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Nakad Z, Saab Y. Precision dosing for patients on tricyclic antidepressants. Pharmacogenet Genomics 2024; 34:117-125. [PMID: 38465522 DOI: 10.1097/fpc.0000000000000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVE We aim to develop a personalized dosing tool for tricyclic antidepressants (TCAs) that integrates CYP2D6 and CYP2C19 gene variants and their effects while also considering the polypharmacy effect. METHODS The study first adopted a scoring system that assigns weights to each genetic variant. A formula was then developed to compute the effect of both genes' variants on drug dosing. The output of the formula was assessed by a comparison with the clinical pharmacogenetics implementation consortium recommendation. The study also accounts for the effect of the co-administration of inhibitors and inducers on drug metabolism. Accordingly, a user-friendly tool, Clinical Dosing Tool ver.2, was created to assist clinicians in dosing patients on TCAs. RESULTS The study provides a comprehensive list of all alleles with corresponding activity values and phenotypes for both enzymes. The tool calculated an updated area under the curve ratio that utilizes the effects of both enzymes' variants for dose adjustment. The tool provided a more accurate individualized dosing that also integrates the polypharmacy effect. CONCLUSION To the best of our knowledge, the literature misses such a tool that provides a numerical adjusted dose based on continuous numerical activity scores for the considered patients' alleles and phenoconversion.
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Affiliation(s)
- Zahi Nakad
- Electrical and Computer Engineering Department, School of Engineering, Lebanese American University, Lebanon
| | - Yolande Saab
- Pharmaceutical Sciences Department, School of Pharmacy, Lebanese American University, Lebanon
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Davoutis E, Panou C, Stachika N, Dalla C, Kokras N. Drug-drug interactions between COVID-19 drug therapies and antidepressants. Expert Opin Drug Metab Toxicol 2023; 19:937-950. [PMID: 37934891 DOI: 10.1080/17425255.2023.2280750] [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: 08/06/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Antidepressants are widely used for the pharmacological treatment of anxiety and mood disorders. Since the eruption of the SARS-COV-2 pandemic and the later development of targeted treatments against COVID-19, inevitably many patients receive antidepressants as well as targeted treatments against COVID-19 against COVID-19. Co-administration of antidepressants with COVID-19 therapeutics has the potential of drug-drug interactions, of varying severity and clinical significance. AREAS COVERED This is a curated narrative review of the current state of the art regarding drug-drug interactions between COVID-19 therapeutics and medications licensed for the pharmacotherapy of depression. A systematic search of electronic databases, using as keywords the international nonproprietaty names of currently approved COVID-19 therapeutics and antidepressants was performed, and additionally online interaction checker tools were consulted. Derived data were synthesized for each COVID-19 therapeutic and presented with up-to-date guidance. EXPERT OPINION Several COVID-19 therapeutics have potential for drug-drug interactions with antidepressants. Remdesivir and Nirmatrelvir-Ritonavir have the higher risk, whereas several monoclonal antibodies appear safer. The most serious drug-drug interactions (serotonin syndrome and QTc prolongation) require close monitoring; however, DDI toward reducing the efficacy of antidepressants may be difficult to recognize. As COVID-19 treatment protocols take precedence, psychiatrists should exert flexibility in antidepressant use and proactively monitor treatment progress.
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Affiliation(s)
- Efstathia Davoutis
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrysa Panou
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolina Stachika
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Dalla
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kokras
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- First Department of Psychiatry, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Luo Y, Zhong Z, Li H, Wang L, Guo D, Dong X, Liu J, Xie M, Wu M, Xiang Y, Zhang X, Meng P. Integrating serum metabolomics and network analysis to explore the antidepressant activity of crocin in rats with chronic unexpected mild stress-induced depression. PHARMACEUTICAL BIOLOGY 2023; 61:1414-1430. [PMID: 37688460 PMCID: PMC10494758 DOI: 10.1080/13880209.2023.2246531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 09/10/2023]
Abstract
CONTEXT Crocin exhibits anti-depressant properties. However, its underlying mechanisms and its relationship with metabolomics remain unclear. OBJECTIVE This study elucidates the mechanism of action and potential targets of crocin in treating chronic unexpected mild stress (CUMS)-induced depression in rats. MATERIALS AND METHODS Male Sprague-Dawley (SD) rats underwent 4 weeks of CUMS to establish the depression model. The normal control (distilled water), crocin (25 mg/kg), and fluoxetine (5.4 mg/kg) groups were orally administered for 4-weeks. Behavioural tests evaluated the effects of crocin, while liquid chromatography-mass spectrometry metabolomics identified differential metabolites and their associated metabolic pathways. Subsequently, network pharmacology was utilized to predict the targets of crocin. RESULTS Crocin significantly increased body weight (from 319.16 ± 4.84 g to 325.67 ± 2.84 g), sucrose preference (from 0.46 ± 0.09 to 0.70 ± 0.09), vertical activity (from 2.83 ± 1.94 to 8 ± 2.36), horizontal activity (from 1 ± 0.63 to 4.5 ± 3.08) and decreased immobilization time (from 13.16 ± 2.69 to 3.97 ± 3.00). Metabolomics analysis identified 7 metabolites and 5 associated metabolic pathways. From the combined analysis of network pharmacology and metabolomics, three targets (PRMT1, CYP3A4, and GLB1) are the overlapping targets and the two most important metabolic pathways are tryptophan metabolism and glycerolipid metabolism. DISCUSSION AND CONCLUSIONS This study provides insights into the antidepressant therapeutic effect of crocin and its underlying mechanisms. The findings contribute to a better understanding of the metabolic mechanism involved in the anti-depressant effect of crocin, establishing a strong foundation for future research in this area.
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Affiliation(s)
- Yan Luo
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, P.R. China
| | - Ziyan Zhong
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, P.R. China
| | - Huan Li
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, P.R. China
| | - Le Wang
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, P.R. China
| | - Dongwei Guo
- The Second People’s Hospital of Hunan Province, Changsha, Hunan, P.R. China
| | - Xuanqi Dong
- The Second People’s Hospital of Hunan Province, Changsha, Hunan, P.R. China
| | - Jian Liu
- First Affiliated Hospital, Hunan University of Chinese Medicine, Changsha, Hunan, P.R. China
| | - Mingxia Xie
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, P.R. China
| | - Mei Wu
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, P.R. China
| | - Yun Xiang
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, P.R. China
| | - Xi Zhang
- The Second People’s Hospital of Hunan Province, Changsha, Hunan, P.R. China
| | - Pan Meng
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, P.R. China
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Roberts B, Cooper Z, Lu S, Stanley S, Majda BT, Collins KRL, Gilkes L, Rodger J, Akkari PA, Hood SD. Utility of pharmacogenetic testing to optimise antidepressant pharmacotherapy in youth: a narrative literature review. Front Pharmacol 2023; 14:1267294. [PMID: 37795032 PMCID: PMC10545970 DOI: 10.3389/fphar.2023.1267294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Pharmacogenetics (PGx) is the study and application of how interindividual differences in our genomes can influence drug responses. By evaluating individuals' genetic variability in genes related to drug metabolism, PGx testing has the capabilities to individualise primary care and build a safer drug prescription model than the current "one-size-fits-all" approach. In particular, the use of PGx testing in psychiatry has shown promising evidence in improving drug efficacy as well as reducing toxicity and adverse drug reactions. Despite randomised controlled trials demonstrating an evidence base for its use, there are still numerous barriers impeding its implementation. This review paper will discuss the management of mental health conditions with PGx-guided treatment with a strong focus on youth mental illness. PGx testing in clinical practice, the concerns for its implementation in youth psychiatry, and some of the barriers inhibiting its integration in clinical healthcare will also be discussed. Overall, this paper provides a comprehensive review of the current state of knowledge and application for PGx in psychiatry and summarises the capabilities of genetic information to personalising medicine for the treatment of mental ill-health in youth.
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Affiliation(s)
- Bradley Roberts
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia
| | - Zahra Cooper
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Stephanie Lu
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Susanne Stanley
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | | | - Khan R. L. Collins
- Western Australian Department of Health, North Metropolitan Health Service, Perth, WA, Australia
| | - Lucy Gilkes
- School of Medicine, University of Notre Dame, Fremantle, WA, Australia
- Divison of General Practice, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Jennifer Rodger
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia
| | - P. Anthony Akkari
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, WA, Australia
- Division of Neurology, Duke University Medical Centre, Duke University, Durham, United States
| | - Sean D. Hood
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley, WA, Australia
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Jiang X, Wu J, Tan B, Yan S, Deng N, Wei H. Effect of chronic unpredicted mild stress-induced depression on clopidogrel pharmacokinetics in rats. PeerJ 2022; 10:e14111. [PMID: 36213502 PMCID: PMC9536304 DOI: 10.7717/peerj.14111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/02/2022] [Indexed: 01/25/2023] Open
Abstract
Background Clopidogrel is widely used to prevent and treat cardiovascular atherosclerosis and thrombosis. However, disturbance in the expression and activity of liver cytochrome metabolic enzymes significantly changes clopidogrel efficacy. Therefore, the effect of chronic unpredictable mild stress (CUMS)-induced depression on the expression of liver cytochrome metabolic enzymes and clopidogrel pharmacokinetics in rats were explored. Methods Nine different CUMSs were selected to establish a rat model of depression. Open field experiment and sucrose preference test were applied to explore the depressive behaviors. The concentration of serotonin in the cortex of depressed rats was determined using enzyme linked immunosorbent assay (ELISA). All rats were given 10 mg/kg clopidogrel orally after 12 weeks, and blood samples were collected at different time points. The clopidogrel concentration and CYP2C19/ CYP2C9 activity in rat liver microsomes were assayed by high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The rat liver drug enzymes expression was determined by Real-Time Quantitative Reverse Transcription PCR (RT-qPCR). Results Open field experiment and sucrose preference test indicated the successful construction of the CUMS-induced depression model. The concentration of serotonin in the cortex of depressed rats decreased by 42.56% (∗∗ p < 0.01). The area under the curve of clopidogrel pharmacokinetics decreased by 33.13% (∗ p < 0.05) in the depression rats, while distribution volume and clearance increased significantly (∗∗ p < 0.01). The half-time and distribution volume did not significantly differ. The CYP2C19 and CYP2C9 activity of liver microsomes in the CUMS-induced depression group were significantly higher than that in the control group (∗∗ p < 0.01). CYP2C11 and CYP1A2 mRNA expression up-regulated approximately 1.3 - fold in the depressed rat livers compared with that in the control, whereas that of CYP2C13 was down-regulated by 27.43% (∗∗ p < 0.01). CYP3A1 and CYP2C12 expression were slightly up-regulated, and that of CES1 did not change. Conclusions These results indicated that CUMS-induced depression altered clopidogrel pharmacokinetics, and the change in CYP450 activity and expression in depressed rat livers might contribute to the disturbance of clopidogrel pharmacokinetics.
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Affiliation(s)
| | - Jing Wu
- Hunan Normal University, Changsha, Hunan, China
| | - Boyu Tan
- Department of Pharmacy, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Sulan Yan
- Department of Cardiovascular, The First Affiliated Hospital of Hunan Normal University, Hunan Provincial People’s Hospital, Changsha, Hunan, China
| | - Nan Deng
- Department of Pharmacy, The First Affiliated Hospital of Hunan Normal University, Hunan Provincial People’s Hospital, Changsha, Hunan, China
| | - Hongyan Wei
- Department of Pharmacy, The First Affiliated Hospital of Hunan Normal University, Hunan Provincial People’s Hospital, Changsha, Hunan, China
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Tian H, Hu Z, Xu J, Wang C. The molecular pathophysiology of depression and the new therapeutics. MedComm (Beijing) 2022; 3:e156. [PMID: 35875370 PMCID: PMC9301929 DOI: 10.1002/mco2.156] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 12/21/2022] Open
Abstract
Major depressive disorder (MDD) is a highly prevalent and disabling disorder. Despite the many hypotheses proposed to understand the molecular pathophysiology of depression, it is still unclear. Current treatments for depression are inadequate for many individuals, because of limited effectiveness, delayed efficacy (usually two weeks), and side effects. Consequently, novel drugs with increased speed of action and effectiveness are required. Ketamine has shown to have rapid, reliable, and long-lasting antidepressant effects in treatment-resistant MDD patients and represent a breakthrough therapy for patients with MDD; however, concerns regarding its efficacy, potential misuse, and side effects remain. In this review, we aimed to summarize molecular mechanisms and pharmacological treatments for depression. We focused on the fast antidepressant treatment and clarified the safety, tolerability, and efficacy of ketamine and its metabolites for the MDD treatment, along with a review of the potential pharmacological mechanisms, research challenges, and future clinical prospects.
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Affiliation(s)
- Haihua Tian
- Ningbo Key Laboratory of Behavioral Neuroscience Ningbo University School of Medicine Ningbo Zhejiang China.,Zhejiang Provincial Key Laboratory of Pathophysiology School of Medicine Ningbo University Ningbo Zhejiang China.,Department of Physiology and Pharmacology Ningbo University School of Medicine Ningbo Zhejiang China.,Department of Laboratory Medicine Ningbo Kangning Hospital Ningbo Zhejiang China
| | - Zhenyu Hu
- Department of Child Psychiatry Ningbo Kanning Hospital Ningbo Zhejiang China
| | - Jia Xu
- Ningbo Key Laboratory of Behavioral Neuroscience Ningbo University School of Medicine Ningbo Zhejiang China.,Zhejiang Provincial Key Laboratory of Pathophysiology School of Medicine Ningbo University Ningbo Zhejiang China.,Department of Physiology and Pharmacology Ningbo University School of Medicine Ningbo Zhejiang China
| | - Chuang Wang
- Ningbo Key Laboratory of Behavioral Neuroscience Ningbo University School of Medicine Ningbo Zhejiang China.,Zhejiang Provincial Key Laboratory of Pathophysiology School of Medicine Ningbo University Ningbo Zhejiang China.,Department of Physiology and Pharmacology Ningbo University School of Medicine Ningbo Zhejiang China
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