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Bansal R, Hellerstein DJ, Sawardekar S, Chen Y, Peterson BS. A randomized controlled trial of desvenlafaxine-induced structural brain changes in the treatment of persistent depressive disorder. Psychiatry Res Neuroimaging 2023; 331:111634. [PMID: 36996664 DOI: 10.1016/j.pscychresns.2023.111634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 04/01/2023]
Abstract
The anatomical changes that antidepressant medications induce in the brain and through which they exert their therapeutic effects remain largely unknown. We randomized 61 patients with Persistent Depressive Disorder (PDD) to receive either desvenlafaxine or placebo in a 12-week trial and acquired anatomical MRI scans in 42 of those patients at baseline before randomization and immediately at the end of the trial. We also acquired MRIs once in 39 age- and sex-matched healthy controls. We assessed whether the serotonin-norepinephrine reuptake inhibitor, desvenlafaxine, differentially changed cortical thickness during the trial compared with placebo. Patients relative to controls at baseline had thinner cortices across the brain. Although baseline thickness was not associated with symptom severity, thicker baseline cortices predicted greater reduction in symptom severity in those treated with desvenlafaxine but not placebo. We did not detect significant treatment-by-time effects on cortical thickness. These findings suggest that baseline thickness may serve as predictive biomarkers for treatment response to desvenlafaxine. The absence of treatment-by-time effects may be attributable either to use of insufficient desvenlafaxine dosing, a lack of desvenlafaxine efficacy in treating PDD, or the short trial duration.
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Affiliation(s)
- Ravi Bansal
- Institute for the Developing Mind, Children's Hospital Los Angeles, CA 90027, USA; Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, CA 90033, USA.
| | - David J Hellerstein
- Depression Evaluation Service, Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY 10032, USA; Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA; New York State Psychiatric Institute, New York, NY 10032, USA
| | - Siddhant Sawardekar
- Institute for the Developing Mind, Children's Hospital Los Angeles, CA 90027, USA
| | - Ying Chen
- Depression Evaluation Service, Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY 10032, USA; New York State Psychiatric Institute, New York, NY 10032, USA
| | - Bradley S Peterson
- Institute for the Developing Mind, Children's Hospital Los Angeles, CA 90027, USA; Department of Psychiatry, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA 90033, USA
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Anderson GM, Bruno-Pacella I. Systematic review of studies using platelet serotonin content to assess bioeffect of serotonin reuptake inhibitors at the serotonin transporter. Psychopharmacology (Berl) 2023; 240:1-13. [PMID: 36399187 DOI: 10.1007/s00213-022-06276-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022]
Abstract
RATIONALE Assessment of the bioeffect of serotonin reuptake inhibitors (SRIs, including both selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)) at the serotonin transporter (SERT) in patients and healthy controls can have important theoretical and clinical implications. OBJECTIVES Bioeffect at SERT has been assessed by neuroimaging of brain SERT occupancy, through in vitro measurements of platelet serotonin (5-HT) uptake, and by measuring platelet 5-HT content pre- and post-initiation of SRI administration. Studies of platelet 5-HT content were reviewed in order to (1) determine the overall apparent bioeffect of SRIs; (2) compare bioeffect across types of SRIs; (3) compare the three approaches to assessing SRI bioeffect; and (4) determine how the findings might inform clinical practice. METHODS We performed a systematic review of the published studies that measured platelet 5-HT content to assess SRI bioeffect at the platelet SERT. Studies using neuroimaging and in vitro platelet 5-HT uptake to assess SRI bioeffect were reviewed for comparison purposes. RESULTS Clinical doses of SRIs typically resulted in 70-90% reductions in platelet 5-HT content. The observed bioeffect at the platelet SERT appeared similar among different SSRIs and SNRIs. The bioeffect estimations based on platelet 5-HT content were consistent with those obtained using neuroimaging to assess brain SERT occupancy and those based on the in vitro measurement of platelet 5-HT uptake. CONCLUSIONS In general, excellent agreement was seen in the apparent SRI bioeffect (70-90% inhibition) among the platelet 5-HT content studies and across the three bioeffect approaches. Theoretical and practical clinical implications are discussed.
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Gao H, Zhang IY, Zhang L, Song Y, Liu S, Ren H, Liu H, Zhou H, Su Y, Yang Y, Badie B. S100B suppression alters polarization of infiltrating myeloid-derived cells in gliomas and inhibits tumor growth. Cancer Lett 2018; 439:91-100. [PMID: 30076898 PMCID: PMC7048242 DOI: 10.1016/j.canlet.2018.07.034] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 01/03/2023]
Abstract
S100B, a member of the multigene family of Ca2+-binding proteins, is overexpressed by most malignant gliomas but its biological role in gliomagenesis is unclear. Recently, we demonstrated that low concentrations of S100B attenuated microglia activation through the induction of STAT3. Furthermore, S100B downregulation in a murine glioma model inhibited macrophage trafficking and tumor growth. Based on these observations, we hypothesized that S100B inhibitors may have antiglioma properties through modulation of tumor microenvironment. To discover novel S100B inhibitors, we developed a high-throughput screening cell-based S100B promoter-driven luciferase reporter assay. Initial screening of 768 compounds in the NIH library identified 36 hits with >85% S100B inhibitory activity. Duloxetine (Dul, an SNRI) was selected for the initial proof-of-concept studies. At low concentrations (1–5 μM) Dul inhibited S100B and CCL2 production in mouse GL261 glioma cells, but had minimal cytotoxic activity in vitro. In vivo, however, Dul (30 mg/kg/14 days) inhibited S100B production, altered the polarization and trafficking of tumor-associated myeloid-derived cells, and inhibited the growth of intracranial GL261 gliomas. Dul therapeutic efficacy, however, was not observed in the K-Luc glioma model that expresses low levels of S100B. These findings affirm the role of S100B in gliomagenesis and justify the development of more potent S100B inhibitors for glioma therapy.
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Affiliation(s)
- Hang Gao
- Department of Bone and Joint Surgery, No.1 Hospital of Jilin University, Changchun, Jilin Province, PR China.
| | - Ian Y Zhang
- Division of Neurosurgery, City of Hope Beckman Research Institute, USA.
| | - Leying Zhang
- Division of Neurosurgery, City of Hope Beckman Research Institute, USA.
| | - Yanyan Song
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin Province, PR China.
| | - Shunan Liu
- Department of Pharmacology, The Pharmacy School of Jilin University, Changchun, Jilin Province, PR China.
| | - Hui Ren
- Department of General Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, PR China.
| | - Huili Liu
- Division of Neurosurgery, City of Hope Beckman Research Institute, USA.
| | - Hui Zhou
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang Province, PR China.
| | - Yanping Su
- College of Pharmacy, Fujian Medical University, Fuzhou, Fujian Province, PR China.
| | - Yihang Yang
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, PR China.
| | - Behnam Badie
- Department of Cancer Immunotherapeutics & Tumor Immunology, City of Hope Beckman Research Institute, Duarte, CA 91010, USA.
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Gyurak A, Patenaude B, Korgaonkar MS, Grieve SM, Williams LM, Etkin A. Frontoparietal Activation During Response Inhibition Predicts Remission to Antidepressants in Patients With Major Depression. Biol Psychiatry 2016; 79:274-81. [PMID: 25891220 DOI: 10.1016/j.biopsych.2015.02.037] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite cognitive function impairment in depression, its relationship to treatment outcome is not well understood. Here, we examined whether pretreatment activation of cortical circuitry during test of cognitive functions predicts outcomes for three commonly used antidepressants. METHODS Eighty medication-free outpatients with major depression and 34 matched healthy controls were included as participants in the International Study to Predict Optimized Treatment in Depression (iSPOT-D) trial. During functional magnetic resonance imaging, participants completed three tasks that assessed core domains of cognitive functions: response inhibition (Go/NoGo), selective attention (oddball), and selective working memory updating (1-back). Participants were randomized to 1 of 3 arms: escitalopram, sertraline (serotonin-specific reuptake inhibitors [SSRI]), or venlafaxine-extended release (serotonin and norepinephrine reuptake inhibitor [SNRI]) therapy. Functional magnetic resonance imaging scans were repeated after 8 weeks of treatment, and remission was assessed using the Hamilton Rating Scale for Depression. RESULTS Dorsolateral prefrontal cortex activation during inhibitory "no go" responses was a general predictor of remission, with remitters having the same pretreatment activation as control participants and nonremitters hypoactivating relative to controls. Posttreatment dorsolateral prefrontal cortex activation was reduced in both remitters and controls but not in nonremitters. By contrast, inferior parietal activation differentially predicted remission between SSRI and SNRI medications, with SSRI remitters showing greater pretreatment activation than SSRI nonremitters and the SNRI group showing the opposite pattern. CONCLUSIONS Intact activation in the frontoparietal network during response inhibition, a core cognitive function, predicts remission with antidepressant treatment, particularly for SSRIs, and may be a potential substrate of the clinical effect of treatment.
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Affiliation(s)
- Anett Gyurak
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California; Department of Psychology, Stanford University, Stanford, California; Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Brian Patenaude
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California; Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Mayuresh S Korgaonkar
- The Brain Dynamics Center, Sydney Medical School, University of Sydney and Westmead Millennium Institute, Sydney, New South Wales, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney and Westmead Millennium Institute, Sydney, New South Wales, Australia
| | - Stuart M Grieve
- The Brain Dynamics Center, Sydney Medical School, University of Sydney and Westmead Millennium Institute, Sydney, New South Wales, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney and Westmead Millennium Institute, Sydney, New South Wales, Australia
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California; Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California; Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
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Lee MS, Ahn YM, Chung S, Walton R, Raskin J, Kim MS. The effect of initial duloxetine dosing strategy on nausea in korean patients with major depressive disorder. Psychiatry Investig 2012; 9:391-9. [PMID: 23251205 PMCID: PMC3521117 DOI: 10.4306/pi.2012.9.4.391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 04/20/2012] [Accepted: 07/17/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the relative severity of nausea in patients from Korea with major depressive disorder (MDD) who were treated with duloxetine at low (30 mg) or high (60 mg) doses, with or without food, for the first week of an 8 week treatment. METHODS Adult patients (n=249), with MDD and a 17-item Hamilton Rating Scale for Depression (HAMD(17)) score of ≥15, received open-label once daily duloxetine. At Week 0, patients were randomized to 4 groups: 30 mg with food (n=63), 60 mg with food (n=59), 30 mg without food (n=64), and 60 mg without food (n=63). At Week 1, all patients switched to duloxetine 60 mg for 7 weeks. The primary outcome measure was item 112 (nausea) of the Association for Methodology and Documentation in Psychiatry adverse event scale. Effectiveness was assessed by change in HAMD(17) total score. RESULTS Overall, 94.4% (235/249) of patients completed Week 1 and 55.0% (137/249) of patients completed the study. For Week 1, nausea was significantly less severe for patients who received 30 mg compared with 60 mg duloxetine (p=0.003), regardless of food intake. In all groups, nausea severity was highest at Week 1 and declined throughout the study. HAMD(17) score was reduced in all groups and the most common adverse event reported was nausea (145/249; 58.2%). CONCLUSION To minimize nausea, Korean patients with MDD who require duloxetine treatment could be given 30 mg once daily, regardless of food, for the first week followed by 60 mg once daily for the course of therapy.
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Affiliation(s)
- Min-Soo Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yong Min Ahn
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seockhoon Chung
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Richard Walton
- Asia-Pacific Neuroscience, Eli Lilly Pty Ltd, Sydney, Australia
| | - Joel Raskin
- Lilly Research Laboratories, Eli Lilly Canada, Toronto, Canada
| | - Mun Sung Kim
- Neuroscience Medical, Quality and Regulatory Affairs, Eli Lilly Korea Ltd, Seoul, Republic of Korea
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Abstract
Gastroesophageal reflux disease (GERD) is the most common cause of noncardiac chest pain (NCCP) and is present in up to 60% of patients with NCCP in Western countries. In Korea, after a reasonable cardiac evaluation, GERD is reported to underlie 41% of NCCP cases. Typical reflux symptoms are frequent in Korean patients suffering from NCCP. Therefore, a careful history of the predominant symptoms, including heartburn and acid regurgitation, is relatively indicative of the GERD diagnosis in Korea. In Korea, in contrast to Western countries, patients aged 40 years and over who have been diagnosed with NCCP but who are without alarming features should undergo endoscopy to exclude gastric cancer or peptic ulcers because of the higher prevalence of peptic ulcer disease and gastric cancers in the region. In a primary care setting, in the absence of any alarming symptoms, a symptomatic response to a trial of a proton pump inhibitor (PPI) is sufficient for the presumptive diagnosis of GERD. In addition, the optimal duration of a PPI test may be at least 2 weeks, as GERD symptoms tend to be less frequent or atypical in Korean patients than in patients from Western countries. In patients diagnosed with GERD-related NCCP, long-term therapy (more than 2 months) with double the standard dose of a PPI is required to alleviate symptoms. Esophageal dysmotility is relatively uncommon, and pain modulators seem to offer significant improvement of chest pain control in non-GERD-related NCCP. Most traditionally available tricyclics or heterocyclics have many undesirable effects. Therefore, newer drugs with fewer side effects (for example, the serotonin - norepinephrine reuptake inhibitors) may be needed.
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Affiliation(s)
- Jeong Hwan Kim
- Department of Internal Medicine, Digestive Disease Center, Medical Immunology Center, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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