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Kaiya H. Anxious-depressive attack and rejection sensitivity-Toward a new approach to treatment-resistant depression. Neuropsychopharmacol Rep 2024; 44:17-28. [PMID: 38059339 PMCID: PMC10932773 DOI: 10.1002/npr2.12399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 10/03/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023] Open
Abstract
This paper aimed to find clues to treatment-resistant depression (TRD) solutions. Depression comorbid with anxiety is often treatment-resistant where anxious-depressive attack (ADA) often lurks. ADA is a recently proposed clinical idea for just a psychological version of a panic attack. It mostly begins with an abrupt surge of intense anxiety followed by uninterrupted intrusive thoughts; lasting ruminations about regret or worry produced by violent anxiety, agitation, and loneliness. Acting-out behaviors such as deliberate self-injury and over-dose may also be observed during the attack. As the basic psychopathology of ADA, rejection sensitivity (RS) was revealed by a structural equation model. It is said that the presence of RS in depressive disorders implies a poor prognosis. The following biological markers for RS were reviewed in the literature: first, the involvement of the μ-opioid receptor function in RS and, secondly, hypersensitivity of the dopamine D4 receptor (DRD4) in the medial prefrontal cortex. The latter has been suggested in fear-conditioned animal experiments. Manipulation of the μ-opioid receptor function together with the DRD4 function may culminate in a treatment for RS, which could contribute to the development of a treatment for TRD via the improvement of ADA.
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Affiliation(s)
- Hisanobu Kaiya
- Panic Disorder Research CenterWarakukai Medical CorporationTokyoJapan
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2
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The Effects of Drying Techniques on Phytochemical Contents and Biological Activities on Selected Bamboo Leaves. Molecules 2022; 27:molecules27196458. [PMID: 36234995 PMCID: PMC9571890 DOI: 10.3390/molecules27196458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/20/2022] [Accepted: 09/24/2022] [Indexed: 11/07/2022] Open
Abstract
The therapeutic potential of bamboos has acquired global attention. Nonetheless, the biological activities of the plants are rarely considered due to limited available references in Sabah, Malaysia. Furthermore, the drying technique could significantly affect the retention and degradation of nutrients in bamboos. Consequently, the current study investigated five drying methods, namely, sun, shade, microwave, oven, and freeze-drying, of the leaves of six bamboo species, Bambusa multiplex, Bambusa tuldoides, Bambusa vulgaris, Dinochloa sublaevigata, Gigantochloa levis, and Schizostachyum brachycladum. The infused bamboo leaves extracts were analysed for their total phenolic content (TPC) and total flavonoid content (TFC). The antioxidant activities of the samples were determined via the 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), and ferric reducing antioxidant power (FRAP) assays, whereas their toxicities were evaluated through the brine shrimp lethality assay (BSLA). The chemical constituents of the samples were determined using liquid chromatography−tandem mass spectrometry (LC-MS/MS). The freeze-drying method exhibited the highest phytochemical contents and antioxidant activity yield, excluding the B. vulgaris sample, in which the microwave-dried sample recorded the most antioxidant and phytochemical levels. The TPC and TFC results were within the 2.69 ± 0.01−12.59 ± 0.09 mg gallic acid equivalent (GAE)/g and 0.77 ± 0.01−2.12 ± 0.01 mg quercetin equivalent (QE)/g ranges, respectively. The DPPH and ABTS IC50 (half-maximal inhibitory concentration) were 2.92 ± 0.01−4.73 ± 0.02 and 1.89−0.01 to 3.47 ± 0.00 µg/mL, respectively, indicating high radical scavenging activities. The FRAP values differed significantly between the drying methods, within the 6.40 ± 0.12−36.65 ± 0.09 mg Trolox equivalent (TE)/g range. The phytochemical contents and antioxidant capacities exhibited a moderate correlation, revealing that the TPC and TFC were slightly responsible for the antioxidant activities. The toxicity assessment of the bamboo extracts in the current study demonstrated no toxicity against the BSLA based on the LC50 (lethal concentration 50) analysis at >1000 µg/mL. LC-MS analysis showed that alkaloid and pharmaceutical compounds influence antioxidant activities, as found in previous studies. The acquired information might aid in the development of bamboo leaves as functional food items, such as bamboo tea. They could also be investigated for their medicinal ingredients that can be used in the discovery of potential drugs.
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Hashemi SMH, Enayatifard R, Akbari J, Saeedi M, Seyedabadi M, Morteza-Semnani K, Babaei A, Asare-Addo K, Nokhodchi A. Venlafaxine HCl Encapsulated in Niosome: Green and Eco-friendly Formulation for the Management of Pain. AAPS PharmSciTech 2022; 23:149. [PMID: 35595933 DOI: 10.1208/s12249-022-02299-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/03/2022] [Indexed: 01/16/2023] Open
Abstract
The goal of this experimentation was to increase the cutaneous absorption of venlafaxine HCl (VFX) encapsulated in a niosome (venlasosme) produced by an ultrasonic approach. The impact of the cholesterol:surfactant (Chol:Surf) proportion was examined to modify the venlasosme properties. Photon correlation spectroscopy, powder X-ray diffraction (PXRD), SEM, DSC, and ATR-FTIR spectroscopy were utilized to investigate the solid-state and morphology of VFX in the venlasosme. The studies revealed that increasing the level of Chol in the venlasosme increased the size of the particles. Alterations in the Chol to surfactant ratios (when Chol decreased from 2.5 to 0%) caused the zeta potential enhancement from 7.37 ± 0.67 to 15.53 ± 1.47 mV. The venlasosme with the highest cholesterol concentration (2.5%) had the highest encapsulation efficiency (approximately 63%). PXRD results revealed that VFX in venlasosme was in the amorphous form. The levels of VFX in the cutaneous layers and the receiver compartment were higher for the venlasosme gel than for VFX simple gel in the cutaneous permeability study and showed no cutaneous irritancy in rats. Furthermore, the venlasosme gel demonstrated significant antinociceptive and anti-inflammatory responses when compared to the control groups (VFX simple gel and diclofenac gel). The topical administration of the venlasosme gel also considerably increased the tail-flick and hot-plate response time when compared to the VFX simple gel, control groups, and diclofenac gel (p < 0.05). These findings suggest that niosomes can improve VFX efficacy as an antinociceptive and anti-inflammatory substance by improving the medicaments delivery to the specified site.
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Affiliation(s)
| | - Reza Enayatifard
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Jafar Akbari
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Majid Saeedi
- Pharmaceutical Sciences Research Center, Haemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Seyedabadi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Katayoun Morteza-Semnani
- Department of Medicinal Chemistry, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amirhossein Babaei
- Student Research Committee, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Kofi Asare-Addo
- Department of Pharmacy, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - Ali Nokhodchi
- Pharmaceutics Research Laboratory, School of Life Sciences, University of Sussex, Brighton, BN1 9QJ, UK.
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Sahebi Vaighan N, Parhiz S, Sabetkasaei M, Moini Zanjani T, Zarei M. Paroxetine effects on morphine analgesic tolerance in rats. Scand J Pain 2022; 22:186-192. [PMID: 34298592 DOI: 10.1515/sjpain-2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To alleviate different pain intensities, morphine administration has been extensively used. However, prolonged administration of morphine leads to a progressive decline of its analgesic effect which limits their overall utility. Morphine tolerance is considered as a challenging issue for the treatment of both acute and chronic pain. We conducted this study in rats to investigate the effect of paroxetine on morphine tolerance when used preemptively or after morphine tolerance had developed. METHODS Male Wistar rats (weight 250-300 g, n=10) were used to evaluate the effects of paroxetine on tolerance to morphine. In order to induce tolerance, daily intraperitoneal injection of morphine (7 mg/kg) was done. After tolerance induction, a group of animals received intraperitoneal injection of 10 mg/kg paroxetine 30 min prior to each morphine dose. In another trial, to investigate the potential of paroxetine to prevent tolerance to morphine, animals were pretreated with 10 mg/kg paroxetine 30 min before morphine administration. In the control groups, 10 mL/kg of saline was injected. The behavioral test (tail-flick test) was done for all groups. RESULTS Our data showed that paroxetine significantly reversed tolerance to morphine when used after tolerance induction (p<0.001). However, administration of paroxetine before occurrence of tolerance had no effect. CONCLUSIONS We conclude that paroxetine could decrease tolerance to morphine when used after the occurrence of morphine tolerance, while it was not able to prevent morphine tolerance when administered preemptively. ETHICAL COMMITTEE NUMBER IRIB.SBMU.MSP.REC.1394.098.
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Affiliation(s)
- Navideh Sahebi Vaighan
- Department of Pharmacology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soha Parhiz
- Department of Pharmacology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Sabetkasaei
- Department of Pharmacology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Taraneh Moini Zanjani
- Department of Pharmacology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Malek Zarei
- Department of Pharmacology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Differences in the antinociceptive effects of serotonin-noradrenaline reuptake inhibitors via sodium channel blockade using the veratrine test in mice. Neuroreport 2021; 32:797-802. [PMID: 33994525 DOI: 10.1097/wnr.0000000000001658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Antidepressants exert their analgesic effects by inhibiting the reuptake of noradrenaline. Several antidepressants have been shown to block the sodium channels, which might contribute to their analgesic potency. The aim of this study was to determine whether serotonin-noradrenaline reuptake inhibitors (SNRIs) could produce antinociceptive effects via sodium channel blockade using the veratrine test in mice. Furthermore, the effects of these agents on the veratrine test were examined to elucidate the effects of several antidepressants and tramadol on sodium channels. The administration of duloxetine (10 mg/kg) and venlafaxine (30 mg/kg) suppressed cuff-induced mechanical allodynia; however, these antinociceptive effects were only partially suppressed by atipamezole. Furthermore, duloxetine and venlafaxine demonstrated antinociceptive effects via sodium channel blockade, as assayed by the veratrine test. In addition, several antidepressants, including amitriptyline, paroxetine and mirtazapine, reduced veratrine-induced nociception. In contrast, milnacipran and tramadol did not alter the veratrine-induced nociception. These results indicated that, in addition to the primary action of SNRIs on monoamine transporters, sodium channel blockade might be involved in the antinociceptive activities of duloxetine and venlafaxine, but not milnacipran.
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Malejko K, Huss A, Schönfeldt-Lecuona C, Braun M, Graf H. Emotional Components of Pain Perception in Borderline Personality Disorder and Major Depression-A Repetitive Peripheral Magnetic Stimulation (rPMS) Study. Brain Sci 2020; 10:brainsci10120905. [PMID: 33255481 PMCID: PMC7761125 DOI: 10.3390/brainsci10120905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022] Open
Abstract
Various studies suggested alterations in pain perception in psychiatric disorders, such as borderline personality disorder (BPD) and major depression (MD). We previously investigated affective components of pain perception in BPD compared to healthy controls (HC) by increasing aversive stimulus intensities using repetitive peripheral magnetic stimulation (rPMS) and observed alterations in emotional rather than somatosensory components in BPD. However, conclusions on disorder specific alterations in these components of pain perception are often limited due to comorbid depression and medication in BPD. Here, we compared 10 patients with BPD and comorbid MD, 12 patients with MD without BPD, and 12 HC. We applied unpleasant somatosensory stimuli with increasing intensities by rPMS and assessed pain threshold (PT), cutaneous sensation, emotional valence, and arousal by a Self-Assessments Manikins scale. PTs in BPD were significantly higher compared to HC. The somatosensory discrimination of stimulus intensities did not differ between groups. Though elevated rPMS intensities led to increased subjective aversion and arousal in MD and HC, these emotional responses among intensity levels remained unchanged in BPD. Our data give further evidence for disorder-specific alterations in emotional components of pain perception in BPD with an absent emotional modulation among varying aversive intensity levels.
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Affiliation(s)
- Kathrin Malejko
- Department of Psychiatry and Psychotherapy III, University of Ulm, 89075 Ulm, Germany; (C.S.-L.); (M.B.); (H.G.)
- Correspondence: ; Tel.: +49-0731-5006-1401; Fax: +49-0731-5006-1402
| | - André Huss
- Department of Neurology, University of Ulm, 89081 Ulm, Germany;
| | - Carlos Schönfeldt-Lecuona
- Department of Psychiatry and Psychotherapy III, University of Ulm, 89075 Ulm, Germany; (C.S.-L.); (M.B.); (H.G.)
| | - Maren Braun
- Department of Psychiatry and Psychotherapy III, University of Ulm, 89075 Ulm, Germany; (C.S.-L.); (M.B.); (H.G.)
| | - Heiko Graf
- Department of Psychiatry and Psychotherapy III, University of Ulm, 89075 Ulm, Germany; (C.S.-L.); (M.B.); (H.G.)
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Fluoxetine and Paroxetine: Repositioning as a Therapeutic Alternative in the Treatment of Various Diseases. Am J Ther 2020; 27:e547-e551. [PMID: 32902939 DOI: 10.1097/mjt.0000000000001011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Belinskaia DA, Belinskaia MA, Barygin OI, Vanchakova NP, Shestakova NN. Psychotropic Drugs for the Management of Chronic Pain and Itch. Pharmaceuticals (Basel) 2019; 12:ph12020099. [PMID: 31238561 PMCID: PMC6631469 DOI: 10.3390/ph12020099] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 12/11/2022] Open
Abstract
Clinical observations have shown that patients with chronic neuropathic pain or itch exhibit symptoms of increased anxiety, depression and cognitive impairment. Such patients need corrective therapy with antidepressants, antipsychotics or anticonvulsants. It is known that some psychotropic drugs are also effective for the treatment of neuropathic pain and pruritus syndromes due to interaction with the secondary molecular targets. Our own clinical studies have identified antipruritic and/or analgesic efficacy of the following compounds: tianeptine (atypical tricyclic antidepressant), citalopram (selective serotonin reuptake inhibitor), mianserin (tetracyclic antidepressant), carbamazepine (anticonvulsant), trazodone (serotonin antagonist and reuptake inhibitor), and chlorprothixene (antipsychotic). Venlafaxine (serotonin-norepinephrine reuptake inhibitor) is known to have an analgesic effect too. The mechanism of such effect of these drugs is not fully understood. Herein we review and correlate the literature data on analgesic/antipruritic activity with pharmacological profile of these compounds.
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Affiliation(s)
- Daria A Belinskaia
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, pr. Torez 44, St. Petersburg 194223, Russia.
| | - Mariia A Belinskaia
- International Centre for Neurotherapeutics, Dublin City University, Glasnevin, Dublin 9, Ireland.
| | - Oleg I Barygin
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, pr. Torez 44, St. Petersburg 194223, Russia.
| | - Nina P Vanchakova
- Department of Pedagogy and Psychology, Faculty of Postgraduate Education, First Pavlov State Medical University, L'va Tolstogo str. 6-8, St. Petersburg 197022, Russia.
| | - Natalia N Shestakova
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, pr. Torez 44, St. Petersburg 194223, Russia.
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Bektur E, Şahin E, Ceyhan E, Donmez DB, Canbek M, Baycu C, Can OD. Beneficial effect of mirtazapine on diabetes-induced hyperalgesia: involvement of TRPV1 and ASIC1 channels in the spinal cord and dorsal root ganglion. Neurol Res 2019; 41:544-553. [PMID: 30822229 DOI: 10.1080/01616412.2019.1580462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Ezgi Bektur
- Histology and Embryology Department, School of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Erhan Şahin
- Histology and Embryology Department, School of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Emre Ceyhan
- Molecular biology department, School of science, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Dilek Burukoglu Donmez
- Histology and Embryology Department, School of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Mediha Canbek
- Molecular biology department, School of science, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Cengiz Baycu
- Histology and Embryology Department, School of Medicine, Okan University, Istanbul, Turkey
| | - Ozgur Devrim Can
- Pharmacology Department, School of pharmacy, Anadolu University, Eskisehir, Turkey
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Alboghobeish S, Naghizadeh B, Kheirollah A, Ghorbanzadeh B, Mansouri MT. Fluoxetine increases analgesic effects of morphine, prevents development of morphine tolerance and dependence through the modulation of L-type calcium channels expression in mice. Behav Brain Res 2018; 361:86-94. [PMID: 30550947 DOI: 10.1016/j.bbr.2018.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 12/14/2022]
Abstract
Here, we aimed to investigate the effects of fluoxetine on morphine-induced analgesia, as well as preventive effects of it on morphine induced tolerance and dependence in mice. We also elucidate the involvement of L-type Ca2+ channels in these phenomena. To induce morphine tolerance, mice were treated with morphine (50 mg/kg) for 3 consecutive days. To evaluate the involvement of the calcium channel in the effects of fluoxetine (5, 20 mg/kg), combination ineffective doses of the two L-type calcium channel blockers, nimodipine (5 mg/kg) or diltiazem (20 mg/kg) with flouxetine were used with each morphine dose. Nociceptive behavior was evaluated using hot-plate test, while physical dependence assessed by naloxone-precipitated withdrawal on the fourth day of experiment. The expression of Cav1.2 and Cav1.3 subunits of the L-type calcium channels in cortex and mesolimbic tissues were measured using western immunoassay. Results showed that co-administration of fluoxetine (20 mg/kg) with morphine increased its acute analgesia effect and prevented the induction of morphine antinociceptive tolerance and physical dependence in mice. Moreover, these effects was potentiated by pre-treatment with diltiazem or nimodipine. Results also showed up-regulation of the Cav1.3 and Cav1.2 expression in the cerebral cortex and mesolimbic regions through the development of morphine dependence. Moreover, chronic administration of fluoxetine with morphine reduced the observed up-regulation of Cav1.3 and Cav1.2 expression in cortex and mesolimbic tissues. Our data indicated that co-administering of fluoxetine with morphine could potentiate the antinociceptive effect of morphine, prevent morphine analgesia tolerance and attenuated the morphine withdrawal signs during induction phases. Moreover, we also pointed out for the first time the role of L-type Ca2+ channel channels in the modulatory effects of fluoxetine on the morphine-related effects.
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Affiliation(s)
- Soheila Alboghobeish
- Department of Pharmacology, School of Pharmacy, Toxicology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Bahareh Naghizadeh
- Department of Pharmacology, School of Pharmacy, Toxicology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Kheirollah
- Department of Biochemistry, Cellular &Molecular Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Behnam Ghorbanzadeh
- Department of Pharmacology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Mohammad Taghi Mansouri
- Department of Pharmacology, School of Pharmacy, Toxicology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Neuroanesthesia Laboratory, Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA.
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Serhatlioglu I, Bilgin B, Kacar E, Ozcan S, Canpolat S, Ayar A, Kelestimur H, Ozcan M. Agomelatine modulates calcium signaling through protein kinase C and phospholipase C-mediated mechanisms in rat sensory neurons. J Cell Physiol 2018; 234:10741-10746. [PMID: 30443943 DOI: 10.1002/jcp.27748] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/22/2018] [Indexed: 01/06/2023]
Abstract
Agomelatine, a novel antidepressant exerting its effects through melatonergic and serotonergic systems, implicated to be effective against pain including neuropathic pain but without any knowledge of mechanism of action. To explore the possible role of agomelatine on nociceptive transmission at the peripheral level, the effects of agomelatine on intracellular calcium ([Ca2+ ]i ) signaling in peripheral neurons were investigated in cultured rat dorsal root ganglion (DRG) neurons. Using the fura-2-based calcium imaging technique, the effects of agomelatine on [Ca2+ ]i and roles of the second messenger-mediated pathways were assessed. Agomelatine caused [Ca2+ ]i signaling in a dose-dependent manner when tested at 10 and 100 μM concentration. Luzindole, a selective melatonin receptor antagonist, almost completely blocked the agomelatine-induced calcium signals. The agomelatine-induced calcium transients were also nearly abolished following pretreatment with the 100 ng/ml pertussis toxin, a Gi/o protein inhibitor. The stimulatory effects of agomelatine on [Ca2+ ]i transients were significantly reduced by applications of phospholipase C (PLC) and protein kinase C (PKC) blockers, 10 μM U73122, and 10 μM chelerythrine chloride, respectively. The obtained results of agomelatine-induced [Ca2+ ]i signals indicates that peripheral mechanisms are involved in analgesic effects of agomelatine. These mechanisms seems to involve G-protein-coupled receptor activation and PLC and PKC mediated mechanisms.
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Affiliation(s)
- Ihsan Serhatlioglu
- Department of Biophysics, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Batuhan Bilgin
- Department of Biophysics, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Emine Kacar
- Department of Physiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Sibel Ozcan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Sinan Canpolat
- Department of Physiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Ahmet Ayar
- Department of Physiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Haluk Kelestimur
- Department of Physiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Mete Ozcan
- Department of Biophysics, Faculty of Medicine, Firat University, Elazig, Turkey
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12
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Malejko K, Neff D, Brown RC, Plener PL, Bonenberger M, Abler B, Grön G, Graf H. Somatosensory Stimulus Intensity Encoding in Borderline Personality Disorder. Front Psychol 2018; 9:1853. [PMID: 30327632 PMCID: PMC6174222 DOI: 10.3389/fpsyg.2018.01853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 09/11/2018] [Indexed: 12/23/2022] Open
Abstract
Borderline Personality Disorder (BPD) is clinically characterized by emotional instability, interpersonal disturbances and dysfunctional behavior such as non-suicidal self-injury (NSSI). During NSSI, patients with BPD typically report analgesic or hypoalgesic phenomena, and pain perception and pain processing in BPD have been repeatedly investigated. Most of the studies so far focused on affective-motivational and cognitive-evaluative neural components of pain within categorial study designs. By contrast, rather basic somatosensory aspects such as neural intensity-encoding of somatosensory stimuli were not examined in further details. Thus, we investigated patients with BPD and healthy controls (HC) by functional magnetic resonance imaging (fMRI) during an unpleasant sensory stimulation task with parametrically increasing stimulus intensities. 15 females diagnosed with BPD and 15 HCs were investigated with fMRI during four individually adjusted levels of electrical stimulus intensities. Ratings of stimulus intensity were assessed by button presses during fMRI. fMRI-data were analyzed by analyses of variances (ANOVA) at a statistical threshold of p < 0.05 FWE-corrected on cluster level. Subjective ratings of stimulus intensities were alike between BPD and HC, and intensity levels identified with equal accuracy. Significant intensity-encoding neural activations were observed within the primary and secondary somtasensory cortex, the posterior insula, the posterior midcingulate cortex (pMCC) and the supplementary motor area (SMA) in both, HC and BPD. Notably, there were no significant between-groups differences in intensity-encoding neural activations, even at lowered significance thresholds. Present results suggest a similar neural somatosensory stimulus intensity encoding in BPD as previously observed on a behavioral level. The alterations in neural affective-motivational or cognitive-evaluative components reported so far may be restricted to pain rather than unpleasant stimulus processing and were absent in our study.
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Affiliation(s)
- Kathrin Malejko
- Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
| | - Dominik Neff
- Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
| | - Rebecca C Brown
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany.,Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Martina Bonenberger
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Birgit Abler
- Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
| | - Georg Grön
- Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
| | - Heiko Graf
- Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
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13
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Hamdy MM, Elbadr MM, Barakat A. Fluoxetine uses in nociceptive pain management: a promising adjuvant to opioid analgesics. Fundam Clin Pharmacol 2018; 32:532-546. [DOI: 10.1111/fcp.12383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/17/2018] [Accepted: 05/04/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Mostafa M. Hamdy
- Department of Medical Pharmacology; Faculty of Medicine; Assiut University; Assiut 71526 Egypt
| | - Mohamed M. Elbadr
- Department of Medical Pharmacology; Faculty of Medicine; Assiut University; Assiut 71526 Egypt
| | - Ahmed Barakat
- Department of Medical Pharmacology; Faculty of Medicine; Assiut University; Assiut 71526 Egypt
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Tavares LRR, Baptista-de-Souza D, Canto-de-Souza A. Activation of 5-HT2C (but not 5-HT1A) receptors in the amygdala enhances fear-induced antinociception: Blockade with local 5-HT2C antagonist or systemic fluoxetine. Neuropharmacology 2018; 135:376-385. [DOI: 10.1016/j.neuropharm.2018.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 12/28/2022]
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Barakat A, Hamdy MM, Elbadr MM. Uses of fluoxetine in nociceptive pain management: A literature overview. Eur J Pharmacol 2018; 829:12-25. [PMID: 29608897 DOI: 10.1016/j.ejphar.2018.03.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 12/16/2022]
Abstract
Fluoxetine is one of the top ten prescribed antidepressants. Other therapeutic applications were approved for fluoxetine including, anxiety disorders, bulimia nervosa, and premature ejaculation. However, the role of fluoxetine in nociceptive pain management is still unclear. In this review, we discuss an overview of five possible roles of fluoxetine in pain management: intrinsic antinociceptive effect, enhancement of acute opioid analgesia, attenuation of tolerance development to opioid analgesia, attenuation of dependence development and abstinence syndrome, and attenuation of opioid induced hyperalgesia. Conflicting data were reported about fluoxetine intrinsic anti-nociceptive effect in preclinical and clinical studies except for inflammatory pain. Similar controversy was described in preclinical and clinical studies which explored the possible enhancement of opioid analgesia by fluoxetine co-administration. However, fluoxetine was found to have a promising effect on opioid tolerance and dependence in animal and human studies. Regarding opioid induced hyperalgesia, no studies examined fluoxetine effects in this regard. Our literature review revealed that, the most likely beneficial use of fluoxetine in nociceptive pain management is for alleviation of inflammatory pain and attenuation of opioid tolerance and dependence. Non-steroidal anti-inflammatory and corticosteroids carry many adverse effects and toxicities. Effective alleviation of opioid tolerance and dependence represents a huge health burden and growing unmet medical need. Moreover, most agents used to attenuate these phenomena are either experimental or poorly tolerable drugs which limit their transitional value. Fluoxetine offers an effective, safe, and tolerable alternative for management of both inflammatory pain and opioid tolerance and dependence presently available to clinicians.
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Affiliation(s)
- Ahmed Barakat
- Department of Medical Pharmacology, Faculty of Medicine, Assiut University, Assiut 71526, Egypt.
| | - Mostafa M Hamdy
- Department of Medical Pharmacology, Faculty of Medicine, Assiut University, Assiut 71526, Egypt
| | - Mohamed M Elbadr
- Department of Medical Pharmacology, Faculty of Medicine, Assiut University, Assiut 71526, Egypt
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Hansen TM, Lelic D, Olesen AE, Drewes AM, Frøkjaer JB. Differential effects of oxycodone and venlafaxine on resting state functional connectivity-A randomized placebo-controlled magnetic resonance imaging study. CNS Neurosci Ther 2018; 24:820-827. [PMID: 29468854 DOI: 10.1111/cns.12827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 01/27/2023] Open
Abstract
AIM Different mechanisms may be involved in the antinociceptive effects of oxycodone (opioid) and venlafaxine (serotonin-norepinephrine reuptake inhibitor), and the aim of this study was to investigate the effect of these drugs on brain functional connectivity. METHODS Resting state functional magnetic resonance imaging was acquired in 20 healthy volunteers before and after a 5-day treatment with oxycodone, venlafaxine, or placebo in a randomized, double-blind, crossover study. Functional connectivity analyses were performed between four predefined seeds (dorsal anterior cingulate cortex, rostral anterior cingulate cortex, posterior insula, and prefrontal cortex), and the whole brain. RESULTS The overall interpretation was that there were differences between the effects of oxycodone and venlafaxine on functional connectivity. Oxycodone mainly showed decreased functional connectivity between limbic structures and to supralimbic areas (all P < 0.05). Venlafaxine also showed decreased functional connectivity between limbic structures and to supralimbic areas, but increased functional connectivity to structures in the midbrain and brain stem was also found (all P < 0.05). CONCLUSIONS Oxycodone and venlafaxine showed differential effects on resting-state functional connectivity as compared to placebo. This supports that the two drugs exert different mechanisms, and that the drugs in combination may exert additive effects and could potentially improve pain therapy.
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Affiliation(s)
- Tine M Hansen
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dina Lelic
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne E Olesen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Asbjørn Mohr Drewes
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens B Frøkjaer
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Kosiorek-Witek A, Makulska-Nowak HE. Morphine Analgesia Modification in Normotensive and Hypertensive Female Rats after Repeated Fluoxetine Administration. Basic Clin Pharmacol Toxicol 2015; 118:45-52. [DOI: 10.1111/bcpt.12438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 06/25/2015] [Indexed: 12/20/2022]
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Brvar M, Koželj G, Mašič LP. Hypoglycemia in venlafaxine overdose: a hypothesis of increased glucose uptake. Eur J Clin Pharmacol 2014; 71:261-2. [PMID: 25407614 DOI: 10.1007/s00228-014-1784-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/10/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Miran Brvar
- Centre for Clinical Toxicology and Pharmacology, Division of Internal Medicine, University Medical Centre Ljubljana, Zaloška cesta 7, Ljubljana, Slovenia,
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Preventive effect of central administration of venlafaxine on morphine physical dependence, nociception, and blood cortisol level in rat. Int J Prev Med 2014; 5:1422-31. [PMID: 25538838 PMCID: PMC4274549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 09/09/2014] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Chronic abuse of opiates induces dependency, but the neurobiological mechanisms of this event remain unclear. The aim of this study was to evaluate the effects of intracerebroventricular of venlafaxine on the morphine dependence and pain perception. METHODS A total of 80 adult male rats were divided into two major groups: (1) 40 of them was divided into groups of positive control (morphine dependent) negative control (received saline) and morphine dependent groups under treatment by central administration of venlafaxine at various dosages (25, 50, or 100 μg), after drug treatment total withdrawal index (TWI), latency time of withdrawal syndrome expression and blood cortisol as marker of anxiety were measured and compared with positive control and negative control. (2) Forty rats were grouped in control; indometacin treated (5 mg/kg) and grouped which received central administration of venlafaxine at three doses (25, 50, or 100 μg) and then pain perception and expression was assessed in the writhing test (acetic acid induced abdominal constriction), tail flick, and hot plate test. RESULTS Central administration of three doses (25, 50, or 100 μg,) of venlafaxine attenuates TWI to 47 ± 1.2, 38 ± 1.5, and 23 ± 1.1 and decrease blood cortisol level to 14 ± 1, 13.75 ± 0.5, and 12.5 ± 0.8, this decreases was significant in comparison with the positive control group (P < 0.05). Central administration of venlafaxine at mentioned doses significantly attenuates pain response with 37%, 24%, and 20% inhibition in writhing test, 69%, 34%, and 23% inhibition in hot plate test, and 29%, 23%, and 15% inhibition in tail flick test in comparison with control group (P < 0.05). CONCLUSIONS This study suggested that central administration of venlafaxine attenuated morphine withdrawal index and can be effective in modulation of pain that was induced by morphine dependency.
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Varghese SP, Koola MM, Eiger RI, Devens M. Opioid use remits, depression remains. CURRENT PSYCHIATRY 2014; 13:45-50. [PMID: 25505852 PMCID: PMC4260355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Sajoy P Varghese
- Dr. Varghese is Attending Psychiatrist, Department of Mental Health, Captain James A. Lovell, Federal Health Care Center, Assistant Professor of Psychiatry and Behavioral Sciences, Department of Psychiatry and Behavioral Sciences, Rosalind Franklin University of Medicine and Science, Chicago, Illinois. Dr. Koola is Attending Psychiatrist, Clinical Research Program, Sheppard Pratt Health System, Assistant Professor of Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland. Dr. Eiger is Chief of Addictions Programs, Jesse Brown Veterans Affairs Medical Center, Director of Addiction Psychiatry Fellowship, University of Illinois College of Medicine at Chicago, Chicago, Illinois
| | - Maju Mathew Koola
- Dr. Varghese is Attending Psychiatrist, Department of Mental Health, Captain James A. Lovell, Federal Health Care Center, Assistant Professor of Psychiatry and Behavioral Sciences, Department of Psychiatry and Behavioral Sciences, Rosalind Franklin University of Medicine and Science, Chicago, Illinois. Dr. Koola is Attending Psychiatrist, Clinical Research Program, Sheppard Pratt Health System, Assistant Professor of Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland. Dr. Eiger is Chief of Addictions Programs, Jesse Brown Veterans Affairs Medical Center, Director of Addiction Psychiatry Fellowship, University of Illinois College of Medicine at Chicago, Chicago, Illinois
| | - Rodney I Eiger
- Dr. Varghese is Attending Psychiatrist, Department of Mental Health, Captain James A. Lovell, Federal Health Care Center, Assistant Professor of Psychiatry and Behavioral Sciences, Department of Psychiatry and Behavioral Sciences, Rosalind Franklin University of Medicine and Science, Chicago, Illinois. Dr. Koola is Attending Psychiatrist, Clinical Research Program, Sheppard Pratt Health System, Assistant Professor of Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland. Dr. Eiger is Chief of Addictions Programs, Jesse Brown Veterans Affairs Medical Center, Director of Addiction Psychiatry Fellowship, University of Illinois College of Medicine at Chicago, Chicago, Illinois
| | - Maria Devens
- Dr. Varghese is Attending Psychiatrist, Department of Mental Health, Captain James A. Lovell, Federal Health Care Center, Assistant Professor of Psychiatry and Behavioral Sciences, Department of Psychiatry and Behavioral Sciences, Rosalind Franklin University of Medicine and Science, Chicago, Illinois. Dr. Koola is Attending Psychiatrist, Clinical Research Program, Sheppard Pratt Health System, Assistant Professor of Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland. Dr. Eiger is Chief of Addictions Programs, Jesse Brown Veterans Affairs Medical Center, Director of Addiction Psychiatry Fellowship, University of Illinois College of Medicine at Chicago, Chicago, Illinois
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Psychiatric agents and implications for perioperative analgesia. Best Pract Res Clin Anaesthesiol 2014; 28:167-81. [PMID: 24993437 DOI: 10.1016/j.bpa.2014.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 05/11/2014] [Accepted: 05/14/2014] [Indexed: 11/22/2022]
Abstract
The use of antidepressants, anxiolytics, mood stabilizers, anticonvulsants, and major tranquilizers introduces neurochemical, behavioral, cognitive, and emotional factors that increase the complexity of medical and surgical tasks. Increasingly, various classes of psychotropic medications are being prescribed in the perioperative setting for their analgesic properties in patients with or without a psychiatric diagnosis. In many cases, the precise mechanisms of action and dose-response relationships by which these agents mediate analgesia are largely unclear. An appreciation of the side effects and adverse-effect profiles of such medications and familiarity with the clinically relevant drug interactions that may occur in the perioperative setting are imperative to ensure the best possible outcome in dealing with patients on these medications. This review focuses on various classes of psychotropic agents, which are addressed individually, with particular focus on their analgesic properties. The latest published research is summarized, deficiencies in our current collective knowledge are discussed, and evidence-based recommendations are made for clinical practice.
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Peripheral and spinal 5-HT receptors participate in the pronociceptive and antinociceptive effects of fluoxetine in rats. Neuroscience 2013; 252:396-409. [DOI: 10.1016/j.neuroscience.2013.08.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 08/03/2013] [Accepted: 08/15/2013] [Indexed: 01/13/2023]
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Abstract
This paper is the thirty-fourth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2011 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (Section 2), and the roles of these opioid peptides and receptors in pain and analgesia (Section 3); stress and social status (Section 4); tolerance and dependence (Section 5); learning and memory (Section 6); eating and drinking (Section 7); alcohol and drugs of abuse (Section 8); sexual activity and hormones, pregnancy, development and endocrinology (Section 9); mental illness and mood (Section 10); seizures and neurologic disorders (Section 11); electrical-related activity and neurophysiology (Section 12); general activity and locomotion (Section 13); gastrointestinal, renal and hepatic functions (Section 14); cardiovascular responses (Section 15); respiration (Section 16); and immunological responses (Section 17).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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Graves SM, Persons AL, Riddle JL, Napier TC. The atypical antidepressant mirtazapine attenuates expression of morphine-induced place preference and motor sensitization. Brain Res 2012; 1472:45-53. [PMID: 22820297 DOI: 10.1016/j.brainres.2012.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 06/24/2012] [Accepted: 07/03/2012] [Indexed: 12/27/2022]
Abstract
Opioid abuse and dependence remains prevalent despite having multiple FDA-approved medications to help maintain abstinence. Mirtazapine is an atypical antidepressant receiving attention for substance abuse pharmacotherapy, and its action includes alterations in monoaminergic transmission. As monoamines are indirectly altered by opioids, the current investigation assessed the ability of mirtazapine to ameliorate morphine-induced behaviors. Conditioned place preference (CPP) is a behavioral assay wherein a rewarding drug is paired with a distinct environmental context resulting in reward-related salience of cues through learning-related neuronal plasticity. A second behavioral assay involved motor sensitization (MSn), wherein repeated administration results in an enhanced motoric response to an acute challenge, also reflecting neuronal plasticity. Attenuation of CPP and/or MSn provides two behavioral measures to suggest therapeutic potential for addiction therapy, and the present study evaluated the effectiveness of mirtazapine to reduce both behaviors. To do so, morphine-induced CPP was established using an eight day conditioning paradigm, and expression of CPP was tested on day 10 following a 24h or 30min mirtazapine pretreatment. To determine if mirtazapine altered the expression of MSn, on day 11, rats received a pretreatment of mirtazapine, followed 30min later by a challenge injection of morphine. Pretreatment with mirtazapine 24h prior to the CPP test had no effect on CPP expression. In contrast, a 30min pretreatment of mirtazapine attenuated the expression of both CPP and MSn. Collectively, these results indicate that mirtazapine may help to maintain abstinence in opioid dependent patients.
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Affiliation(s)
- Steven M Graves
- Department of Pharmacology, Center for Compulsive Behaviors and Addiction, Rush University Medical Center, Chicago, IL 60657, USA
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