Hadith Tangestani
- Department of Nutrition, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr 7514633341, Iran
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Chang Y, Xie X, Liu Y, Liu M, Zhang H. Exploring clinical applications and long-term effectiveness of benzodiazepines: An integrated perspective on mechanisms, imaging, and personalized medicine. Biomed Pharmacother 2024; 173:116329. [PMID: 38401518 DOI: 10.1016/j.biopha.2024.116329] [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: 11/21/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024] Open
Abstract
Benzodiazepines have been long-established treatments for various conditions, including anxiety disorders and insomnia. Recent FDA warnings emphasize the risks of misuse and dependence associated with benzodiazepines. This article highlights their benefits and potential drawbacks from various perspectives. It achieves this by explaining how benzodiazepines work in terms of neuroendocrinology, immunomodulation, sleep, anxiety, cognition, and addiction, ultimately improving their clinical effectiveness. Benzodiazepines play a regulatory role in the HPA axis and impact various systems, including neuropeptide Y and cholecystokinin. Benzodiazepines can facilitate sleep-dependent memory consolidation by promoting spindle wave activity, but they can also lead to memory deficits in older individuals due to reduced slow-wave sleep. The cognitive effects of chronic benzodiazepines use remain uncertain; however, no adverse findings have been reported in clinical imaging studies. This article aims to comprehensively review the evidence on benzodiazepines therapy, emphasizing the need for more clinical studies, especially regarding long-term benzodiazepines use.
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Affiliation(s)
- Yiheng Chang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xueting Xie
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yudan Liu
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Meichen Liu
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Huimin Zhang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
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Tomasi J, Zai CC, Pouget JG, Tiwari AK, Kennedy JL. Heart rate variability: Evaluating a potential biomarker of anxiety disorders. Psychophysiology 2024; 61:e14481. [PMID: 37990619 DOI: 10.1111/psyp.14481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/19/2023] [Accepted: 10/20/2023] [Indexed: 11/23/2023]
Abstract
Establishing quantifiable biological markers associated with anxiety will increase the objectivity of phenotyping and enhance genetic research of anxiety disorders. Heart rate variability (HRV) is a physiological measure reflecting the dynamic relationship between the sympathetic and parasympathetic nervous systems, and is a promising target for further investigation. This review summarizes evidence evaluating HRV as a potential physiological biomarker of anxiety disorders by highlighting literature related to anxiety and HRV combined with investigations of endophenotypes, neuroimaging, treatment response, and genetics. Deficient HRV shows promise as an endophenotype of pathological anxiety and may serve as a noninvasive index of prefrontal cortical control over the amygdala, and potentially aid with treatment outcome prediction. We propose that the genetics of HRV can be used to enhance the understanding of the genetics of pathological anxiety for etiological investigations and treatment prediction. Given the anxiety-HRV link, strategies are offered to advance genetic analytical approaches, including the use of polygenic methods, wearable devices, and pharmacogenetic study designs. Overall, HRV shows promising support as a physiological biomarker of pathological anxiety, potentially in a transdiagnostic manner, with the heart-brain entwinement providing a novel approach to advance anxiety treatment development.
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Affiliation(s)
- Julia Tomasi
- Molecular Brain Science Department, Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Clement C Zai
- Molecular Brain Science Department, Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Jennie G Pouget
- Molecular Brain Science Department, Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Arun K Tiwari
- Molecular Brain Science Department, Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - James L Kennedy
- Molecular Brain Science Department, Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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4
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Blokhin IO, Martinez-Garza DM, Patel D, Douaihy AB, Salloum IM. Editorial: Genome-wide molecular mechanisms of substance use disorders. Front Psychiatry 2024; 14:1356103. [PMID: 38260789 PMCID: PMC10800646 DOI: 10.3389/fpsyt.2023.1356103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Affiliation(s)
- Ilya O. Blokhin
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, United States
| | | | - Dhruti Patel
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, United States
| | - Antoine B. Douaihy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ihsan M. Salloum
- Department of Neuroscience, University of Texas Rio Grande Valley, Edinburg, TX, United States
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Boucherie DE, Reneman L, Booij J, Martins D, Dipasquale O, Schrantee A. Modulation of functional networks related to the serotonin neurotransmitter system by citalopram: Evidence from a multimodal neuroimaging study. J Psychopharmacol 2023; 37:1209-1217. [PMID: 37947344 PMCID: PMC10714691 DOI: 10.1177/02698811231211154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) potentiate serotonergic neurotransmission by blocking the serotonin transporter (5-HTT), but the functional brain response to SSRIs involves neural circuits beyond regions with high 5-HTT expression. Currently, it is unclear whether and how changes in 5-HTT availability after SSRI administration modulate brain function of key serotoninergic circuits, including those characterized by high availability of the serotonin 1A receptor (5-HT1AR). AIM We investigated the association between 5-HTT availability and 5-HTT- and 5-HT1AR-enriched functional connectivity (FC) after an acute citalopram challenge. METHODS We analyzed multimodal data from a dose-response, placebo-controlled, double-blind study, in which 45 healthy women were randomized into three groups receiving placebo, a low (4 mg), or high (16 mg) oral dose of citalopram. Receptor-Enhanced Analysis of functional Connectivity by Targets was used to estimate 5-HTT- and 5-HT1AR-enriched FC from resting-state and task-based fMRI. 5-HTT availability was determined using [123I]FP-CIT single-photon emission computerized tomography. RESULTS 5-HTT availability was negatively correlated with resting-state 5-HTT-enriched FC, and with task-dependent 5-HT1AR-enriched FC. Our exploratory analyses revealed lower 5-HT1AR-enriched FC in the low-dose group compared to the high-dose group at rest and the placebo group during the emotional face-matching task. CONCLUSIONS Taken together, our findings provide evidence for differential links between 5-HTT availability and brain function within 5-HTT and 5-HT1AR pathways and in context- and dose-dependent manner. As such, they support a potential pivotal role of the 5-HT1AR in the effects of citalopram on the brain and add to its potential as a therapeutic avenue for mood and anxiety disturbances.
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Affiliation(s)
- Daphne E Boucherie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Liesbeth Reneman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Jan Booij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Daniel Martins
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Ottavia Dipasquale
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Anouk Schrantee
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Amsterdam Medical Center, Amsterdam, The Netherlands
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Cabral IB, de Lima Moreira CV, Rodrigues ACC, da Silva Moreira LK, Pereira JKA, Gomides CD, Lião LM, Machado LS, Vaz BG, da Cunha LC, de Oliveira Neto JR, da Silva-Júnior EF, de Aquino TM, da Silva Santos-Júnior PF, Silva ON, da Rocha FF, Costa EA, Menegatti R, Fajemiroye JO. Preclinical data on morpholine (3,5-di-tertbutyl-4-hydroxyphenyl) methanone induced anxiolysis. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2023; 396:2957-2975. [PMID: 37097335 DOI: 10.1007/s00210-023-02502-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/15/2023] [Indexed: 04/26/2023]
Abstract
Trimetozine is used to be indicated for the treatment of mental illnesses, particularly anxiety. The present study provides data on the pharmacological profile of trimetozine derivative morpholine (3,5-di-tert-butyl-4-hydroxyphenyl) methanone (LQFM289) which was designed from molecular hybridization of trimetozine lead compound and 2,6-di-tert-butyl-hydroxytoluene to develop new anxiolytic drugs. Here, we conduct molecular dynamics simulations, docking studies, receptor binding assays, and in silico ADMET profiling of LQFM289 before its behavioral and biochemical assessment in mice within the dose range of 5-20 mg/kg. The docking of LQFM289 showed strong interactions with the benzodiazepine binding sites and matched well with receptor binding data. With the ADMET profile of this trimetozine derivative that predicts a high intestinal absorption and permeability to blood-brain barrier without being inhibited by the permeability glycoprotein, the oral administration of LQFM289 10 mg/kg consistently induced anxiolytic-like behavior of the mice exposed to the open field and light-dark box apparatus without eliciting motor incoordination in the wire, rotarod, and chimney tests. A decrease in the wire and rotarod´s fall latency coupled with an increase in the chimney test´s climbing time and a decrease in the number of crossings in the open field apparatus at the dose of 20 mg/kg of this trimetozine derivative suggest sedative or motor coordination impairment at this highest dose. The attenuation of the anxiolytic-like effects of LQFM289 (10 mg/kg) by flumazenil pretreatment implicates the participation of benzodiazepine binding sites. The lowering of corticosterone and tumor necrosis factor alpha (cytokine) in LQFM289-treated mice at a single oral (acute) dose of 10 mg/kg suggests that the anxiolytic-like effect of this compound also involves the recruitment of non-benzodiazepine binding sites/GABAergic molecular machinery.
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Affiliation(s)
- Iara Barbosa Cabral
- Institute of Biological Science, Federal University of Goiás, CEP 74001-970, Goiânia, GO, Brazil
| | | | | | | | | | - Christian Dias Gomides
- Institute of Chemistry, Federal University of Goiás, Av. Esperança S/N, Campus Samambaia, Goiânia, GO, 74690-900, Brazil
| | - Luciano M Lião
- Institute of Chemistry, Federal University of Goiás, Av. Esperança S/N, Campus Samambaia, Goiânia, GO, 74690-900, Brazil
| | - Lucas S Machado
- Institute of Chemistry, Federal University of Goiás, Av. Esperança S/N, Campus Samambaia, Goiânia, GO, 74690-900, Brazil
| | - Boniek G Vaz
- Institute of Chemistry, Federal University of Goiás, Av. Esperança S/N, Campus Samambaia, Goiânia, GO, 74690-900, Brazil
| | - Luiz Carlos da Cunha
- Faculty of Pharmacy, Federal University of Goiás, PMB 131, CEP 74001-970, Goiânia, Brazil
| | | | - Edeildo Ferreira da Silva-Júnior
- Institute of Chemistry and Biotechnology, Federal University of Alagoas, Lourival Melo Mota Avenue, Alagoas, Maceió, 57072-900, Brazil
| | - Thiago Mendonça de Aquino
- Research Group in Therapeutic Strategies, Federal University of Alagoas, Lourival Melo Mota Avenue, Alagoas, Maceió, 57072-900, Brazil
| | | | - Osmar N Silva
- Evangelical University of Goias, UniEvangélica, Av. Universitária Km 3, 5 Cidade Universitária Anápolis, Goias, GO, 75083-515, Brazil
| | - Fábio Fagundes da Rocha
- Department of Physiological Sciences, Institute of Biology, Federal Rural University of Rio de Janeiro, Seropédica, RJ, Brazil
| | - Elson Alves Costa
- Institute of Biological Science, Federal University of Goiás, CEP 74001-970, Goiânia, GO, Brazil
| | - Ricardo Menegatti
- Faculty of Pharmacy, Federal University of Goiás, PMB 131, CEP 74001-970, Goiânia, Brazil
| | - James O Fajemiroye
- Institute of Biological Science, Federal University of Goiás, CEP 74001-970, Goiânia, GO, Brazil.
- Evangelical University of Goias, UniEvangélica, Av. Universitária Km 3, 5 Cidade Universitária Anápolis, Goias, GO, 75083-515, Brazil.
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Wilson EJ, Abbott MJ, Norton AR. The impact of psychological treatment on intolerance of uncertainty in generalized anxiety disorder: A systematic review and meta-analysis. J Anxiety Disord 2023; 97:102729. [PMID: 37271039 DOI: 10.1016/j.janxdis.2023.102729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 04/03/2023] [Accepted: 05/18/2023] [Indexed: 06/06/2023]
Abstract
Research has demonstrated a strong link between intolerance of uncertainty and generalized anxiety disorder (GAD). The current systematic review and meta-analysis aimed to evaluate how effective evidence-based psychological treatments are at reducing intolerance of uncertainty for adults with GAD. An extensive literature search identified 26 eligible studies, with a total of 1199 participants with GAD. Psychological treatments (k = 32 treatment groups) yielded large significant within-group effect size from pre- to post-treatment and pre-treatment to follow-up for intolerance of uncertainty (g = 0.88; g = 1.05), as well as related symptoms including worry (g = 1.32; g = 1.45), anxiety (g = 0.94; g = 1.04) and depression (g = 0.96; g = 1.00). Psychological treatment also yielded a large significant between-group effect on intolerance of uncertainty (g = 1.35). Subgroups analysis found that CBT that directly targeted intolerance of uncertainty (CBT-IU) throughout treatment was significantly more effective than general CBT at reducing intolerance of uncertainty (p < 0.01) and worry (p < 0.01) from pre- to post treatment, however, this result was not maintained at follow-up. Meta-regression analyses supported this finding as increases in the amount of time spent directly targeting intolerance of uncertainty, significantly increased the effect size for both intolerance of uncertainty (z = 2.01, p < 0.01) and worry (z = 2.23, p < 0.01). Overall, these findings indicate that psychological treatments are effective at reducing IU, and related symptom measures of GAD.
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Affiliation(s)
- Emily J Wilson
- Graduate School of Health, University of Technology Sydney, Australia
| | - Maree J Abbott
- School of Psychology, The University of Sydney, Australia.
| | - Alice R Norton
- Graduate School of Health, University of Technology Sydney, Australia; School of Psychology, The University of Sydney, Australia
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Therapeutic Implications of microRNAs in Depressive Disorders: A Review. Int J Mol Sci 2022; 23:ijms232113530. [PMID: 36362315 PMCID: PMC9658840 DOI: 10.3390/ijms232113530] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
MicroRNAs are hidden players in complex psychophysical phenomena such as depression and anxiety related disorders though the activation and deactivation of multiple proteins in signaling cascades. Depression is classified as a mood disorder and described as feelings of sadness, loss, or anger that interfere with a person’s everyday activities. In this review, we have focused on exploration of the significant role of miRNAs in depression by affecting associated target proteins (cellular and synaptic) and their signaling pathways which can be controlled by the attachment of miRNAs at transcriptional and translational levels. Moreover, miRNAs have potential role as biomarkers and may help to cure depression through involvement and interactions with multiple pharmacological and physiological therapies. Taken together, miRNAs might be considered as promising novel therapy targets themselves and may interfere with currently available antidepressant treatments.
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Starcevic V. Representation of Benzodiazepines in Treatment Guidelines: The Paradox of Undesirable Objectivity. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:295-299. [PMID: 35551128 DOI: 10.1159/000524772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Vladan Starcevic
- Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Specialty of Psychiatry, University of Sydney, Sydney, New South Wales, Australia.,Nepean Hospital, Department of Psychiatry, Penrith, New South Wales, Australia
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Dubovsky SL, Marshall D. Benzodiazepines Remain Important Therapeutic Options in Psychiatric Practice. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:307-334. [PMID: 35504267 DOI: 10.1159/000524400] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/29/2022] [Indexed: 12/27/2022]
Abstract
Benzodiazepines and medications acting on benzodiazepine receptors that do not have a benzodiazepine structure (z-drugs) have been viewed by some experts and regulatory bodies as having limited benefit and significant risks. Data presented in this article support the use of these medications as treatments of choice for acute situational anxiety, chronic anxiety disorders, insomnia, alcohol withdrawal syndromes, and catatonia. They may also be useful adjuncts in the treatment of anxious depression and mania, and for medically ill patients. Tolerance develops to sedation and possibly psychomotor impairment, but not to the anxiolytic effect of benzodiazepines. Sedation can impair cognitive function in some patients, but assertions that benzodiazepines increase the risk of dementia are not supported by recent data. Contrary to popular opinion, benzodiazepines are not frequently misused or conduits to misuse of other substances in patients without substance use disorders who are prescribed these medications for appropriate indications; most benzodiazepine misuse involves medications that are obtained from other people. Benzodiazepines are usually not lethal in overdose except when ingested with other substances, especially alcohol and opioids. Benzodiazepines comprise one of the few classes of psychotropic medication the mechanisms of action of which are clearly delineated, allowing for greater precision in their clinical use. These medications, therefore, belong in the therapeutic armamentarium of the knowledgeable clinician.
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Affiliation(s)
- Steven L Dubovsky
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,Departments of Psychiatry and Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Dori Marshall
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Jiang SS, Liu XH, Han N, Zhang HJ, Xie WX, Xie ZJ, Lu XY, Zhou XZ, Zhao YQ, Duan AD, Zhao SQ, Zhang ZC, Huang XB. Effects of group mindfulness-based cognitive therapy and group cognitive behavioural therapy on symptomatic generalized anxiety disorder: a randomized controlled noninferiority trial. BMC Psychiatry 2022; 22:481. [PMID: 35854250 PMCID: PMC9295460 DOI: 10.1186/s12888-022-04127-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mindfulness-based cognitive therapy (MBCT) is a promising alternative treatment for generalized anxiety disorder (GAD). The objective of this study was to examine whether the efficacy of group MBCT adapted for treating GAD (MBCT-A) was noninferior to group cognitive behavioural therapy (CBT) designed to treat GAD (CBT-A), which was considered one of first-line treatments for GAD patients. We also explored the efficacy of MBCT-A in symptomatic GAD patients compared with CBT-A for a variety of outcomes of anxiety symptoms, as well as depressive symptoms, overall illness severity, quality of life and mindfulness. METHODS This was a randomized, controlled, noninferiority trial with two arms involving symptomatic GAD patients. Adult patients with GAD (n = 138) were randomized to MBCT-A or CBT-A in addition to treatment as usual (TAU). The primary outcome was the anxiety response rate assessed at 8 weeks after treatment as measured using the Hamilton Anxiety Scale (HAMA). Secondary outcomes included anxiety remission rates, scores on the HAMA, the state-trait anxiety inventory (STAI), the Hamilton Depression Scale (HAMD), the Severity Subscale of the Clinical Global Impression Scale (CGI-S), and the 12-item Short-Form Health Survey (SF-12), as well as mindfulness, which was measured by the Five Facet Mindfulness Questionnaire (FFMQ). Assessments were performed at baseline, 8 weeks after treatment, and 3 months after treatment. Both intention-to-treat (ITT) and per-protocol (PP) analyses were performed for primary analyses. The χ2 test and separate two-way mixed ANOVAs were used for the secondary analyses. RESULTS ITT and PP analyses showed noninferiority of MBCT-A compared with CBT-A for response rate [ITT rate difference = 7.25% (95% CI: -8.16, 22.65); PP rate difference = 5.85% (95% CI: - 7.83, 19.53)]. The anxiety remission rate, overall illness severity and mindfulness were significantly different between the two groups at 8 weeks. There were no significant differences between the two groups at the 3-month follow-up. No severe adverse events were identified. CONCLUSIONS Our data indicate that MBCT-A was noninferior to CBT-A in reducing anxiety symptoms in GAD patients. Both interventions appeared to be effective for long-term benefits. TRIAL REGISTRATION Registered at chictr.org.cn (registration number: ChiCTR1800019150 , registration date: 27/10/2018).
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Affiliation(s)
- Si-si Jiang
- grid.11135.370000 0001 2256 9319NHC Key Laboratory of Mental Health (Peking University), Peking University Sixth Hospital, Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xue-hua Liu
- grid.11135.370000 0001 2256 9319NHC Key Laboratory of Mental Health (Peking University), Peking University Sixth Hospital, Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Nan Han
- Beijing Chang Ping Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Hai-jing Zhang
- grid.11135.370000 0001 2256 9319NHC Key Laboratory of Mental Health (Peking University), Peking University Sixth Hospital, Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Wu-xiang Xie
- grid.11135.370000 0001 2256 9319Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China
| | - Zhi-juan Xie
- grid.411634.50000 0004 0632 4559Peking University People’s Hospital, Beijing, China
| | - Xin-yuan Lu
- grid.11135.370000 0001 2256 9319NHC Key Laboratory of Mental Health (Peking University), Peking University Sixth Hospital, Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xuan-zi Zhou
- grid.11135.370000 0001 2256 9319NHC Key Laboratory of Mental Health (Peking University), Peking University Sixth Hospital, Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yu-qi Zhao
- grid.11135.370000 0001 2256 9319NHC Key Laboratory of Mental Health (Peking University), Peking University Sixth Hospital, Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Ai-deng Duan
- grid.11135.370000 0001 2256 9319NHC Key Laboratory of Mental Health (Peking University), Peking University Sixth Hospital, Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Shu-qin Zhao
- grid.11135.370000 0001 2256 9319NHC Key Laboratory of Mental Health (Peking University), Peking University Sixth Hospital, Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Zhi-cheng Zhang
- grid.11135.370000 0001 2256 9319NHC Key Laboratory of Mental Health (Peking University), Peking University Sixth Hospital, Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xue-bing Huang
- grid.11135.370000 0001 2256 9319NHC Key Laboratory of Mental Health (Peking University), Peking University Sixth Hospital, Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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Millan MJ. Agomelatine for the treatment of generalized anxiety disorder: focus on its distinctive mechanism of action. Ther Adv Psychopharmacol 2022; 12:20451253221105128. [PMID: 35795687 PMCID: PMC9251978 DOI: 10.1177/20451253221105128] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Generalized anxiety disorder (GAD), the most frequently diagnosed form of anxiety, is usually treated by cognitive-behavioural approaches or medication; in particular, benzodiazepines (acutely) and serotonin or serotonin/noradrenaline reuptake inhibitors (long term). Efficacy, compliance, and acceptability are, however, far from ideal, reinforcing interest in alternative options. Agomelatine, clinically employed in the treatment of major depression, expresses anxiolytic properties in rodents and was effective in the treatment of GAD (including severely ill patients) in several double-blind, short-term (12 weeks) and relapse-prevention (6 months) studies. At active doses, the incidence of adverse effects was no higher than for placebo. Agomelatine possesses a unique binding profile, behaving as a melatonin (MT1/MT2) receptor agonist and 5-HT2C receptor antagonist, yet recognizing neither monoamine transporters nor GABAA receptors. Extensive evidence supports a role for 5-HT2C receptors in the induction of anxious states, and their blockade likely plays a primary role in mediating the anxiolytic actions of agomelatine, including populations in the amygdala and bed nucleus of stria terminalis, as well as the hippocampus. Recruitment of MT receptors in the suprachiasmatic nucleus, thalamic reticular nucleus, and hippocampus appears to fulfil a complimentary role. Downstream of 5-HT2C and MT receptors, modulation of stress-sensitive glutamatergic circuits and altered release of the anxiogenic neuropeptides, corticotrophin-releasing factor, and vasopressin, may be implicated in the actions of agomelatine. To summarize, agomelatine exerts its anxiolytic actions by mechanisms clearly distinct from those of other agents currently employed for the management of GAD. PLAIN LANGUAGE SUMMARY How agomelatine helps in the treatment of anxiety disorders. INTRODUCTION • Anxiety disorders have a significant negative impact on quality of life.• The most common type of anxiety disorder, called generalized anxiety disorder (GAD), is associated with nervousness and excessive worry.• These symptoms can lead to additional symptoms like tiredness, sleeplessness, irritability, and poor attention.• GAD is generally treated through either cognitive-behavioural therapy or medication. However, widely used drugs like benzodiazepines and serotonin reuptake inhibitors have adverse effects.• Agomelatine, a well-established antidepressant drug, has shown anxiety-lowering ('anxiolytic') properties in rats and has been shown to effectively treat GAD with minimal side effects.• However, exactly how it acts on the brain to manage GAD is not yet clear.• Thus, this review aims to shed light on agomelatine's mechanism of action in treating GAD. METHODS • The authors reviewed studies on how agomelatine treats anxiety in animals.• They also looked at clinical studies on the effects of agomelatine in people with GAD. RESULTS • The study showed that agomelatine 'blocks' a receptor in nerve cells, which plays a role in causing anxiety, called the 5-HT2C receptor.• Blocking this receptor, especially in specific brain regions such as nerve cells of the amygdala, bed nucleus of stria terminalis, and hippocampus, produced the anxiety reduction seen during agomelatine treatment.• Agomelatine also activates the melatonin (MT) receptor, which is known to keep anxiety in check, promote sleep, and maintain the sleep cycle.• Agomelatine should thus tackle sleep disturbances commonly seen in patients with GAD.• Beyond 5-HT2C and MT receptors, signalling molecules in nerve cells that are known to be involved in anxiety disorders (called 'neurotransmitters' and 'neuropeptides') are also affected by agomelatine. CONCLUSION • Agomelatine's anxiolytic effects are caused by mechanisms that are distinct from those of other medications currently used to treat GAD.• This explains its therapeutic success and minimal adverse side effects.
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Affiliation(s)
- Mark J Millan
- Institute of Neuroscience and Psychology, College of Medicine, Vet and Life Sciences, Glasgow University, 28 Hillhead Street, Glasgow G12 8QB, UK
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Li Q, Zhang H, Lin G, Shi S, Zhang Y, Ji J, Yang L, Yao J, Wu W. Relative Safety and Efficacy of Two Doses of Tandospirone Citrate for Generalized Anxiety Disorder: A Multicenter Randomized Controlled Trial. Neuropsychiatr Dis Treat 2022; 18:1653-1664. [PMID: 35968511 PMCID: PMC9374096 DOI: 10.2147/ndt.s366048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine the relative safety and efficacy of different doses of tandospirone in treating generalized anxiety disorder (GAD). PATIENTS AND METHODS This parallel randomized controlled trial enrolled patients with GAD from eight centers in China. The patients were randomly assigned to 60 mg/day or 30 mg/day tandospirone groups. The primary endpoint was the overall response rate after receiving 6-week treatment. The secondary endpoints included significant response rate, clinical recovery rate, change in the Hamilton Anxiety Scale (HAMA) total score, HAMA subscale score, Hamilton Depression Scale-17 (HAMD-17), Clinical Global Impression-Severity Scale (CGI-S) score, and Impression-Improvement scale (CGI-I) score. RESULTS No significant difference was found in the overall response rate between the two groups (65.7% vs 58.4%, p = 0.213). A higher significant response rate and change in the HAMA total score were found in the 60 mg/day group. The reduction in the CGI-S score and percentage of patients with a CGI-I score of ≤2 were higher in 60 mg/day group. The reduction in HAMA somatic anxiety factor, cardiovascular symptom factor, gastrointestinal symptom factor, and HAMD-17 score were more significant in the 60 mg/day group. The incidence of total adverse events was higher in the 60 mg/day group than in the 30 mg/day group. No significant difference was found in the proportion of withdrawal due to adverse events. CONCLUSION Both 60 mg/day and 30 mg/day tandospirone show good efficacy in treating patients with GAD. High doses of tandospirone may have advantages in relieving the somatic symptoms but also present disadvantages due to their high level. TRIAL REGISTRATION The trial registration no. was NCT01614041.
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Affiliation(s)
- Qingwei Li
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Haiyin Zhang
- Clinical Psychology, Shanghai Mental Health Center, Shanghai, People's Republic of China
| | - Guozhen Lin
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Shenxun Shi
- Psychiatry Department, Fudan University Affiliated Huashan Hospital, Shanghai, People's Republic of China
| | - Yingli Zhang
- Department of Depressive Disorders, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, People's Republic of China
| | - Jianlin Ji
- Department of Psychological Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Lipeng Yang
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Jun Yao
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Wenyuan Wu
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
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Martin EL, Strickland JC, Schlienz NJ, Munson J, Jackson H, Bonn-Miller MO, Vandrey R. Antidepressant and Anxiolytic Effects of Medicinal Cannabis Use in an Observational Trial. Front Psychiatry 2021; 12:729800. [PMID: 34566726 PMCID: PMC8458732 DOI: 10.3389/fpsyt.2021.729800] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/16/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Anxiety and depressive disorders are highly prevalent. Patients are increasingly using medicinal cannabis products to treat these disorders, but little is known about the effects of medicinal cannabis use on symptoms of anxiety and depression. The aim of the present observational study was to assess general health in medicinal cannabis users and non-using controls with anxiety and/or depression. Methods: Participants (368 Cannabis Users; 170 Controls) completed an online survey assessing anxiety and depressive symptoms, cannabis product use, sleep, quality of life, and comorbid chronic pain. Participants that completed this baseline survey were then invited to complete additional follow-up surveys at 3-month intervals. Baseline differences between Cannabis Users and Controls were assessed using independent-samples t-tests and generalized linear mixed effects models were used to assess the impact of initiating cannabis product use, sustained use, or discontinuation of use on anxiety and depressive symptoms at follow-up. Results: Medicinal cannabis use was associated with lower self-reported depression, but not anxiety, at baseline. Medicinal cannabis users also reported superior sleep, quality of life, and less pain on average. Initiation of medicinal cannabis during the follow-up period was associated with significantly decreased anxiety and depressive symptoms, an effect that was not observed in Controls that never initiated cannabis use. Conclusions: Medicinal cannabis use may reduce anxiety and depressive symptoms in clinically anxious and depressed populations. Future placebo-controlled studies are necessary to replicate these findings and to determine the route of administration, dose, and product formulation characteristics to optimize clinical outcomes.
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Affiliation(s)
- Erin L. Martin
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, United States
| | - Justin C. Strickland
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nicolas J. Schlienz
- Department of Psychology, University at Buffalo, Buffalo, NY, United States
- Realm of Caring Foundation, Colorado Springs, CO, United States
| | - Joel Munson
- Realm of Caring Foundation, Colorado Springs, CO, United States
| | - Heather Jackson
- Realm of Caring Foundation, Colorado Springs, CO, United States
| | | | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Parewa M, Burman AS, Brahma A, Rutten L, Sadhukhan S, Misra P, Gupta B, Saklani N, Michael J, Basu A, Ali SS, Koley M, Saha S. Individualized Homeopathic Medicines in the Treatment of Generalized Anxiety Disorder: A Double-Blind, Randomized, Placebo-Controlled, Pilot Trial. Complement Med Res 2021; 28:407-418. [PMID: 33662951 DOI: 10.1159/000514524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Evidence favoring homeopathy in generalized anxiety disorder (GAD) remains scarce. The objective of this pilot trial was to test feasibility of a definitive trial in future. We also experimented whether individualized homeopathic medicines (IH) plus psychological counseling (PC) can produce significantly different effects beyond placebo plus PC in the treatment of GAD. METHODS A double-blind, randomized, placebo-controlled, parallel arm, pilot trial was conducted on 62 GAD patients at the National Institute of Homoeopathy, India. GAD-7 questionnaire and Hamilton Anxiety Scale (HAM-A) were used as the primary and secondary outcomes, respectively, measured at baseline and 3 months. Patients received either IH plus PC (n = 31) or identical-looking placebo plus PC (n = 31). Intention-to-treat sample was analyzed to detect group differences using unpaired t tests. RESULTS Recruitment and retention rates were 56 and 90%, respectively. Mean age was 31.5 years; 56.5% were male. GAD-7 reductions were non-significantly higher in IH than placebo (p = 0.122). Group differences on HAM-A favored IH significantly (p = 0.018). Effect sizes were small to medium. Calcarea carbonica was the most frequently indicated medicine. No serious adverse events happened. CONCLUSIONS A small but positive direction of anxiolytic effect was observed favoring homeopathy over placebo. A definitive trial appeared feasible in future.
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Affiliation(s)
- Maneet Parewa
- Department of Repertory, National Institute of Homoeopathy, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, India,
| | - Avijit Shee Burman
- Department of Forensic Medicine and Toxicology, National Institute of Homoeopathy, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, India
| | - Arabinda Brahma
- Consultant Psychiatrist, Kolkata Police Hospital and Bharat Sevasram Sangha Hospital, Kolkata, India
| | - Lex Rutten
- Independent Researcher, VHAN, Dutch Association of Homeopathic Physicians, Breda, The Netherlands
| | - Satarupa Sadhukhan
- Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Ministry of AYUSH, Government of India, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, India
| | - Pankhuri Misra
- Department of Materia Medica, National Institute of Homoeopathy, Ministry of AYUSH, Government of India, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, India
| | - Bharti Gupta
- Department of Pediatrics, National Institute of Homoeopathy, Ministry of AYUSH, Government of India, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, India
| | - Nitin Saklani
- Department of Repertory, National Institute of Homoeopathy, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, India
| | - James Michael
- Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Ministry of AYUSH, Government of India, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, India
| | - Anamika Basu
- House Staff, Mahesh Bhattacharyya Homoeopathic Medical College & Hospital, Government of West Bengal, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Howrah, India
| | - Sk Swaif Ali
- House Staff, Mahesh Bhattacharyya Homoeopathic Medical College & Hospital, Government of West Bengal, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Howrah, India
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Dong MX, Chen GH, Hu L. Dopaminergic System Alteration in Anxiety and Compulsive Disorders: A Systematic Review of Neuroimaging Studies. Front Neurosci 2020; 14:608520. [PMID: 33343291 PMCID: PMC7744599 DOI: 10.3389/fnins.2020.608520] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/30/2020] [Indexed: 12/16/2022] Open
Abstract
Objective: The dopaminergic system is involved in many psychiatric disorders as a GABAergic, serotonergic, and glutamatergic system. A systematic review and meta-analysis was performed to elucidate the alteration of the dopaminergic system in anxiety and compulsive disorders. Methods: The databases of Pubmed, Embase, and ScienceDirect were searched and articles reporting the involvement of the dopaminergic system in patients with anxiety disorder and obsessive compulsive disorder (OCD) were recognized. The key research data were extracted from the included articles and standardized mean differences were calculated using meta-analyses if there were more than two studies with obtainable data. Sensitivity analyses were further performed to detect the stability of results, and the qualities of all the included studies were assessed using the Newcastle Ottawa scale. Results: Finally, we identified 8 and 11 studies associated with anxiety disorder and OCD for further analysis, respectively. Most consistently, the striatal dopamine D2 receptor (D2R) of OCD patients had decreased while no significant correlation was found between striatal D2R and disease severity. The striatal dopamine transporter (DAT) had not been significantly altered in both the anxiety disorder and OCD patients. The heterogeneity values from the meta-analyses were extremely high while those results remained stable after sensitivity analyses. Inconsistent data were found in the striatal D2R of patients with anxiety disorder. Limited data had suggested that dopamine synthesis increased in most regions of the cerebral cortex and cerebellum in OCD patients. Conclusions: The most convincing finding was that the D2 receptor decreased in patients with obsessive compulsive disorder. The dopamine transporter may have no relationship with anxiety and compulsive disorder.
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Affiliation(s)
- Mei-Xue Dong
- Department of Neurology, Hubei General Hospital, Renmin Hospital of Wuhan University, Wuhan, China
| | - Guang-Hui Chen
- Department of Pharmacy, Hubei General Hospital, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling Hu
- Department of Neurology, Hubei General Hospital, Renmin Hospital of Wuhan University, Wuhan, China
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Wang SM, Woo YS, Kim NY, Na HR, Lim HK, Bahk WM. Agomelatine for the Treatment of Generalized Anxiety Disorder: A Meta-Analysis. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:423-433. [PMID: 32702221 PMCID: PMC7383014 DOI: 10.9758/cpn.2020.18.3.423] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/17/2022]
Abstract
Objective Despite multiple drugs available, a large proportion of patients with generalized anxiety disorder (GAD) do not show adequate response and remission. Thus, additional novel pharmacological agents are needed to increase treatment option for GAD. We aimed to investigate efficacy and safety of agomelatine in the treatment of GAD by conducting a meta-analysis. Methods An extensive search of multiple databases and clinical trial registries were conducted. Mean change in total scores on Hamilton Anxiety Rating Scale (HAM-A) from baseline to endpoint was our primary outcome measure. Secondary efficacy measures included response and remission rates, as defined by a 50% or greater reduction in HAM-A total scores and a score of 7 or less in HAM-A total scores at study endpoint respectively. Results Four published double blinded, randomized, placebo-controlled trials were included in this meta-analysis. Agomelatine more significantly (standardized mean difference = −0.56, p = 0.004) improved HAM-A total scores than placebo. The odds ratios (ORs) of agomelatine over placebo for response and remission rates were 3.75 (p < 0.00001) and 2.74 (p < 0.00001), respectively. Agomelatine was generally well tolerated with insignificance in dropout rate, somnolence, headache, nasopharyngitis, and dizziness compared with placebo. However, agomelatine showed significantly higher incidence of liver function increment (OR = 3.13, p = 0.01) and nausea (OR = 3.27, p = 0.02). Conclusion We showed that agomelatine may be another treatment option in patients with GAD. However, the results should be interpreted and translated into clinical practice with caution because the meta-analysis was based on limited numbers of clinical trials.
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Affiliation(s)
- Sheng-Min Wang
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Sup Woo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nak-Young Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae-Ran Na
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Kook Lim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
We examined the outpatient prescription pattern of psychotropic drugs used for the treatment of five major psychiatric diseases in Bahrain. Setting outpatient department of the main psychiatric hospital in Bahrain. Methods This was a retrospective, cross-sectional study in which we targeted randomly selected prescriptions (n = 992, 56.1% males, 43.9% females) from 1st of January until 31st of December, 2017. Main outcome measure the types of outpatient psychotropic drugs prescribed by the physicians. Results The pharmacotherapy of schizophrenia consisted of atypical anti-psychotics (92.8%), or typical anti-psychotics (17.8%). The anti-depressants used were: Selective-serotonin reuptake inhibiters (SSRIs) (41.6%), Serotonin-norepinephrine reuptake inhibiters (SNRIs) (34.5%), tricyclic anti-depressants (TCAs) (12.8%), and atypical anti-depressants (10.6%). Combination anti-depressants was employed in (12.4%) of cases. The pharmacotherapy for anxiety disorders was composed of benzodiazepines (59.5%), atypical anti-psychotics (45.2%), SSRIs (40.5%), SNRIs (28.6%), TCAs (14.3%), and anti-convulsants (16.7%) and atypical anti-psychotics (7.1). The medications prescribed for bipolar disorder were atypical anti-psychotics (78.6%), anti-convulsants (66.5%), benzodiazepines (27.7%), typical anti-psychotics (8.9%) and lithium (6.7%). Schizoaffective disorder patients received atypical anti-psychotics (97.3%), anti-convulsants (47.8%), benzodiazepines (27.4%), SNRIs (25.7%), SSRIs (15%), typical anti-psychotics (10.6%), atypical anti-depressants (10.6%) and TCAs (6.2%). A combination of antipsychotics and anti-depressants was employed in 33.6% and 4.7% of all subjects regardless of the diagnosis, respectively. Conclusions With a few exceptions, the pharmacotherapy of psychiatric diseases in Bahrain was in line with the latest recommendations. However, psychotropic polypharmacy was observed and calls for immediate attention.
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Balon R, Starcevic V. Role of Benzodiazepines in Anxiety Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:367-388. [DOI: 10.1007/978-981-32-9705-0_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Genario R, Giacomini AC, de Abreu MS, Marcon L, Demin KA, Kalueff AV. Sex differences in adult zebrafish anxiolytic-like responses to diazepam and melatonin. Neurosci Lett 2020; 714:134548. [DOI: 10.1016/j.neulet.2019.134548] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/16/2019] [Accepted: 10/09/2019] [Indexed: 01/05/2023]
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Tomasi J, Lisoway AJ, Zai CC, Harripaul R, Müller DJ, Zai GCM, McCabe RE, Richter MA, Kennedy JL, Tiwari AK. Towards precision medicine in generalized anxiety disorder: Review of genetics and pharmaco(epi)genetics. J Psychiatr Res 2019; 119:33-47. [PMID: 31563039 DOI: 10.1016/j.jpsychires.2019.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/15/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023]
Abstract
Generalized anxiety disorder (GAD) is a prevalent and chronic mental disorder that elicits widespread functional impairment. Given the high degree of non-response/partial response among patients with GAD to available pharmacological treatments, there is a strong need for novel approaches that can optimize outcomes, and lead to medications that are safer and more effective. Although investigations have identified interesting targets predicting treatment response through pharmacogenetics (PGx), pharmaco-epigenetics, and neuroimaging methods, these studies are often solitary, not replicated, and carry several limitations. This review provides an overview of the current status of GAD genetics and PGx and presents potential strategies to improve treatment response by combining better phenotyping with PGx and improved analytical methods. These strategies carry the dual benefit of delivering data on biomarkers of treatment response as well as pointing to disease mechanisms through the biology of the markers associated with response. Overall, these efforts can serve to identify clinical, genetic, and epigenetic factors that can be incorporated into a pharmaco(epi)genetic test that may ultimately improve treatment response and reduce the socioeconomic burden of GAD.
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Affiliation(s)
- Julia Tomasi
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Amanda J Lisoway
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Clement C Zai
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ricardo Harripaul
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Molecular Neuropsychiatry & Development (MiND) Lab, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel J Müller
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gwyneth C M Zai
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; General Adult Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Randi E McCabe
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Margaret A Richter
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Frederick W. Thompson Anxiety Disorders Centre, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - James L Kennedy
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Arun K Tiwari
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Pharmacological and psychological interventions for generalized anxiety disorder in adults: A network meta-analysis. J Psychiatr Res 2019; 118:73-83. [PMID: 31494377 DOI: 10.1016/j.jpsychires.2019.08.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 02/06/2023]
Abstract
Generalized anxiety disorder (GAD) is a significant and common mental illness with a lifetime prevalence of 3.7%. Regardless of the complexity of treatment decisions for GAD, few studies have conducted systematic comparisons of the efficacies of varying interventions. Thus, this study performed a valid network meta-analysis (NMA) of randomized controlled trials (RCTs) to synthesize direct and indirect evidence for alternative interventions for GAD. We searched four major bibliographic databases, the Cochrane Central Register of Controlled Trials, Embase, PsycINFO, and PubMed, for published RCTs of adult patients with a diagnosis of GAD and allowed for all comorbidities. A total of 91 articles (14,812 participants) were identified in the final NMA. The results showed that all pharmacological treatments except for serotonin modulators and second-generation antipsychotics had greater effects than placebo: norepinephrine-dopamine reuptake inhibitors (standardized mean difference (SMD) -1.84, 95% credible interval -3.05 to -0.62), noradrenergic and specific serotonergic antidepressants (-0.91, -1.62 to -0.20), melatonergic receptor agonists (-0.68, -1.15 to -0.21), selective serotonin reuptake inhibitors (SSRIs; -0.67, -0.90 to -0.43), azapirones (-0.58, -1.00 to -0.17), anticonvulsants (-0.56, -0.85 to -0.28), serotonin-norepinephrine reuptake inhibitors (SNRIs; -0.54, -0.79 to -0.30), and benzodiazepines (BZDs; -0.40, -0.65 to -0.15). Most psychological and self-help interventions exerted greater effects than the waitlist group. However, no psychological interventions had greater effects compared with the psychological placebo. Overall, most pharmacological interventions had larger effect sizes than psychological interventions, and most psychological interventions showed larger effect sizes than self-help interventions.
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Abstract
Importance: Benzodiazepines (BZs) are still widely prescribed for the treatment of anxiety disorders despite many publications in the literature which favour antidepressants (ADs) instead. What is the evidence?Observations: Treatment guidelines favour ADs over BZs for treatment of anxiety disorders without any head-to-head comparison of both drug groups with placebo. BZs are claimed to cause less efficacy and more safety issues than ADs, yet ADs also cause disturbing adverse events and, similar to BZs, discontinuation symptoms. Until evidence-based data become available, a look at two 6-month generalized anxiety disorder trials conducted by the same research group, one with a BZ and the other with an AD, might provide some guidance for the clinician. Most improvement with a BZ was obtained by 4 weeks, suggesting that BZ treatment longer than 4 weeks should only be offered to patients maximally improved at 4 weeks. In contrast, ADs may have to be prescribed for 3-6 months to obtain maximal benefits.Conclusion: Results of a controlled trial as proposed will go a long way in providing clinicians missing information to guide them in the appropriate use of both BZs and ADs in anxiety disorders.
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Affiliation(s)
- Karl Rickels
- Stuart and Emily Mudd Professor of Human Behavior and Professor of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Hans Juergen Moeller
- Professor of Psychiatry and former Chair, Department of Psychiatry of the Ludwig Maximilian University, Munich, Germany
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Orsolini L, De Berardis D, Bellantuono C. The ‘hidden' and ‘forgotten' psychiatry: The Perinatal Psychiatry. ACTA ACUST UNITED AC 2019. [DOI: 10.3280/rsf2019-001003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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25
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L-theanine in the adjunctive treatment of generalized anxiety disorder: A double-blind, randomised, placebo-controlled trial. J Psychiatr Res 2019; 110:31-37. [PMID: 30580081 DOI: 10.1016/j.jpsychires.2018.12.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 01/21/2023]
Abstract
Partial or non-response to antidepressants in Generalized Anxiety Disorder (GAD) is common in clinical settings, and adjunctive biological interventions may be required. Adjunctive herbal and nutraceutical treatments are a novel and promising treatment option. L-theanine is a non-protein amino acid derived most-commonly from tea (Camellia sinensis) leaves, which may be beneficial in the treatment of anxiety and sleep disturbance as suggested by preliminary evidence. We conducted a 10-week study (consisting of an 8-week double-blind placebo-controlled period, and 1-week pre-study and 2-week post-study single-blinded observational periods) involving 46 participants with a DSM-5 diagnosis of GAD. Participants received adjunctive L-theanine (450-900 mg) or matching placebo with their current stable antidepressant treatment, and were assessed on anxiety, sleep quality, and cognition outcomes. Results revealed that adjunctive L-theanine did not outperform placebo for anxiety reduction on the HAMA (p = 0.73) nor insomnia severity on the Insomnia Severity Index (ISI; p = 0.35). However, LT treated participants reported greater self-reported sleep satisfaction than placebo (ISI item 4; p = 0.015). Further, a separation in favour of L-theanine was noted on the ISI in those with non-clinical levels of insomnia symptoms (ISI ≤ 14; p = 0.007). No significant cognitive effects (trail making time and the modified emotional Stroop) were revealed. While this preliminary study did not support the efficacy of L-theanine in the treatment of anxiety symptoms in GAD, further studies to explore the application of L-theanine in sleep disturbance are warranted.
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Supasitthumrong T, Bolea-Alamanac BM, Asmer S, Woo VL, Abdool PS, Davies SJC. Gabapentin and pregabalin to treat aggressivity in dementia: a systematic review and illustrative case report. Br J Clin Pharmacol 2019; 85:690-703. [PMID: 30575088 DOI: 10.1111/bcp.13844] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 12/12/2022] Open
Abstract
AIMS The prevalence of dementia is rising as life expectancy increases globally. Behavioural and psychological symptoms of dementia (BPSD), including agitation and aggression, are common, presenting a challenge to clinicians and caregivers. METHODS Following PRISMA guidelines, we systematically reviewed evidence for gabapentin and pregabalin against BPSD symptoms of agitation or aggression in any dementia, using six databases (Pubmed, CINHL, PsychINFO, HealthStar, Embase, and Web of Science). Complementing this formal systematic review, an illustrative case of a patient with BPSD in mixed Alzheimer's/vascular dementia, who appeared to derive benefits in terms of symptom control and functioning from the introduction of gabapentin titrated up to 3600 mg day-1 alongside other interventions, is presented. RESULTS Twenty-four relevant articles were identified in the systematic review. There were no randomized trials. Fifteen papers were original case series/case reports of patients treated with these compounds, encompassing 87 patients given gabapentin and six given pregabalin. In 12 of 15 papers, drug treatment was effective in the majority of cases. The remaining nine papers were solely reviews, of which two were described as systematic but predated PRISMA guidelines. Preliminary low-grade evidence based on case series and case reviews suggests possible benefit of gabapentin and pregabalin in patients with BPSD in Alzheimer's disease. These benefits cannot be confirmed until well-powered randomized controlled trials are undertaken. Evidence in frontotemporal dementia is lacking. CONCLUSION Gabapentin and pregabalin could be considered for BPSD when medications having stronger evidence bases (risperidone, other antipsychotics, carbamazepine and citalopram) have been ineffective or present unacceptable risks of adverse outcomes.
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Affiliation(s)
- Thitiporn Supasitthumrong
- Geriatric Mental Health Service, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Psychiatry, Faculty of Medicine, King Chulalongkorn University, Bangkok, Thailand
| | - Blanca M Bolea-Alamanac
- Department of Psychiatry, University of Toronto, Toronto, Canada.,General Systems Division, Centre for Addiction and Mental Health, University of Toronto, Canada
| | - Selim Asmer
- Geriatric Mental Health Service, Centre for Addiction and Mental Health, Toronto, Canada
| | - Vincent L Woo
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Specialized Geriatrics Program, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Petal S Abdool
- Geriatric Mental Health Service, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Simon J C Davies
- Geriatric Mental Health Service, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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Rincón-Cortés M, Gagnon KG, Dollish HK, Grace AA. Diazepam reverses increased anxiety-like behavior, social behavior deficit, and dopamine dysregulation following withdrawal from acute amphetamine. Neuropsychopharmacology 2018; 43:2418-2425. [PMID: 29959439 PMCID: PMC6180061 DOI: 10.1038/s41386-018-0123-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 12/19/2022]
Abstract
Psychostimulants such as amphetamine (AMPH) increase dopamine (DA) release from ventral tegmental area (VTA) neurons, which is associated with their acute reinforcing actions. This positive state is followed by a negative affective state during the withdrawal period each time the drug is taken (i.e., opponent process theory). AMPH withdrawal is accompanied by symptoms of anxiety and depression, which are associated with DA system dysfunction in humans and animal models. Most studies have focused on the negative affective state after withdrawal from chronic drug administration; yet, this negative state appears even after a drug is taken for the first time in both humans and rodents. In rats, withdrawal from a single dose of AMPH (2 mg/kg) increases forced swim test immobility and decreases the number of spontaneously active VTA DA neurons up to 48 h post-withdrawal. In the current study, acute AMPH withdrawal was found to increase anxiety-like behavior in the elevated plus maze (EPM), reduce social cage time in the three-chambered social approach test (SAT), and attenuate VTA population activity. The effects of diazepam, a drug commonly used to treat anxiety disorders, were tested on anxiety-like and social behavior as well as VTA DA neuron activity following acute AMPH withdrawal. A single (5 mg/kg) dose of diazepam circumvented the neurobehavioral effects induced by acute AMPH withdrawal, as demonstrated by increased open arm time and social cage time as well as normalized VTA DA activity comparable to controls, suggesting that these neurobehavioral effects of acute AMPH withdrawal reflect an anxiety-like state.
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Affiliation(s)
- Millie Rincón-Cortés
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, 15217, USA. .,Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15217, USA.
| | - Kimberly G. Gagnon
- 0000 0004 1936 9000grid.21925.3dDepartment of Neuroscience, University of Pittsburgh, Pittsburgh, PA 15217 USA
| | - Hannah K. Dollish
- 0000 0004 1936 9000grid.21925.3dDepartment of Neuroscience, University of Pittsburgh, Pittsburgh, PA 15217 USA
| | - Anthony A. Grace
- 0000 0004 1936 9000grid.21925.3dDepartment of Neuroscience, University of Pittsburgh, Pittsburgh, PA 15217 USA ,0000 0004 1936 9000grid.21925.3dDepartment of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15217 USA ,0000 0004 1936 9000grid.21925.3dDepartment of Psychology, University of Pittsburgh, Pittsburgh, PA 15217 USA
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Strawn JR, Geracioti L, Rajdev N, Clemenza K, Levine A. Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opin Pharmacother 2018; 19:1057-1070. [PMID: 30056792 DOI: 10.1080/14656566.2018.1491966] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Generalized anxiety disorder (GAD) often begins during adolescence or early adulthood and persists throughout the lifespan. Randomized controlled trials support the efficacy of selective serotonin and selective serotonin norepinephrine reuptake inhibitors (SSRIs and SNRIs, respectively), as well as benzodiazepines, azapirones, anti-adrenergic medications, melatonin analogs, second-generation antipsychotics, kava, and lavender oil in GAD. However, psychopharmacologic treatment selection requires clinicians to consider multiple factors, including age, co-morbidity, and prior treatment. Areas covered: The authors review the literature concerning pharmacotherapy for pediatric and adult patients with GAD with specific commentary on the efficacy and tolerability of selected agents in these age groups. The authors describe an algorithmic approach to the pediatric and adult patient with GAD and highlight considerations for the use of selected medications in these patients. Expert opinion: In adults with GAD, SSRIs and SNRIs represent the first-line psychopharmacologic treatment while second-line pharmacotherapies include buspirone, benzodiazepines, SGAs, and pregabalin. In pediatric patients with GAD, SSRIs should be considered the first line pharmacotherapy and psychotherapy enhances antidepressant response.
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Affiliation(s)
- Jeffrey R Strawn
- a University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Laura Geracioti
- a University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Neil Rajdev
- a University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | | | - Amir Levine
- b Columbia University , New York City , NY , USA
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Storch EA, Gregory S, Salloum A, Quast T. Psychopharmacology Utilization Among Children with Anxiety and Obsessive-Compulsive and Related Disorders Following Hurricane Katrina. Child Psychiatry Hum Dev 2018; 49:632-642. [PMID: 29299728 PMCID: PMC11189098 DOI: 10.1007/s10578-017-0779-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This study aimed to examine the impact of Hurricane Katrina exposure on medication utilization among children with pre-existing anxiety and obsessive-compulsive and related disorders (OCRDs). Medicaid claims data from 2004 to 2006 were analyzed. Children with pre-existing anxiety/OCRDs were compared as a function of those living in a Louisiana disaster area, Louisiana non-disaster area, or Texas in terms of filled prescriptions and average days medication supply. This was further examined as a function of disorder/medication type. Prescriptions filled and average days medication supply were lower for those who resided in the disaster area of Louisiana relative to non-disaster zones in Texas (but not Louisiana). Children with OCD who lived in a disaster zone in Louisiana had 16.6 fewer days supply of antidepressants relative to youth in Texas. Similarly, children with PTSD who lived in a disaster zone in Louisiana had approximately 7 fewer days supply of stimulant medication relative to those who lived in Texas. Medication utilization was reduced for those youth directly exposed to Katrina relative to children in Texas, suggesting potential service disruption. Children with OCD and PTSD may be more likely to experience treatment disruption. Following disasters, particular attention should be given to ensuring continued treatment access for youth with pre-existing anxiety and OCRDs (as well as other conditions).
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Affiliation(s)
- Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, USA.
| | | | - Alison Salloum
- School of Social Work, University of South Florida, Tampa, USA
| | - Troy Quast
- Department of Psychiatry & Behavioral Neurosciences, University of South Florida, Tampa, USA
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30
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Gomez AF, Barthel AL, Hofmann SG. Comparing the efficacy of benzodiazepines and serotonergic anti-depressants for adults with generalized anxiety disorder: a meta-analytic review. Expert Opin Pharmacother 2018; 19:883-894. [PMID: 29806492 DOI: 10.1080/14656566.2018.1472767] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Generalized anxiety disorder (GAD) is a common form of anxiety disorder. Selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines (BZs) are the most commonly prescribed medications for GAD, but little is known about the relative efficacy of these pharmacological treatments. Areas covered: This study provides a meta-analytic review of the efficacy of these medications in the treatment of adults with GAD. A comprehensive literature search yielded 54 articles reporting 56 unique studies with 12,655 participants treated with either pill placebo (6,191 participants), SSRIs (16 trials, 2,712 participants), SNRIs (17 trials, 2,603 participants), or BZs (23 trials, 1,149 participants). The overall combined effect size was modest to moderate (Hedges' g = 0.37, p < 0.0001). Effect sizes decreased significantly over time. SSRIs (Hedges' g = 0.33) and SNRIs (Hedges' g = 0.36) demonstrated significantly lower effect sizes than BZs (Hedges' g = 0.50). These findings were not due to differences in treatment length or publication year. Expert opinion: The results of this study suggest that the most common forms of pharmacotherapy for adult GAD are moderately effective, with BZs being the most effective drug.
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Affiliation(s)
- Angelina F Gomez
- a Department of Psychological and Brain Sciences , Boston University , Boston , MA , USA
| | - Abigail L Barthel
- a Department of Psychological and Brain Sciences , Boston University , Boston , MA , USA
| | - Stefan G Hofmann
- a Department of Psychological and Brain Sciences , Boston University , Boston , MA , USA
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31
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Paschoalin-Maurin T, dos Anjos-Garcia T, Falconi-Sobrinho LL, de Freitas RL, Coimbra JPC, Laure CJ, Coimbra NC. The Rodent-versus-wild Snake Paradigm as a Model for Studying Anxiety- and Panic-like Behaviors: Face, Construct and Predictive Validities. Neuroscience 2018; 369:336-349. [DOI: 10.1016/j.neuroscience.2017.11.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 11/09/2017] [Accepted: 11/17/2017] [Indexed: 12/22/2022]
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Huang Z, Zhan S, Chen C, Li N, Ding Y, Hou Y, Wang L, Wang Y. The Effect of Insomnia on Cortical Excitability in Patients With Generalized Anxiety Disorder. Front Psychiatry 2018; 9:755. [PMID: 30687140 PMCID: PMC6335338 DOI: 10.3389/fpsyt.2018.00755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/20/2018] [Indexed: 12/16/2022] Open
Abstract
The high rate of comorbidity between insomnia and anxiety disorders have been confirmed by previous studies. However, the underlying neurobiological correlates of the relationship between insomnia and anxiety disorders are largely unknown. The aim of the present study was to investigate the effect of insomnia on cortical excitability in patients with generalized anxiety disorder (GAD) by examining the recovery functions of median nerve somatosensory evoked potentials (SEPs) in patients with GAD without insomnia and patients with GAD comorbid with insomnia. We studied the recovery functions of median nerve SEPs in 12 medication-naive patients with GAD without insomnia, 15 medication-naive patients with GAD comorbid with insomnia, and 15 age and sex matched healthy controls. SEPs in response to single stimulus and paired stimuli at interstimulus intervals (ISIs) of 20, 60, 100, and 150 ms were recorded. The recovery function of the P25 component showed significantly reduced suppression in patients with GAD without insomnia as compared to patients with GAD comorbid with insomnia and healthy controls. There were no significant differences in the recovery functions of median nerve SEPs between patients with GAD comorbid with insomnia and healthy controls. The present study suggested that the cortical excitability of right parietal cortex increased in patients with GAD without insomnia, and cortical excitability in patients with GAD comorbid with insomnia was modulated by insomnia. Our findings provide new insights into the underlying neurobiological correlates of the effects of insomnia on GAD, which could ultimately be used to inform clinical intervention.
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Affiliation(s)
- Zhaoyang Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Shuqin Zhan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Chao Chen
- Key Laboratory of Complex System Control Theory and Application, Tianjin University of Technology, Tianjin, China
| | - Ning Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Yan Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Yue Hou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Li Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
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Korn CW, Vunder J, Miró J, Fuentemilla L, Hurlemann R, Bach DR. Amygdala Lesions Reduce Anxiety-like Behavior in a Human Benzodiazepine-Sensitive Approach-Avoidance Conflict Test. Biol Psychiatry 2017; 82:522-531. [PMID: 28364943 PMCID: PMC5598543 DOI: 10.1016/j.biopsych.2017.01.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/18/2017] [Accepted: 01/29/2017] [Indexed: 12/03/2022]
Abstract
BACKGROUND Rodent approach-avoidance conflict tests are common preclinical models of human anxiety disorder. Their translational validity mainly rests on the observation that anxiolytic drugs reduce rodent anxiety-like behavior. Here, we capitalized on a recently developed approach-avoidance conflict computer game to investigate the impact of benzodiazepines and of amygdala lesions on putative human anxiety-like behavior. In successive epochs of this game, participants collect monetary tokens on a spatial grid while under threat of virtual predation. METHODS In a preregistered, randomized, double-blind, placebo-controlled trial, we tested the effect of a single dose (1 mg) of lorazepam (n = 59). We then compared 2 patients with bilateral amygdala lesions due to Urbach-Wiethe syndrome with age- and gender-matched control participants (n = 17). Based on a previous report, the primary outcome measure was the effect of intra-epoch time (i.e., an adaptation to increasing potential loss) on presence in the safe quadrant of the spatial grid. We hypothesized reduced loss adaptation in this measure under lorazepam and in patients with amygdala lesions. RESULTS Lorazepam and amygdala lesions reduced loss adaptation in the primary outcome measure. We found similar results in several secondary outcome measures. The relative reduction of anxiety-like behavior in patients with amygdala lesions was qualitatively and quantitatively indistinguishable from an impact of anterior hippocampus lesions found in a previous report. CONCLUSIONS Our results establish the translational validity of human approach-avoidance conflict tests in terms of anxiolytic drug action. We identified the amygdala, in addition to the hippocampus, as a critical structure in human anxiety-like behavior.
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Affiliation(s)
- Christoph W. Korn
- Division of Clinical Psychiatry Research, Psychiatric Hospital, Zurich, Switzerland,Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland,Address correspondence to Christoph W. Korn, Ph.D., Psychiatrische Universitätsklinik Zürich, Lenggstrasse 31, 8032 Zurich, Switzerland;Psychiatrische Universitätsklinik Zürich, Lenggstrasse 31Zurich8032Switzerland
| | - Johanna Vunder
- Division of Clinical Psychiatry Research, Psychiatric Hospital, Zurich, Switzerland,Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Júlia Miró
- Epilepsy Unit, University Hospital of Bellvitge, Barcelona, Spain
| | - Lluís Fuentemilla
- Cognition and Brain Plasticity Unit, Institute of Biomedicine Research of Bellvitge, Barcelona, Spain,Department of Cognition, Development, and Educational Psychology, Barcelona, Spain,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Rene Hurlemann
- Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany
| | - Dominik R. Bach
- Division of Clinical Psychiatry Research, Psychiatric Hospital, Zurich, Switzerland,Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland,Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom
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Buoli M, Grassi S, Serati M, Altamura AC. Agomelatine for the treatment of generalized anxiety disorder. Expert Opin Pharmacother 2017; 18:1373-1379. [DOI: 10.1080/14656566.2017.1359257] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico , Milan, Italy
| | - Silvia Grassi
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico , Milan, Italy
| | - Marta Serati
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico , Milan, Italy
| | - A. Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico , Milan, Italy
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Li CT, Lu CF, Lin HC, Huang YZ, Juan CH, Su TP, Bai YM, Chen MH, Lin WC. Cortical inhibitory and excitatory function in drug-naive generalized anxiety disorder. Brain Stimul 2017; 10:604-608. [DOI: 10.1016/j.brs.2016.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/07/2016] [Accepted: 12/15/2016] [Indexed: 01/01/2023] Open
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Goddard AW. Morbid Anxiety: Identification and Treatment. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2017; 15:136-143. [PMID: 31975846 DOI: 10.1176/appi.focus.20160046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Due to their prevalence, chronicity, and poorly understood pathophysiology, anxiety disorders remain an important public health problem. Despite clear diagnostic guidelines and the availability of excellent evidence-based treatments, most anxiety patients remain underrecognized and inadequately treated. This clinical synthesis highlights changes to anxiety disorder diagnosis that became effective with DSM-5. The article also provides some clinical perspective on clarifying differential diagnostic problems and building an alliance with the anxious patient. The quality and strength of the evidence base for current anxiolytic medications options (selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, benzodiazepines, and other agents), antianxiety psychotherapies (cognitive-behavioral therapy and brief dynamic therapies), and combination treatments are discussed. A brief update on newer treatment strategies, such as cognitive enhancement, complementary therapies, and neuromodulation, is included. Future directions for anxiety nosology and treatment are summarized, including the National Institute of Mental Health Research Domain Criteria initiative and the promising role of personalized medicine.
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Affiliation(s)
- Andrew W Goddard
- Dr. Goddard is professor of psychiatry with the University of California, San Francisco, Fresno Medical Education and Research Program, Fresno
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37
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Buoli M, Caldiroli A, Serati M. Pharmacokinetic evaluation of pregabalin for the treatment of generalized anxiety disorder. Expert Opin Drug Metab Toxicol 2017; 13:351-359. [DOI: 10.1080/17425255.2017.1281247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alice Caldiroli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Serati
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
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Michels H, Seinstra RI, Uitdehaag JCM, Koopman M, van Faassen M, Martineau CN, Kema IP, Buijsman R, Nollen EAA. Identification of an evolutionary conserved structural loop that is required for the enzymatic and biological function of tryptophan 2,3-dioxygenase. Sci Rep 2016; 6:39199. [PMID: 27995966 PMCID: PMC5171515 DOI: 10.1038/srep39199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/21/2016] [Indexed: 01/25/2023] Open
Abstract
The enzyme TDO (tryptophan 2,3-dioxygenase; TDO-2 in Caenorhabditis elegans) is a potential therapeutic target to cancer but is also thought to regulate proteotoxic events seen in the progression of neurodegenerative diseases. To better understand its function and develop specific compounds that target TDO we need to understand the structure of this molecule. In C. elegans we compared multiple different CRISPR/Cas9-induced tdo-2 deletion mutants and identified a motif of three amino acids (PLD) that is required for the enzymatic conversion of tryptophan to N-formylkynurenine. Loss of TDO-2’s enzymatic activity in PDL deletion mutants was accompanied by an increase in motility during aging and a prolonged lifespan, which is in line with the previously observed phenotypes induced by a knockdown of the full enzyme. Comparison of sequence structures suggests that blocking this motif might interfere with haem binding, which is essential for the enzyme’s activity. The fact that these three residues are situated in an evolutionary conserved structural loop of the enzyme suggests that the findings can be translated to humans. The identification of this specific loop region in TDO-2–essential for its catalytic function–will aid in the design of novel inhibitors to treat diseases in which the TDO enzyme is overexpressed or hyperactive.
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Affiliation(s)
- Helen Michels
- European Research Institute for the Biology of Aging, University of Groningen, University Medical Center Groningen, Laboratory of Molecular Neurobiology of Aging, The Netherlands
| | - Renée I Seinstra
- European Research Institute for the Biology of Aging, University of Groningen, University Medical Center Groningen, Laboratory of Molecular Neurobiology of Aging, The Netherlands
| | | | - Mandy Koopman
- European Research Institute for the Biology of Aging, University of Groningen, University Medical Center Groningen, Laboratory of Molecular Neurobiology of Aging, The Netherlands
| | - Martijn van Faassen
- University of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, The Netherlands
| | - Céline N Martineau
- European Research Institute for the Biology of Aging, University of Groningen, University Medical Center Groningen, Laboratory of Molecular Neurobiology of Aging, The Netherlands
| | - Ido P Kema
- University of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, The Netherlands
| | - Rogier Buijsman
- Netherlands Translational Research Center B.V., Oss, The Netherlands
| | - Ellen A A Nollen
- European Research Institute for the Biology of Aging, University of Groningen, University Medical Center Groningen, Laboratory of Molecular Neurobiology of Aging, The Netherlands
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Keefe JR, Mao JJ, Soeller I, Li QS, Amsterdam JD. Short-term open-label chamomile (Matricaria chamomilla L.) therapy of moderate to severe generalized anxiety disorder. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2016; 23:1699-1705. [PMID: 27912871 PMCID: PMC5589135 DOI: 10.1016/j.phymed.2016.10.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/28/2016] [Accepted: 10/23/2016] [Indexed: 05/06/2023]
Abstract
BACKGROUND Conventional drug treatments for Generalized Anxiety Disorder (GAD) are often accompanied by substantial side effects, dependence, and/or withdrawal syndrome. A prior controlled study of oral chamomile (Matricaria chamomilla L.) extract showed significant efficacy versus placebo, and suggested that chamomile may have anxiolytic activity for individuals with GAD. HYPOTHESIS We hypothesized that treatment with chamomile extract would result in a significant reduction in GAD severity ratings, and would be associated with a favorable adverse event and tolerability profile. STUDY DESIGN We report on the open-label phase of a two-phase randomized controlled trial of chamomile versus placebo for relapse-prevention of recurrent GAD. METHODS Subjects with moderate to severe GAD received open-label treatment with pharmaceutical-grade chamomile extract 1500mg/day for up to 8 weeks. Primary outcomes were the frequency of clinical response and change in GAD-7 symptom scores by week 8. Secondary outcomes included the change over time on the Hamilton Rating Scale for Anxiety, the Beck Anxiety Inventory, and the Psychological General Well Being Index. Frequency of treatment-emergent adverse events and premature treatment discontinuation were also examined. RESULTS Of 179 subjects, 58.1% (95% CI: 50.9% to 65.5%) met criteria for response, while 15.6% prematurely discontinued treatment. Significant improvement over time was also observed on the GAD-7 rating (β=-8.4 [95% CI=-9.1 to -7.7]). A similar proportion of subjects demonstrated statistically significant and clinically meaningful reductions in secondary outcome ratings of anxiety and well-being. Adverse events occurred in 11.7% of subjects, although no serious adverse events occurred. CONCLUSION Chamomile extract produced a clinically meaningful reduction in GAD symptoms over 8 weeks, with a response rate comparable to those observed during conventional anxiolytic drug therapy and a favorable adverse event profile. Future comparative effectiveness trials between chamomile and conventional drugs may help determine the optimal risk/benefit of these therapies for patients suffering from GAD.
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Affiliation(s)
- John R Keefe
- Department of Psychology, University of Pennsylvania, Philadelphia, PA United States
| | - Jun J Mao
- Bendheim Center for Integrative Medicine, Memorial Sloan-Kettering Cancer Center, 1429 First Avenue, New York, NY 10021 United States.
| | - Irene Soeller
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA United States
| | - Qing S Li
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA United States
| | - Jay D Amsterdam
- Depression Research Unit, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA United States
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Mao JJ, Xie SX, Keefe JR, Soeller I, Li QS, Amsterdam JD. Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2016; 23:1735-1742. [PMID: 27912875 PMCID: PMC5646235 DOI: 10.1016/j.phymed.2016.10.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/28/2016] [Accepted: 10/23/2016] [Indexed: 05/22/2023]
Abstract
BACKGROUND Generalized Anxiety Disorder (GAD) is one of the most common anxiety disorders treated in primary care, yet current therapies have limited efficacy and substantial side effects. PURPOSE To evaluate long-term chamomile (Matricaria chamomilla L.) use for prevention of GAD symptom relapse. METHODS Outpatients from primary care practices and local communities with a primary diagnosis of moderate-to-severe GAD were enrolled for this two-phase study at a large US academic medical center. During Phase 1, eligible participants received 12 weeks of open-label therapy with chamomile pharmaceutical grade extract 1500mg (500mg capsule 3 times daily). During Phase 2, treatment responders were randomized to either 26 weeks of continuation chamomile therapy or placebo in a double-blinded, placebo-substitution design. The primary outcome was time to relapse during continuation therapy, analyzed using Cox proportional hazards. Secondary outcomes included the proportion who relapsed, treatment-emergent adverse events, and vital sign changes. This study is registered at ClinicalTrials.gov, identifier NCT01072344. RESULTS Between March 1, 2010, and June 30, 2015, we enrolled 179 participants. Of those, 93 (51.9%) were responders and agreed to continue in the double-blind randomized controlled trial. A numerically greater number of placebo-switched (n=12/47; 25.5%) versus chamomile-continuation (n = 7/46; 15.2%) participants relapsed during follow-up. Mean time to relapse was 11.4 ± 8.4 weeks for chamomile and 6.3 ± 3.9 weeks for placebo. Hazard of relapse was non-significantly lower for chamomile (hazard ratio, 0.52; 95% CI, 0.20-1.33; P = 0.16). During follow-up, chamomile participants maintained significantly lower GAD symptoms than placebo (P = 0.0032), with significant reductions in body weight (P = 0.046) and mean arterial blood pressure (P = 0.0063). Both treatments had similar low adverse event rates. CONCLUSIONS Long-term chamomile was safe and significantly reduced moderate-to-severe GAD symptoms, but did not significantly reduce rate of relapse. Our limited sample size and lower than expected rate of placebo group relapse likely contributed to the non-significant primary outcome finding. Possible chamomile superiority over placebo requires further examination in large-scale studies.
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Affiliation(s)
- Jun J Mao
- Bendheim Center for Integrative Medicine, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY 10021, United States.
| | - Sharon X Xie
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - John R Keefe
- Department of Psychology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, United States
| | - Irene Soeller
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Qing S Li
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jay D Amsterdam
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Abstract
Anxiety is a common yet frequently overlooked psychiatric symptom in patients with ESRD treated with hemodialysis (HD). Anxiety is characterized by disruptive feelings of uncertainty, dread, and fearfulness. A variety of common medical complaints may be manifestations of an anxiety disorder, including palpitations, tremors, indigestion, numbness/tingling, nervousness, shortness of breath, diaphoresis, and fear. It is essential for the clinician to rule out specific medical conditions, including cardiovascular, pulmonary, and neurologic diseases, before ascribing these symptoms to an anxiety disorder. In addition, there is considerable overlap between the symptoms of anxiety and those of depression and uremia. This psychiatric condition has a significant adverse impact on patients' perception of quality of life. Little is known regarding the prevalence and impact of anxiety disorders in patients with ESRD treated with HD; however, many of the seemingly irrational behaviors of patients, or behaviors which place them in conflict with staff and physicians, such as behavioral noncompliance, may be the expression of an underlying anxiety disorder. In this review, we present three clinical vignettes, highlighting the impact of anxiety disorders in patients with ESRD treated with HD.
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Affiliation(s)
- Scott D. Cohen
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University Medical Center, Washington, DC
| | - Daniel Cukor
- Department of Psychiatry and Behavioral Science, State University of New York Downstate Medical Center, Brooklyn, New York; and
| | - Paul L. Kimmel
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University Medical Center, Washington, DC
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Butler TR, Karkhanis AN, Jones SR, Weiner JL. Adolescent Social Isolation as a Model of Heightened Vulnerability to Comorbid Alcoholism and Anxiety Disorders. Alcohol Clin Exp Res 2016; 40:1202-14. [PMID: 27154240 DOI: 10.1111/acer.13075] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/24/2016] [Indexed: 01/01/2023]
Abstract
Individuals diagnosed with anxiety-related illnesses are at increased risk of developing alcoholism, exhibit a telescoped progression of this disease and fare worse in recovery, relative to alcoholics that do not suffer from a comorbid anxiety disorder. Similarly, preclinical evidence supports the notion that stress and anxiety represent major risk factors for the development of alcohol use disorder (AUD). Despite the importance of understanding the link between anxiety and alcoholism, much remains unknown about the neurobiological substrates underlying this relationship. One stumbling block has been the lack of animal models that reliably reproduce the spectrum of behaviors associated with increased vulnerability to these diseases. Here, we review the literature that has examined the behavioral and neurobiological outcomes of a simple rodent adolescent social isolation procedure and discuss its validity as a model of vulnerability to comorbid anxiety disorders and alcoholism. Recent studies have provided strong evidence that adolescent social isolation of male rats leads to the expression of a variety of behaviors linked with increased vulnerability to anxiety and/or AUD, including deficits in sensory gating and fear extinction, and increases in anxiety measures and ethanol drinking. Neurobiological studies are beginning to identify mesolimbic adaptations that may contribute to the behavioral phenotype engendered by this model. Some of these changes include increased excitability of ventral tegmental area dopamine neurons and pyramidal cells in the basolateral amygdala and significant alterations in baseline and stimulated catecholamine signaling. A growing body of evidence suggests that adolescent social isolation may represent a reliable rodent model of heightened vulnerability to anxiety disorders and alcoholism in male rats. These studies provide initial support for the face, construct, and predictive validity of this model and highlight its utility in identifying neurobiological adaptations associated with increased risk of developing these disorders.
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Affiliation(s)
- Tracy R Butler
- Department of Psychology , University of Dayton, Dayton, Ohio
| | - Anushree N Karkhanis
- Department of Physiology and Pharmacology , Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Sara R Jones
- Department of Physiology and Pharmacology , Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Jeffrey L Weiner
- Department of Physiology and Pharmacology , Wake Forest School of Medicine, Winston Salem, North Carolina
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The Role of Psychotropic Medications in the Management of Anorexia Nervosa: Rationale, Evidence and Future Prospects. CNS Drugs 2016; 30:419-42. [PMID: 27106297 PMCID: PMC4873415 DOI: 10.1007/s40263-016-0335-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anorexia nervosa (AN) is a severe psychiatric disorder without approved medication intervention. Every class of psychoactive medication has been tried to improve treatment outcome; however, randomized controlled trials have been ambiguous at best and across studies have not shown robust improvements in weight gain and recovery. Here we review the available literature on pharmacological interventions since AN came to greater public recognition in the 1960s, including a critical review of why those trials may not have been successful. We further provide a neurobiological background for the disorder and discuss how cognition, learning, and emotion-regulating circuits could become treatment targets in the future. Making every effort to develop effective pharmacological treatment options for AN is imperative as it continues to be a complex psychiatric disorder with high disease burden and mortality.
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