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De Filippis S, Lombardozzi G, Matrone M, Amici E, Trovini G, Perrini F, Di Giovanni A, Giovanetti V, Kotzalidis GD. Differential Response to Three Antidepressants in Patients with Major Depressive Episode Who Suffered Covid-19-Related Trauma. Curr Neuropharmacol 2022; 20:2393-2407. [PMID: 35272591 PMCID: PMC9890288 DOI: 10.2174/1570159x20666220310122849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/11/2022] [Accepted: 03/05/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Covid 19 pandemic might have impacted response to drug treatment in major depressive episode (MDE). We compared responses to three different antidepressant drugs, i.e., vortioxetine, sertraline, and trazodone, in outpatients with MDE during Major Depressive Disorder (MDD), Bipolar Disorder (BD), or schizophrenia and related psychoses (SSOPDs) during two time periods, i.e., before and after suffering Covid-19-related trauma. METHODS We conducted an observational study on clinically stabilised for at least 6 months outpatients with MDE during the course of MDD (N=58), BD (N=33), or SSOPDs (N=51). Patients, whose baseline assessments of Montgomery-Åsberg Rating Scale (MADRS), Hamilton Anxiety Rating Scale (Ham-A), Brief Psychiatric Rating Scale (BPRS), Visual Analogue Scale for Craving (VAS-crav) and World Health Organization Quality of Life, Brief version (WHOQOL-BREF) were available, were recruited at the time they suffered Covid-19-related traumas. Fifty patients, prior to the pandemic, when they were clinically stable, were treated with 15 mg/die vortioxetine, 44 with 450 mg/die trazodone, and 48 with 150 mg/die sertraline. After experiencing a major Covid-19-related personal trauma, patients showed clinical worsening which required dosage adjustment (20 mg/day vortioxetine; 600 mg/day trazodone, and 200 mg/day sertraline) and, for some of them, hospitalisation. Scores on the MADRS, Ham-A, BPRS, VAS-crav and WHOQOL-BREF were compared drug-wise and genderwise with Student's t test for continuous variables and Χ2 for categorical variables. RESULTS The sample consisted of 142 outpatients (age, mean 39.63 ± 16.84; 70 men and 72 women); women were older than men (mean age 43.18 ± 17.61 vs. 35.98 ± 15.30; p=0.01). The two genders did not differ on other variables. For all treatments, worsening symptoms were observed at the time of trauma, followed by slow recovery with treatment readjustment. Trauma-related worsening in patients on vortioxetine was less intense than patients on the other two antidepressants and recovery was faster. All drugs were associated with an improvement in QoL. The vortioxetine group showed a lower hospitalisation rate (24%) than sertraline (35.4%) and trazodone (38.6%), but this was not significant (p=0.27). CONCLUSION All drugs improved symptoms of Covid-19 trauma in patients with MDE, with vortioxetine showing a small advantage. No differences between vortioxetine, sertraline and trazodone were found as concerning the need for hospitalisation.
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Affiliation(s)
- Sergio De Filippis
- Von Siebenthal Neuropsychiatric Clinic and Hospital, Via della Madonnina 1, Genzano di Roma 00045 RM, Italy
| | - Ginevra Lombardozzi
- Von Siebenthal Neuropsychiatric Clinic and Hospital, Via della Madonnina 1, Genzano di Roma 00045 RM, Italy
| | - Marta Matrone
- Von Siebenthal Neuropsychiatric Clinic and Hospital, Via della Madonnina 1, Genzano di Roma 00045 RM, Italy
| | - Emanuela Amici
- Von Siebenthal Neuropsychiatric Clinic and Hospital, Via della Madonnina 1, Genzano di Roma 00045 RM, Italy
| | - Giada Trovini
- Von Siebenthal Neuropsychiatric Clinic and Hospital, Via della Madonnina 1, Genzano di Roma 00045 RM, Italy
| | - Filippo Perrini
- Von Siebenthal Neuropsychiatric Clinic and Hospital, Via della Madonnina 1, Genzano di Roma 00045 RM, Italy
| | - Alessandro Di Giovanni
- Von Siebenthal Neuropsychiatric Clinic and Hospital, Via della Madonnina 1, Genzano di Roma 00045 RM, Italy
| | - Valeria Giovanetti
- Von Siebenthal Neuropsychiatric Clinic and Hospital, Via della Madonnina 1, Genzano di Roma 00045 RM, Italy
| | - Georgios D. Kotzalidis
- Von Siebenthal Neuropsychiatric Clinic and Hospital, Via della Madonnina 1, Genzano di Roma 00045 RM, Italy
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
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Ľupták M, Fišar Z, Hroudová J. Agomelatine, Ketamine and Vortioxetine Attenuate Energy Cell Metabolism-In Vitro Study. Int J Mol Sci 2022; 23:ijms232213824. [PMID: 36430306 PMCID: PMC9697131 DOI: 10.3390/ijms232213824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
This determination of the mitochondrial effect of pharmacologically different antidepressants (agomelatine, ketamine and vortioxetine) was evaluated and quantified in vitro in pig brain-isolated mitochondria. We measured the activity of mitochondrial complexes, citrate synthase, malate dehydrogenase and monoamine oxidase, and the mitochondrial respiratory rate. Total hydrogen peroxide production and ATP production were assayed. The most potent inhibitor of all mitochondrial complexes and complex I-linked respiration was vortioxetine. Agomelatine and ketamine inhibited only complex IV activity. None of the drugs affected complex II-linked respiration, citrate synthase or malate dehydrogenase activity. Hydrogen peroxide production was mildly increased by agomelatine, which might contribute to increased oxidative damage and adverse effects at high drug concentrations. Vortioxetine significantly reduced hydrogen peroxide concentrations, which might suggest antioxidant mechanism activation. All tested antidepressants were partial MAO-A inhibitors, which might contribute to their antidepressant effect. We observed vortioxetine-induced MAO-B inhibition, which might be linked to decreased hydrogen peroxide formation and contribute to its procognitive and neuroprotective effects. Mitochondrial dysfunction could be linked to the adverse effects of vortioxetine, as vortioxetine is the most potent inhibitor of mitochondrial complexes and complex I-linked respiration. Clarifying the molecular interaction between drugs and mitochondria is important to fully understand their mechanism of action and the connection between their mechanisms and their therapeutic and/or adverse effects.
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Affiliation(s)
- Matej Ľupták
- Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Albertov 4, 128 00 Prague, Czech Republic
| | - Zdeněk Fišar
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Ke Karlovu 11, 120 00 Prague, Czech Republic
| | - Jana Hroudová
- Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Albertov 4, 128 00 Prague, Czech Republic
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Ke Karlovu 11, 120 00 Prague, Czech Republic
- Correspondence:
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Tian H, Hu Z, Xu J, Wang C. The molecular pathophysiology of depression and the new therapeutics. MedComm (Beijing) 2022; 3:e156. [PMID: 35875370 PMCID: PMC9301929 DOI: 10.1002/mco2.156] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 12/21/2022] Open
Abstract
Major depressive disorder (MDD) is a highly prevalent and disabling disorder. Despite the many hypotheses proposed to understand the molecular pathophysiology of depression, it is still unclear. Current treatments for depression are inadequate for many individuals, because of limited effectiveness, delayed efficacy (usually two weeks), and side effects. Consequently, novel drugs with increased speed of action and effectiveness are required. Ketamine has shown to have rapid, reliable, and long-lasting antidepressant effects in treatment-resistant MDD patients and represent a breakthrough therapy for patients with MDD; however, concerns regarding its efficacy, potential misuse, and side effects remain. In this review, we aimed to summarize molecular mechanisms and pharmacological treatments for depression. We focused on the fast antidepressant treatment and clarified the safety, tolerability, and efficacy of ketamine and its metabolites for the MDD treatment, along with a review of the potential pharmacological mechanisms, research challenges, and future clinical prospects.
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Affiliation(s)
- Haihua Tian
- Ningbo Key Laboratory of Behavioral Neuroscience Ningbo University School of Medicine Ningbo Zhejiang China.,Zhejiang Provincial Key Laboratory of Pathophysiology School of Medicine Ningbo University Ningbo Zhejiang China.,Department of Physiology and Pharmacology Ningbo University School of Medicine Ningbo Zhejiang China.,Department of Laboratory Medicine Ningbo Kangning Hospital Ningbo Zhejiang China
| | - Zhenyu Hu
- Department of Child Psychiatry Ningbo Kanning Hospital Ningbo Zhejiang China
| | - Jia Xu
- Ningbo Key Laboratory of Behavioral Neuroscience Ningbo University School of Medicine Ningbo Zhejiang China.,Zhejiang Provincial Key Laboratory of Pathophysiology School of Medicine Ningbo University Ningbo Zhejiang China.,Department of Physiology and Pharmacology Ningbo University School of Medicine Ningbo Zhejiang China
| | - Chuang Wang
- Ningbo Key Laboratory of Behavioral Neuroscience Ningbo University School of Medicine Ningbo Zhejiang China.,Zhejiang Provincial Key Laboratory of Pathophysiology School of Medicine Ningbo University Ningbo Zhejiang China.,Department of Physiology and Pharmacology Ningbo University School of Medicine Ningbo Zhejiang China
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4
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Intrinsically disordered proteins and proteins with intrinsically disordered regions in neurodegenerative diseases. Biophys Rev 2022; 14:679-707. [DOI: 10.1007/s12551-022-00968-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/28/2022] [Indexed: 12/14/2022] Open
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Adamo D, Pecoraro G, Aria M, Favia G, Mignogna MD. Vortioxetine in the Treatment of Mood Disorders Associated with Burning Mouth Syndrome: Results of an Open-Label, Flexible-Dose Pilot Study. PAIN MEDICINE 2021; 21:185-194. [PMID: 31343684 DOI: 10.1093/pm/pnz120] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a new multimodal antidepressant, vortioxetine (VO), in the management of burning mouth syndrome (BMS). DESIGN Longitudinal single-assessment open-label pilot study. SETTING University hospital. Subjects. Thirty BMS patients were enrolled. METHODS BMS patients were treated with topical clonazepam and a flexible dose of VO (10 mg, 15 mg, or 20 mg). The visual analog scale (VAS), the Total Pain Rating Index (T-PRI), the Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A), and the Pittsburgh Sleep Quality Index (PSQI) were performed at baseline (time 0) and after two (time 1), four (time 2), six (time 3), and 12 months (time 4) of treatment. Descriptive statistics and the Wilcoxon nonparametric test for two paired samples were used. RESULTS The BMS patients showed a statistically significant improvement in VAS and T-PRI scores from baseline (median [interquartile range {IQR}] = 10.0 [10-10] and 22.0 [20-24], respectively) to time 4 (median [IQR] = 0.0 [0-0] and 8.0 [7-9], P < 0.001, respectively). Similarly, the HAM-A and HAM-D and PSQI scores showed an improvement from time 0 (median [IQR] = 20 [15.8-22], 19 [16-20.3], and 4.0 [4-7.3], respectively) to time 4 (median [IQR] = 6.0 [6-7], 6.0 [6-7], and 3.0 [3-4], respectively, P < 0.001). CONCLUSIONS VO is efficacious and well tolerated in the treatment of BMS in firstline therapy on account of its better receptor pharmacological profile and in second-line treatment for patients who have only partially responded or have reported adverse effects to previous treatments.
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Affiliation(s)
- Daniela Adamo
- Departments of *Neurosciences, Reproductive and Odontostomatological Sciences
| | - Giuseppe Pecoraro
- Departments of *Neurosciences, Reproductive and Odontostomatological Sciences
| | - Massimo Aria
- Economics and Statistics, University Federico II of Naples, Naples, Italy
| | - Gianfranco Favia
- Oro- Maxillofacial Pathology and Surgery Unit, University Hospital Policlinico Bari, Bari, Italy
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Du R, Xu J, Li J, Zhang L, Ning L, Li S. Pharmaceutical salt and salt hydrates of vortioxetine with sulfonic acid to ameliorate the solubility and hygroscopicity via the charge-assisted hydrogen bond assembly. NEW J CHEM 2021. [DOI: 10.1039/d0nj05052k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Salt forms of vortioxetine (VOT) with three sulfonic acids have been designed and prepared in 1 : 1 stoichiometry ratio, and their crystal structures and physicochemical properties have also been characterized in detail.
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Affiliation(s)
- Rongkai Du
- MOE International Joint Laboratory on Synthetic Biology and Medicines
- School of Biology and Biological Engineering
- South China University of Technology
- Guangzhou 510006
- P. R. China
| | - Juan Xu
- National Research Institute for Family Planning
- Beijing 100081
- P. R. China
| | - Jing Li
- MOE International Joint Laboratory on Synthetic Biology and Medicines
- School of Biology and Biological Engineering
- South China University of Technology
- Guangzhou 510006
- P. R. China
| | - Lei Zhang
- MOE International Joint Laboratory on Synthetic Biology and Medicines
- School of Biology and Biological Engineering
- South China University of Technology
- Guangzhou 510006
- P. R. China
| | - Lifeng Ning
- National Research Institute for Family Planning
- Beijing 100081
- P. R. China
| | - Shan Li
- MOE International Joint Laboratory on Synthetic Biology and Medicines
- School of Biology and Biological Engineering
- South China University of Technology
- Guangzhou 510006
- P. R. China
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Zhang Y, Long Y, Yu S, Li D, Yang M, Guan Y, Zhang D, Wan J, Liu S, Shi A, Li N, Peng W. Natural volatile oils derived from herbal medicines: A promising therapy way for treating depressive disorder. Pharmacol Res 2020; 164:105376. [PMID: 33316383 DOI: 10.1016/j.phrs.2020.105376] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 12/30/2022]
Abstract
Depression is a common global mental disorder that seriously harms human physical and mental health. With the development of society, the increase of pressure and the role of various other factors make the incidence of depression increase year by year. However, there is a lack of drugs that have a fast onset, significant effects, and few side effects. Some volatile oils from traditional natural herbal medicines are usually used to relieve depression and calm emotions, such as Lavender essential oil and Acorus tatarinowii essential oil. It was reported that these volatile oils, are easy to enter the brain through the blood-brain barrier and have good antidepressant effects with little toxicity and side effects. In this review, we summarized the classification of depression, and listed the history of using volatile oils to fight depression in some countries. Importantly, we summarized the anti-depressant natural volatile oils and their monomers from herbal medicine, discussed the anti-depressive mechanisms of the volatile oils from natural medicine. The volatile oils of natural medicine and antidepressant drugs were compared and analyzed, and the application of volatile oils was explained from the clinical use and administration routes. This review would be helpful for the development of potential anti-depressant medicine and provide new alternative treatments for depressive disorders.
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Affiliation(s)
- Yulu Zhang
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Chengdu, 611137, PR China
| | - Yu Long
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Chengdu, 611137, PR China
| | - Shuang Yu
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Chengdu, 611137, PR China
| | - Dan Li
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Chengdu, 611137, PR China
| | - Ming Yang
- Key Laboratory of Modern Preparation of TCM, Ministry of Education, Jiangxi University of Traditional Chinese Medicine, No.1688 Meiling Avenue, Nanchang, 330004, China
| | - Yongmei Guan
- Key Laboratory of Modern Preparation of TCM, Ministry of Education, Jiangxi University of Traditional Chinese Medicine, No.1688 Meiling Avenue, Nanchang, 330004, China
| | - Dingkun Zhang
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Chengdu, 611137, PR China
| | - Jinyan Wan
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Chengdu, 611137, PR China
| | - Songyu Liu
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Chengdu, 611137, PR China
| | - Ai Shi
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Chengdu, 611137, PR China
| | - Nan Li
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Chengdu, 611137, PR China.
| | - Wei Peng
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Chengdu, 611137, PR China.
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Mills NT, Sampson E, Fourrier C, Baune BT. Clinical Switching Strategies of Various Antidepressants to Vortioxetine in the PREDDICT Trial. Int J Neuropsychopharmacol 2020; 24:314-321. [PMID: 33269395 PMCID: PMC8059490 DOI: 10.1093/ijnp/pyaa092] [Citation(s) in RCA: 2] [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: 03/20/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Partial response to antidepressant medication as well as relapse and treatment resistance are common in major depressive disorder (MDD). Therefore, for most patients with MDD, there will be a need to consider changing antidepressant medication at some stage during the course of the illness. The PREDDICT study investigates the efficacy of augmenting vortioxetine with celecoxib. METHODS We describe the method used in the PREDDICT study to change participants, who were already taking antidepressant medication at the time of the screening visit, to vortioxetine. We used a cross-titration to change study participants to vortioxetine. RESULTS Of a total of 122 study participants who were randomized to receive vortioxetine plus celecoxib or vortioxetine plus placebo at the study baseline visit, 82 were taking antidepressant medication (other than vortioxetine) prior to randomization. These medications were selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, tricyclic antidepressants, mirtazapine, or agomelatine. Eighty of these 82 participants completed the changeover to vortioxetine as well as the study baseline visit. We found side effects were generally mild during this changeover period. In addition, there was a reduction in mean total Montgomery-Åsberg Depression Rating Scale score of 2.5 (SD 6.0) from study baseline to week 2 and a further reduction in mean total Montgomery-Åsberg Depression Rating Scale of 2.5 (SD 5.9) from week 2 to week 4. CONCLUSION Changing other antidepressants to vortioxetine can be done safely and was generally well-tolerated. However, there are some antidepressant classes, in particular monoamine oxidase inhibitors that require a washout period, which were not represented in this study. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR); ID number 12617000527369p; http://www.anzctr.org.au/ACTRN12617000527369p.aspx.
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Affiliation(s)
- Natalie T Mills
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Emma Sampson
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Célia Fourrier
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia,Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Bernhard T Baune
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia,Department of Psychiatry and Psychotherapy, University Hospital Münster, University of Münster, Münster, Germany,Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Australia,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia,Correspondence: Bernhard T. Baune, MD, PhD, Department of Mental Health, Lab Division of Molecular Neurobiology of Mental Health, University of Münster, Albert-Schweitzer Campus 1, Building A 9, 48149 Münster, Germany ()
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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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A randomized, double-blind study comparing the efficacy and safety of trazodone once-a-day and venlafaxine extended-release for the treatment of patients with major depressive disorder. Int Clin Psychopharmacol 2020; 35:137-146. [PMID: 31972628 PMCID: PMC7099841 DOI: 10.1097/yic.0000000000000304] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This double-blind, randomized study evaluated the efficacy and safety of trazodone OAD (once-a-day) in comparison with venlafaxine XR (extended-release) in 324 patients (166 trazodone and 158 venlafaxine) with major depressive disorder (MDD). The primary efficacy endpoint was the mean change from baseline in the 17-item Hamilton Depression Rating Scale (HAM-D) at week 8. Both treatments were effective in reducing the HAM-D-17 total score at week 8 vs. baseline (intent-to-treat: trazodone -12.9, venlafaxine -14.7; per protocol: trazodone -15.4, venlafaxine -16.4). Patients in the venlafaxine group achieved better results after 8 weeks, whereas the trazodone group achieved a statistically significant reduction in HAM-D-17 following only 7 days of treatment. The most frequent adverse events (AEs) were dizziness and somnolence in the trazodone group, and nausea and headache in the venlafaxine group. Most AEs were mild-to-moderate in severity. This study confirmed that both venlafaxine XR and trazodone OAD may represent a valid treatment option for patients with MDD.
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Atila Karaca S, Rashidova N, Uğur A, Yeniceli Uğur D. Development of a simple HPLC method for the quantitation of vortioxetine in pharmaceuticals using DoE approach. CHEMICAL PAPERS 2019. [DOI: 10.1007/s11696-019-01008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Callegari C, Ielmini M, Caselli I, Lucca G, Isella C, Diurni M, Pettenon F, Poloni N. Paroxetine versus Vortioxetine for Depressive Symptoms in Postmenopausal Transition: A Preliminary Study. PSYCHOPHARMACOLOGY BULLETIN 2019; 49:28-43. [PMID: 30858637 PMCID: PMC6386432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The impact of menopause is a consequence of social, physical and mental changes; hormonal changes play an important role in inducing an increased risk of developing depressive symptoms. It is essential to treat mood and vasomotor symptoms and to prevent their onset to promote an improvement in the quality of life, both in terms of clinical and psychological conditions. OBJECTIVE This observational study aims to compare paroxetine and vortioxetine in a sample of patients affected by postmenopausal depression attending the Anxiety and Depression Clinic in terms of: efficacy in determining clinical remission (HDRS ≤ 7) and tolerability; improvement of autonomic and cognitive symptoms. METHODS 39 female outpatients with a diagnosis of Postmenopausal Depression (according to DSM-5 criteria) were evaluated as the routine clinical practice through the following scales: Hamilton Depression Rating Scale (HDRS); Menopause Rating Scale (MRS); Montreal Cognitive Assessment (MoCA); Antidepressant Side-Effect Checklist (ASEC); data from/of baseline, after 8 weeks and 12 weeks were recorded. RESULTS Both antidepressants resulted to be effective in clinical remission (HDRS ≤ 7) without statistical differences between the two groups (p = 0.3), although paroxetine showed a faster remission than vortioxetine (p = 0.01). Autonomic symptoms showed a higher improvement in the vortioxetine group (p = 0.002). Paroxetine group referred insomnia and sexual problems while patients taking vortioxetine referred diarrhoea and palpitations. Data show a superiority of cognitive performance in the Paroxetine group (p = 0.005), contrary to what stated in literature. CONCLUSIONS Data are related to a small sample retrospectively assessed trough a 6-month observation period. Thus, the preliminary results need further research to be confirmed.
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Affiliation(s)
- Camilla Callegari
- Callegari, MD, PhD, Associate Professor, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Ielmini, MD, PhD Student, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Caselli, MD, PhD Student, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Lucca, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Isella, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Diurni, MD, PhD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Pettenon, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Poloni, MD, PhD, Researcher, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Marta Ielmini
- Callegari, MD, PhD, Associate Professor, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Ielmini, MD, PhD Student, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Caselli, MD, PhD Student, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Lucca, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Isella, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Diurni, MD, PhD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Pettenon, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Poloni, MD, PhD, Researcher, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Ivano Caselli
- Callegari, MD, PhD, Associate Professor, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Ielmini, MD, PhD Student, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Caselli, MD, PhD Student, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Lucca, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Isella, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Diurni, MD, PhD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Pettenon, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Poloni, MD, PhD, Researcher, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Giulia Lucca
- Callegari, MD, PhD, Associate Professor, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Ielmini, MD, PhD Student, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Caselli, MD, PhD Student, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Lucca, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Isella, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Diurni, MD, PhD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Pettenon, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Poloni, MD, PhD, Researcher, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Celeste Isella
- Callegari, MD, PhD, Associate Professor, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Ielmini, MD, PhD Student, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Caselli, MD, PhD Student, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Lucca, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Isella, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Diurni, MD, PhD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Pettenon, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Poloni, MD, PhD, Researcher, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Marcello Diurni
- Callegari, MD, PhD, Associate Professor, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Ielmini, MD, PhD Student, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Caselli, MD, PhD Student, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Lucca, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Isella, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Diurni, MD, PhD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Pettenon, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Poloni, MD, PhD, Researcher, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Fabiana Pettenon
- Callegari, MD, PhD, Associate Professor, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Ielmini, MD, PhD Student, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Caselli, MD, PhD Student, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Lucca, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Isella, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Diurni, MD, PhD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Pettenon, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Poloni, MD, PhD, Researcher, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Nicola Poloni
- Callegari, MD, PhD, Associate Professor, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Ielmini, MD, PhD Student, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Caselli, MD, PhD Student, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Lucca, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Isella, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Diurni, MD, PhD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Pettenon, MD, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy. Poloni, MD, PhD, Researcher, Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
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13
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Djillani A, Pietri M, Mazella J, Heurteaux C, Borsotto M. Fighting against depression with TREK-1 blockers: Past and future. A focus on spadin. Pharmacol Ther 2018; 194:185-198. [PMID: 30291907 DOI: 10.1016/j.pharmthera.2018.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Depression is a devastating mood disorder and a leading cause of disability worldwide. Depression affects approximately one in five individuals in the world and represents heavy economic and social burdens. The neurobiological mechanisms of depression are not fully understood, but evidence highlights the role of monoamine neurotransmitter balance. Several antidepressants (ADs) are marketed to treat depression and related mood disorders. However, despite their efficacy, they remain nonspecific and unsafe because they trigger serious adverse effects. Therefore, developing new molecules for new targets in depression has become a real necessity. Eight years ago, spadin was described as a natural peptide with AD properties. This 17-amino acid peptide blocks TREK-1 channels, an original target in depression. Compared to the classical AD drugs such as fluoxetine, which requires 3-4 weeks for the AD effect to manifest, spadin acts rapidly within only 4 days of treatment. The AD properties are associated with increased neurogenesis and synaptogenesis in the brain. Despite the advantages of this fast-acting AD, the in vivo stability is weak and does not last for >7 h. The present review summarizes different strategies such as retro-inverso strategy, cyclization, and shortening the spadin sequence that has led to the development and optimization of spadin as an AD. Shortened spadin analogs present increased inhibition potency for TREK-1, an improved AD activity, and prolonged in vivo bioavailability. Finally, we also discuss about other inhibitors of TREK-1 channels with a proven efficacy in treating depression in the clinic, such as fluoxetine.
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Affiliation(s)
- Alaeddine Djillani
- Centre National de la Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, UMR7275, Université Côte d'Azur, Valbonne, France; Université Côte d'Azur, CNRS, IPMC, France
| | - Mariel Pietri
- Centre National de la Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, UMR7275, Université Côte d'Azur, Valbonne, France; Université Côte d'Azur, CNRS, IPMC, France
| | - Jean Mazella
- Centre National de la Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, UMR7275, Université Côte d'Azur, Valbonne, France; Université Côte d'Azur, CNRS, IPMC, France
| | - Catherine Heurteaux
- Centre National de la Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, UMR7275, Université Côte d'Azur, Valbonne, France; Université Côte d'Azur, CNRS, IPMC, France
| | - Marc Borsotto
- Centre National de la Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, UMR7275, Université Côte d'Azur, Valbonne, France; Université Côte d'Azur, CNRS, IPMC, France.
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14
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Xu X, Wei Y, Guo Q, Zhao S, Liu Z, Xiao T, Liu Y, Qiu Y, Hou Y, Zhang G, Wang K. Pharmacological Characterization of H05, a Novel Serotonin and Noradrenaline Reuptake Inhibitor with Moderate 5-HT 2A Antagonist Activity for the Treatment of Depression. J Pharmacol Exp Ther 2018; 365:624-635. [PMID: 29615471 DOI: 10.1124/jpet.118.248351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/28/2018] [Indexed: 01/16/2023] Open
Abstract
Multitarget antidepressants selectively inhibiting monoaminergic transporters and 5-hydroxytryptamine (5-HT) 2A receptor have demonstrated higher efficacy and fewer side effects than selective serotonin reuptake inhibitors. In the present study, we synthesized a series of novel 3-(benzo[d][1,3]dioxol-4-yloxy)-3-arylpropyl amine derivatives, among which compound H05 was identified as a lead, exhibiting potent inhibitory effects on both serotonin (Ki = 4.81 nM) and norepinephrine (NE) (Ki = 6.72 nM) transporters and moderate 5-HT2A antagonist activity (IC50 = 60.37 nM). H05 was able to dose-dependently reduce the immobility duration in mouse forced swimming test and tail suspension test, with the minimal effective doses lower than those of duloxetine, and showed no stimulatory effect on locomotor activity. The administration of H05 (5, 10, and 20 mg/kg, by mouth) significantly shortened the immobility time of adrenocorticotropin-treated rats that serve as a model of treatment-resistant depression, whereas imipramine (30 mg/kg, by mouth) and duloxetine (30 mg/kg, by mouth) showed no obvious effects. Chronic treatment with H05 reversed the depressive-like behaviors in a rat model of chronic unpredictable mild stress and a mouse model of corticosterone-induced depression. Microdialysis analysis revealed that the administration of H05 at either 10 or 20 mg/kg increased the release of 5-HT and NE from the frontal cortex. The pharmacokinetic (PK) and brain penetration analyses suggest that H05 has favorable PK properties with good blood-brain penetration ability. Therefore, it can be concluded that H05, a novel serotonin and NE reuptake inhibitor with 5-HT2A antagonist activity, possesses efficacious activity in the preclinical models of depression and treatment-resistant depression, and it may warrant further evaluation for clinical development.
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Affiliation(s)
- Xiangqing Xu
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Yaqin Wei
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Qiang Guo
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Song Zhao
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Zhiqiang Liu
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Ting Xiao
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Yani Liu
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Yinli Qiu
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Yuanyuan Hou
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - Guisen Zhang
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
| | - KeWei Wang
- Department of Molecular and Cellular Pharmacology, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China (X.X., T.X., K.W.); School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China (Y.W.); Institute of Pharmaceutical Research, Jiangsu Nhwa Pharmaceutical Co., Ltd., Xuzhou, Jiangsu, People's Republic of China (Q.G., S.Z., Z.L., Y.Q., Y.H., G.Z.); and Department of Pharmacology, School of Pharmacy, Qingdao University, Qingdao, Shandong, People's Republic of China (Y.L., K.W.)
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15
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An open-label, flexible dose adaptive study evaluating the efficacy of vortioxetine in subjects with panic disorder. Ann Gen Psychiatry 2018; 17:19. [PMID: 29760763 PMCID: PMC5946398 DOI: 10.1186/s12991-018-0190-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/04/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Despite the current treatments available for panic disorder (PD), as many as one-third of patients have persistent and treatment-resistant panic attacks. Vortioxetine is an approved medicine for major depressive disorder and has been shown to have anxiolytic properties. The purpose of this study was to evaluate its efficacy and safety in an adult population with a diagnosis of PD. METHODS The study design was open label with flexible dose strategies (5, 10, or 20 mg) with a treatment period of 10 weeks. 27 male and female subjects aged between 18 and 60 years, who met DSM-IV criteria for PD with or without agoraphobia, or who had a Panic Disorder Severity Scale (PDSS) score > 8 at baseline were enrolled. Statistical significance was established by the Student's T test. RESULTS A statistically significant decrease in the occurrence of panic attacks was measured with the PDSS with vortioxetine. In addition, a moderate improvement in the quality of life and no significant side effects were observed using the Quality-of-Life Scale and Monitoring of Side Effects Scale, respectively. CONCLUSIONS These results provide some support for the use of vortioxetine in the management of panic disorder.Trial registration ClinicalTrials.gov ID#: NCT02395510. Registered March 23, 2015, https://clinicaltrials.gov/ct2/show/NCT02395510.
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McIntyre RS. The role of new antidepressants in clinical practice in Canada: a brief review of vortioxetine, levomilnacipran ER, and vilazodone. Neuropsychiatr Dis Treat 2017; 13:2913-2919. [PMID: 29238196 PMCID: PMC5716309 DOI: 10.2147/ndt.s150589] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Although many branded and generic antidepressants are approved for the treatment of major depressive disorder (MDD) in Canada, efficacy and tolerability differ among patients, and new treatment options are needed. Symptom types (eg, fatigue, energy/motivation, cognition, and functioning), medication type, treatment duration, and the need for maintenance therapy are factors that may influence treatment effectiveness. Three antidepressants, vortioxetine, levomilnacipran extended-release (ER), and vilazodone have recently become available in Canada. The aim of this review is to contextualize differences in their mechanistic and clinical profiles, thereby providing practitioners with knowledge to support treatment decisions. In trials versus placebo, each drug improved depressive symptoms in adult patients with MDD. The antidepressant effect of vortioxetine may be related to enhanced serotonergic activity via reuptake inhibition and agonism and/or antagonism of various serotonin receptors. Vortioxetine may also improve cognitive functioning in MDD, and has proven efficacious in relapse prevention. Nausea was the most commonly reported adverse event (AE); rates of sexual dysfunction were low and abrupt discontinuation was well tolerated. Levomilnacipran ER, a serotonin norepinephrine reuptake inhibitor, demonstrated greater improvement versus placebo in functional impairment as well as depressive symptoms; in post hoc analyses, improvement in symptoms of motivation and energy were observed. Nausea was the most commonly reported AE; gradual discontinuation is recommended to avoid discontinuation syndrome. Vilazodone is a serotonin reuptake inhibitor and partial serotonergic 5-HT1A receptor agonist. In addition to improvement in depressive symptoms, evidence suggests that vilazodone may be particularly well suited for depressed patients with high anxiety levels. Diarrhea, nausea, and headache were the most common AEs; low rates of sexual dysfunction were reported. The 2016 Canadian Network for Mood and Anxiety Treatments guidelines for MDD includes vortioxetine as a first-line treatment; levomilnacipran ER and vilazodone are considered as second-line treatments due to lack of relapse prevention data at the time of approval.
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Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry, University of Toronto
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
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17
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Sowa-Kućma M, Pańczyszyn-Trzewik P, Misztak P, Jaeschke RR, Sendek K, Styczeń K, Datka W, Koperny M. Vortioxetine: A review of the pharmacology and clinical profile of the novel antidepressant. Pharmacol Rep 2017; 69:595-601. [DOI: 10.1016/j.pharep.2017.01.030] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/20/2017] [Accepted: 01/30/2017] [Indexed: 12/31/2022]
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18
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Kurhe Y, Mahesh R, Devadoss T. Novel 5-HT 3 receptor antagonist QCM-4 attenuates depressive-like phenotype associated with obesity in high-fat-diet-fed mice. Psychopharmacology (Berl) 2017; 234:1165-1179. [PMID: 28238069 DOI: 10.1007/s00213-017-4558-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 02/02/2017] [Indexed: 12/17/2022]
Abstract
RATIONALE Depression associated with obesity remains an interesting area to study the biological mechanisms and novel therapeutic intervention. OBJECTIVES The present study investigates the effect of a novel 5-HT3 receptor antagonist 3-methoxy-N-p-tolylquinoxalin-2-carboxamide (QCM-4) on several pathogenic markers of depression associated with obesity such as plasma insulin resistance, hippocampal cyclic adenosine monophosphate (cAMP), brain-derived neurotrophic factor (BDNF), serotonin (5-HT) concentrations, hippocampal neuronal damage, and p53 protein expression in high-fat-diet (HFD)-fed mice. METHODS Obesity was experimentally induced in mice by feeding with HFD for 14 weeks followed by administration of QCM-4 (1 and 2 mg/kg, p.o.)/standard escitalopram (ESC) (10 mg/kg, p.o.)/vehicle (10 ml/kg, p.o.) for 28 days. Behavioral assays such as sucrose preference test (SPT); forced swim test (FST); elevated plus maze (EPM); biochemical assays including oral glucose tolerance tests (OGTT), insulin, cAMP, BDNF, and 5-HT concentrations; and molecular assays mainly histology and immunohistochemistry (IHC) of p53 protein in the dentate gyrus (DG), CA1, and CA3 regions of hippocampus in HFD fed mice were performed. RESULTS Chronic treatment with QCM-4 in HFD-fed mice reversed the behavioral alterations in SPT, FST, and EPM. QCM-4 showed poor sensitivity for plasma glucose, improved insulin sensitivity, increased hippocampal cAMP, BDNF, and 5-HT concentrations. In the hippocampal DG, CA1, and CA3 regions, QCM-4 treatment improved the neuronal morphology in the histopathology and inhibited p53 protein expression in IHC assay in HFD-fed mice. CONCLUSION QCM-4 attenuated the depressive-like phenotype in HFD-fed mice by improving behavioral, biochemical, and molecular alterations through serotonergic neuromodulation.
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Affiliation(s)
- Yeshwant Kurhe
- Department of Pharmacy, Birla Institute of Technology & Science, Pilani, Pilani Campus, Pilani, Rajasthan, 333031, India.
| | - R Mahesh
- Department of Pharmacy, Birla Institute of Technology & Science, Pilani, Pilani Campus, Pilani, Rajasthan, 333031, India
| | - Thangaraj Devadoss
- Department of Pharmaceutical Chemistry, School of Pharmacy, International Medical University (IMU), No. 126, Jalan Jalil Perkasa 19, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
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Treatment-emergent sexual dysfunction in randomized trials of vortioxetine for major depressive disorder or generalized anxiety disorder: a pooled analysis. CNS Spectr 2016; 21:367-378. [PMID: 26575433 DOI: 10.1017/s1092852915000553] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Antidepressants are frequently associated with treatment-emergent sexual dysfunction (TESD). Vortioxetine, which was approved for patients with major depressive disorder (MDD), has a receptor profile that suggests limited impact on sexual functioning. METHODS Arizona Sexual Experiences Scale (ASEX) patient-level data were pooled from 7 short-term vortioxetine trials (6 in MDD, 1 in generalized anxiety disorder) and analyzed for incidence of TESD at any post-baseline visit in patients without sexual dysfunction at baseline (defined as ASEX total score ≥19; individual ASEX item score ≥5; or a score ≥4 on any 3 ASEX items). The primary objective was to confirm the non-inferiority of vortioxetine 5-20 mg/day to placebo on the incidence of TESD. Comparisons were based on the common risk difference (95% confidence interval). Additional analyses compared vortioxetine to duloxetine and duloxetine to placebo. A sensitivity analysis, defined as TESD at 2 consecutive post-baseline visits, was conducted. RESULTS TESD incidence, relative to placebo, generally increased with vortioxetine dose with vortioxetine 5 mg non-inferior to placebo. Vortioxetine 10, 15, and 20 mg did not meet the non-inferiority criterion, but no dose had a significantly higher risk of developing TESD versus placebo. Changes in ASEX individual item scores supported the similarity of vortioxetine doses to placebo. Significantly higher TESD risk occurred with duloxetine 60 mg/day versus placebo and versus vortioxetine 5 or 10 mg. The sensitivity analysis was generally consistent with the primary analysis. Rates of spontaneously reported sexual adverse events were low. CONCLUSIONS Vortioxetine was associated with rates of TESD that were not significantly different from placebo in short-term clinical trials.
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Italian neurologists' perception on cognitive symptoms in major depressive disorder. Neurol Sci 2016; 37:1437-42. [PMID: 27155852 DOI: 10.1007/s10072-016-2601-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
The assessment of cognition is an important part of major depressive disorder (MDD) evaluation and a crucial issue is the physicians' perception of cognitive dysfunction in MDD that remains nowadays a little known matter. The present study aims at investigating the understanding of neurologists' perception about cognitive dysfunction in MDD. An on-line survey addressed to 85 Italian neurologists in the period between May and June 2015 was performed. The questionnaire comprised three sections: the first section collecting information on neurologists' socio-demographic profile, the second investigating cognitive symptoms relevance in relation with different aspects and the third one explicitly focusing on cognitive symptoms in MDD. Cognitive symptoms are considered most significant among DSM-5 symptoms to define the presence of a Major Depressive Episode in a MDD, to improve antidepressant therapy adherence, patients' functionality and concurrent neurological condition, once resolved. Furthermore, an incongruity came to light from this survey: the neurologists considered cognitive symptoms a not relevant aspect to choose the antidepressant treatment in comparison with the other DSM-5 symptoms on one side, but they declared the opposite in the third part of the questionnaire focused on cognitive symptoms. Cognitive symptoms appeared to be a relevant aspect in MDD and neurologists have a clear understanding of this issue. Nevertheless, the discrepancy between neurologists' perception on cognitive symptoms and the antidepressant treatment highlights the feeling of an unmet need that could be filled increasing the awareness of existing drugs with pro-cognitive effects.
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Orsolini L, Tomasetti C, Valchera A, Iasevoli F, Buonaguro EF, Vellante F, Fornaro M, Fiengo A, Mazza M, Vecchiotti R, Perna G, de Bartolomeis A, Martinotti G, Di Giannantonio M, De Berardis D. New advances in the treatment of generalized anxiety disorder: the multimodal antidepressant vortioxetine. Expert Rev Neurother 2016; 16:483-95. [PMID: 27050932 DOI: 10.1586/14737175.2016.1173545] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Generalized Anxiety Disorder (GAD) is a persistent condition characterized by chronic anxiety, exaggerated worry and tension, mainly comorbid with Major Depressive Disorder (MDD). Currently, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are recommended as first-line treatment of GAD. However, some patients may not respond to the treatment or discontinue due to adverse effects. Vortioxetine (VRX) is a multimodal antidepressant with a unique mechanism of action, by acting as 5-HT3A, 5-HT1D and 5-HT7 receptor antagonist, partial agonist at the 5-HT1A and 5-HT1B receptors and inhibitor at the 5-HT transporter. Preliminary clinical trials showed contrasting findings in terms of improvement of the anxiety symptomatology and/or cognitive impairment. Here, we aim to systematically review the evidence currently available on the efficacy, safety and tolerability of VRX in the treatment of GAD. The generalizability of results on the efficacy of VRX in patients with anxiety symptomatology and GAD is limited due to few and contrasting RCTs so far available. Only two studies, of which one prevention relapse trial, reported a significant improvement in anxiety symptomatology compared to three with negative findings.
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Affiliation(s)
- Laura Orsolini
- a School of Life and Medical Sciences , University of Hertfordshire , Hatfield , UK.,b Villa San Giuseppe Hospital , Hermanas Hospitalarias , Ascoli Piceno , Italy.,c Polyedra Research Group , Teramo , Italy.,d Department of Psychiatry and Neuropsychology , University of Maastricht , Maastricht , The Netherlands
| | - Carmine Tomasetti
- c Polyedra Research Group , Teramo , Italy.,e NHS, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment , Hospital 'Maria SS dello Splendore' , Giulianova , Italy.,f Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatogical Sciences , University of Naples 'Federico II' , Napoli , Italy
| | - Alessandro Valchera
- b Villa San Giuseppe Hospital , Hermanas Hospitalarias , Ascoli Piceno , Italy.,c Polyedra Research Group , Teramo , Italy
| | - Felice Iasevoli
- c Polyedra Research Group , Teramo , Italy.,f Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatogical Sciences , University of Naples 'Federico II' , Napoli , Italy
| | - Elisabetta Filomena Buonaguro
- c Polyedra Research Group , Teramo , Italy.,f Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatogical Sciences , University of Naples 'Federico II' , Napoli , Italy
| | - Federica Vellante
- c Polyedra Research Group , Teramo , Italy.,g NHS, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment , Hospital 'G. Mazzini' , Teramo , Italy.,h Department of Neuroscience and Imaging , University 'G. d'Annunzio' , Chieti , Italy
| | - Michele Fornaro
- c Polyedra Research Group , Teramo , Italy.,i New York Psychiatric Institute , Columbia University , New York , NY , USA
| | | | - Monica Mazza
- c Polyedra Research Group , Teramo , Italy.,j Department of Life, Health and Environmental Sciences , University of L'Aquila , L'Aquila , Italy
| | - Roberta Vecchiotti
- b Villa San Giuseppe Hospital , Hermanas Hospitalarias , Ascoli Piceno , Italy.,c Polyedra Research Group , Teramo , Italy.,d Department of Psychiatry and Neuropsychology , University of Maastricht , Maastricht , The Netherlands
| | - Giampaolo Perna
- d Department of Psychiatry and Neuropsychology , University of Maastricht , Maastricht , The Netherlands.,k Hermanas Hospitalarias, FoRiPsi, Department of Clinical Neurosciences , Villa San Benedetto Menni , Albese con Cassano , Como , Italy.,l Department of Psychiatry and Behavioral Sciences , Leonard Miller School of Medicine, University of Miami , Coral Gables , Florida , USA
| | - Andrea de Bartolomeis
- f Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatogical Sciences , University of Naples 'Federico II' , Napoli , Italy
| | - Giovanni Martinotti
- i New York Psychiatric Institute , Columbia University , New York , NY , USA
| | | | - Domenico De Berardis
- c Polyedra Research Group , Teramo , Italy.,g NHS, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment , Hospital 'G. Mazzini' , Teramo , Italy.,i New York Psychiatric Institute , Columbia University , New York , NY , USA
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Choi SE, Brignone M, Cho SJ, Jeon HJ, Jung R, Campbell R, Francois C, Milea D. Cost-effectiveness of vortioxetine versus venlafaxine (extended release) in the treatment of major depressive disorder in South Korea. Expert Rev Pharmacoecon Outcomes Res 2016; 16:629-638. [DOI: 10.1586/14737167.2016.1128830] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Sang-Eun Choi
- College of Pharmacy, Korea University, Sejong, South Korea
| | | | - Seong Jin Cho
- Gil Medical Center, Gachon University, Incheon, South Korea
| | - Hong Jin Jeon
- School of Medicine, Sungkyunkwan University, Seoul, South Korea
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Liu L, Cao N, Ma X, Xiong K, Sun L, Zou Q, Yao L. Stability-indicating reversed-phase HPLC method development and characterization of impurities in vortioxetine utilizing LC–MS, IR and NMR. J Pharm Biomed Anal 2016; 117:325-32. [DOI: 10.1016/j.jpba.2015.08.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 08/17/2015] [Accepted: 08/19/2015] [Indexed: 11/15/2022]
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Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, Hopwood M, Lyndon B, Mulder R, Murray G, Porter R, Singh AB. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2015; 49:1087-206. [PMID: 26643054 DOI: 10.1177/0004867415617657] [Citation(s) in RCA: 511] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. METHODS Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (Mood Disorders CPG) provide up-to-date guidance and advice regarding the management of mood disorders that is informed by evidence and clinical experience. The Mood Disorders CPG is intended for clinical use by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSIONS The Mood Disorder CPG is the first Clinical Practice Guideline to address both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Professor Gin Malhi (Chair), Professor Darryl Bassett, Professor Philip Boyce, Professor Richard Bryant, Professor Paul Fitzgerald, Dr Kristina Fritz, Professor Malcolm Hopwood, Dr Bill Lyndon, Professor Roger Mulder, Professor Greg Murray, Professor Richard Porter and Associate Professor Ajeet Singh. INTERNATIONAL EXPERT ADVISORS Professor Carlo Altamura, Dr Francesco Colom, Professor Mark George, Professor Guy Goodwin, Professor Roger McIntyre, Dr Roger Ng, Professor John O'Brien, Professor Harold Sackeim, Professor Jan Scott, Dr Nobuhiro Sugiyama, Professor Eduard Vieta, Professor Lakshmi Yatham. AUSTRALIAN AND NEW ZEALAND EXPERT ADVISORS Professor Marie-Paule Austin, Professor Michael Berk, Dr Yulisha Byrow, Professor Helen Christensen, Dr Nick De Felice, A/Professor Seetal Dodd, A/Professor Megan Galbally, Dr Josh Geffen, Professor Philip Hazell, A/Professor David Horgan, A/Professor Felice Jacka, Professor Gordon Johnson, Professor Anthony Jorm, Dr Jon-Paul Khoo, Professor Jayashri Kulkarni, Dr Cameron Lacey, Dr Noeline Latt, Professor Florence Levy, A/Professor Andrew Lewis, Professor Colleen Loo, Dr Thomas Mayze, Dr Linton Meagher, Professor Philip Mitchell, Professor Daniel O'Connor, Dr Nick O'Connor, Dr Tim Outhred, Dr Mark Rowe, Dr Narelle Shadbolt, Dr Martien Snellen, Professor John Tiller, Dr Bill Watkins, Dr Raymond Wu.
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Affiliation(s)
- Gin S Malhi
- Discipline of Psychiatry, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Darryl Bassett
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia School of Medicine, University of Notre Dame, Perth, WA, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, VIC, Australia
| | - Kristina Fritz
- CADE Clinic, Discipline of Psychiatry, Sydney Medical School - Northern, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Bill Lyndon
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia Mood Disorders Unit, Northside Clinic, Greenwich, NSW, Australia ECT Services Northside Group Hospitals, Greenwich, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Greg Murray
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Richard Porter
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Ajeet B Singh
- School of Medicine, Deakin University, Geelong, VIC, Australia
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Hellerstein DJ, Flaxer J. Vilazodone for the treatment of major depressive disorder: an evidence-based review of its place in therapy. CORE EVIDENCE 2015; 10:49-62. [PMID: 25945081 PMCID: PMC4408952 DOI: 10.2147/ce.s54075] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION It has clearly been demonstrated that depressive disorders constitute a major worldwide public health problem, with massive economic and quality-of-life consequences. Existing pharmacological treatments have limited efficacy, with only about a third of patients achieving remission on any one medication. Delayed onset of action and variable tolerability contribute to this limited efficacy. Vilazodone, introduced in the US in 2011, has been described as the first member of the serotonin partial agonist-reuptake inhibitor (SPARI) class of medications, combining serotonin-reuptake inhibition with 5-HT1A partial agonism. This agent could potentially have benefits for subgroups of depressed patients, including depressed patients with comorbid anxiety and patients with anxiety disorders, and might have fewer sexual side effects than selective serotonin-reuptake inhibitors (SSRIs). AIMS We reviewed existing clinical trials that assess the benefits of vilazodone for treatment of major depression. EVIDENCE REVIEW In clinical trials, including two Phase III studies and two Phase IV studies, vilazodone has been shown to have efficacy greater than placebo on the Montgomery-Åsberg Depression Rating Scale, comparable efficacy to citalopram, and continued benefit after 52 weeks of treatment. The safety profile for vilazodone is comparable to other SSRI medications, and tolerability also appears generally comparable to other SSRI medications. PLACE IN THERAPY Vilazodone, which has been described as the first-of-class SPARI medication, may potentially have benefits for subgroups of patients, particularly those depressed individuals with coexisting anxiety symptoms or anxiety disorders. However, convincing evidence for these benefits has as yet not been published.
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Affiliation(s)
- David J Hellerstein
- Department of Psychiatry, Columbia University, New York, NY, USA ; New York State Psychiatric Institute, New York, NY, USA
| | - Joseph Flaxer
- Department of Psychiatry, Columbia University, New York, NY, USA
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Saltiel PF, Silvershein DI. Major depressive disorder: mechanism-based prescribing for personalized medicine. Neuropsychiatr Dis Treat 2015; 11:875-88. [PMID: 25848287 PMCID: PMC4386790 DOI: 10.2147/ndt.s73261] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Individual patients with depression present with unique symptom clusters - before, during, and even after treatment. The prevalence of persistent, unresolved symptoms and their contribution to patient functioning and disease progression emphasize the importance of finding the right treatment choice at the onset and the utility of switching medications based on suboptimal responses. Our primary goal as clinicians is to improve patient function and quality of life. In fact, feelings of well-being and the return to premorbid levels of functioning are frequently rated by patients as being more important than symptom relief. However, functional improvements often lag behind resolution of mood, attributed in large part to persistent and functionally impairing symptoms - namely, fatigue, sleep/wake disturbance, and cognitive dysfunction. Thus, patient outcomes can be optimized by deconstructing each patient's depressive profile to its component symptoms and specifically targeting those domains that differentially limit patient function. This article will provide an evidence-based framework within which clinicians may tailor pharmacotherapy to patient symptomatology for improved treatment outcomes.
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Affiliation(s)
- Philip F Saltiel
- Department of Psychiatry, New York University School of Medicine/Langone Medical Center New York University Behavioral Health Programs, New York University Pearl Barlow Center for Memory Evaluation and Treatment, New York, NY, USA
| | - Daniel I Silvershein
- Department of Medicine, New York University School of Medicine/Langone Medical Center, New York, NY, USA
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Lin JY, Jiang MY, Kan ZM, Chu Y. Influence of 5-HTR2A genetic polymorphisms on the efficacy of antidepressants in the treatment of major depressive disorder: a meta-analysis. J Affect Disord 2014; 168:430-8. [PMID: 25108775 DOI: 10.1016/j.jad.2014.06.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/03/2014] [Accepted: 06/05/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of the current meta-analysis was to assess the influence of common genetic polymorphisms in the 5-HTR2A gene on the efficacy of antidepressants in the treatment of major depressive disorder (MDD). METHOD MEDLINE (1966-2013), Cochrane Library Database (Issue 12, 2013), EMBASE (1980-2013), CINAHL (1982-2013), Web of Science (1945-2013) and Chinese Biomedical Database (CBM) (1982-2013) were searched without language restrictions. Meta-analysis was performed using the STATA statistical software. We calculated the odds ratio (OR) and its 95% confidence interval (95% CI) to estimate the efficacy of antidepressants in the treatment of MDD. RESULTS Eleven studies with a total of 1775 MDD patients met the inclusion criteria of this meta-analysis. Three common polymorphisms in the 5-HTR2A gene were assessed, including rs6311 C>T, rs7997012 G>A, and rs6313 T>C. Our findings suggested that the 5-HTR2A rs6313 T>C polymorphism was significantly correlated with a higher response rate to antidepressants in MDD patients (allele model: OR=1.33, 95% CI=1.05-1.68, P=0.020; dominant model: OR=1.62, 95% CI=1.21-2.18, P=0.001; homozygous model: OR=1.85, 95% CI=1.18-2.90, P=0.008). The rs7997012 G>A polymorphism was also associated with a higher response rate to antidepressants in MDD patients under the dominant model (OR=1.92, 95% CI=1.02-3.61, P=0.044). However, no significant correlation was found for the 5-HTR2A rs6311 C>T polymorphism under five genetic models (all P>0.05). CONCLUSION Our findings provide empirical evidence that the 5-HTR2A rs6313 T>C and rs7997012 G>A polymorphism may be correlated with the efficacy of antidepressants in the treatment of MDD.
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Affiliation(s)
- Jian-Yang Lin
- Department of Pharmacy, the First Hospital of China Medical University, Nanjing Street No. 155, Heping District, Shenyang 110001, PR China.
| | - Ming-Yan Jiang
- Department of Pharmacy, the First Hospital of China Medical University, Nanjing Street No. 155, Heping District, Shenyang 110001, PR China
| | - Zhou-Mi Kan
- Department of Pharmacy, the First Hospital of China Medical University, Nanjing Street No. 155, Heping District, Shenyang 110001, PR China
| | - Yang Chu
- Department of Pharmacy, the First Hospital of China Medical University, Nanjing Street No. 155, Heping District, Shenyang 110001, PR China
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Faster, better, stronger: towards new antidepressant therapeutic strategies. Eur J Pharmacol 2014; 753:32-50. [PMID: 25092200 DOI: 10.1016/j.ejphar.2014.07.046] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 05/28/2014] [Accepted: 07/24/2014] [Indexed: 12/26/2022]
Abstract
Major depression is a highly prevalent disorder and is predicted to be the second leading cause of disease burden by 2020. Although many antidepressant drugs are currently available, they are far from optimal. Approximately 50% of patients do not respond to initial first line antidepressant treatment, while approximately one third fail to achieve remission following several pharmacological interventions. Furthermore, several weeks or months of treatment are often required before clinical improvement, if any, is reported. Moreover, most of the commonly used antidepressants have been primarily designed to increase synaptic availability of serotonin and/or noradrenaline and although they are of therapeutic benefit to many patients, it is clear that other therapeutic targets are required if we are going to improve the response and remission rates. It is clear that more effective, rapid-acting antidepressants with novel mechanisms of action are required. The purpose of this review is to outline the current strategies that are being taken in both preclinical and clinical settings for identifying superior antidepressant drugs. The realisation that ketamine has rapid antidepressant-like effects in treatment resistant patients has reenergised the field. Further, developing an understanding of the mechanisms underlying the rapid antidepressant effects in treatment-resistant patients by drugs such as ketamine may uncover novel therapeutic targets that can be exploited to meet the Olympian challenge of developing faster, better and stronger antidepressant drugs.
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Kornstein SG, McIntyre RS, Thase ME, Boucher M. Desvenlafaxine for the treatment of major depressive disorder. Expert Opin Pharmacother 2014; 15:1449-63. [DOI: 10.1517/14656566.2014.923403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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