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Wang P, Wang WW, Liu YQ, Li WQ, Hu JX, Su YA, Li JT, Li N, Si TM. The dose-response relationship of vortioxetine on major depressive disorder: an umbrella review. Psychiatry Res 2024; 340:116118. [PMID: 39121757 DOI: 10.1016/j.psychres.2024.116118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/25/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024]
Abstract
Vortioxetine is a novel multimodal antidepressant, but its precise efficacy and dose-response relationship for treating different symptoms in major depressive disorder (MDD) is still unclear. This umbrella review aims to assess the effectiveness, tolerability, and dose-response relationship of vortioxetine across a comprehensive range of clinical features in adults with MDD, including cognition, depression, anxiety, quality of life, and side effects. We meticulously searched eight electronic databases and included systematic reviews (SRs) and meta-analyses (MAs) of vortioxetine. The methodological quality of each included SR was independently assessed using the AMSTAR2 tool. To evaluate the credibility of the evidence, we utilized the GRADE framework and the Ioannidis criteria. In total, 35 SRs with 278 MAs met the inclusion criteria and based on these studies we performed 56 MAs of interest. While vortioxetine has been consistently shown to have positive effects on various domains, the evidence regarding cognitive performance and depression symptoms is notably robust compared to placebo, despite of relatively overall low quality of evidence. Finally, a dose-response relationship was observed across all categories within the treatment range of 5-20 mg/d and a dosage of vortioxetine 20 mg/d is recommended for adult MDD patients to achieve full functional recovery.
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Affiliation(s)
- Ping Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China; Department of Neurology and Psychiatry, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Wei-Wei Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Yi-Qi Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Wen-Qiang Li
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China; Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
| | - Jian-Xin Hu
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
| | - Yun-Ai Su
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Ji-Tao Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China.
| | - Nan Li
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China; Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China.
| | - Tian-Mei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China.
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El-Kadi RA, AbdelKader NF, Zaki HF, Kamel AS. Vilazodone Alleviates Neurogenesis-Induced Anxiety in the Chronic Unpredictable Mild Stress Female Rat Model: Role of Wnt/β-Catenin Signaling. Mol Neurobiol 2024:10.1007/s12035-024-04142-3. [PMID: 38584231 DOI: 10.1007/s12035-024-04142-3] [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: 08/10/2023] [Accepted: 03/19/2024] [Indexed: 04/09/2024]
Abstract
Defective β-catenin signaling is accompanied with compensatory neurogenesis process that may pave to anxiety. β-Catenin has a distinct role in alleviating anxiety in adolescence; however, it undergoes degradation by the degradation complex Axin and APC. Vilazodone (VZ) is a fast, effective antidepressant with SSRI activity and 5-HT1A partial agonism that amends somatic and/or psychic symptoms of anxiety. Yet, there is no data about anxiolytic effect of VZ on anxiety-related neurogenesis provoked by stress-reduced β-catenin signaling. Furthermore, females have specific susceptibility toward psychopathology. The aim of the present study is to uncover the molecular mechanism of VZ relative to Wnt/β-catenin signaling in female rats. Stress-induced anxiety was conducted by subjecting the rats to different stressful stimuli for 21 days. On the 15th day, stressed rats were treated with VZ(10 mg/kg, p.o.) alone or concomitant with the Wnt inhibitor: XAV939 (0.1 mg/kg, i.p.). Anxious rats showed low β-catenin level turned over by Axin-1 with unanticipated reduction of APC pursued with elevated protein levels of neurogenesis-stimulating proteins: c-Myc and pThr183-Erk likewise gene expressions of miR-17-5p and miR-18. Two weeks of VZ treatment showed anxiolytic effect figured by alleviation of hippocampal histological examination. VZ protected β-catenin signal via reduction in Axin-1 and elevation of APC conjugated with modulation of β-catenin downstream targets. The cytoplasmic β-catenin turnover by Axin-1 was restored by XAV939. Herein, VZ showed anti-anxiety effect, which may be in part through regaining the balance of the reduced β-catenin and its subsequent exaggerated response of p-Erk, c-Myc, Dicer-1, miR-17-5p, and miR-18.
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Affiliation(s)
- Rana A El-Kadi
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini, Cairo, 11562, Egypt
- Alexandria University Hospitals, Champollion Street, El-Khartoum Square, El Azareeta, Alexandria, 21131, Egypt
| | - Noha F AbdelKader
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini, Cairo, 11562, Egypt
| | - Hala F Zaki
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini, Cairo, 11562, Egypt
| | - Ahmed S Kamel
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini, Cairo, 11562, Egypt.
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Mattingly GW, Necking O, Schmidt SN, Reines E, Ren H. Long-term safety and efficacy, including anhedonia, of vortioxetine for major depressive disorder: findings from two open-label studies. Curr Med Res Opin 2023; 39:613-619. [PMID: 36884024 DOI: 10.1080/03007995.2023.2178082] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE Evaluate the long-term safety and efficacy of vortioxetine in the management of major depressive disorder (MDD) in two open-label one-year studies, including a post-hoc analysis of its effects on symptoms related to anhedonia. METHODS Both studies were 52-week, open-label, flexible-dose extension studies to evaluate the safety and efficacy of vortioxetine in adult patients with MDD following prior double-blind studies. Patients in the first study (NCT00761306) were flexibly treated with vortioxetine 5 or 10 mg/day (N = 74), and patients in the second study (NCT01323478) received vortioxetine 15 or 20 mg/day (N = 71). RESULTS The safety and tolerability profile of vortioxetine was similar between the two studies; treatment-emergent adverse events with the highest incidence were nausea, dizziness, headache, and nasopharyngitis. Across both studies, improvements achieved during the preceding double-blind studies period were maintained, and additional improvements were observed with open-label treatment. Patients showed a mean ± SD reduction (improvement) in Montgomery and Åsberg Depression Rating Scale (MADRS) total score from open-label baseline to Week 52 of 4.3 ± 9.2 points in the 5-10 mg study, and 10.9 ± 10.0 in the 15-20 mg study. Post-hoc MMRM analyses of MADRS anhedonia factor scores also showed continued improvements over long-term treatment; patients showed a mean ± SE reduction from an open-label baseline to Week 52 of 3.10 ± 0.57 points in the 5-10 mg study, and 5.62 ± 0.60 in the 15-20 mg study. CONCLUSIONS Data from both studies confirm the safety and efficacy of flexibly dosed vortioxetine over 52 weeks of treatment and demonstrate that MADRS anhedonia factor scores continue to improve with long-term maintenance treatment.
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Affiliation(s)
- Gregory W Mattingly
- Midwest Research Group, Washington University School of Medicine, St. Louis, MO, USA
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Waters K. The clinical utility of newer antidepressant agents: Understanding the role in management of MDD. Ment Health Clin 2022; 12:309-319. [PMID: 36405509 PMCID: PMC9645287 DOI: 10.9740/mhc.2022.10.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/07/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Whereas MDD is characterized in part by changes in mood, other symptoms can also cause significant impairment, including sexual dysfunction, cognitive impairment, and fatigue. Newer antidepressants are explored with the goal of more optimally treating these non–mood-related symptoms of MDD. The 3 oral antidepressants that have been FDA-approved most recently include vortioxetine, vilazodone, and levomilnacipran. Unique features of these antidepressants are explored through 3 patient cases.
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Affiliation(s)
- Kristin Waters
- 1 (Corresponding author) Assistant Clinical Professor, University of Connecticut, Storrs, Connecticut,
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5
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Lurati AR. Management of Antidepressant Therapy–Induced Sexual Dysfunction in Women. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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McIntyre RS, Loft H, Christensen MC. Efficacy of Vortioxetine on Anhedonia: Results from a Pooled Analysis of Short-Term Studies in Patients with Major Depressive Disorder. Neuropsychiatr Dis Treat 2021; 17:575-585. [PMID: 33654400 PMCID: PMC7910099 DOI: 10.2147/ndt.s296451] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/04/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Anhedonia is a core symptom of major depressive disorder (MDD), which has important functional consequences for the patient. This post hoc analysis investigated the relationship between anhedonia and functioning in patients with MDD treated with vortioxetine. PATIENTS AND METHODS We conducted a pooled analysis of all 11 short-term, double-blind, randomized, placebo-controlled studies of vortioxetine (fixed dose, 5-20 mg/day) in patients with MDD which included Montgomery-Åsberg Depression Rating Scale (MADRS) and Sheehan Disability Scale (SDS) assessments. A short-term, randomized, active-controlled trial of flexible-dose treatment with vortioxetine (10-20 mg/day) versus agomelatine (25-50 mg/day) was also analyzed. Mean changes from baseline to study endpoint in MADRS total, MADRS anhedonia subscale, SDS total, and SDS social-functioning scores were analyzed by a mixed model for repeated measures. The relationship between treatment effects on anhedonia and functioning was investigated using path analysis. RESULTS A total of 4988 patients with MDD were included in the placebo-controlled studies and 495 in the active-comparator study. Significant dose-dependent improvements in overall depressive symptoms, anhedonia, and measures of functioning were seen in vortioxetine-treated patients compared with those who received placebo or agomelatine. Results of the path analysis for the placebo-controlled studies suggested that the effect on functioning was mostly driven by the effect of treatment on MADRS anhedonia factors. CONCLUSION Vortioxetine showed significant short-term efficacy against anhedonia in this large population of patients with MDD. In the placebo-controlled studies, improvements in functioning associated with vortioxetine appeared to be mostly driven by the effect of treatment on MADRS anhedonia factors.
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Affiliation(s)
- Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Henrik Loft
- Department of Biostatistics and Programming, H. Lundbeck A/S, Valby, Denmark
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Adamo D, Calabria E, Coppola N, Pecoraro G, Mignogna MD. Vortioxetine as a new frontier in the treatment of chronic neuropathic pain: a review and update. Ther Adv Psychopharmacol 2021; 11:20451253211034320. [PMID: 34497709 PMCID: PMC8419528 DOI: 10.1177/20451253211034320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/06/2021] [Indexed: 01/10/2023] Open
Abstract
Chronic neuropathic pain (CNP) is a disabling medical condition that impairs the health-related quality-of-life of affected patients. A high prevalence of anxiety, depression, sleep disturbance and cognitive impairment has frequently been reported in association with CNP, making the management of this disease complex and often multidisciplinary. Dual-acting agents such as selective serotonin and noradrenalin reuptake inhibitors (SNRIs) are considered particularly useful in the modulation of pain and in treatment of the mood disorders frequently associated with CNP. Recent evidence suggests that the top-down inhibitory control of pain involves the engagement and enhancement of descending endogenous opioidergic, cannabinoid and serotonergic systems, with the effect of serotonin being particularly related to the receptor subtypes that are preferentially activated; indeed serotonin induces analgesia via activation of 5-HT7 receptors and hyperalgesia via activation of 5-HT3 receptors. Vortioxetine (VO) is a novel multimodal serotonergic antidepressant with a unique mechanism of action. It has been demonstrated recently in experimental and clinical studies to have efficacy on pain hypersensitivity and on mood disorders. This drug inhibits the serotonin transporter with a high affinity, antagonises the 5-HT3, 5-HT1D and 5HT7 serotonin receptors, and activates the 5-HT1A and 5-HT1B receptors. In clinical studies, VO has proved effective at a dose of 10-20 mg/daily in short- and long-term treatment of patients with chronic orofacial pain, demonstrating a higher rate of clinical response and remission, a better acceptability, safety rate and tolerability, and a lower latency of action compared with other antidepressants. In the light of these recent findings, VO may be considered as a new pharmacological treatment also in relation to various types of CNP, particularly in elderly patients with concomitant mood disorders and cognitive impairment. The purpose of this review is to provide an up-to-date overview of the pharmacology and clinical applications of VO and to highlight its potential therapeutic properties and advantages in the management of CNP.
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Affiliation(s)
- Daniela Adamo
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Elena Calabria
- Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, via Pansini no.5, Naples, 80131, Italy
| | - Noemi Coppola
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Giuseppe Pecoraro
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Michele Davide Mignogna
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
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Besckow EM, Nonemacher NT, Garcia CS, da Silva Espíndola CN, Balbom ÉB, Gritzenco F, Savegnago L, Godoi B, Bortolatto CF, Brüning CA. Antidepressant-like effect of a selenopropargylic benzamide in mice: involvement of the serotonergic system. Psychopharmacology (Berl) 2020; 237:3149-3159. [PMID: 32617647 DOI: 10.1007/s00213-020-05600-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 06/26/2020] [Indexed: 12/13/2022]
Abstract
RATIONALE Major depressive disorder is a psychiatric disorder that requires considerable attention, since it dramatically impairs the quality of life of the sufferers. The available treatments do not have the efficacy needed, often presenting several side effects. Organoselenium compounds and benzamides have presented some pharmacological properties, among them an antidepressant-like effect. OBJECTIVES AND METHODS This study evaluated the antidepressant-like effect of N-(3-(phenylselanyl)prop-2-yn-1-yl)benzamide (SePB), an organoselenium compound containing a benzamide moiety, on the forced swimming test (FST) and the tail suspension test (TST) in mice, as well as the involvement of the serotonergic system in its effect. RESULTS SePB, tested after different times (15-120 min) and doses (1-50 mg/kg, intragastrically (i.g.)), reduced immobility of male mice during FST and TST, without changing locomotor activity in the open-field test (OFT), demonstrating its antidepressant-like effect. SePB (10 mg/kg) also produced an antidepressant-like effect in female mice in the TST. The preadministration of the serotonin (5-HT) depletor p-chlorophenylalanine (pCPA; 100 mg/kg, intraperitoneal route (i.p.) once daily for 4 days) prevented the anti-immobility effect of SePB, indicating that the serotonergic system is involved in the SePB antidepressant-like effect. The preadministration of the selective serotonergic receptor antagonists WAY100635 (0.1 mg/kg, subcutaneous route (s.c.), a selective 5-HT1A receptor antagonist), ketanserin (1 mg/kg, i.p., a 5-HT2A/2C receptor antagonist), and ondansetron (1 mg/kg, i.p., a selective 5-HT3 receptor antagonist) also prevented the anti-immobility effect of SePB, demonstrating that these receptors are involved in the antidepressant-like effect of SePB. CONCLUSION The search for new antidepressants drugs is a noteworthy goal. This study has described a new compound with an antidepressant-like effect, whose mechanism of action is related to modulation of the serotonergic system.
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Affiliation(s)
- Evelyn Mianes Besckow
- Laboratory of Biochemistry and Molecular Neuropharmacology (LABIONEM), Neurobiotechnology Research Group, Postgraduate Program in Biochemistry and Bioprospecting (PPGBBio), Center for Chemical, Pharmaceutical and Food Sciences (CCQFA), Federal University of Pelotas (UFPel), Capão do Leão Campus, Pelotas, RS, 96010-900, Brazil
| | - Natália Tavares Nonemacher
- Laboratory of Biochemistry and Molecular Neuropharmacology (LABIONEM), Neurobiotechnology Research Group, Postgraduate Program in Biochemistry and Bioprospecting (PPGBBio), Center for Chemical, Pharmaceutical and Food Sciences (CCQFA), Federal University of Pelotas (UFPel), Capão do Leão Campus, Pelotas, RS, 96010-900, Brazil
| | - Cleisson Schossler Garcia
- Laboratory of Biochemistry and Molecular Neuropharmacology (LABIONEM), Neurobiotechnology Research Group, Postgraduate Program in Biochemistry and Bioprospecting (PPGBBio), Center for Chemical, Pharmaceutical and Food Sciences (CCQFA), Federal University of Pelotas (UFPel), Capão do Leão Campus, Pelotas, RS, 96010-900, Brazil
| | - Carlos Natã da Silva Espíndola
- Laboratory of Biochemistry and Molecular Neuropharmacology (LABIONEM), Neurobiotechnology Research Group, Postgraduate Program in Biochemistry and Bioprospecting (PPGBBio), Center for Chemical, Pharmaceutical and Food Sciences (CCQFA), Federal University of Pelotas (UFPel), Capão do Leão Campus, Pelotas, RS, 96010-900, Brazil
| | - Éverton Berwanger Balbom
- Núcleo de Síntese, Aplicação e Análise de Compostos Orgânicos e Inorgânicos (NUSAACOI), Federal University of Fronteira Sul (UFFS), Cerro Largo, RS, Brazil
| | - Fabiane Gritzenco
- Núcleo de Síntese, Aplicação e Análise de Compostos Orgânicos e Inorgânicos (NUSAACOI), Federal University of Fronteira Sul (UFFS), Cerro Largo, RS, Brazil
| | - Lucielli Savegnago
- Postgraduate Program in Biotechnology, Neurobiotechnology Research Group, Center of Biotechnology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Benhur Godoi
- Núcleo de Síntese, Aplicação e Análise de Compostos Orgânicos e Inorgânicos (NUSAACOI), Federal University of Fronteira Sul (UFFS), Cerro Largo, RS, Brazil
| | - Cristiani Folharini Bortolatto
- Laboratory of Biochemistry and Molecular Neuropharmacology (LABIONEM), Neurobiotechnology Research Group, Postgraduate Program in Biochemistry and Bioprospecting (PPGBBio), Center for Chemical, Pharmaceutical and Food Sciences (CCQFA), Federal University of Pelotas (UFPel), Capão do Leão Campus, Pelotas, RS, 96010-900, Brazil.
| | - César Augusto Brüning
- Laboratory of Biochemistry and Molecular Neuropharmacology (LABIONEM), Neurobiotechnology Research Group, Postgraduate Program in Biochemistry and Bioprospecting (PPGBBio), Center for Chemical, Pharmaceutical and Food Sciences (CCQFA), Federal University of Pelotas (UFPel), Capão do Leão Campus, Pelotas, RS, 96010-900, Brazil.
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De Carlo V, Vismara M, Grancini B, Benatti B, Bosi MF, Colombo A, Viganò CA, Dell'Osso B. Effectiveness, tolerability, and dropout rates of vortioxetine in comorbid depression: A naturalistic study. Hum Psychopharmacol 2020; 35:e2750. [PMID: 32662933 DOI: 10.1002/hup.2750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/16/2020] [Accepted: 06/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Vortioxetine is a novel antidepressant whose safety, tolerability, and therapeutic action have been supported by several studies. The present naturalistic study aimed to characterize its effectiveness, tolerability, and dropout rate in the real world. METHODS Total sample consisted of 66 outpatients with major depressive episode, treated with vortioxetine, whose clinical variables were evaluated over three time points. RESULTS Most common primary diagnoses were major depressive disorder (45.5%) and bipolar disorder (33.4%), with an overall comorbidity rate of 48.5% and concomitant medications in the 89.4%. The mean vortioxetine daily dosage was 12.90 ± 5.65 mg. Effectiveness of vortioxetine through a significant improvement on specific psychometric scales emerged, while only a nonsignificant trend of association between higher dosage and effectiveness was found. In the total sample, 51.5% were classified as responders and 36.4% as remitters. Two-thirds of subjects did not report side effects, while in the remaining patients, gastrointestinal ones were the most frequent (72.7%). Almost two-thirds of the sample could complete the follow-up, while 36.4% dropped out; the main reasons for dropout were side effects (37.5%) and lack of efficacy (29.2%). CONCLUSIONS Larger sample studies are warranted to better characterize vortioxetine effectiveness and tolerability in the real world.
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Affiliation(s)
- Vera De Carlo
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatriy Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Matteo Vismara
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatriy Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Benedetta Grancini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatriy Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Beatrice Benatti
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatriy Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Monica Francesca Bosi
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatriy Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Anna Colombo
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatriy Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Caterina Adele Viganò
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatriy Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatriy Clinic, Ospedale Sacco-Polo Universitario-ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
- "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy
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10
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Sun B, Lv Y, Xu H, Qi C, Li C, Liu P. Effects of Vortioxetine on depression model rats and expression of BDNF and Trk B in hippocampus. Exp Ther Med 2020; 20:2895-2902. [PMID: 32765787 DOI: 10.3892/etm.2020.9026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/15/2020] [Indexed: 12/28/2022] Open
Abstract
Effects of Vortioxetine on the expression of brain-derived neurotrophic factor (BDNF) and tyrosine kinase B (Trk B) in hippocampus of depressive rats were investigated. Forty-five SD rats were randomly divided into three groups: model control, Vortioxetine and normal control group, with 15 rats in each group. The changes of body mass were recorded within 5 weeks, and the open field test, sugar water preference test and Morris water maze test were performed to evaluate the behavior and mental status of the rats. The expression of BDNF and Trk B in rat hippocampus was detected by enzyme-linked immuno sorbent assay. Compared with the model control group, the body mass, horizontal and vertical movement, sugar and water preference rate of the vortioxetine group in the 5th week were significantly higher than those of the model control group (P<0.05), and significantly lower than those of the normal control group (P<0.05). The escape latency of the Vortioxetine group within 4 days was significantly lower than that of model control group (P<0.05), but higher than that of normal control group (P<0.05). The target quadrant residence time of the Vortioxetine group was significantly lower than that of the model control group (P<0.05), but higher than that of the normal control group (P<0.05). Expression of BDNF and Trk B in the Vortioxetine group was significantly higher than that in the model control group (P<0.05), but lower than that of the normal control group (P<0.05). Collectively, Vortioxetine can effectively alleviate the symptoms of autonomous and exploratory behavior, and reduce the decrease of learning and memory in depressive rats. Vortioxetine can increase the expression of BDNF and Trk B in depressive rats and alleviate their depressive behavior.
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Affiliation(s)
- Baomin Sun
- Department of Psychology, Taian City Central Hospital, Taian, Shandong 271000, P.R. China
| | - Yanhua Lv
- Department of Psychiatry, Taian City Mental Hospital, Taian, Shandong 271000, P.R. China
| | - Hua Xu
- Department of Neurology, Taian City Central Hospital, Taian, Shandong 271000, P.R. China
| | - Chunhua Qi
- Central Laboratory, Taian City Central Hospital, Taian, Shandong 271000, P.R. China
| | - Cuiping Li
- Department of Psychology, Taian City Central Hospital, Taian, Shandong 271000, P.R. China
| | - Pengfei Liu
- Department of Psychology, Taian City Central Hospital, Taian, Shandong 271000, P.R. China
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Tran BX, Ha GH, Vu GT, Nguyen LH, Latkin CA, Nathan K, McIntyre RS, Ho CS, Tam WW, Ho RC. Indices of Change, Expectations, and Popularity of Biological Treatments for Major Depressive Disorder between 1988 and 2017: A Scientometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2255. [PMID: 31247926 PMCID: PMC6651662 DOI: 10.3390/ijerph16132255] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/11/2019] [Accepted: 06/19/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Major Depressive Disorder (MDD) is the most common psychiatric disorder with high prevalence and disease burden. Biological treatments of MDD over the last several decades include a wide range of antidepressants and neurostimulation therapies. While recent meta-analyses have explored the efficacy and tolerability of antidepressants, the changing trends of biological treatments have not been evaluated. Our study measured the indices of change, expectations, and popularity of biological treatments of MDD between 1988 and 2017. METHODS We performed a scientometric analysis to identify all relevant publications related to biological treatments of MDD from 1988 to 2017. We searched the Web of Science websites for publications from 1 January 1988 to 31 December 2017. We included publications of fluoxetine, paroxetine, citalopram, sertraline, amitriptyline, fluvoxamine, escitalopram, venlafaxine, duloxetine, milnacipran, desvenlafaxine, levomilnacipran, clomipramine, nortriptyline, bupropion, trazodone, nefazodone, mirtazapine, agomelatine, vortioxetine, vilazodone, electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS), deep brain stimulation (DBS), and transcranial direct current stimulation (tDCS). We excluded grey literature, conference proceedings, books/book chapters, and publications with low quality as well as publications not related to medicine or human health. The primary outcomes assessed were indices of change, expectations, and popularity. RESULTS Of 489,496 publications identified, we included 355,116 publications in this scientometric analysis. For the index of change, fluoxetine, sertraline and ECT demonstrated a positive index of change in 6 consecutive periods. Other neurostimulation therapies including rTMS, VNS, DBS and tDCS had shown a positive index of change since 1998. We calculated the index of change of popularity index (PI), which indicates that from 2013 to 2017, the number of publications on tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) were reduced by 85.0% and 81.3% respectively, as compared with the period 2008-2012. For the index of expectation, fluoxetine and ECT showed the highest index of expectations in six consecutive periods and remained the highest in 2013-2017. For popularity, the three antidepressants with highest PI were fluoxetine (4.01), paroxetine (2.09), and sertraline (1.66); the three antidepressants with lowest PI were desvenlafaxine (0.08), vilazodone (0.04) and levomilnacipran (0.03). Among neurostimulation therapies, ECT has the highest PI (2.55), and tDCS the lowest PI (0.14). The PI of SSRI remained the highest among all biological treatments of MDD in 2013-2017. In contrast, the PI of ECT was reduced by approximately 50% during the period 2008 to2012 than that in the period 2013 to 2017. CONCLUSIONS This scientometric analysis represents comprehensive evidence on the popularity and change in prospects of biological treatments for MDD from 1988 to 2017. The popularity of SSRI peaked between 1998 and 2002, when their efficacy, tolerability and safety profile allowed them to replace the TCAs and MAOIs. While the newer neurostimulation therapies are gaining momentum, the popularity of ECT has sustained.
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Affiliation(s)
- Bach X Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Vietnam Young Physicians' Association, Hanoi 100000, Vietnam
| | - Giang H Ha
- Institute for Global Health Innovations, Duy Tan University, Hanoi 100000, Vietnam
| | - Giang T Vu
- Center of Excellence in Evidence-Based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 70000, Vietnam
| | - Long H Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 70000, Vietnam
| | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Kalpana Nathan
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Roger S McIntyre
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON M5G 2C4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Department of Toxicology and Pharmacology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Cyrus S Ho
- Department of Psychological Medicine, National University Health System, Singapore 119228, Singapore
| | - Wilson W Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Center of Excellence in Evidence-Based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 70000, Vietnam
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 117599, Singapore.
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 70000, Vietnam.
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Slee A, Nazareth I, Bondaronek P, Liu Y, Cheng Z, Freemantle N. Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis. Lancet 2019; 393:768-777. [PMID: 30712879 DOI: 10.1016/s0140-6736(18)31793-8] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/27/2018] [Accepted: 07/27/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Generalised anxiety disorder is a disease that can be associated with substantial dysfunction. Pharmacological treatment is often the first choice for clinicians because of the cost and resource constraints of psychological alternatives, but there is a paucity of comparative information for the multiple available drug choices. METHODS A systematic review and network meta-analysis was performed on randomised trials in adult outpatients with generalised anxiety disorder identified from MEDLINE, Web of Science, Cochrane Library, ClinicalTrials.gov, Chinese National Knowledge Infrastructure (CNKI), Wanfang data, Drugs@FDA and commercial pharmaceutical registries. Placebo and active control trials were included. Data were extracted from all manuscripts and reports. Primary outcomes were efficacy (mean difference [MD] in change in Hamilton Anxiety Scale Score) and acceptability (study discontinuations for any cause). We estimated summary mean treatment differences and odds ratios using network meta-analyses with random effects. This study is registered with PROSPERO, number CRD42018087106. FINDINGS Studies were published between Jan 1, 1994 and Aug 1, 2017, in which 1992 potential studies were screened for inclusion. This analysis is based on 89 trials, which included 25 441 patients randomly assigned to 22 different active drugs or placebo. Duloxetine (MD -3·13, 95% credible interval [CrI] -4·13 to -2·13), pregabalin (MD -2·79, 95% CrI -3·69 to -1·91), venlafaxine (MD -2·69, 95% CrI -3·50 to -1·89), and escitalopram (MD -2·45, 95% CrI -3·27 to -1·63) were more efficacious than placebo with relatively good acceptability. Mirtazapine, sertraline, fluoxetine, buspirone, and agomelatine were also found to be efficacious and well tolerated but these findings were limited by small sample sizes. Quetiapine (MD -3·60 95% CrI -4·83 to -2·39) had the largest effect on HAM-A but it was poorly tolerated (odds ratio 1·44, 95% CrI 1·16-1·80) when compared with placebo. Likewise, paroxetine and benzodiazepines were effective but also poorly tolerated when compared with placebo. Risk of reporting bias was considered low, and when possible all completed studies were included to avoid publication bias. INTERPRETATION To our knowledge, this is the largest contemporary review of pharmacological agents for the treatment of generalised anxiety disorder by use of network analysis. There are several effective treatment choices for generalised anxiety disorder across classes of medication. The failure of initial pharmacological therapy might not be a reason to abandon a pharmacological treatment strategy. FUNDING No funding was received for this research.
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Affiliation(s)
- April Slee
- Department of Primary Care and Population Health, University College London, London UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London, London UK
| | - Paulina Bondaronek
- Department of Primary Care and Population Health, University College London, London UK
| | - Yifeng Liu
- Department of Primary Care and Population Health, University College London, London UK
| | - Zhihang Cheng
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Nick Freemantle
- Institute for Clinical Trials, University College London, London UK.
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13
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Kędzierska E, Fiorino F, Magli E, Poleszak E, Wlaź P, Orzelska-Górka J, Knap B, Kotlińska JH. New arylpiperazine derivatives with antidepressant-like activity containing isonicotinic and picolinic nuclei: evidence for serotonergic system involvement. Naunyn Schmiedebergs Arch Pharmacol 2019; 392:743-754. [DOI: 10.1007/s00210-019-01620-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/16/2019] [Indexed: 01/09/2023]
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14
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De Giorgi R. Vortioxetine for depression: the evidence for its current use in the UK. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2018.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYThe pharmacological treatment of depression is often hampered by side-effects and unsatisfactory response to treatment. Vortioxetine is one of the newest antidepressants on the market, purportedly with a different mechanism of action compared with other antidepressants. This month's Cochrane Corner review examines the evidence available for the use of vortioxetine as a first-line treatment for depression in adults. This commentary puts the Cochrane review's findings into their clinical context and revises them in view of earlier and later studies.DECLARATION OF INTERESTNone.
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15
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Cao B, Park C, Subramaniapillai M, Lee Y, Iacobucci M, Mansur RB, Zuckerman H, Phan L, McIntyre RS. The Efficacy of Vortioxetine on Anhedonia in Patients With Major Depressive Disorder. Front Psychiatry 2019; 10:17. [PMID: 30766492 PMCID: PMC6365446 DOI: 10.3389/fpsyt.2019.00017] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 01/11/2019] [Indexed: 02/06/2023] Open
Abstract
Background: Anhedonia is a common, persistent, and disabling phenomenon in treated adults with Major Depressive Disorder (MDD). Hitherto, relatively few antidepressant agents have been evaluated with respect to their effect on anhedonia in MDD. Methods: This is a post-hoc analysis of a primary study that sought to evaluate the sensitivity to change of the THINC-integrated tool (THINC-it) in MDD (ClinicalTrials.gov Identifier: NCT03053362). Adults meeting DSM-5 criteria for MDD with at least moderate depressive symptom severity [i.e., Montgomery Åsberg Depression Rating Scale (MADRS) total score ≥20] were eligible. Subjects were recruited between October 2017 and August 2018 in Toronto, Ontario at the Brain and Cognition Discovery Foundation. All subjects received open-label vortioxetine (10-20 mg/day, flexibly-dosed) for 8 weeks. Herein, the primary outcome of interest was the change from baseline to endpoint in the Snaith-Hamilton Pleasure Scale (SHAPS) total score, as well as the MADRS anhedonia factor. The mediational effects of improvements in anhedonia on general function and quality of life, as measured by the Sheehan Disability Scale (SDS) and the 5-Item World Health Organization Well-Being Index (WHO-5), were secondarily assessed. Results: A total of 100 subjects with MDD were enrolled in the primary study and began treatment with vortioxetine. Vortioxetine significantly improved anhedonia as evidenced by significant baseline to endpoint improvements in SHAPS and MADRS anhedonia factor scores (p < 0.0001). Improvements in the SHAPS and the MADRS anhedonia factor correlated with improvements in general function (i.e., SDS) and quality of life (i.e., WHO-5) (p < 0.0001). Notably, improvements in anhedonia were found to mediate the association between improvements in overall depressive symptom severity (i.e., MADRS total score) and social functioning (i.e., social life component of the SDS) (p = 0.026). Conclusion: The unmet need in depression is to improve patient functioning and other patient-reported outcomes (e.g., quality of life). Antidepressant interventions capable of attenuating anhedonia as well as cognitive dysfunction in MDD may help in this regard, as improvement in these domains have been associated with improvement in psychosocial function and quality of life.
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Affiliation(s)
- Bing Cao
- School of Public Health, Peking University, Beijing, China.,Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Caroline Park
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Mehala Subramaniapillai
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Michelle Iacobucci
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Hannah Zuckerman
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Lee Phan
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Brain and Cognition Discovery Foundation, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Pharmacology, University of Toronto, Toronto, ON, Canada
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16
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Li Y, Peng Y, Ma P, Yang H, Xiong H, Wang M, Peng C, Tu P, Li X. Antidepressant-Like Effects of Cistanche tubulosa Extract on Chronic Unpredictable Stress Rats Through Restoration of Gut Microbiota Homeostasis. Front Pharmacol 2018; 9:967. [PMID: 30186183 PMCID: PMC6112285 DOI: 10.3389/fphar.2018.00967] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/06/2018] [Indexed: 12/11/2022] Open
Abstract
Growing evidence shows that neuropsychiatric disorders, such as depression, are linked with gut microbiome through the gut–brain axis. Cistanches Herba is well known for the treatment of “kidney-yang” deficiency in traditional Chinese medicine (TCM), and has been used for treatment of neurodegenerative diseases in recent years. In this study, chronic unpredictable stress (CUS)-induced depression model was established to explore the impact of Cistanche tubulosa extract (CTE) on behavioral tests, monoamine neurotransmitters and neurotrophic factors in hippocampus and colon, gut microbiota composition, and short-chain fatty acids (SCFAs) production. Moreover, correlation analysis was used to evaluate the functional relationship between altered gut microbiota, changed neurotransmitters and neurotrophins in hippocampus and colon, and disturbed concentration of SCFAs. CTE significantly improved depression-like behaviors in rats under CUS. Brain level of 5-hydroxytryptamine (5-HT) and brain-derived neurotrophic factor (BDNF) expression in CUS rats were restored by CTE. The relative abundance of gut microbiota and the concentrations of acetate and hexanoic acid could also be modulated by CTE treatment. We further showed that the application of CTE in CUS rats led to strong correlation among disrupted gut microbiota composition, hippocampus neurotransmitter levels, and production of neuroactive metabolite SCFAs. Altogether, these results identify CTE as a potential treatment for depressive symptoms by restoring homeostasis of gut microbiota for microbiota–gut–brain axis disorders, opening new avenues in the field of neuropsychopharmacology.
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Affiliation(s)
- Yang Li
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Peng
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
| | - Ping Ma
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
| | - Hanlin Yang
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
| | - Haiyan Xiong
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
| | - Mengyue Wang
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
| | - Chongsheng Peng
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
| | - Pengfei Tu
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xiaobo Li
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
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