1
|
Dold M, Bartova L, Fugger G, Kautzky A, Mitschek MMM, Fabbri C, Montgomery S, Zohar J, Souery D, Mendlewicz J, Serretti A, Kasper S. Melancholic features in major depression - a European multicenter study. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110285. [PMID: 33609603 DOI: 10.1016/j.pnpbp.2021.110285] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/31/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
There is still a debate, if melancholic symptoms can be seen rather as a more severe subtype of major depressive disorder (MDD) or as a separate diagnostic entity. The present European multicenter study comprising altogether 1410 MDD in- and outpatients sought to investigate the influence of the presence of melancholic features in MDD patients. Analyses of covariance, chi-squared tests, and binary logistic regression analyses were accomplished to determine differences in socio-demographic and clinical variables between MDD patients with and without melancholia. We found a prevalence rate of 60.71% for melancholic features in MDD. Compared to non-melancholic MDD patients, they were characterized by a significantly higher likelihood for higher weight, unemployment, psychotic features, suicide risk, inpatient treatment, severe depressive symptoms, receiving add-on medication strategies in general, and adjunctive treatment with antidepressants, antipsychotics, benzodiazepine (BZD)/BZD-like drugs, low-potency antipsychotics, and pregabalin in particular. With regard to the antidepressant pharmacotherapy, we found a less frequent prescription of selective serotonin reuptake inhibitors (SSRIs) in melancholic MDD. No significant between-group differences were found for treatment response, non-response, and resistance. In summary, we explored primarily variables to be associated with melancholia which can be regarded as parameters for the presence of severe/difficult-to treat MDD conditions. Even if there is no evidence to realize any specific treatment strategy in melancholic MDD patients, their prescribed medication strategies were different from those for patients without melancholia.
Collapse
Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Marleen M M Mitschek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Chiara Fabbri
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | | | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Souery
- School of Medicine, Free University of Brussels, Brussels, Belgium; Psy Pluriel - European Centre of Psychological Medicine, Brussels, Belgium
| | | | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Center for Brain Research, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
2
|
Efficacy and Adverse Effects of Tranylcypromine and Tricyclic Antidepressants in the Treatment of Depression: A Systematic Review and Comprehensive Meta-analysis. J Clin Psychopharmacol 2020; 40:63-74. [PMID: 31834088 DOI: 10.1097/jcp.0000000000001153] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE We conducted a comprehensive meta-analysis of the comparison of tranylcypromine (TCP) and tricyclic antidepressants (TCAs) in the treatment of depression because such work is lacking in medical scientific literature. METHODS Literature was searched for studies of TCP controlled by TCAs in multiple databases and in reviews of TCP and monoamine oxidase inhibitors. The natural logarithm of the odds ratio (logOR) and the pooled logOR according to a fixed effect model were calculated for the numbers of responders and nonresponders. RESULTS A total of 227 studies of TCP were found including 75 controlled studies of TCP-monotherapy. Twelve of 23 studies of TCP monotherapy and TCAs were excluded for several reasons (duplicates, safety studies, retrospective, cross-over), leaving 11 prospective and parallel controlled studies of TCP monotherapy versus TCAs (6 randomized double-blind). One study was excluded from the meta-analysis because of low quality of study design according to the Food and Drug Administration guidelines of studies of antidepressant drugs and high risk of bias according to the Cochrane's tool. Two studies with equal efficacy of TCP and TCAs in continuous endpoints did not provide dichotomous response data. A pooled logOR of 0.480 (95% confidence interval, 0.105-0.857, P = 0.01) resulted for the remaining eight studies in the primary meta-analysis, which favors TCP significantly over TCAs (test for heterogeneity: Х = 8.1, df = 7, P > 0.3, not heterogenous; I = 13.6%, heterogeneity not important). The result is robust with respect to inclusion of hypothetical response data of the 2 studies with continuous data only: pooled logOR, 0.350 (95% confidence interval, 0.028-0.672, P = 0.03). Visual inspection of forest plots and subgroup analysis suggest that superiority of TCP over TCAs is determined by 2 studies in psychomotor-retarded (anergic) depression. CONCLUSIONS Tranylcypromine and TCAs have an equal antidepressant effect in a mean sample of depressed patients with mixed psychomotor symptoms. Tranylcypromine might be superior to TCAs in depression with predominant psychomotor retardation.
Collapse
|
3
|
|
4
|
Ricken R, Ulrich S, Schlattmann P, Adli M. Tranylcypromine in mind (Part II): Review of clinical pharmacology and meta-analysis of controlled studies in depression. Eur Neuropsychopharmacol 2017; 27:714-731. [PMID: 28579071 DOI: 10.1016/j.euroneuro.2017.04.003] [Citation(s) in RCA: 196] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 04/13/2017] [Accepted: 04/28/2017] [Indexed: 01/03/2023]
Abstract
It has been over 50 years since a review has focused exclusively on the monoamine oxidase (MAO) inhibitor tranylcypromine (TCP). A new review has therefore been conducted for TCP in two parts which are written to be read preferably in close conjunction: part I - pharmacodynamics, pharmacokinetics, drug interactions, toxicology; and part II - clinical studies with meta-analysis of controlled studies in depression, practice of TCP treatment, place in therapy. The irreversible and nonselective MAO-A/B inhibitor TCP has been confirmed as an efficacious and safe antidepressant drug. For the first time, a meta-analysis of controlled clinical trials in depression demonstrated that TCP is superior to placebo (pooled logOR=0.509, 95%CI=0.026 to 0.993, 4 studies) and equal to other antidepressants (pooled logOR=0.208, 95%CI=-0.128 to 0.544, 10 studies). In treatment resistant depression (TRD) after tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), TCP was superior to placebo (logOR=2.826, 95%CI=1.494 to 4.158, one study) and non-established antidepressants (pooled logOR=1.976, 95%CI=0.907 to 3.045, 4 studies), and was equal to other MAO inhibitors and an antidepressant combination (pooled logOR=-0.366, 95%CI=-0.869 to 0.137, 4 studies). Controlled studies revealed that TCP might provide a special advantage in the treatment of atypical depression, which was supported by a recent PET study of MAO-A activity in brain. However, TCP treatment remains beset with the need for a mandatory tyramine-restricted diet and is therefore limited to use as a third-line antidepressant according to recent treatment algorithms and guidelines for depression treatment. On the other hand, the effort needed to maintain a tyramine-restricted diet may have been overestimated in the perception of both doctors and patients, which may have led to relative underuse of TCP. Interaction with serotonergic drugs bears the risk of severe serotonin toxicity (SST) and combination with indirect sympathomimetic drugs may result in hypertensive crisis which both adds to the risks of TCP. At the same time, TCP has low to no risks of central anticholinergic, sedative, cardiac conduction, body weight, hemostatic effects, or pharmacokinetic drug interactions. Neuroprotection by MAO inhibitors due to reduced oxidative stress is becoming increasingly studied. Taken together, TCP is being increasingly recognized as an important option in systematic treatment approaches for patients suffering from severe courses of depression, such as TRD and atypical depression, by offering a MAO-related pathophysiological rationale.
Collapse
Affiliation(s)
- Roland Ricken
- Department of Psychiatry and Psychotherapy, Charité, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany.
| | - Sven Ulrich
- Aristo Pharma GmbH, Wallenroder Str. 8-10, 13435 Berlin, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Friedrich Schiller University Jena, Bachstraße 18, 07743 Jena, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| |
Collapse
|
5
|
Parekh A, Smeeth D, Milner Y, Thure S. The Role of Lipid Biomarkers in Major Depression. Healthcare (Basel) 2017; 5:healthcare5010005. [PMID: 28165367 PMCID: PMC5371911 DOI: 10.3390/healthcare5010005] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 12/11/2022] Open
Abstract
In the UK, the lifetime-documented prevalence of major depressive disorder (MDD) is currently 10%. Despite its increasing prevalence and devastating impact on quality of life, the pathophysiological mechanisms underpinning MDD remain to be fully elucidated. Current theories of neurobiological components remain incomplete and protein-centric, rendering pharmacological treatment options suboptimal. In this review, we highlight the pivotal role of lipids in intra- and inter-neuronal functioning, emphasising the potential use of lipids as biomarkers for MDD. The latter has significant implications for improving our understanding of MDD at the cellular and circuit level. There is particular focus on cholesterol (high and low density lipoprotein), omega-3, and omega-6 polyunsaturated fatty acids due to established evidence in the literature of a link between atherosclerotic disease and major depression. We argue that there is significant potential scope for the use of such peripheral biomarkers in the diagnosis, stratification and treatment of MDD.
Collapse
Affiliation(s)
- Amy Parekh
- Basic and Clinical Neuroscience, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK.
| | - Demelza Smeeth
- Basic and Clinical Neuroscience, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK.
| | - Yasmin Milner
- Basic and Clinical Neuroscience, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK.
| | - Sandrine Thure
- Basic and Clinical Neuroscience, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK.
| |
Collapse
|
6
|
Rush G, O'Donovan A, Nagle L, Conway C, McCrohan A, O'Farrelly C, Lucey JV, Malone KM. Alteration of immune markers in a group of melancholic depressed patients and their response to electroconvulsive therapy. J Affect Disord 2016; 205:60-68. [PMID: 27414954 PMCID: PMC5291160 DOI: 10.1016/j.jad.2016.06.035] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/10/2016] [Accepted: 06/11/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Immune system dysfunction is implicated in the pathophysiology of major depression, and is hypothesized to normalize with successful treatment. We aimed to investigate immune dysfunction in melancholic depression and its response to ECT. METHODS 55 melancholic depressed patients and 26 controls participated. 33 patients (60%) were referred for ECT. Blood samples were taken at baseline, one hour after the first ECT session, and 48h after ECT series completion. RESULTS At baseline, melancholic depressed patients had significantly higher levels of the pro-inflammatory cytokine IL-6, and lower levels of the regulatory cytokine TGF-β than controls. A significant surge in IL-6 levels was observed one hour after the first ECT session, but neither IL-6 nor TGF-β levels normalized after completion of ECT series. Seventy per cent (n=23) of ECT recipients showed clinical response and 42% (n=10) reached remission. Neither IL-6 nor TGF-β changes correlated with clinical improvement following ECT. No significant changes in IL-10, TNF-α and CRP levels were found in relation to melancholia or response to ECT. LIMITATIONS As a naturalistic study, some potential confounders could not be eliminated or controlled, including medication use. CONCLUSIONS Melancholic depressed patients demonstrated a peripheral increase in IL-6 and reduction in TGF-β, which did not normalize despite clinical response to ECT. These findings may be consistent with emerging hypotheses of the role of inflammation in mediating neurotrophin expression. The implications of chronic inflammation in the melancholic depressed population for future medical health, particularly cardiovascular risk, are largely unknown and warrant further investigation.
Collapse
Affiliation(s)
- Gavin Rush
- St. Patrick's University Hospital, Dublin, Ireland.
| | - Aoife O'Donovan
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland; Department of Psychiatry, Psychotherapy and Mental Health Research, St. Vincent's University Hospital, Dublin, Ireland; Stress and Health Research Program, San Francisco Veteran's Affairs Medical Center, San Francisco, CA, United States; Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Laura Nagle
- St. Patrick's University Hospital, Dublin, Ireland
| | | | - AnnMaria McCrohan
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland; Department of Psychiatry, Psychotherapy and Mental Health Research, St. Vincent's University Hospital, Dublin, Ireland
| | - Cliona O'Farrelly
- School of Biochemistry and Immunology, University of Dublin Trinity College, Dublin, Ireland
| | | | - Kevin M Malone
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland; Department of Psychiatry, Psychotherapy and Mental Health Research, St. Vincent's University Hospital, Dublin, Ireland
| |
Collapse
|
7
|
Lin CH, Huang CJ, Liu SK. Melancholic features in inpatients with major depressive disorder associate with differential clinical characteristics and treatment outcomes. Psychiatry Res 2016; 238:368-373. [PMID: 26899817 DOI: 10.1016/j.psychres.2015.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 11/01/2015] [Accepted: 11/07/2015] [Indexed: 11/17/2022]
Abstract
To determine whether the presence of melancholic features in hospitalized patients with major depressive disorder (MDD) was associated with specific clinical characteristics and treatment outcomes, supporting melancholic depression as a distinct subtype within MDD. 126 acutely ill inpatients with MDD were enrolled in an open, 6-week trial with fixed-dose fluoxetine 20mg daily. Symptom severity was assessed regularly, using the 17-item Hamilton Depression Rating Scale (HAMD-17) and Clinical Global Impression of Severity (CGI-S). Melancholic features were defined according to the DSM-IV criteria. Clinical variables were compared between patients with and without melancholic features. Generalized estimating equations method was used to explore the differences in HAMD-17 and CGI-S scores between the 2 groups over time. Clinical response was defined as having a 50% or greater reduction in HAMD-17 scores. 96 (76.2%) of the 126 patients with at least one post-baseline assessment met the criteria for melancholic depression. Melancholic depression differed from non-melancholic depression in clinical characteristics and predicted a better response to fluoxetine treatment. The differentiation between melancholic and non-melancholic depression within MDD hence is clinically significant and valid.
Collapse
Affiliation(s)
- Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Jen Huang
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan
| | - Shi-Kai Liu
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
8
|
Cleare A, Pariante CM, Young AH, Anderson IM, Christmas D, Cowen PJ, Dickens C, Ferrier IN, Geddes J, Gilbody S, Haddad PM, Katona C, Lewis G, Malizia A, McAllister-Williams RH, Ramchandani P, Scott J, Taylor D, Uher R. Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol 2015; 29:459-525. [PMID: 25969470 DOI: 10.1177/0269881115581093] [Citation(s) in RCA: 414] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A revision of the 2008 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken in order to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in September 2012. Key areas in treating depression were reviewed and the strength of evidence and clinical implications were considered. The guidelines were then revised after extensive feedback from participants and interested parties. A literature review is provided which identifies the quality of evidence upon which the recommendations are made. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse and stopping treatment. Significant changes since the last guidelines were published in 2008 include the availability of new antidepressant treatment options, improved evidence supporting certain augmentation strategies (drug and non-drug), management of potential long-term side effects, updated guidance for prescribing in elderly and adolescent populations and updated guidance for optimal prescribing. Suggestions for future research priorities are also made.
Collapse
Affiliation(s)
- Anthony Cleare
- Professor of Psychopharmacology & Affective Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - C M Pariante
- Professor of Biological Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - A H Young
- Professor of Psychiatry and Chair of Mood Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - I M Anderson
- Professor and Honorary Consultant Psychiatrist, University of Manchester Department of Psychiatry, University of Manchester, Manchester, UK
| | - D Christmas
- Consultant Psychiatrist, Advanced Interventions Service, Ninewells Hospital & Medical School, Dundee, UK
| | - P J Cowen
- Professor of Psychopharmacology, Psychopharmacology Research Unit, Neurosciences Building, University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - C Dickens
- Professor of Psychological Medicine, University of Exeter Medical School and Devon Partnership Trust, Exeter, UK
| | - I N Ferrier
- Professor of Psychiatry, Honorary Consultant Psychiatrist, School of Neurology, Neurobiology & Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - J Geddes
- Head, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - S Gilbody
- Director of the Mental Health and Addictions Research Group (MHARG), The Hull York Medical School, Department of Health Sciences, University of York, York, UK
| | - P M Haddad
- Consultant Psychiatrist, Cromwell House, Greater Manchester West Mental Health NHS Foundation Trust, Salford, UK
| | - C Katona
- Division of Psychiatry, University College London, London, UK
| | - G Lewis
- Division of Psychiatry, University College London, London, UK
| | - A Malizia
- Consultant in Neuropsychopharmacology and Neuromodulation, North Bristol NHS Trust, Rosa Burden Centre, Southmead Hospital, Bristol, UK
| | - R H McAllister-Williams
- Reader in Clinical Psychopharmacology, Institute of Neuroscience, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - P Ramchandani
- Reader in Child and Adolescent Psychiatry, Centre for Mental Health, Imperial College London, London, UK
| | - J Scott
- Professor of Psychological Medicine, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - D Taylor
- Professor of Psychopharmacology, King's College London, London, UK
| | - R Uher
- Associate Professor, Canada Research Chair in Early Interventions, Dalhousie University, Department of Psychiatry, Halifax, NS, Canada
| | | |
Collapse
|
9
|
Zhao X, Chen Q, Liu Y, Xia C, Shi J, Zheng M. Effect of xanthone derivatives on animal models of depression. Curr Ther Res Clin Exp 2014; 76:45-50. [PMID: 25067986 PMCID: PMC4109418 DOI: 10.1016/j.curtheres.2014.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2014] [Indexed: 12/19/2022] Open
Abstract
Background Extracts of the plant Hypericum perforatum L. have been traditionally used in folk medicine for the treatment of depressive disorders. Xanthone, a component of Hypericum perforatum L., has been shown to be effective in animal models of depression. Objective We investigated if 2 xanthone derivatives (1101 and 1105) were as effective as venlafaxine, which is a serotonin–norepinephrine reuptake inhibitor and was used as a positive control, in animal models of depression. Methods A series of derivatives from xanthone were designed and synthesized. After preliminary experiments, 2 xanthone derivatives (1101 and 1105) were considered to be effective in our mouse depression model. To further determine their effects on depression, classical behavioral despair animal models (forced swim and tail suspension tests) were used to assess the efficacies of these derivatives, whereas venlafaxine hydrochloride was used as a positive control. Oral acute toxicity studies were used to determine if the derivatives were toxic in mice. Results The oral acute toxicity studies of 2 xanthone derivatives (1101 and 1105) did not show any toxic effect until the dose at 1000 mg/kg body weight, and xanthone derivatives 1101 and 1105 resulted in a significant decrease of the immobility period (in seconds) compared with the untreated control group during the forced swim test with rats (dose = 12 mg/kg; P < 0.05) and mice (dose = 25 mg/kg; P < 0.001). At lower doses, derivatives 1101 and 1105 also decreased the immobility period of rats and mice during the forced swim test but significant differences were only found in mice compared with the untreated control group (P < 0.05). No difference was found between the groups treated with xanthone derivatives and the positive control group during the swimming period in both mice (dose = 25 mg/kg) and rats (dose = 12 mg/kg) (P > 0.05). In the tail suspension test, derivatives 1101 and 1105 produced marked effects with regard to the motion of mice (P < 0.01 or 0.001, respectively) and the derivatives were also noted to have some effects on rats at a dose of 12 mg/kg (P < 0.05). Compared with the positive venlafaxine control group, no differences were found between those treated with either derivative 1101 or derivative 1105 and venlafaxine (P > 0.05). Conclusions Within certain dose ranges, xanthone derivatives 1101 and 1105 have similar effects to venlafaxine hydrochloride in the treatment of depression as suggested by behavioral despair animal models using rats and mice.
Collapse
Affiliation(s)
- Xu Zhao
- College of Pharmacy, Nanjing University of Technology, Nanjing, China
| | - Qunying Chen
- Department of Pharmacology, Jiangsu Institute of Materia Medica Co, Ltd, Nanjing University of Technology, Nanjing, China
| | - Yuan Liu
- College of Pharmacy, Nanjing University of Technology, Nanjing, China
| | - Chao Xia
- Plant Chemical Laboratory, Jiangsu Institute of Materia Medica Co, Ltd, Nanjing University of Technology, Nanjing, China
| | - Jincheng Shi
- College of Pharmacy, Nanjing University of Technology, Nanjing, China
| | - Maqing Zheng
- College of Pharmacy, Nanjing University of Technology, Nanjing, China
| |
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW To overview historical ascriptions and the current nosological status of melancholia, before reporting diagnostic strategy, biological marker and treatment studies. RECENT FINDINGS As melancholia has never been satisfactorily differentiated by reliance on symptoms, strategies that adopt a more prototypic approach and incorporate illness correlates in conjunction with symptoms appear to provide greater precision in differentiating melancholic and nonmelancholic depression. An early indicative biological marker--hyperactive Hypothalamic-Pituitary-Adrenal axis functioning--remains supported, whereas a number of other recently proposed candidate markers require clarification. Implications for treatment from recent clinical trials are also discussed. SUMMARY We note that the Diagnostic and Statistical Manual 5 (DSM-5) definition of melancholia [as for Diagnostic and Statistical Manual IV (DSM-IV)] may be limited in its differentiating capacity and so compromise research into melancholia's causes and treatments. Clarifying melancholia's status, primary causes and differential treatment responsiveness awaits more precise definition of this depressive condition.
Collapse
|
11
|
Gahr M, Schönfeldt-Lecuona C, Kölle MA, Freudenmann RW. Intoxications with the monoamine oxidase inhibitor tranylcypromine: an analysis of fatal and non-fatal events. Eur Neuropsychopharmacol 2013; 23:1364-72. [PMID: 23791433 DOI: 10.1016/j.euroneuro.2013.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 02/25/2013] [Accepted: 05/28/2013] [Indexed: 12/01/2022]
Abstract
Tranylcypromine (TCP) is a non-selective and irreversible monoamine oxidase inhibitor and an effective agent in the treatment of major depression. It features a complex pharmacologic profile and overdoses might induce severe intoxications. To identify typical clinical presentations of TCP-intoxications, range of associated TCP-dosages and possible differences between fatal and non-fatal intoxications a systematic review of all previously published cases of TCP-intoxications was conducted. We detected n=20 reports of TCP-intoxications in the literature (fatalities n=10). Mean age was 36.7 years (median 37); the majority of patients were female (60%). Frequent findings in patients with TCP-intoxications were disturbance of consciousness/cognitive dysfunction (90%), cardio-vascular symptoms (55%), hyperthermia (50%), respiratory distress (45%), delirium (45%), muscular rigidity (30%) and renal failure (20%). Suicidal intent was present in n=18 (90%) patients. First clinical symptoms related to TCP-intoxication developed on average in less than 1 day. The average dosage related to TCP-intoxication was 677 mg. The highest survived TCP-dosage was 4000 mg and the lowest fatal dosage was 170 mg. Patients with fatal intoxications were on average older (40.5 vs. 32.8 years) and developed a more rapid onset of symptoms (0.2 vs. 0.8 days). Death occurred after a mean time of 0.6 days; symptom relief in patients with non-fatal intoxications developed on average after 3.2 days. Considering the large dose spectrum between survived and lethal TCP-dosages individual susceptibility factors might play a role regarding the severity of clinical symptoms independently of the ingested dosage.
Collapse
Affiliation(s)
- Maximilian Gahr
- Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany.
| | | | | | | |
Collapse
|
12
|
Parker G, Blanch B, Paterson A, Hadzi-Pavlovic D, Sheppard E, Manicavasagar V, Synnott H, Graham RK, Friend P, Gilfillan D, Perich T. The superiority of antidepressant medication to cognitive behavior therapy in melancholic depressed patients: a 12-week single-blind randomized study. Acta Psychiatr Scand 2013; 128:271-81. [PMID: 23240706 DOI: 10.1111/acps.12049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To pursue the previously long-standing but formally untested clinical view that melancholia is preferentially responsive to antidepressant medication in comparison with psychotherapy [specifically Cognitive Behavior Therapy (CBT)]. Second, to determine whether a broader action antidepressant medication sequencing regimen is superior to a Selective Serotonin Reuptake Inhibitor (SSRI) alone. METHOD We sought to recruit a large sample of participants with melancholic depression for a 12-week trial but inclusion criteria compromised recruitment and testing the second hypothesis. The first hypothesis was evaluated by comparing 18 participants receiving antidepressant medication to 11 receiving CBT. Primary study measures were the Hamilton Rating Scale for Depression (HAM-D) and the Hamilton Endogenous Subscale (HES), rated blindly, while several secondary measures also evaluated outcome. RESULTS Participants receiving medication had a superior 12-week outcome to those receiving CBT, with significant differences present on primary measures as early as 4 weeks. At trial conclusion, the percentage improvement in HAM-D scores was 61.1% vs. 34.4%, respectively [Number Needed to Treat (NNT) = 3.7] and with those in receipt of medication returning non-significantly higher HAM-D responder (66.6% vs. 36.4%, NNT = 2.8) and remission (66.7% vs. 45.4%, NNT = 4.7) rates. CONCLUSION As the sample size was small and participants evidenced only moderate levels of depression severity, the study risked being underpowered and idiosyncratic. Despite the small sample, the superiority of antidepressant medication to CBT in those with a melancholic depression was distinctive in this pilot study.
Collapse
Affiliation(s)
- G Parker
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Parker G. A case for reprising and redefining melancholia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:183-9. [PMID: 23547640 DOI: 10.1177/070674371305800402] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify limitations to severity-based classifications of depression, and to argue for positioning melancholia as a distinct melancholic subtype. METHOD An overview of relevant literature was conducted. RESULTS First, dimensionalizing depressive disorders effectively aggregates multiple heterogeneous depressive types and syndromes, and thus limits, if not prevents, identification of differential causes and treatments. Second, the melancholic depressive subtype can be defined with some relative precision, and that as it shows quite distinct differential treatment responsiveness, identification should be a clinical priority. CONCLUSION Melancholia can be positioned and classified as a distinct depressive subtype.
Collapse
|
14
|
Parker G, Paterson A, McCraw S, Friend P, Hong M. Do practitioners managing mood disorders work to a sub-typing or a 'one size fits all' model? Australas Psychiatry 2013; 21:17-21. [PMID: 23221737 DOI: 10.1177/1039856212465776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess whether psychiatrists in the community operate to a sub-typing model of mood disorders when choosing psychotropic medications. METHOD Patients assessed through the Black Dog Institute depression clinic provided information on their previously prescribed and current medications, on how effective they found them and whether they had to be ceased due to side-effects. The prevalence of each medication trialled was analysed according to diagnosis (bipolar I, bipolar II, unipolar melancholic depression or unipolar non-melancholic depression). RESULTS Analyses indicate that psychiatrists prescribe medications differentially in line with diagnosis. This effect was found in both previously prescribed and currently prescribed medications, and was most distinct for mood stabiliser and antipsychotic medications. Several medications, in contrast, appeared to have been trialled by the majority of patients, regardless of diagnosis. Analyses of effectiveness and cessation due to side-effects were compromised by small sub-sample sizes. CONCLUSIONS Psychiatrists in the community appear to operate to a sub-typing model of mood disorders, preferentially prescribing many medications according to mood disorder sub-type.
Collapse
Affiliation(s)
- Gordon Parker
- School of Psychiatry, University of New South Wales, Randwick, NSW, Australia.
| | | | | | | | | |
Collapse
|
15
|
Caldieraro MAK, Baeza FLC, Pinheiro DO, Ribeiro MR, Parker G, Fleck MP. Clinical differences between melancholic and nonmelancholic depression as defined by the CORE system. Compr Psychiatry 2013; 54:11-5. [PMID: 22770717 DOI: 10.1016/j.comppsych.2012.05.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 05/20/2012] [Accepted: 05/24/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The definition and delineation of melancholia have remained elusive for an extended period. A longstanding signal of psychomotor disturbance has been operationalized via the observer-rated CORE measure and with CORE-assigned melancholic and nonmelancholic compared in several Australian studies. Replication studies in other regions have not previously been reported. This study compares Brazilian patients with melancholic and nonmelancholic depression according to the CORE measure of psychomotor disturbance in terms of clinical characteristics, suicide ideation, stressful life events, quality of life, parental care, and personality styles. METHODS A total of 181 patients with unipolar major depression attending a tertiary care outpatient service in Brazil were evaluated in relation to melancholic status and study variables. RESULTS The CORE-assigned melancholic patients presented higher symptom severity, greater prevalence of suicide ideation, and Axis I comorbidities than nonmelancholics. Scores of dysfunctional personality styles and dysfunctional parental care measures were also higher among melancholics. Quality-of-life scores were low in both groups. LIMITATIONS The absence of a criterion standard for the diagnosis of melancholia and the use of medication can be potential limitations of the study. CONCLUSION Differences suggest that CORE-assigned melancholia defines a distinct group of patients and probably a disorder distinct from nonmelancholic depression not only in quantitative but also in qualitative aspects.
Collapse
Affiliation(s)
- Marco Antonio Knob Caldieraro
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-003, Brazil.
| | | | | | | | | | | |
Collapse
|
16
|
Abstract
BACKGROUND This is an update of a Cochrane review first published in The Cochrane Library in Issue 4, 2006 and previously updated in 2009.Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation. It has been compared with chronic pain, and may be associated with depression or depressive symptoms which can affect quality of life and the ability to work. Antidepressant drugs have been used to treat tinnitus in patients with and without depressive symptoms. OBJECTIVES To assess the effectiveness of antidepressants in the treatment of tinnitus and to ascertain whether any benefit is due to a direct tinnitus effect or a secondary effect due to treatment of concomitant depressive states. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; PsycINFO; CINAHL; Web of Science; BIOSIS; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 5 January 2012. SELECTION CRITERIA Randomised controlled clinical studies of antidepressant drugs versus placebo in patients with tinnitus. DATA COLLECTION AND ANALYSIS Two authors critically appraised the retrieved studies and extracted data independently. Where necessary we contacted study authors for further information. MAIN RESULTS Six trials involving 610 patients were included. Trial quality was generally low. Four of the trials looked at the effect of tricyclic antidepressants on tinnitus, investigating 405 patients. One trial investigated the effect of a selective serotonin reuptake inhibitor (SSRI) in a group of 120 patients. One study investigated trazodone, an atypical antidepressant, versus placebo. Only the trial using the SSRI drug reached the highest quality standard. None of the other included trials met the highest quality standard, due to use of inadequate outcome measures, large drop-out rates or failure to separate the effects on tinnitus from the effects on symptoms of anxiety and depression. All the trials assessing tricyclic antidepressants suggested that there was a slight improvement in tinnitus but these effects may have been attributable to methodological bias. The trial that investigated the SSRI drug found no overall improvement in any of the validated outcome measures that were used in the study although there was possible benefit for a subgroup that received higher doses of the drug. This observation merits further investigation. In the trial investigating trazodone, the results showed an improvement in tinnitus intensity and in quality of life after treatment, but in neither case reached statistical significance. Reports of side effects including sedation, sexual dysfunction and dry mouth were common. AUTHORS' CONCLUSIONS There is as yet insufficient evidence to say that antidepressant drug therapy improves tinnitus.
Collapse
Affiliation(s)
- Paolo Baldo
- Pharmacy Unit, Drug Information Centre, CRO Aviano - Centro di RiferimentoOncologico IRCCS, Aviano (PN), Italy. .
| | | | | | | | | |
Collapse
|
17
|
Quinn CR, Dobson-Stone C, Outhred T, Harris A, Kemp AH. The contribution of BDNF and 5-HTT polymorphisms and early life stress to the heterogeneity of major depressive disorder: a preliminary study. Aust N Z J Psychiatry 2012; 46:55-63. [PMID: 22247094 DOI: 10.1177/0004867411430878] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Two reported genetic polymorphisms related to the production of brain-derived neurotrophic factor (BNDF) and reuptake by the serotonin transporter (5-HTT) appear to contribute to depression in combination with stressful life events. The aim of the current study was to investigate the contribution of early life stress (ELS), BDNF (Val versus Met alleles) and 5-HTT polymorphisms (L versus S alleles) to melancholic (n = 65) and non-melancholic depression (n = 59). METHODS A mediation approach ((G × G) × E mediation model) was employed to confirm the indirect effects of ELS on the relationship between 5-HTTPLR × BDNF polymorphism combinations and depression subtype. A series of binary logistic regressions were then conducted to determine whether genotype, ELS, and their interaction were able to predict depression subtype. RESULTS Key findings indicated that BDNF and 5-HTT polymorphisms in combination with ELS contributed to the development of non-melancholic depression. An interaction between BDNF and ELS increased the risk of non-melancholia by 3.327, whereas the interaction between 5-HTT and ELS increased risk by 2.406. CONCLUSION The results support a role for genetic factors in the development of non-melancholia. The lack of findings in melancholia indicates that other mechanisms may underlie the subtype. Alternatively, null findings may reflect a Type II error associated with a small sample size. Future studies should consider further examination of differential gene-environment interactions for melancholia versus non-melancholia.
Collapse
Affiliation(s)
- Candice R Quinn
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Australia
| | | | | | | | | |
Collapse
|
18
|
Abstract
Increasing evidence points to an association between major depressive disorders (MDDs) and diverse types of GABAergic deficits. In this review, we summarize clinical and preclinical evidence supporting a central and causal role of GABAergic deficits in the etiology of depressive disorders. Studies of depressed patients indicate that MDDs are accompanied by reduced brain concentration of the inhibitory neurotransmitter γ-aminobutyric acid (GABA) and by alterations in the subunit composition of the principal receptors (GABA(A) receptors) mediating GABAergic inhibition. In addition, there is abundant evidence that suggests that GABA has a prominent role in the brain control of stress, the most important vulnerability factor in mood disorders. Furthermore, preclinical evidence suggests that currently used antidepressant drugs (ADs) designed to alter monoaminergic transmission and nonpharmacological therapies may ultimately act to counteract GABAergic deficits. In particular, GABAergic transmission has an important role in the control of hippocampal neurogenesis and neural maturation, which are now established as cellular substrates of most if not all antidepressant therapies. Finally, comparatively modest deficits in GABAergic transmission in GABA(A) receptor-deficient mice are sufficient to cause behavioral, cognitive, neuroanatomical and neuroendocrine phenotypes, as well as AD response characteristics expected of an animal model of MDD. The GABAergic hypothesis of MDD suggests that alterations in GABAergic transmission represent fundamentally important aspects of the etiological sequelae of MDDs that are reversed by monoaminergic AD action.
Collapse
|
19
|
Advances pertaining to the pharmacology and interactions of irreversible nonselective monoamine oxidase inhibitors. J Clin Psychopharmacol 2011; 31:66-74. [PMID: 21192146 DOI: 10.1097/jcp.0b013e31820469ea] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recent advances clarifying the pharmacology and interactions of irreversible nonselective monoamine oxidase inhibitors that have not been considered in depth lately are discussed. These new data elucidate aspects of enzyme inhibition and pharmacokinetic interactions involving amine oxidases, cytochrome P450 enzymes, aminotransferases (transaminases), and decarboxylases (carboxy-lyases) and the effects of tyramine. Phenelzine and tranylcypromine remain widely available, and many publications have data relevant to this review. Their effect on CYP 450 enzymes is less than many newer drugs. Tranylcypromine only inhibits CYP 450 2A6 (selectively and potently). Phenelzine has no reported interactions, but, like isoniazid, weakly and irreversibly inhibits CYP 450 2C19 and 3A4 in vitro. It might possibly be implicated in interactions (as isoniazid is). Phenelzine has some clinically relevant inhibitory effects on amine oxidases, aminotransferases, and decarboxylases, and it lowers pyridoxal phosphate levels. It commonly causes pyridoxal deficiency, weight gain, sedation, and sexual dysfunction, but only rarely causes hepatic damage and failure, or neurotoxicity. The adverse effects and difficulties with monoamine oxidase inhibitors are less than previously believed or estimated, including a lower risk of hypertension, because the tyramine content in foods is now lower. Potent norepinephrine reuptake inhibitors have a strong protective effect against tyramine-induced hypertension. The newly discovered trace amine-associated receptors probably mediate the pressor response. The therapeutic potential of tranylcypromine and L-dopa in depression and Parkinson disease is worthy of reassessment. Monoamine oxidase inhibitors are not used to an extent proportionate with their benefits; medical texts and doctors' knowledge require a major update to reflect the evidence of recent advances.
Collapse
|
20
|
Shen Q, Lal R, Luellen BA, Earnheart JC, Andrews AM, Luscher B. gamma-Aminobutyric acid-type A receptor deficits cause hypothalamic-pituitary-adrenal axis hyperactivity and antidepressant drug sensitivity reminiscent of melancholic forms of depression. Biol Psychiatry 2010; 68:512-20. [PMID: 20579975 PMCID: PMC2930197 DOI: 10.1016/j.biopsych.2010.04.024] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 04/16/2010] [Accepted: 04/18/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND The gamma-aminobutyric acid (GABA) Type A receptor deficits that are induced by global or forebrain-specific heterozygous inactivation of the gamma2 subunit gene in mouse embryos result in behavior indicative of trait anxiety and depressive states. By contrast, a comparable deficit that is delayed to adolescence is without these behavioral consequences. Here we characterized gamma2-deficient mice with respect to hypothalamic-pituitary-adrenal (HPA) axis abnormalities and antidepressant drug responses. METHODS We analyzed the behavioral responses of gamma2(+/-) mice to desipramine and fluoxetine in novelty suppressed feeding, forced swim, tail suspension, and sucrose consumption tests as well as GABA(A) receptor deficit- and antidepressant drug treatment-induced alterations in serum corticosterone. RESULTS Baseline corticosterone concentrations in adult gamma2-deficient mice were elevated independent of whether the genetic lesion was induced during embryogenesis or delayed to adolescence. However, the manifestation of anxious-depressive behavior in different gamma2-deficient mouse lines was correlated with early onset HPA axis hyperactivity during postnatal development. Chronic but not subchronic treatment of gamma2(+/-) mice with fluoxetine or desipramine normalized anxiety-like behavior in the novelty suppressed feeding test. Moreover, desipramine had antidepressant-like effects in that it normalized HPA axis function and depression-related behavior of gamma2(+/-) mice in the forced swim, tail suspension, and sucrose consumption tests. By contrast, fluoxetine was ineffective as an antidepressant and failed to normalize HPA axis function. CONCLUSIONS Developmental deficits in GABAergic inhibition in the forebrain cause behavioral and endocrine abnormalities and selective antidepressant drug responsiveness indicative of anxious-depressive disorders such as melancholic depression, which are frequently characterized by HPA axis hyperactivity and greater efficacy of desipramine versus fluoxetine.
Collapse
Affiliation(s)
- Qiuying Shen
- Department of Biochemistry & Molecular Biology, Pennsylvania State University, University Park, PA 16802
| | - Rachnanjali Lal
- Department of Biology, Pennsylvania State University, University Park, PA 16802
| | - Beth A. Luellen
- Department of Biology, Pennsylvania State University, University Park, PA 16802
| | - John C. Earnheart
- Department of Biochemistry & Molecular Biology, Pennsylvania State University, University Park, PA 16802
| | - Anne Milasincic Andrews
- Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, PA 16802, Department of Chemistry, Pennsylvania State University, University Park, PA 16802, Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA 16802
| | - Bernhard Luscher
- Department of Biochemistry & Molecular Biology, Pennsylvania State University, University Park, PA 16802, Department of Biology, Pennsylvania State University, University Park, PA 16802, Department of Psychiatry, Pennsylvania State University, College of Medicine, Hershey, PA 17033, Corresponding Author: Bernhard Luscher, Ph. D., Department of Biology Penn State University 301 Life Sciences Building University Park, PA 16801 Phone office: 814-865 5549 Phone lab: 814-865 5563
| |
Collapse
|
21
|
Noggle CA, Dean RS. Use and impact of antidepressants in the school setting. PSYCHOLOGY IN THE SCHOOLS 2009. [DOI: 10.1002/pits.20426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
22
|
Mcferran D, Baguley D. The efficacy of treatments for depression used in the management of tinnitus. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/16513860801945224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
23
|
Hyett MP, Parker GB, Proudfoot J, Fletcher K. Examining age effects on prototypic melancholic symptoms as a strategy for refining definition of melancholia. J Affect Disord 2008; 109:193-7. [PMID: 18162189 DOI: 10.1016/j.jad.2007.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Revised: 11/15/2007] [Accepted: 11/16/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Melancholic depression appears to have a later age of onset than the non-melancholic disorders, and its phenotypic picture also appears to change with age. The latter phenomenon allows clarification of key symptoms of melancholia by examining for age effects on putative melancholic symptoms, thus enabling identification and refinement of the melancholic sub-type. METHODS We studied 158 patients receiving a diagnosis of unipolar depression (65 melancholic: 93 non-melancholic), dichotomised by age and with a higher representation of those with melancholia in the older age band. The severity of individual DSM-IV-TR melancholic candidate symptom constructs were quantified across age groups and diagnostic sub-type. RESULTS Symptom constructs identified as most clearly associated with age effects in those with melancholia were anhedonia, non-reactivity, diurnal mood variation and, to a lesser degree, psychomotor slowing. When melancholic and non-melancholic patients were compared, non-reactivity, psychomotor slowing and diurnal mood variation were the most differentiating in the older age group. CONCLUSIONS The capacity of certain symptoms to mark the changing phenotypic expression of melancholia with age may not only assist refined definition of melancholia but inform about underlying causes and, of key importance, explain the suggested differential impact of narrow-action and broad-action antidepressant on those with melancholia across differing age groups.
Collapse
Affiliation(s)
- Matthew P Hyett
- School of Psychiatry, University of New South Wales, Sydney, Australia.
| | | | | | | |
Collapse
|
24
|
Parker GB, Fletcher K, Hyett MP. The Mood Assessment Program: a computerised diagnostic tool for deriving management plans for mood disorders. Med J Aust 2008; 188:S126-8. [DOI: 10.5694/j.1326-5377.2008.tb01875.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Accepted: 03/02/2008] [Indexed: 12/17/2022]
Affiliation(s)
- Gordon B Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW
- Black Dog Institute, Prince of Wales Hospital, Sydney, NSW
| | - Kathryn Fletcher
- School of Psychiatry, University of New South Wales, Sydney, NSW
- Black Dog Institute, Prince of Wales Hospital, Sydney, NSW
| | - Matthew P Hyett
- School of Psychiatry, University of New South Wales, Sydney, NSW
- Black Dog Institute, Prince of Wales Hospital, Sydney, NSW
| |
Collapse
|
25
|
Anderson IM, Ferrier IN, Baldwin RC, Cowen PJ, Howard L, Lewis G, Matthews K, McAllister-Williams RH, Peveler RC, Scott J, Tylee A. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology guidelines. J Psychopharmacol 2008; 22:343-96. [PMID: 18413657 DOI: 10.1177/0269881107088441] [Citation(s) in RCA: 335] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A revision of the 2000 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in May 2006. Key areas in treating depression were reviewed, and the strength of evidence and clinical implications were considered. The guidelines were drawn up after extensive feedback from participants and interested parties. A literature review is provided, which identifies the quality of evidence to inform the recommendations, the strength of which are based on the level of evidence. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse, and stopping treatment.
Collapse
Affiliation(s)
- I M Anderson
- Senior Lecturer and Honorary Consultant Psychiatrist, Neuroscience and Psychiatry Unit, University of Manchester, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Möller HJ. Systematic of psychiatric disorders between categorical and dimensional approaches: Kraepelin's dichotomy and beyond. Eur Arch Psychiatry Clin Neurosci 2008; 258 Suppl 2:48-73. [PMID: 18516518 DOI: 10.1007/s00406-008-2004-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This paper describes basic principles of systematics for psychiatric disorders such as the categorical and dimensional approach. It summarises validity aspects of the traditional psychiatric nosology and syndromatology. The importance and limitations of the dichotomy of schizophrenia and affective disorders, first suggested by Kraepelin, is reviewed in the light of results from modern research in the field of classification, follow-up and neurobiological studies, especially neurochemical, neurogenetic and neuroimaging studies. Current developments towards DSM-V and ICD-11 are critically reflected. The conclusion is reached that there might be insufficient data to establish a new systematics of psychoses. Therefore it might be premature to leave the Kraepelinian dichotomy totally although it has to be modified in the light of new research.
Collapse
Affiliation(s)
- Hans-Jürgen Möller
- Psychiatrische Klinik, Ludwig-Maximilians-Universität München, Nubbaumstrabe 7, 80336, Munich, Germany.
| |
Collapse
|
27
|
Borroni G, Andreoletti M, Casiraghi MA, Ceriani R, Guerzoni P, Omazzi B, Terreni N, Salerno F. Effectiveness of pegylated interferon/ribavirin combination in 'real world' patients with chronic hepatitis C virus infection. Aliment Pharmacol Ther 2008; 27:790-7. [PMID: 18298638 DOI: 10.1111/j.1365-2036.2008.03657.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Clinical trials have shown that the combination of pegylated interferon/ribavirin induces a sustained virological response in 54-63% of patients with chronic hepatitis C virus infection, but its effectiveness in day-to-day clinical practice is less clear. AIM To verify if the efficacy of pegylated interferon/ribavirin combination in 'real world' patients is comparable to that observed in trials. Methods The medical records of 397 consecutive naïve patients with chronic hepatitis C virus infection treated with pegylated interferon/ribavirin combination in nontertiary hospital settings were reviewed in order to assess the response to anti-viral treatment. RESULTS The sustained virological response rate achieved in this population was similar to that recorded in registration trials (total population: 64%; genotype 1: 46%; genotypes 2-3: 84%). Also, the premature discontinuation rate (15%) was similar to that observed in registration trials, but there were fewer dose reductions in one or both medications (26%). We confirmed the association between adherence and sustained virological response among the patients infected with hepatitis C virus genotype 1 who were treated for > or =80% of the planned duration of treatment. CONCLUSION The effectiveness of pegylated interferon/ribavirin therapy and factors predicting an sustained virological response in everyday clinical practice mirror those reported in randomized-controlled studies.
Collapse
Affiliation(s)
- G Borroni
- Unità Organizzativa Alcoldipendenze, ASL Provincia di Milano 1, Abbiategrasso, Milan, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Studies have shown a high prevalence of depressive disorders among nursing home residents around the world. Various losses in old age may precipitate depression, and physical illness and disability are major factors that contribute to the development and persistence of depressive disorders. Demoralization (existential distress) is common. Recognition of what a nursing home resident has lost is often a key to developing plans for management. The prognosis for recovery from depression is worse for patients who face an ongoing distressing situation or physical condition. For ongoing loss-related distress, including sadness about loss of health, it is important for patients to ventilate feelings, and to either re-acquire what is lost or to grieve and then adapt to the new situation. For major depression with melancholia, psychotic depression and bipolar disorders, biological treatments are of prime importance. Non-melancholic major depression is best treated with a combination of antidepressants and psychosocial therapies, the latter being particularly indicated when the depression has been precipitated by stressful and depressing events or situations. Psychosocial and environmental interventions are important in all types of depression and may prove more effective than the use of antidepressants for milder disorders. There has been a welcome increase in the recognition of depression in nursing homes and in the prescription of newer antidepressants, but the published evidence to date does not allow definitive recommendations regarding which antidepressants to use in this setting. Outcome research is needed to assess antidepressant efficacy and to better plan multifaceted treatment strategies for depressions of varying types and aetiologies among nursing home residents.
Collapse
|
29
|
Abstract
OBJECTIVE To argue that melancholia is a categorically distinct depressive condition, able to be differentiated from other depressive conditions by a neuropathological marker [observable psychomotor disturbance (PMD)] and having a differential response to various antidepressant treatments. METHOD The above statements are addressed by review of a wide body of research, which identified observable PMD as the cardinal marker of melancholia and developed the CORE measure as a strategy for assessing PMD and its severity. Properties of the CORE measure, including reliability, validity and treatment prediction, are overviewed. RESULTS A case is made for defining melancholia and a strategy for establishing its probability. CONCLUSION Melancholia is positioned as a categorical entity capable of being circumscribed by its cardinal feature of PMD.
Collapse
Affiliation(s)
- G Parker
- School of Psychiatry, University of New South Wales and Black Dog Institute, Sydney, NSW, Australia.
| |
Collapse
|
30
|
Gillman PK. Tricyclic antidepressant pharmacology and therapeutic drug interactions updated. Br J Pharmacol 2007; 151:737-48. [PMID: 17471183 PMCID: PMC2014120 DOI: 10.1038/sj.bjp.0707253] [Citation(s) in RCA: 414] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
New data on the pharmacology of tricyclic antidepressants (TCAs), their affinities for human cloned CNS receptors and their cytochrome P450 enzyme inhibition profiles, allow improved deductions concerning their effects and interactions and indicate which of the TCAs are the most useful. The relative toxicity of TCAs continues to be more precisely defined, as do TCA interactions with selective serotonin reuptake inhibitors (SSRIs). TCA interactions with monoamine oxidase inhibitors (MAOIs) have been, historically, an uncertain and difficult question, but are now well understood, although this is not reflected in the literature. The data indicate that nortriptyline and desipramine have the most pharmacologically desirable characteristics as noradrenaline reuptake inhibitors (NRIs), and as drugs with few interactions that are also safe when coadministered with either MAOIs or SSRIs. Clomipramine is the only available antidepressant drug that has good evidence of clinically relevant serotonin and noradrenaline reuptake inhibition (SNRI). These data assist drug selection for monotherapy and combination therapy and predict reliably how and why pharmacodynamic and pharmacokinetic interactions occur. In comparison, two newer drugs proposed to have SNRI properties, duloxetine and venlafaxine, may have insufficient NRI potency to be effective SNRIs. Combinations such as sertraline and nortriptyline may therefore offer advantages over drugs like venlafaxine that have fixed ratios of SRI/NRI effects that are not ideal. However, no TCA/SSRI combination is sufficiently safe to be universally applicable without expert knowledge. Standard texts (e.g. the British National Formulary) and treatment guidelines would benefit by taking account of these new data and understandings.
Collapse
Affiliation(s)
- P K Gillman
- PsychoTropical Research, Bucasia, Queensland, Australia.
| |
Collapse
|
31
|
Parker G. Through a glass darkly: the disutility of the DSM nosology of depressive disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2006; 51:879-86. [PMID: 17249630 DOI: 10.1177/070674370605101403] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To demonstrate that the dimension-weighted DSM-IV model for classifying the depressive disorders lacks utility. METHOD The logical flaws in classifying the depressive disorders with any severity-based model (which underpin both the DSM-IV and ICD-10 systems) are noted. Integral definitional limitations to the DSM-IV definition of key depressive disorders are identified. It is argued that the DSM-IV classificatory system lacks utility for providing information on etiology and preferential management strategies. An alternative subtyping model is considered. RESULTS It is asserted that, in practice, the DSM-IV model and criteria lack explanatory power and compromise research and clinical practice. CONCLUSIONS It is hoped that this article evokes wider debate about modelling and classifying the depressive disorders.
Collapse
Affiliation(s)
- Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, Australia.
| |
Collapse
|
32
|
Abstract
BACKGROUND Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation. It has been compared with chronic pain, and may be associated with depression or depressive symptoms which can affect quality of life and the ability to work. Antidepressant drugs have been used to treat tinnitus in patients with and without depressive symptoms. OBJECTIVES To assess the effectiveness of antidepressants in the treatment of tinnitus and to ascertain whether any benefit was due to a direct tinnitus effect or a secondary effect due to treatment of concomitant depressive states. SEARCH STRATEGY We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) The Cochrane Library Issue 1, 2006); MEDLINE (January 1951 to 2006); EMBASE (1974 to 2006), CINAHL (to 2006), PSYCINFO (to 2006), LILACS (to 2006), and Cambridge Scientific Abstracts. The date of the most recent search was March 2006. SELECTION CRITERIA Randomised controlled clinical studies of antidepressant drugs versus placebo in patients with tinnitus. DATA COLLECTION AND ANALYSIS The studies retrieved were critically appraised and data extracted independently by two authors. Where necessary study authors were contacted for further information. MAIN RESULTS Five trials involving 525 patients were included. Four of these trials looked at the effect of tricyclic antidepressants on tinnitus, investigating 405 patients. One trial investigated the effect of a selective serotonin reuptake inhibitor (SSRI) in a group of 120 patients. No trials involving other antidepressant agents met the inclusion criteria. Only the trial using the SSRI drug met the highest quality standard. None of the other included trials met the highest quality standard, due to use of inadequate outcome measures, large drop out rates or failure to separate the effects on tinnitus from the effects on symptoms of anxiety and depression. All the trials assessing tricyclic antidepressants suggested that there was a slight improvement in tinnitus but these effects may have been attributable to methodological bias. The trial that investigated the SSRI drug found no overall improvement in any of the validated outcome measures that were used in the study although there was possible benefit for a subgroup that received higher doses of the drug. This observation merits further investigation. Reports of side effects including sedation, sexual dysfunction and dry mouth were common. AUTHORS' CONCLUSIONS There is insufficient evidence to say that antidepressant drug therapy improves tinnitus.
Collapse
Affiliation(s)
- P Baldo
- Centro di Riferimento Oncologico--CRO Aviano (PN) Italy, Hospital Pharmacy, Via Pedemontana Occidentale, 12, Aviano (PN), Friuli-Venezia-Giulia, Italy.
| | | | | | | | | |
Collapse
|
33
|
Overholser JC. Panacea or Placebo: The Historical Quest for Medications to Treat Depression. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2006. [DOI: 10.1007/s10879-006-9023-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
34
|
Posternak MA, Solomon DA, Leon AC, Mueller TI, Shea MT, Endicott J, Keller MB. The naturalistic course of unipolar major depression in the absence of somatic therapy. J Nerv Ment Dis 2006; 194:324-9. [PMID: 16699380 DOI: 10.1097/01.nmd.0000217820.33841.53] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The goal of the study was to describe the naturalistic course of unipolar major depression in subjects not receiving somatic therapy for their depressive illness. Affectively ill individuals were recruited into the Collaborative Depression Study and followed prospectively for up to 15 years. One hundred thirty subjects who recovered from their intake episode of major depression subsequently experienced a recurrence that went untreated for at least 4 weeks following onset of the recurrence. The duration of the recurrent episode was examined using survival analytic techniques. Of the 130 subjects, 46 obtained somatic therapy at some time during the course of their depressive illness, while 84 subjects received no somatic therapy throughout their entire depressive episode. Survival analysis, which accounts for these 46 individuals by censoring their episodes at the time treatment was obtained, yielded a median time to recovery of 23 weeks. In the subsample of 84 subjects whose depressive illness went untreated from its inception through its resolution, the median time to recovery was 13 weeks. These results suggest that there is a high rate of recovery in individuals not receiving somatic treatment of their depressive illness, particularly in the first 3 months of an episode. Because treatment-seeking behavior is known to be associated with a worse prognosis, 23 weeks probably represents a lower-limit approximation of the median duration of an untreated depressive episode.
Collapse
Affiliation(s)
- Michael A Posternak
- Brown University School of Medicine, Department of Psychiatry and Human Behavior, Providence, Rhode Island, USA
| | | | | | | | | | | | | |
Collapse
|
35
|
Hill MN, Gorzalka BB. Is there a role for the endocannabinoid system in the etiology and treatment of melancholic depression? Behav Pharmacol 2006; 16:333-52. [PMID: 16148438 DOI: 10.1097/00008877-200509000-00006] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
With advances in basic and clinical neuroscience, many gaps have appeared in the traditional monoamine theory of depression that have led to reformulation of the hypotheses concerning the neurobiology of depression. The more recent hypotheses suggest that melancholic depression is characterized by central glucocorticoid resistance that results in hypercortisolemia, which in turn leads to down-regulation of neurotrophins and subsequent neurodegeneration. Examining the neurobiology of depression from this perspective suggests that the endocannabinoid system may play a role in the etiology of melancholic depression. Specifically, pharmacological and genetic blockade of the cannabinoid CB1 receptor induces a phenotypic state that is analogous to melancholic depression, including symptoms such as reduced food intake, heightened anxiety, increased arousal and wakefulness, deficits in extinction of aversive memories and supersensitivity to stress. These similarities between melancholic depression and an endocannabinoid deficiency become more interesting in light of recent findings that endocannabinoid activity is down-regulated by chronic stress and possibly increased by some antidepressant regimens. We propose that an endocannabinoid deficiency may underlie some of the symptoms of melancholic depression, and that enhancement of this system may ultimately be a novel form of pharmacotherapy for treatment-resistant depression.
Collapse
Affiliation(s)
- M N Hill
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | | |
Collapse
|
36
|
Taylor S, Stein MB. The future of selective serotonin reuptake inhibitors (SSRIs) in psychiatric treatment. Med Hypotheses 2006; 66:14-21. [PMID: 16213665 DOI: 10.1016/j.mehy.2005.08.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Accepted: 08/25/2005] [Indexed: 11/30/2022]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed and widely regarded as a first-line treatment for depression. Yet, a growing body of evidence indicates that these agents are only moderately more effective than placebo in treating major depressive disorder. In recent years, it has been debated whether SSRIs offer any clinically meaningful advantage over placebos. As part of this debate, it has been argued that these agents are first-line treatments for some forms of depression but not necessarily for others. The present paper examines two hypotheses that are central to these issues. The first hypothesis is that SSRIs are more effective than placebo for some types of depression but not for others. The second is that SSRIs are more effective than psychotherapies for some types of depression than others. A review of the empirical literature reveals three main classifications of depression that are relevant to the first hypothesis: (a) more vs. less severe depression, (b) melancholic vs. non-melancholic depression, and (c) depression defined according to associated genetic factors (particularly the long vs. short allele of the serotonin transporter gene promoter). There is no strong or consistent support for (a) or (b). There is, however, emerging and consistent evidence for (c), and so the first hypothesis is tentatively supported, but only for (c). Most of the empirical evidence does not support the second hypothesis. Psychotherapies (cognitive-behavioral and interpersonal therapies) and SSRIs generally have equivalent efficacy, regardless of the severity of depression. The research literature also suggests a third hypothesis that remains to be evaluated: that SSRIs are more effective for treating anxiety disorders (and possibly other disorders) than they are for treating depression. If that hypothesis is supported by subsequent research, then the future of SSRIs may lie largely in the treatment of anxiety disorders, and in the management of particular subtypes of depression.
Collapse
Affiliation(s)
- Steven Taylor
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada, V6T 2A1.
| | | |
Collapse
|
37
|
Abstract
Efficacy studies suggest that all kinds of treatment have similar efficacy. For instance, according to a meta-analysis from 102 randomised controlled trials in major depression, there is no overall difference in efficacy between SSRIs and TCAs. Taking into consideration the pathophysiological heterogeneity of affective disorders involving a number of neurotransmitters, the different pharmacodynamic profiles of the antidepressant compounds, and the large variety of presentations of depressive illness, it is very simplistic to suppose that all classes of antidepressants are equally effective. Meanwhile, the development of antidepressants with different mechanisms of action provides the opportunity to evaluate whether certain relevant subtypes of depressed patients, based on specific patterns of symptoms, respond preferentially to one class of antidepressants compared with another. The aim of this paper is to review the relationship between the depressive subtypes included in the DSM-IV (melancholic depression, atypical depression, bipolar depression, psychotic bipolar and dysthymia) and the efficacy of antidepressant treatment.
Collapse
|
38
|
Buckley MJ, Surowy C, Meyer M, Curzon P. Mechanism of action of A-85380 in an animal model of depression. Prog Neuropsychopharmacol Biol Psychiatry 2004; 28:723-30. [PMID: 15276699 DOI: 10.1016/j.pnpbp.2004.05.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2004] [Indexed: 02/03/2023]
Abstract
A role for neuronal nicotinic receptor (NNR) activation in animal models of depression has been established. In order to determine the mechanism by which NNR ligands exert their antidepressant effects, experiments using different NNR receptor antagonists in both the mouse and the rat forced swim test (RFST) were performed. In the mouse forced swim test (MFST), A-85380 (0.62 micromol/kg = 0.14 mg/kg, i.p.), an NNR agonist, increased swim distance when administered 15 min prior to test. This effect was blocked by pre-treatment with mecamylamine (1.5 micromol/kg = 0.3 mg/kg, i.p.), suggesting that an NNR mechanism is involved. Further, chlorisondamine at a non-central nervous system (CNS) penetrating dose (1.6 micromol/kg = 1 mg/kg, i.p.) did not antagonize A-85380 in this model, thus implicating central rather than peripheral nicotinic receptors. Dihydro-beta-erythroidine (DHbetaE, 0.3 micromol/kg = 0.1 mg/kg, i.p.) pre-treatment also blocked this effect, indicating that the alpha4beta2 receptor subtype may be involved in A-85380-induced antidepressant effects. Finally, methiothepin (0.33 micromol/kg = 0.14 mg/kg, i.p.) pre-treatment antagonized this effect, suggesting serotonergic involvement. In the rat modified forced swim test, sub-acute administration of A-85380 (0.62 micromol/kg, i.p.) increased swimming behavior and decreased immobility. Climbing behavior was unaffected. In contrast, desipramine treatment (33 micromol/kg = 10 mg/kg, i.p.) resulted in an increase in climbing behavior with no effect on swimming. This behavioral profile has been shown to be more typical of serotonergic rather than noradrenergic antidepressants, suggesting that A-85380 exerts its effects via NNR activation of serotonergic systems.
Collapse
Affiliation(s)
- Michael J Buckley
- Neuroscience Research, Global Pharmaceutical Research and Development, Abbott Laboratories, R4N5, Building AP9A, Abbott Park, IL 60064, USA.
| | | | | | | |
Collapse
|
39
|
Sartori SB, Burnet PWJ, Sharp T, Singewald N. Evaluation of the effect of chronic antidepressant treatment on neurokinin-1 receptor expression in the rat brain. Neuropharmacology 2004; 46:1177-1183. [PMID: 15111024 DOI: 10.1016/j.neuropharm.2004.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2003] [Revised: 01/23/2004] [Accepted: 02/11/2004] [Indexed: 12/27/2022]
Abstract
Clinically effective antidepressants are thought to exert their therapeutic effects by facilitating central monoamine neurotransmission. However, recent data showing that neurokinin-1 receptor (NK1R) antagonists have antidepressant properties in both animal and clinical studies raise the possibility that classical antidepressants may also influence NK1R expression in the brain. To test this hypothesis, rats were treated with desipramine, paroxetine, venlafaxine, tranylcypromine or vehicle for 14-42 days. NK1R binding sites and mRNA were determined in a wide variety of brain areas using in situ hybridization and quantitative receptor autoradiography. In all areas examined, the abundance of NK1R binding sites was unchanged after 14 days of treatment. None of the treatments altered the number of NK1R binding sites following 42 days treatment with the exception that an increase was found in the locus coeruleus with tranylcypromine. Taken together, we report that repeated treatment with antidepressants of different classes does not cause significant changes in NK1R expression.
Collapse
Affiliation(s)
- S B Sartori
- Department of Pharmacology and Toxicology, Institute of Pharmacy, University of Innsbruck, Peter-Mayr-Strasse 1, A-6020 Innsbruck, Austria
| | | | | | | |
Collapse
|
40
|
Abstract
AIM Less than half of those suffering major depressive episodes achieve remission with the first antidepressant provided and one-third of all patients suffering depression have a chronic condition. Clinical experience indicates that a substantial proportion of patients suffer treatment-resistant depression (TRD). Our aim is to explore the literature reporting the drug treatment of TRD, and to present such information as would be of interest to clinical psychiatrists. METHOD Literature searches were conducted using PubMed and entering the words antidepressant, augmentation, combined antidepressants, treatment resistant depression and the names of individual antidepressant medications. RESULTS Most authors recommended that TRD should be first approached by reassessing the diagnosis, adding psychotherapy and attending to psychosocial factors. Details of the following pharmacological options were identified: (i) augmentation of the currently employed antidepressant with a medication which is not an antidepressant; (ii) change of antidepressant; and (iii) addition of a second antidepressant to the current antidepressant, or commencement of a combination of two antidepressants. CONCLUSIONS When monotherapy provided at the maximum manufacturer-recommended doses for 3-4 weeks has failed to provide remission in depression, the diagnosis should be confirmed, psychotherapy added and psychosocial factors should receive attention. In the sustained absence of remission, a better outcome may be obtained by augmenting the antidepressant, changing from a single-action to a double- or multiple-action drug, or by combining antidepressants.
Collapse
|
41
|
Abstract
Three cases are presented in which electroconvulsive therapy (ECT) for depression led to the relief of comorbid complex regional pain syndrome as well as depression. In one of the cases, concomitant fibromyalgia was not relieved during 2 separate series of ECT. The literature regarding the role of ECT in the management of chronic pain is reviewed and discussed in light of recent findings about ECT and changes in neurotransmission associated with seizures.
Collapse
Affiliation(s)
- William W McDaniel
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
| |
Collapse
|
42
|
Abstract
BACKGROUND venlafaxine has been available for use as an antidepressant in the United States for a decade. OBJECTIVE Comprehensive reviews of venlafaxine have been published elsewhere; thus, this update focuses on newer issues of treatment remission in depression, treatment-resistant depression, and extended-release venlafaxine for generalized anxiety disorder (GAD). METHODS Relevant clinical literature from 1993 through 2003 was identified from database searches of MEDLINE and International Pharmaceutical Abstracts, and from manual searches of reference lists of the identified papers. Search terms included venlafaxine extended-release, venlafaxine XR, treatment-resistant depression, depressive disorders, anxiety disorders, generalized anxiety disorder, and antidepressive agents second generation. RESULTS With its dual action of serotonin and noradrenergic reuptake inhibition, venlafaxine has been shown to be superior in efficacy to selective serotonin reuptake inhibitors for severe major depressive disorder, treatment-resistant depression, and depressive symptom remission. Its demonstrated efficacy for both short- and long-term treatment of GAD has led to its use for obsessive-compulsive disorder and chronic pain syndromes, although inadequate clinical literature currently exists to support these latter 2 uses. In the past decade, no new or unexpected adverse events have been identified with venlafaxine therapy, except a possibly greater risk of fatal overdose compared with other serotonergic drugs, suggesting the need for caution in patients with suicidal ideation. Because venlafaxine is a potent serotonin agonist, caution must also be exercised to prevent the possibility of serotonin syndrome when used with other serotonin agonists, and its dose should be tapered very gradually to minimize the risk of a serotonin withdrawal reaction. CONCLUSION Venlafaxine has emerged as a successful post-SSRI-era antidepressant with an expanded range of uses since it was first marketed.
Collapse
Affiliation(s)
- Mary A Gutierrez
- School of Pharmacy, University of Southern California, Los Angeles 90089-9121, USA.
| | | | | |
Collapse
|
43
|
Abstract
Conflicting or sparse data on predictors of treatment response in depression have resulted in lack of clear guidelines in choosing antidepressant treatment. Critical to treatment outcome are accurate diagnosis and adequate treatment. Other data easy to obtain, such as age, gender, and marital status, have failed to be consistent predictors; more elaborate studies, such as receptor analysis or neuroimaging, are not yet accessible to most clinicians or economically feasible; however, they offer hope for the future, when more biologically based diagnostic distinctions may come to guide treatment choices.
Collapse
Affiliation(s)
- Karin Esposito
- Outpatient Specialty Programs, Department of Psychiatry and Behavioral Science, University of Miami School of Medicine, Suite 304A, 1400 North West 10th Avenue, Miami, FL 33136, USA
| | | |
Collapse
|
44
|
Abstract
Exposure to hostile conditions initiates responses organized to enhance the probability of survival. These coordinated responses, known as stress responses, are composed of alterations in behavior, autonomic function and the secretion of multiple hormones. The activation of the renin-angiotensin system and the hypothalamic-pituitary-adrenocortical axis plays a pivotal role in the stress response. Neuroendocrine components activated by stressors include the increased secretion of epinephrine and norepinephrine from the sympathetic nervous system and adrenal medulla, the release of corticotropin-releasing factor (CRF) and vasopressin from parvicellular neurons into the portal circulation, and seconds later, the secretion of pituitary adrenocorticotropin (ACTH), leading to secretion of glucocorticoids by the adrenal gland. Corticotropin-releasing factor coordinates the endocrine, autonomic, behavioral and immune responses to stress and also acts as a neurotransmitter or neuromodulator in the amygdala, dorsal raphe nucleus, hippocampus and locus coeruleus, to integrate brain multi-system responses to stress. This review discussed the role of classical mediators of the stress response, such as corticotropin-releasing factor, vasopressin, serotonin (5-hydroxytryptamine or 5-HT) and catecholamines. Also discussed are the roles of other neuropeptides/neuromodulators involved in the stress response that have previously received little attention, such as substance P, vasoactive intestinal polypeptide, neuropeptide Y and cholecystokinin. Anxiolytic drugs of the benzodiazepine class and other drugs that affect catecholamine, GABA(A), histamine and serotonin receptors have been used to attenuate the neuroendocrine response to stressors. The neuroendocrine information for these drugs is still incomplete; however, they are a new class of potential antidepressant and anxiolytic drugs that offer new therapeutic approaches to treating anxiety disorders. The studies described in this review suggest that multiple brain mechanisms are responsible for the regulation of each hormone and that not all hormones are regulated by the same neural circuits. In particular, the renin-angiotensin system seems to be regulated by different brain mechanisms than the hypothalamic-pituitary-adrenal system. This could be an important survival mechanism to ensure that dysfunction of one neurotransmitter system will not endanger the appropriate secretion of hormones during exposure to adverse conditions. The measurement of several hormones to examine the mechanisms underlying the stress response and the effects of drugs and lesions on these responses can provide insight into the nature and location of brain circuits and neurotransmitter receptors involved in anxiety and stress.
Collapse
Affiliation(s)
- Gonzalo A Carrasco
- Department of Pharmacology, Center for Serotonin Disorders Research, Loyola University of Chicago, Stritch School of Medicine, 2160 South First Avenue, Maywood, IL 60153, USA
| | | |
Collapse
|
45
|
Abstract
This review of recently published pharmaceutical industry-sponsored comparative psychotropic drug trials aims to classify apparent design and reporting modifications that favor the sponsor's product. The modifications have been grouped into 13 discrete categories, and representative examples of each are presented. Strong circumstantial evidence suggests that marketing goals led to these adjustments. The consequences of marketing influences on comparative psychopharmacology trials are discussed in terms of conflicts of interest, the integrity of the scientific literature, and costs to consumers, as well as their impact on physician practice.
Collapse
Affiliation(s)
- Daniel J Safer
- Departments of Psychiatry and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, 7702 Dunmanway, Dundalk, MD 21222, USA
| |
Collapse
|
46
|
|