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Seshadri A, Prokop LJ, Singh B. Efficacy of intravenous ketamine and intranasal esketamine with dose escalation for Major depression: A systematic review and meta-analysis. J Affect Disord 2024; 356:379-384. [PMID: 38537759 DOI: 10.1016/j.jad.2024.03.137] [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: 11/10/2023] [Revised: 03/09/2024] [Accepted: 03/24/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE Intravenous (IV) racemic ketamine and intranasal (IN) esketamine have demonstrated rapid antidepressant effects in treatment-resistant depression (TRD). This systematic review aims to evaluate the efficacy and safety of ketamine and esketamine at various dosages for depression. METHODS We included randomized controlled trials (RCTs) with parallel group dose comparison of ketamine and esketamine for depression/TRD. Ovid Medline, Embase, PsycINFO, Scopus and Cochrane databases were searched. Standardized mean differences were calculated using Hedges'-g to complete random effects meta-analysis. The efficacy outcomes were changes in depression outcomes for IV ketamine and IN esketamine respectively. Safety was assessed by reported adverse effects. RESULTS A random effects meta-analysis of studies (n = 12) showed efficacy in reducing depression symptoms with IV ketamine (Hedges'g = 1.52 [0.98-2.22], Z = 4.23, p < 0.001) and IN esketamine (Hedges' g = 0.31 [0.18-0.44], Z = 4.53, P < 0.001) compared to control/placebo. Treatment response was observed at IV ketamine doses ≤0.2 mg/kg, >0.2-0.5 mg/kg and > 0.5 mg/kg. Higher IV ketamine doses (>0.5 mg/kg) did not lead to greater treatment response. Esketamine doses of 56-84 mg were superior to 28 mg dose. LIMITATIONS Overall quality of evidence was low and limited by small number of studies. Publication bias was high. CONCLUSIONS This meta-analysis suggests that IV ketamine may be efficacious at doses as low as 0.2 mg/kg, with increasing dose response at 0.5 mg/kg, without demonstrable increased benefit at 1 mg/kg, based on a small number of studies. Efficacy for IN esketamine increases with doses above 28 mg with best response being found between 56 and 84 mg for reducing depressive symptoms.
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Affiliation(s)
- Ashok Seshadri
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA.
| | - Larry J Prokop
- Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Balwinder Singh
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
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Singh B, Kung S, Vande Voort JL. Intravenous (IV) ketamine versus intranasal esketamine for depression- Advantage IV ketamine? J Affect Disord 2024; 356:564-567. [PMID: 38657763 DOI: 10.1016/j.jad.2024.04.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/09/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Balwinder Singh
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America.
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
| | - Jennifer L Vande Voort
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
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Jespersen CP, Pedersen HF, Kleinstäuber M, Fink P, Wellnitz KB, Ørnbøl E, Schröder A, Agger JL, Vase L, Finnerup NB, Gormsen LK. Efficacy of patient education and duloxetine, alone and in combination, for patients with multisystem functional somatic disorder: Study protocol for the EDULOX trial. Contemp Clin Trials 2024; 141:107524. [PMID: 38604496 DOI: 10.1016/j.cct.2024.107524] [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] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Multisystem functional somatic disorder is characterized by specific patterns of persistent physical symptoms with a complex biopsychosocial etiology. The disorder can lead to disability and personal suffering. Current treatment options require specialized settings, therefore patients often wait a long time to receive specific treatment. Patient education is considered important in most treatment programs, but has only been investigated sparsely as a stand-alone treatment. Pharmacological treatment is limited to tricyclic antidepressants in low doses with no antidepressant properties. Duloxetine has been found effective in single organ functional disorders. As a treatment for multisystem functional somatic disorder, duloxetine could reduce symptoms and treat comorbid anxiety and depression. It may furthermore enhance the effect of patient education through a hypothesized effect on cognitive functioning. The purpose of the EDULOX trial is to study psycho-EDUcation and duLOXetine alone and in combination. METHODS This is a nested study design. The parent trial "EDULOX1" (n = 424) will compare a patient education program with enhanced usual care in an open-labelled, randomized controlled trial. In addition to this, eligible participants will furthermore receive either duloxetine or active placebo in the nested, double-blinded, randomized controlled trial, "EDULOX2" (n = 212). Patient and clinician reported outcomes will be collected through questionnaires. CONCLUSION The EDULOX trial may establish evidence for treatments applicable for the majority of patients with multisystem functional somatic disorder. If effective, duloxetine would be a more tolerable pharmacological treatment option that can target comorbid depression and anxiety, and potentially boost the effect of patient education. Trial registration number The study is registered at www. CLINICALTRIALS gov (NCT06232473) and the internal list of research projects at the Region of Central Denmark (Case number 1-16-02-305-23). Approval from the Danish Medical Research Ethics Committees (Case number: 2212291) and the Danish Medicines Agency was obtained under EudraCT Number: 2022-002780-30 and Sponsor's Protocol Code Number: 9515.
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Affiliation(s)
- Cecilia Pihl Jespersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Heidi Frølund Pedersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maria Kleinstäuber
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, UT, USA
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kaare Bro Wellnitz
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Eva Ørnbøl
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Johanne Liv Agger
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Lene Vase
- Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Nanna Brix Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Lise Kirstine Gormsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Dvorak L, Bloemhof-Bris E, Shelef A, Halperin D, Wexler G, Talmon O, Feffer K. Efficacy of Esketamine among patients with treatment resistant depression in a 'real world' health-care setting in Israel. J Psychiatr Res 2024; 174:66-72. [PMID: 38626563 DOI: 10.1016/j.jpsychires.2024.04.008] [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: 11/05/2023] [Revised: 03/06/2024] [Accepted: 04/03/2024] [Indexed: 04/18/2024]
Abstract
One in five people will likely suffer from major depressive disorder (MDD) during their life. Thirty percent of those with MDD will experience Treatment Resistant Depression (TRD), which is characterized by a failure to respond to two adequately administered trials of antidepressants. Esketamine is a rapidly acting intranasal antidepressant. Present-day Esketamine research has limited data in real-world populations. This study aimed to assess Esketamine treatment in a real-world community-based population. This naturalistic retrospective study included 94 individuals age 18 and above diagnosed with TRD, treated with Esketamine in an outpatient setting. The treatment was given in a single clinic, from January 2021 to January 2023, following approval of the Institutional Internal Review Board. The treatment included an acute phase (biweekly treatment, continuing 4-8 weeks), followed by a maintenance phase (once a week to once a month, for 6-12 months). Dosing ranged from 28 mg to 84 mg. Demographic and clinical data were retrospectively gathered. Depressive symptoms were assessed using the Quick Inventory of Depressive Symptomatology, at baseline and during each treatment phase. All patients completed the acute phase. About 60% completed the maintenance phase. Linear improvement of depressive symptoms was revealed in both phases. A sub-analysis of patients with comorbid personality disorder revealed a similar improvement pattern in the acute phase with milder improvement during the maintenance phase, compared to the other patients. This study supports the use of Esketamine for TRD, including patients with comorbid personality disorder and previous electroconvulsive therapy.
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Affiliation(s)
- Lior Dvorak
- Shalvata Mental Health Center, Hod Hasharon, Israel; Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel
| | | | - Assaf Shelef
- Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel; Lev Hasharon Mental Health Center, Tsur Moshe, Israel
| | - Dania Halperin
- Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel
| | - Gay Wexler
- Lev Hasharon Mental Health Center, Tsur Moshe, Israel
| | - Ortal Talmon
- Lev Hasharon Mental Health Center, Tsur Moshe, Israel
| | - Kfir Feffer
- Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel; Lev Hasharon Mental Health Center, Tsur Moshe, Israel
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Zhu Z, Cheng Y, Han X, Wang T, Zhang H, Yao Q, Chen F, Gu L, Yang D, Chen L, Zhao Y. 20( S)-Protopanaxadiol Exerts Antidepressive Effects in Chronic Corticosterone-Induced Rodent Animal Models as an Activator of Brain-Type Creatine Kinase. J Agric Food Chem 2024; 72:10376-10390. [PMID: 38661058 DOI: 10.1021/acs.jafc.4c00415] [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] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
20(S)-Protopanaxadiol (PPD) is one of the bioactive ingredients in ginseng and possesses neuroprotective properties. Brain-type creatine kinase (CK-BB) is an enzyme involved in brain energy homeostasis via the phosphocreatine-creatine kinase system. We previously identified PPD as directly bound to CK-BB and activated its activity in vitro. In this study, we explored the antidepressive effects of PPD that target CK-BB. First, we conducted time course studies on brain CK-BB, behaviors, and hippocampal structural plasticity responses to corticosterone (CORT) administration. Five weeks of CORT injection reduced CK-BB activity and protein levels and induced depression-like behaviors and hippocampal structural plasticity impairment. Next, a CK inhibitor and an adeno-associated virus-targeting CKB were used to diminish CK-BB activity or its expression in the brain. The loss of CK-BB in the brain led to depressive behaviors and morphological damage to spines in the hippocampus. Then, a polyclonal antibody against PPD was used to determine the distribution of PPD in the brain tissues. PPD was detected in the hippocampus and cortex and observed in astrocytes, neurons, and vascular endotheliocytes. Finally, different PPD doses were used in the chronic CORT-induced depression model. Treatment with a high dose of PPD significantly increased the activity and expression of CK-BB after long-term CORT injection. In addition, PPD alleviated the damage to depressive-like behaviors and structural plasticity induced by repeated CORT injection. Overall, our study revealed the critical role of CK-BB in mediating structural plasticity in CORT-induced depression and identified CK-BB as a therapeutic target for PPD, allowing us to treat stress-related mood disorders.
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Affiliation(s)
- Zhu Zhu
- Department of Pathology and Pathophysiology, School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Yao Cheng
- Department of Pathology and Pathophysiology, School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Xu Han
- Department of Pathology and Pathophysiology, School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Tiantian Wang
- Department of Pathology and Pathophysiology, School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Hantao Zhang
- Department of Physiology, School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Qi Yao
- Department of Pathology and Pathophysiology, School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Feiyan Chen
- Research and Innovation Center, College of Traditional Chinese Medicine, Integrated Chinese and Western Medicine College, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Ling Gu
- Research and Innovation Center, College of Traditional Chinese Medicine, Integrated Chinese and Western Medicine College, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Dongqing Yang
- Department of Public Health, School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Lin Chen
- Department of Physiology, School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Yunan Zhao
- Department of Pathology and Pathophysiology, School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
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Zolghadriha A, Anjomshoaa A, Jamshidi MR, Taherkhani F. Rapid and sustained antidepressant effects of intravenous ketamine in treatment-resistant major depressive disorder and suicidal ideation: a randomized clinical trial. BMC Psychiatry 2024; 24:341. [PMID: 38714931 PMCID: PMC11075291 DOI: 10.1186/s12888-024-05716-0] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is the most disabling and burdensome mental disorder, negatively affecting an individual's quality of life and daily functioning. the current study was conducted with the aim of investigating the clinical effects of intravenous ketamine on symptoms of MDD and suicidal ideation. METHODS The current randomized clinical trial was carried out on 64 patients diagnosed with treatment-resistant major depressive disorder between April and August 2022. The participants were randomly assigned to two groups: the intervention group received a dose of 0.5 mg/kg of ketamine, while the control group received normal saline. The Montgomery-Asberg Depression Scale and Beck's Suicidal Ideation Scale were utilized to assess depression and suicidal ideation, respectively. RESULTS One hour after the administration of ketamine treatment, there was a notable and significant improvement in both depression symptoms (35.16 ± 8.13 vs. 14.90 ± 10.09) and suicidal ideation (6.74 ± 6.67 vs. 0.42 ± 1.52). Moreover, there were statistically significant differences in depression scores between the two groups at one hour, four hours, one day, three days, one week, one month, and two months after the administration of ketamine (p-value < 0.001). However, ketamine recipients frequently experienced side effects such as increased heart rate, headache, dizziness, and dissociative syndrome symptoms. CONCLUSION The observed rapid onset of action and sustained effect demonstrate the potential of ketamine to provide relief from depressive symptoms in a shorter timeframe compared to traditional treatment approaches. These findings contribute to the growing body of evidence supporting the use of ketamine as a valuable therapeutic option for patients with treatment-resistant depression. IRCT REGISTRATION IRCT registration number: IRCT20210806052096N1; IRCT URL: https://www.irct.ir/trial/62243 ; Ethical code: IR.ZUMS.REC.1400.150; Registration date: 2022-04-09.
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Affiliation(s)
- Ahmad Zolghadriha
- Department of Psychiatry, Shahid Beheshti Hospital, Zanjan University of Medical Sciences, Zanjan, Iran.
| | - Afagh Anjomshoaa
- Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohammad Reza Jamshidi
- Department of Anesthesia, School of Medicine, Mousavi Hospital, Zanjan University of Medical Sciences, Iran, Zanjan
| | - Farnaz Taherkhani
- Department of Psychiatry, Shahid Beheshti Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
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Oemisch M, Seo H. Therapeutic doses of ketamine acutely attenuate the aversive effect of losses during decision-making. eLife 2024; 12:RP87529. [PMID: 38700991 PMCID: PMC11068354 DOI: 10.7554/elife.87529] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
The discovery of rapid-acting antidepressant, ketamine has opened a pathway to a new generation of treatments for depression, and inspired neuroscientific investigation based on a new perspective that non-adaptive changes in the intrinsic excitatory and inhibitory circuitry might underlie the pathophysiology of depression. Nevertheless, it still remains largely unknown how the hypothesized molecular and synaptic levels of changes in the circuitry might mediate behavioral and neuropsychological changes underlying depression, and how ketamine might restore adaptive behavior. Here, we used computational models to analyze behavioral changes induced by therapeutic doses of ketamine, while rhesus macaques were iteratively making decisions based on gains and losses of tokens. When administered intramuscularly or intranasally, ketamine reduced the aversiveness of undesirable outcomes such as losses of tokens without significantly affecting the evaluation of gains, behavioral perseveration, motivation, and other cognitive aspects of learning such as temporal credit assignment and time scales of choice and outcome memory. Ketamine's potentially antidepressant effect was separable from other side effects such as fixation errors, which unlike outcome evaluation, was readily countered with strong motivation to avoid errors. We discuss how the acute effect of ketamine to reduce the initial impact of negative events could potentially mediate longer-term antidepressant effects through mitigating the cumulative effect of those events produced by slowly decaying memory, and how the disruption-resistant affective memory might pose challenges in treating depression. Our study also invites future investigations on ketamine's antidepressant action over diverse mood states and with affective events exerting their impacts at diverse time scales.
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Affiliation(s)
- Mariann Oemisch
- Department of Neuroscience, Yale School of MedicineNew HavenUnited States
| | - Hyojung Seo
- Department of Psychiatry and Neuroscience, Yale School of MedicineNew HavenUnited States
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Majmasanaye M, Mehrpooya M, Amiri H, Eshraghi A. Discovering the Potential Value of Coenzyme Q10 as an Adjuvant Treatment in Patients With Depression. J Clin Psychopharmacol 2024; 44:232-239. [PMID: 38684047 DOI: 10.1097/jcp.0000000000001845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE/BACKGROUND Depressive disorder or mental cold is the most common mental disorder, and depression exists all over the world and in all countries and cultures. The results of several studies have shown that using compounds with antioxidant properties has been fruitful in patients with depression. Coenzyme Q10 (CoQ10) is a fat-soluble antioxidant and exerts its antioxidant effect by directly neutralizing free radicals or reducing tocopherol and preventing the inhibition of mitochondrial activity because of oxidative stress. This study aimed to investigate the effects of oral CoQ10 in patients with depression as an adjunctive treatment. METHODS/PROCEDURES Sixty-nine patients with moderate and severe depression were randomly divided into 2 CoQ10 groups (36) and placebo (33). The first group of patients received CoQ10 supplements at a dose of 200 mg daily for 8 weeks along with standard interventions and treatments for depression, and the second group received standard treatments for depression along with a placebo. The change in the score of Montgomery-Åsberg Depression Rating Scale depression scale was evaluated 4 and 8 weeks after the intervention. Also, at baseline and 8 weeks later at the end of the study, serum levels of total antioxidant capacity, total thiol groups, nitric oxide, malondialdehyde, and interleukin 6 were assessed. FINDINGS/RESULTS The changes in the depression score at the end of the study showed that, in the group receiving the CoQ10 supplement after 8 weeks, there was a reduction in depression symptoms, which was statistically significant compared with before the start of the study Meanwhile, no significant changes were observed in the patients of the placebo group in terms of symptom reduction. Compared with baseline and the placebo condition, serum levels of nitric oxide and total thiol groups significantly decreased and increased, respectively. Also, no statistically significant changes were observed for interleukin 6, malondialdehyde, and total antioxidant capacity. IMPLICATIONS/CONCLUSIONS A dose of 200 mg of CoQ10 supplement daily for 8 weeks can reduce depression and fatigue, as well as improve the quality of life of patients with depression. In addition, CoQ10 can significantly improve inflammation and oxidative stress status in patients with depression.
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Affiliation(s)
- Mahnam Majmasanaye
- From the School of Pharmacy, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Mehrpooya
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hasan Amiri
- Department of Emergency Medicine, School of Medicine, Emergency Medicine Management Research Center, Hazrate Rasoul General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Eshraghi
- Emergency Medicine Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Ali E, Latif F, Mashkoor Y, Sheikh A, Iqbal A, Owais R, Ahmed J, Naveed S, Moeed A, Ullah I, Mughal S. Role of adjunctive cariprazine for treatment-resistant depression in patients with major depressive disorder: A systematic review and meta-analysis of randomized controlled trials. Asian J Psychiatr 2024; 95:104005. [PMID: 38513509 DOI: 10.1016/j.ajp.2024.104005] [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: 11/12/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Cariprazine is an orally active dopamine D3-preferring D3/D2 receptor and serotonin 5-HT1A receptor partial agonist, being considered as a treatment for refractory MDD. Therefore, we aim to perform the first meta-analysis of current literature, to collate changes in depression from baseline and assess tolerability of adjunctive cariprazine in MDD populace. METHODS PubMed, Embase, Google Scholar, ClinicalTrials.Gov, and Cochrane Library were searched from inception till 1st September 2023. RCTs of adult patients with refractory MDD under adjunctive cariprazine vs. placebo were included. Primary outcomes included improvement in MADRS, CGI-S, and HAM-D 17 scores. Secondary outcomes included treatment-emergent adverse events. The statistical analysis was performed using generic inverse variance with random-effects model. The overall risk ratios (RR) were calculated for dichotomous outcomes. RESULTS A total of five RCTs were analysed, enrolling 2013 participants (cariprazine: 959 participants, Placebo: 1054). Supplementation of ADT with cariprazine demonstrated a significant improvement in MADRAS, CGI-S and HAMD-17 scores from baseline (LSMD: -1.88, 95% CI [-2.94, -0.83], p=0.0005), (LSMD: -0.18, 95% CI [-0.29, -0.07], p=0.002), and (LSMD: -0.96, 95% CI [-1.70, -0.21], p=0.01) respectively. Treatment with adjunctive cariprazine therapy demonstrated significantly increased incidence of akathisia, nausea, dizziness, fatigue, restlessness, somnolence, and tremors when compared with placebo. CONCLUSION Our meta-analysis provides evidence supporting the efficacy of adjunctive cariprazine in patients with refractory MDD. However, it is essential to consider the safety profile of cariprazine, particularly the increased risk of adverse events. The vigilant monitoring and management of these side effects should be integrated into clinical practice to minimize discontinuation rates and optimize patient outcomes.
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Affiliation(s)
- Eman Ali
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Fakhar Latif
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Yusra Mashkoor
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Ayesha Sheikh
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Amna Iqbal
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Rabia Owais
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Jawad Ahmed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Sadiq Naveed
- Psychiatry Program Director at Eastern Connecticut Health Network, CT, USA; Associate Professor of Psychiatry, University of Connecticut, CT, USA; Associate Professor of Psychiatry, Frank H. Netter School of Medicine at Quinnipiac University, CT, USA; Fellow, Infant, Parent Mental Health, University of Massachusetts, Boston, USA
| | - Abdul Moeed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | - Sanila Mughal
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
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Cuomo A, Barillà G, Cattolico M, Pardossi S, Mariantoni E, Koukouna D, Carmellini P, Fagiolini A. Perspectives on the impact of vortioxetine on the treatment armamentarium of major depressive disorder. Expert Rev Neurother 2024; 24:465-476. [PMID: 38536761 DOI: 10.1080/14737175.2024.2333394] [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] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/18/2024] [Indexed: 04/18/2024]
Abstract
INTRODUCTION Major Depressive Disorder (MDD) is a mental health issue that significantly affects patients' quality of life and functioning. Despite available treatments, many patients continue to suffer due to incomplete symptom resolution and side effects. AREAS COVERED This manuscript examines Vortioxetine's role in Major Depressive Disorder (MDD) treatment, highlighting its potential to reshape therapeutic strategies due to its unique Multimodal action and proven broad-spectrum efficacy in multiple depressive domains. A detailed examination of Vortioxetine's pharmacological aspects, including indications, dosage, pharmacodynamics, and pharmacokinetics, is provided, emphasizing its safety and effectiveness. The discussion extends to Vortioxetine's role in acute-phase treatment and maintenance of MDD and its profound impact on specialized depression domains. EXPERT OPINION Vortioxetine is distinguished for its novel multimodal serotonin modulation mechanism, showcasing significant promise as an innovative treatment for MDD. Its efficacy, which is dose-dependent, along with a commendable tolerability profile, positions it as a potential leading option for initial treatment strategies. The discourse on dosage titration, particularly the strategy of initiating treatment at lower doses followed by gradual escalation, underscores the approach toward minimizing initial adverse effects while optimizing therapeutic outcomes, aligning with the principles of personalized medicine in psychiatric care.
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Cavalcanti S, Lopez OA, Kung S, Vande Voort JL, Somers K, Frye MA, Singh B. A Case of Tachyphylaxis After Long-Term Intravenous Racemic Ketamine for Treatment-Resistant Depression. J Clin Psychopharmacol 2024; 44:313-314. [PMID: 38597410 DOI: 10.1097/jcp.0000000000001839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
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Klein AK, Austin EW, Cunningham MJ, Dvorak D, Gatti S, Hulls SK, Kiss L, Kruegel AC, Marek GJ, Papp M, Sporn J, Hughes ZA. GM-1020: a novel, orally bioavailable NMDA receptor antagonist with rapid and robust antidepressant-like effects at well-tolerated doses in rodents. Neuropsychopharmacology 2024; 49:905-914. [PMID: 38177696 PMCID: PMC11039472 DOI: 10.1038/s41386-023-01783-1] [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: 07/17/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
Abstract
The NMDA receptor (NMDAR) antagonist ketamine has shown great potential as a rapid-acting antidepressant; however, its use is limited by poor oral bioavailability and a side effect profile that necessitates in-clinic dosing. GM-1020 is a novel NMDAR antagonist that was developed to address these limitations of ketamine as a treatment for depression. Here, we present the preclinical characterization of GM-1020 alongside ketamine, for comparison. In vitro, we profiled GM-1020 for binding to NMDAR and functional inhibition using patch-clamp electrophysiology. In vivo, GM-1020 was assessed for antidepressant-like efficacy using the Forced Swim Test (FST) and Chronic Mild Stress (CMS), while motor side effects were assessed in spontaneous locomotor activity and on the rotarod. The pharmacokinetic properties of GM-1020 were profiled across multiple preclinical species. Electroencephalography (EEG) was performed to determine indirect target engagement and provide a potentially translational biomarker. These results demonstrate that GM-1020 is an orally bioavailable NMDAR antagonist with antidepressant-like efficacy at exposures that do not produce unwanted motor effects.
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Affiliation(s)
| | | | | | - Dino Dvorak
- Gilgamesh Pharmaceuticals, New York, NY, USA
| | | | | | - Laszlo Kiss
- Gilgamesh Pharmaceuticals, New York, NY, USA
| | | | | | - Mariusz Papp
- Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland
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Zhou Y, Lan X, Wang C, Zhang F, Liu H, Fu L, Li W, Ye Y, Hu Z, Chao Z, Ning Y. Effect of Repeated Intravenous Esketamine on Adolescents With Major Depressive Disorder and Suicidal Ideation: A Randomized Active-Placebo-Controlled Trial. J Am Acad Child Adolesc Psychiatry 2024; 63:507-518. [PMID: 37414272 DOI: 10.1016/j.jaac.2023.05.031] [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: 01/05/2023] [Revised: 05/05/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE Suicide is a major cause of death in adolescents with limited treatment options. Ketamine and its enantiomers have shown rapid anti-suicidal effects in adults with major depressive disorder (MDD), but their efficacy in adolescents is unknown. We conducted an active, placebo-controlled trial to determine the safety and efficacy of intravenous esketamine in this population. METHOD A total of 54 adolescents (aged 13-18 years) with MDD and suicidal ideation were included from an inpatient setting and randomly assigned (1:1) to receive 3 infusions of esketamine (0.25 mg/kg) or midazolam (0.02mg/kg) over 5 days, with routine inpatient care and treatment. Changes from baseline to 24 hours after the final infusion (day 6) in the scores of the Columbia Suicide Severity Rating Scale (C-SSRS) Ideation and Intensity (primary outcome) and the Montgomery-Åsberg Depression Rating Scale (MADRS, key secondary outcome) were analyzed using linear mixed models. In addition, the 4-week clinical treatment response was a key secondary outcome. RESULTS The mean changes in C-SSRS Ideation and Intensity scores from baseline to day 6 were significantly greater in the esketamine group than in the midazolam group (Ideation, -2.6 [SD = 2.0] vs -1.7 [SD = 2.2], p = .007; Intensity, -10.6 [SD = 8.4] vs -5.0 [SD = 7.4], p = .002), and the changes in MADRS scores from baseline to day 6 were significantly greater in the esketamine group than in the midazolam group (-15.3 [SD = 11.2] vs -8.8 [SD = 9.4], p = .004). The rates of antisuicidal and antidepressant responses at 4 weeks posttreatment were 69.2% and 61.5% after esketamine, and were 52.5% and 52.5% after midazolam, respectively. The most common adverse events in the esketamine group were nausea, dissociation, dry mouth, sedation, headache, and dizziness. CONCLUSION These preliminary findings indicate that 3-dose intravenous esketamine, added to routine inpatient care and treatment, was an effective and well-tolerated therapy for treating adolescents with MDD and suicidal ideation. CLINICAL TRIAL REGISTRATION INFORMATION A study to evaluate the efficacy and safety of Esketamine combined with oral antidepressants in the treatment of major depressive disorder with suicidal ideation; http://www.chictr.org.cn; ChiCTR2000041232. DIVERSITY & INCLUSION STATEMENT We worked to ensure that the study questionnaires were prepared in an inclusive way. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. We actively worked to promote sex and gender balance in our author group.
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Affiliation(s)
- Yanling Zhou
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaofeng Lan
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chengyu Wang
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fan Zhang
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haiyan Liu
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ling Fu
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weicheng Li
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanxiang Ye
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhibo Hu
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ziyuan Chao
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Saul H, Cassidy S, Swaithes L, Ford AC. Irritable bowel syndrome: low dose antidepressant improves symptoms. BMJ 2024; 385:q871. [PMID: 38692664 DOI: 10.1136/bmj.q871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
The studyFord AC, Wright-Hughes A, Alderson SL, et al. Amitriptyline at low-dose and titrated for irritable bowel syndrome as second-line treatment in primary care (ATLANTIS): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2023;402:1773-85.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/irritable-bowel-syndrome-low-dose-antidepressant-improves-symptoms/.
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Wang H, Te R, Zhang J, Su Y, Zhou H, Guo N, Chi D, Huang W. Effects of a single subanesthetic dose of esketamine on postoperative subthreshold depressive symptoms in patients undergoing unilateral modified radical mastectomy: a randomised, controlled, double-blind trial. BMC Psychiatry 2024; 24:315. [PMID: 38658886 PMCID: PMC11044398 DOI: 10.1186/s12888-024-05753-9] [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: 10/26/2023] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Breast cancer is the most common malignant tumor in females worldwide. During disease development, breast cancer patients suffer anxious and depressed, which may lead to worse quality of life or even higher mortality. Esketamine has been regarded as an antidepressant in breast cancer patients with mild or moderate depression. Here, we wonder whether the administration of esketamine could reduce the postoperative depressive symptom score of breast cancer patients who have no preoperative depression. METHODS A total of 64 patients treated with unilateral modified radical mastectomy were randomly divided into an experimental group (esketamine group, Group E) and a control group (Group C), with 32 cases in each one. After anesthesia induction, Group C received 0.2 ml/kg of normal saline intravenously and Group E was administered 0.2 mg/kg intravenous esketamine. The primary outcome was the Patient Health Questionnaire-9 (PHQ-9) scores. The secondary outcomes included the Visual Analogue Scale (VAS) scores for pain, inflammatory markers, perioperative-related indicators, and the incidence of postoperative delirium, nausea and vomiting. RESULTS The PHQ-9 score on postoperative day (POD) 1 in Group E declined from the preoperative level, while the score in Group C was higher than before, and the former was far lower than the latter (P = 0.047). There is no statistically significant difference in PHQ-9 scores between Group E and Group C on POD 3, 7, and 30. Moreover, the postoperative leukocyte level of Group E was higher than that of Group C, and the difference was statistically significant (P = 0.030). CONCLUSIONS A single subanesthetic dose of esketamine can result in lower postoperative score on subthreshold depressive symptoms compared to the Group C on POD 1, without increasing the occurrence of postoperative adverse reactions. TRIAL REGISTRATION Registration number: Chinese Clinical Trial Registry ChiCTR2200057028. Date of registration: 26/02/2022.
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Affiliation(s)
- Huanwei Wang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China
| | - Rigen Te
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China
| | - Jianxing Zhang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China
| | - Yanbing Su
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China
| | - Hongxia Zhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China
| | - Na Guo
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China.
| | - Dongmei Chi
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China.
| | - Wan Huang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China.
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Liu H, Wang C, Lan X, Li W, Zhang F, Hu Z, Ye Y, Ning Y, Zhou Y. Functional connectivity of the amygdala subregions and the antidepressant effects of repeated ketamine infusions in major depressive disorder. Eur Psychiatry 2024; 67:e33. [PMID: 38572583 PMCID: PMC11059247 DOI: 10.1192/j.eurpsy.2024.1744] [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: 11/04/2023] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Amygdala subregion-based network dysfunction has been determined to be centrally implicated in major depressive disorder (MDD). Little is known about whether ketamine modulates amygdala subarea-related networks. We aimed to investigate the relationships between changes in the resting-state functional connectivity (RSFC) of amygdala subregions and ketamine treatment and to identify important neuroimaging predictors of treatment outcomes. METHODS Thirty-nine MDD patients received six doses of ketamine (0.5 mg/kg). Depressive symptoms were assessed, and magnetic resonance imaging (MRI) scans were performed before and after treatment. Forty-five healthy controls underwent one MRI scan. Seed-to-voxel RSFC analyses were performed on the amygdala subregions, including the centromedial amygdala (CMA), laterobasal amygdala (LBA), and superficial amygdala subregions. RESULTS Abnormal RSFC between the left LBA and the left precuneus in MDD patients is related to the therapeutic efficacy of ketamine. There were significant differences in changes in bilateral CMA RSFC with the left orbital part superior frontal gyrus and in changes in the left LBA with the right middle frontal gyrus between responders and nonresponders following ketamine treatment. Moreover, there was a difference in the RSFC of left LBA and the right superior temporal gyrus/middle temporal gyrus (STG/MTG) between responders and nonresponders at baseline, which could predict the antidepressant effect of ketamine on Day 13. CONCLUSIONS The mechanism by which ketamine improves depressive symptoms may be related to its regulation of RSFC in the amygdala subregion. The RSFC between the left LBA and right STG/MTG may predict the response to the antidepressant effect of ketamine.
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Affiliation(s)
- Haiyan Liu
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Chengyu Wang
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Xiaofeng Lan
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Weicheng Li
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
- Department of Psychology, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Fan Zhang
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
- Department of Psychology, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhibo Hu
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yanxiang Ye
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yuping Ning
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
- Department of Psychology, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yanling Zhou
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
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Sajid S, Galfalvy HC, Keilp JG, Burke AK, Mann JJ, Grunebaum MF. Acute Dissociation and Ketamine's Antidepressant and Anti-Suicidal Ideation Effects in a Midazolam-Controlled Trial. Int J Neuropsychopharmacol 2024; 27:pyae017. [PMID: 38573154 PMCID: PMC11053360 DOI: 10.1093/ijnp/pyae017] [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: 01/02/2024] [Accepted: 04/03/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE We sought to explore relationships of acute dissociative effects of intravenous ketamine with change in depression and suicidal ideation and with plasma metabolite levels in a randomized, midazolam-controlled trial. METHODS Data from a completed trial in suicidal, depressed participants (n = 40) randomly assigned to ketamine was used to examine relationships between ketamine treatment-emergent dissociative and psychotomimetic symptoms with pre/post-infusion changes in suicidal ideation and depression severity. Nonparametric correlational statistics were used. These methods were also used to explore associations between dissociative or psychotomimetic symptoms and blood levels of ketamine and metabolites in a subset of participants (n = 28) who provided blood samples immediately post-infusion. RESULTS Neither acute dissociative nor psychotomimetic effects of ketamine were associated with changes in suicidal ideation or depressive symptoms from pre- to post-infusion. Norketamine had a trend-level, moderate inverse correlation with dissociative symptoms on Day 1 post-injection (P = .064; P =.013 removing 1 outlier). Dehydronorketamine correlated with Clinician-Administered Dissociative States Scale scores at 40 minutes (P = .034), 230 minutes (P = .014), and Day 1 (P = .012). CONCLUSION We did not find evidence that ketamine's acute, transient dissociative, or psychotomimetic effects are associated with its antidepressant or anti-suicidal ideation actions. The correlation of higher plasma norketamine with lower dissociative symptoms on Day 1 post-treatment suggests dissociation may be more an effect of the parent drug.
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Affiliation(s)
- Sumra Sajid
- New York State Psychiatric Institute, New York, New York, USA
| | - Hanga C Galfalvy
- Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York, USA
| | - John G Keilp
- Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York, USA
| | - Ainsley K Burke
- Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York, USA
| | - J John Mann
- Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York, USA
| | - Michael F Grunebaum
- Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York, USA
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Kotzalidis GD, Fiaschè F, Alcibiade A, Monti L, Di Segni F, Mazza M, Sani G. New pharmacotherapies to tackle the unmet needs in bipolar disorder: a focus on acute suicidality. Expert Opin Pharmacother 2024; 25:435-446. [PMID: 38517222 DOI: 10.1080/14656566.2024.2334425] [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] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/20/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Suicidal behavior is relatively frequent in patients with bipolar disorder (BD) and constitutes their most frequent cause of death. Suicide rates remain high in patients with BD despite adherence to guidelines recommending lithium as first line, and/or antidepressants, antipsychotics, psychotherapy, psychosocial interventions, and electroconvulsive therapy. Hence the need to identify more effective and rapid anti-suicide interventions. AREAS COVERED To tackle the unmet needs of pharmacotherapy, we investigated the PubMed database on 24-25 January 2024 using strategies like ('acute suicid*'[ti] OR 'suicide crisis syndrome' OR 'acute suicidal affective disturbance') AND (lithium[ti] OR clozapine[ti]), which obtained 3 results, and ('acute suicid*'[ti] OR 'suicide crisis syndrome' OR 'acute suicidal affective disturbance') AND (ketamine[ti] OR esketamine[ti] OR NMDA[ti] OR glutamat*[ti]), which yielded 14 results. We explored glutamatergic abnormalities in BD and suicide and found alterations in both. The noncompetitive NMDS antagonist ketamine and its S-enantiomer esketamine reportedly decrease acute suicidality. EXPERT OPINION Intranasal esketamine or subcutaneous ketamine, single-bolus or intravenous, and possibly other glutamate receptor modulators may improve suicidal behavior in patients with unipolar and bipolar depression. This may be achieved through prompt remodulation of glutamate activity. The correct use of glutamatergic modulators could reduce acute suicidality and mortality in patients with BD.
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Affiliation(s)
- Georgios D Kotzalidis
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federica Fiaschè
- ASL RM1, Presidio Ospedaliero San Filippo Neri, Servizio Psichiatrico di Diagnosi e Cura, Rome, Italy
| | - Alessandro Alcibiade
- Marina Militare Italiana (Italian Navy), Defense Ministry of Italy, Rome, Italy
- Psychiatry Residency Training Programme, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Laura Monti
- UOS Clinical Psychology, Clinical Government, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federica Di Segni
- Psychiatry Residency Training Programme, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Marianna Mazza
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
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Olgiati P, Pecorino B, Serretti A. Suicide ideation and male-female differences in major depressive disorder. Int J Psychiatry Clin Pract 2024; 28:53-62. [PMID: 38587055 DOI: 10.1080/13651501.2024.2335950] [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: 05/16/2023] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE This study aimed to explore male-female differences in suicide ideation (SI) and suicide risk factors in major depressive disorder (MDD). METHODS We analysed 482 adults (sample 1) and 438 elderly outpatients (sample 2) with MDD. Sample 1 was treated with different antidepressant combinations (escitalopram; bupropion plus escitalopram; venlafaxine plus mirtazapine) and assessed by means of the Concise Health Risk Tracking (SI), Quick Inventory of Depressive Symptomatology, Altman Mania Rating Scale and Psychiatric Diagnostic Screening Questionnaire. Sample 2 was treated with venlafaxine and assessed using the Hamilton scale for depression, Anxiety Sensitivity Index and Penn State Worry Questionnaire for anxiety, Beck Scale for Suicide Ideation and Repeatable Battery for the Assessment of Neuropsychological Status. RESULTS In sample 1, females had greater depression severity (O.R 0.961 99%CI: 0.929 - 0.995), males reported more alcohol abuse (O.R 1.299 99%CI: 1.118 - 1.509) and active SI (O.R 1.109 99%CI: 1.005 - 1.255). In sample 2 men showed more severe SI (O.R 1.067; 99%CI: 1.014 - 1.122) and weight loss (OR = 5.89 99%CI: 1.01 - 34.19), women more gastrointestinal symptoms. CONCLUSIONS In these selected samples, although women had more severe depression, men had more suicide risk factors. Such differences might contribute to men's increased suicide risk.
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Affiliation(s)
- Paolo Olgiati
- Department of Sciences of Public Health and Paediatrics, University of Turin, Turin, Italy
- Mental Health Department, Azienda Sanitaria Locale TO4, Turin, Italy
| | - Basilio Pecorino
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, Kore University of Enna, Enna, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Department of Medicine and Surgery, Kore University of Enna, Enna, Italy
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Arockiaraj N, Gupta R, Ahmad R, Halder S, Bhatia MS. Sertraline with desvenlafaxine and sertraline with mirtazapine as treatment initiation in MDD patients with moderate to severe depression and effect on inflammatory markers. Int J Psychiatry Clin Pract 2024; 28:9-16. [PMID: 38019131 DOI: 10.1080/13651501.2023.2287754] [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: 04/17/2023] [Accepted: 09/11/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND This study evaluated the effect of sertraline with desvenlafaxine and sertraline with mirtazapine on HAM-D score and inflammatory markers (IL-6 and TNF-α levels) in major depressive disorder. METHODS Patients (18-60 years) with MDD diagnosed by DSM-V criteria and HAM-D score 18 or more were included (n = 60). Group A patients (n = 30) received sertraline 50 mg/day and desvenlafaxine 50 mg/day. Group B patients (n = 30) received sertraline 50 mg/day and mirtazapine 30 mg/day. All patients were followed up for 8 weeks for the evaluation of clinical efficacy, safety, serum IL-6, and TNF-α levels. RESULTS Our study showed a comparatively similar and statistically significant (p < 0.05) reduction in HAM-D score in both groups in the 4th and 8th week of the treatment. Both drug combinations significantly (p < 0.05) decreased serum IL-6 and TNF-α after 8 weeks of treatment. CONCLUSION The present study suggests that the combination therapy (as treatment initiation) with sertraline and desvenlafaxine, and sertraline with mirtazapine is effective and well tolerated in MDD patients with moderate to severe depression, and their therapeutic efficacy is accompanied by decreased inflammatory markers (serum IL-6 and TNF-α).
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Affiliation(s)
- Norman Arockiaraj
- Department of Pharmacology, University College of Medical Sciences (University of Delhi) and Guru Teg Bahadur Hospital, New Delhi, India
| | - Rachna Gupta
- Department of Pharmacology, University College of Medical Sciences (University of Delhi) and Guru Teg Bahadur Hospital, New Delhi, India
| | - Rafat Ahmad
- Department of Biochemistry, University College of Medical Sciences (University of Delhi) and Guru Teg Bahadur Hospital, New Delhi, India
| | - Sumita Halder
- Department of Pharmacology, University College of Medical Sciences (University of Delhi) and Guru Teg Bahadur Hospital, New Delhi, India
| | - M S Bhatia
- Department of Psychiatry, University College of Medical Sciences (University of Delhi) and Guru Teg Bahadur Hospital, New Delhi, India
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Reif A, Bitter I, Buyze J, Cebulla K, Frey R, Fu DJ, Ito T, Kambarov Y, Llorca PM, Oliveira-Maia AJ, Messer T, Mulhern-Haughey S, Rive B, von Holt C, Young AH, Godinov Y. Esketamine Nasal Spray versus Quetiapine for Treatment-Resistant Depression. N Engl J Med 2023; 389:1298-1309. [PMID: 37792613 DOI: 10.1056/nejmoa2304145] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND In treatment-resistant depression, commonly defined as a lack of response to two or more consecutive treatments during the current depressive episode, the percentage of patients with remission is low and the percentage with relapse is high. The efficacy and safety of esketamine nasal spray as compared with extended-release quetiapine augmentation therapy, both in combination with ongoing treatment with a selective serotonin reuptake inhibitor (SSRI) or a serotonin-norepinephrine reuptake inhibitor (SNRI), in patients with treatment-resistant depression are unknown. METHODS In an open-label, single-blind (with raters unaware of group assignments), multicenter, phase 3b, randomized, active-controlled trial, we assigned patients, in a 1:1 ratio, to receive flexible doses (according to the summary of product characteristics) of esketamine nasal spray (esketamine group) or extended-release quetiapine (quetiapine group), both in combination with an SSRI or SNRI. The primary end point was remission, defined as a score of 10 or less on the Montgomery-Åsberg Depression Rating Scale (MADRS), at week 8 (scores range from 0 to 60, with higher scores indicating more severe depression). The key secondary end point was no relapse through week 32 after remission at week 8. All patients were included in the analysis; patients who discontinued the trial treatment were considered as having had an unfavorable outcome (i.e., they were grouped with patients who did not have remission or who had a relapse). Analyses of the primary and key secondary end points were adjusted for age and number of treatment failures. RESULTS Overall, 336 patients were assigned to the esketamine group and 340 to the quetiapine group. More patients in the esketamine group than in the quetiapine group had remission at week 8 (91 of 336 patients [27.1%] vs. 60 of 340 patients [17.6%]; P = 0.003) and had no relapse through week 32 after remission at week 8 (73 of 336 patients [21.7%] vs. 48 of 340 patients [14.1%]). Over 32 weeks of follow-up, the percentage of patients with remission, the percentage of patients with a treatment response, and the change in the MADRS score from baseline favored esketamine nasal spray. The adverse events were consistent with the established safety profiles of the trial treatments. CONCLUSIONS In patients with treatment-resistant depression, esketamine nasal spray plus an SSRI or SNRI was superior to extended-release quetiapine plus an SSRI or SNRI with respect to remission at week 8. (Funded by Janssen EMEA; ESCAPE-TRD ClinicalTrials.gov number, NCT04338321.).
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Affiliation(s)
- Andreas Reif
- From the Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital, Goethe University Frankfurt, and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt (A.R.), Danuvius Klinik, Technische Universität München, Pfaffenhofen an der Ilm (T.M.), and Janssen Germany (K.C.) and Janssen EMEA (C.H.), Neuss - all in Germany; the Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary (I.B.); Janssen Pharmaceutica (J.B.) and Janssen EMEA (Y.K.) - both in Beerse, Belgium; the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna (R.F.); Janssen Research and Development, New Jersey (D.-J.F.); Janssen EMEA, High Wycombe (T.I.), the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham (A.H.Y.) - all in the United Kingdom; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal, Clermont-Ferrand (P.-M.L.), and Janssen EMEA, Paris (B.R.) - both in France; Champalimaud Research and Clinical Center, Champalimaud Foundation, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa - both in Lisbon, Portugal (A.J.O.-M.); Janssen EMEA, Dublin (S.M.-H.); and Janssen EMEA, Sofia, Bulgaria (Y.G.)
| | - Istvan Bitter
- From the Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital, Goethe University Frankfurt, and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt (A.R.), Danuvius Klinik, Technische Universität München, Pfaffenhofen an der Ilm (T.M.), and Janssen Germany (K.C.) and Janssen EMEA (C.H.), Neuss - all in Germany; the Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary (I.B.); Janssen Pharmaceutica (J.B.) and Janssen EMEA (Y.K.) - both in Beerse, Belgium; the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna (R.F.); Janssen Research and Development, New Jersey (D.-J.F.); Janssen EMEA, High Wycombe (T.I.), the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham (A.H.Y.) - all in the United Kingdom; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal, Clermont-Ferrand (P.-M.L.), and Janssen EMEA, Paris (B.R.) - both in France; Champalimaud Research and Clinical Center, Champalimaud Foundation, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa - both in Lisbon, Portugal (A.J.O.-M.); Janssen EMEA, Dublin (S.M.-H.); and Janssen EMEA, Sofia, Bulgaria (Y.G.)
| | - Jozefien Buyze
- From the Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital, Goethe University Frankfurt, and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt (A.R.), Danuvius Klinik, Technische Universität München, Pfaffenhofen an der Ilm (T.M.), and Janssen Germany (K.C.) and Janssen EMEA (C.H.), Neuss - all in Germany; the Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary (I.B.); Janssen Pharmaceutica (J.B.) and Janssen EMEA (Y.K.) - both in Beerse, Belgium; the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna (R.F.); Janssen Research and Development, New Jersey (D.-J.F.); Janssen EMEA, High Wycombe (T.I.), the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham (A.H.Y.) - all in the United Kingdom; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal, Clermont-Ferrand (P.-M.L.), and Janssen EMEA, Paris (B.R.) - both in France; Champalimaud Research and Clinical Center, Champalimaud Foundation, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa - both in Lisbon, Portugal (A.J.O.-M.); Janssen EMEA, Dublin (S.M.-H.); and Janssen EMEA, Sofia, Bulgaria (Y.G.)
| | - Kerstin Cebulla
- From the Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital, Goethe University Frankfurt, and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt (A.R.), Danuvius Klinik, Technische Universität München, Pfaffenhofen an der Ilm (T.M.), and Janssen Germany (K.C.) and Janssen EMEA (C.H.), Neuss - all in Germany; the Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary (I.B.); Janssen Pharmaceutica (J.B.) and Janssen EMEA (Y.K.) - both in Beerse, Belgium; the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna (R.F.); Janssen Research and Development, New Jersey (D.-J.F.); Janssen EMEA, High Wycombe (T.I.), the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham (A.H.Y.) - all in the United Kingdom; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal, Clermont-Ferrand (P.-M.L.), and Janssen EMEA, Paris (B.R.) - both in France; Champalimaud Research and Clinical Center, Champalimaud Foundation, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa - both in Lisbon, Portugal (A.J.O.-M.); Janssen EMEA, Dublin (S.M.-H.); and Janssen EMEA, Sofia, Bulgaria (Y.G.)
| | - Richard Frey
- From the Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital, Goethe University Frankfurt, and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt (A.R.), Danuvius Klinik, Technische Universität München, Pfaffenhofen an der Ilm (T.M.), and Janssen Germany (K.C.) and Janssen EMEA (C.H.), Neuss - all in Germany; the Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary (I.B.); Janssen Pharmaceutica (J.B.) and Janssen EMEA (Y.K.) - both in Beerse, Belgium; the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna (R.F.); Janssen Research and Development, New Jersey (D.-J.F.); Janssen EMEA, High Wycombe (T.I.), the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham (A.H.Y.) - all in the United Kingdom; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal, Clermont-Ferrand (P.-M.L.), and Janssen EMEA, Paris (B.R.) - both in France; Champalimaud Research and Clinical Center, Champalimaud Foundation, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa - both in Lisbon, Portugal (A.J.O.-M.); Janssen EMEA, Dublin (S.M.-H.); and Janssen EMEA, Sofia, Bulgaria (Y.G.)
| | - Dong-Jing Fu
- From the Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital, Goethe University Frankfurt, and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt (A.R.), Danuvius Klinik, Technische Universität München, Pfaffenhofen an der Ilm (T.M.), and Janssen Germany (K.C.) and Janssen EMEA (C.H.), Neuss - all in Germany; the Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary (I.B.); Janssen Pharmaceutica (J.B.) and Janssen EMEA (Y.K.) - both in Beerse, Belgium; the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna (R.F.); Janssen Research and Development, New Jersey (D.-J.F.); Janssen EMEA, High Wycombe (T.I.), the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham (A.H.Y.) - all in the United Kingdom; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal, Clermont-Ferrand (P.-M.L.), and Janssen EMEA, Paris (B.R.) - both in France; Champalimaud Research and Clinical Center, Champalimaud Foundation, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa - both in Lisbon, Portugal (A.J.O.-M.); Janssen EMEA, Dublin (S.M.-H.); and Janssen EMEA, Sofia, Bulgaria (Y.G.)
| | - Tetsuro Ito
- From the Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital, Goethe University Frankfurt, and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt (A.R.), Danuvius Klinik, Technische Universität München, Pfaffenhofen an der Ilm (T.M.), and Janssen Germany (K.C.) and Janssen EMEA (C.H.), Neuss - all in Germany; the Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary (I.B.); Janssen Pharmaceutica (J.B.) and Janssen EMEA (Y.K.) - both in Beerse, Belgium; the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna (R.F.); Janssen Research and Development, New Jersey (D.-J.F.); Janssen EMEA, High Wycombe (T.I.), the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham (A.H.Y.) - all in the United Kingdom; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal, Clermont-Ferrand (P.-M.L.), and Janssen EMEA, Paris (B.R.) - both in France; Champalimaud Research and Clinical Center, Champalimaud Foundation, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa - both in Lisbon, Portugal (A.J.O.-M.); Janssen EMEA, Dublin (S.M.-H.); and Janssen EMEA, Sofia, Bulgaria (Y.G.)
| | - Yerkebulan Kambarov
- From the Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital, Goethe University Frankfurt, and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt (A.R.), Danuvius Klinik, Technische Universität München, Pfaffenhofen an der Ilm (T.M.), and Janssen Germany (K.C.) and Janssen EMEA (C.H.), Neuss - all in Germany; the Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary (I.B.); Janssen Pharmaceutica (J.B.) and Janssen EMEA (Y.K.) - both in Beerse, Belgium; the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna (R.F.); Janssen Research and Development, New Jersey (D.-J.F.); Janssen EMEA, High Wycombe (T.I.), the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham (A.H.Y.) - all in the United Kingdom; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal, Clermont-Ferrand (P.-M.L.), and Janssen EMEA, Paris (B.R.) - both in France; Champalimaud Research and Clinical Center, Champalimaud Foundation, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa - both in Lisbon, Portugal (A.J.O.-M.); Janssen EMEA, Dublin (S.M.-H.); and Janssen EMEA, Sofia, Bulgaria (Y.G.)
| | - Pierre-Michel Llorca
- From the Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital, Goethe University Frankfurt, and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt (A.R.), Danuvius Klinik, Technische Universität München, Pfaffenhofen an der Ilm (T.M.), and Janssen Germany (K.C.) and Janssen EMEA (C.H.), Neuss - all in Germany; the Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary (I.B.); Janssen Pharmaceutica (J.B.) and Janssen EMEA (Y.K.) - both in Beerse, Belgium; the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna (R.F.); Janssen Research and Development, New Jersey (D.-J.F.); Janssen EMEA, High Wycombe (T.I.), the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham (A.H.Y.) - all in the United Kingdom; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal, Clermont-Ferrand (P.-M.L.), and Janssen EMEA, Paris (B.R.) - both in France; Champalimaud Research and Clinical Center, Champalimaud Foundation, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa - both in Lisbon, Portugal (A.J.O.-M.); Janssen EMEA, Dublin (S.M.-H.); and Janssen EMEA, Sofia, Bulgaria (Y.G.)
| | - Albino J Oliveira-Maia
- From the Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital, Goethe University Frankfurt, and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt (A.R.), Danuvius Klinik, Technische Universität München, Pfaffenhofen an der Ilm (T.M.), and Janssen Germany (K.C.) and Janssen EMEA (C.H.), Neuss - all in Germany; the Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary (I.B.); Janssen Pharmaceutica (J.B.) and Janssen EMEA (Y.K.) - both in Beerse, Belgium; the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna (R.F.); Janssen Research and Development, New Jersey (D.-J.F.); Janssen EMEA, High Wycombe (T.I.), the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham (A.H.Y.) - all in the United Kingdom; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal, Clermont-Ferrand (P.-M.L.), and Janssen EMEA, Paris (B.R.) - both in France; Champalimaud Research and Clinical Center, Champalimaud Foundation, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa - both in Lisbon, Portugal (A.J.O.-M.); Janssen EMEA, Dublin (S.M.-H.); and Janssen EMEA, Sofia, Bulgaria (Y.G.)
| | - Thomas Messer
- From the Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital, Goethe University Frankfurt, and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt (A.R.), Danuvius Klinik, Technische Universität München, Pfaffenhofen an der Ilm (T.M.), and Janssen Germany (K.C.) and Janssen EMEA (C.H.), Neuss - all in Germany; the Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary (I.B.); Janssen Pharmaceutica (J.B.) and Janssen EMEA (Y.K.) - both in Beerse, Belgium; the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna (R.F.); Janssen Research and Development, New Jersey (D.-J.F.); Janssen EMEA, High Wycombe (T.I.), the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham (A.H.Y.) - all in the United Kingdom; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal, Clermont-Ferrand (P.-M.L.), and Janssen EMEA, Paris (B.R.) - both in France; Champalimaud Research and Clinical Center, Champalimaud Foundation, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa - both in Lisbon, Portugal (A.J.O.-M.); Janssen EMEA, Dublin (S.M.-H.); and Janssen EMEA, Sofia, Bulgaria (Y.G.)
| | - Siobhán Mulhern-Haughey
- From the Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital, Goethe University Frankfurt, and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt (A.R.), Danuvius Klinik, Technische Universität München, Pfaffenhofen an der Ilm (T.M.), and Janssen Germany (K.C.) and Janssen EMEA (C.H.), Neuss - all in Germany; the Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary (I.B.); Janssen Pharmaceutica (J.B.) and Janssen EMEA (Y.K.) - both in Beerse, Belgium; the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna (R.F.); Janssen Research and Development, New Jersey (D.-J.F.); Janssen EMEA, High Wycombe (T.I.), the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham (A.H.Y.) - all in the United Kingdom; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal, Clermont-Ferrand (P.-M.L.), and Janssen EMEA, Paris (B.R.) - both in France; Champalimaud Research and Clinical Center, Champalimaud Foundation, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa - both in Lisbon, Portugal (A.J.O.-M.); Janssen EMEA, Dublin (S.M.-H.); and Janssen EMEA, Sofia, Bulgaria (Y.G.)
| | - Benoît Rive
- From the Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital, Goethe University Frankfurt, and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt (A.R.), Danuvius Klinik, Technische Universität München, Pfaffenhofen an der Ilm (T.M.), and Janssen Germany (K.C.) and Janssen EMEA (C.H.), Neuss - all in Germany; the Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary (I.B.); Janssen Pharmaceutica (J.B.) and Janssen EMEA (Y.K.) - both in Beerse, Belgium; the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna (R.F.); Janssen Research and Development, New Jersey (D.-J.F.); Janssen EMEA, High Wycombe (T.I.), the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham (A.H.Y.) - all in the United Kingdom; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal, Clermont-Ferrand (P.-M.L.), and Janssen EMEA, Paris (B.R.) - both in France; Champalimaud Research and Clinical Center, Champalimaud Foundation, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa - both in Lisbon, Portugal (A.J.O.-M.); Janssen EMEA, Dublin (S.M.-H.); and Janssen EMEA, Sofia, Bulgaria (Y.G.)
| | - Christian von Holt
- From the Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital, Goethe University Frankfurt, and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt (A.R.), Danuvius Klinik, Technische Universität München, Pfaffenhofen an der Ilm (T.M.), and Janssen Germany (K.C.) and Janssen EMEA (C.H.), Neuss - all in Germany; the Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary (I.B.); Janssen Pharmaceutica (J.B.) and Janssen EMEA (Y.K.) - both in Beerse, Belgium; the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna (R.F.); Janssen Research and Development, New Jersey (D.-J.F.); Janssen EMEA, High Wycombe (T.I.), the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham (A.H.Y.) - all in the United Kingdom; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal, Clermont-Ferrand (P.-M.L.), and Janssen EMEA, Paris (B.R.) - both in France; Champalimaud Research and Clinical Center, Champalimaud Foundation, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa - both in Lisbon, Portugal (A.J.O.-M.); Janssen EMEA, Dublin (S.M.-H.); and Janssen EMEA, Sofia, Bulgaria (Y.G.)
| | - Allan H Young
- From the Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital, Goethe University Frankfurt, and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt (A.R.), Danuvius Klinik, Technische Universität München, Pfaffenhofen an der Ilm (T.M.), and Janssen Germany (K.C.) and Janssen EMEA (C.H.), Neuss - all in Germany; the Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary (I.B.); Janssen Pharmaceutica (J.B.) and Janssen EMEA (Y.K.) - both in Beerse, Belgium; the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna (R.F.); Janssen Research and Development, New Jersey (D.-J.F.); Janssen EMEA, High Wycombe (T.I.), the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham (A.H.Y.) - all in the United Kingdom; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal, Clermont-Ferrand (P.-M.L.), and Janssen EMEA, Paris (B.R.) - both in France; Champalimaud Research and Clinical Center, Champalimaud Foundation, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa - both in Lisbon, Portugal (A.J.O.-M.); Janssen EMEA, Dublin (S.M.-H.); and Janssen EMEA, Sofia, Bulgaria (Y.G.)
| | - Yordan Godinov
- From the Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital, Goethe University Frankfurt, and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt (A.R.), Danuvius Klinik, Technische Universität München, Pfaffenhofen an der Ilm (T.M.), and Janssen Germany (K.C.) and Janssen EMEA (C.H.), Neuss - all in Germany; the Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary (I.B.); Janssen Pharmaceutica (J.B.) and Janssen EMEA (Y.K.) - both in Beerse, Belgium; the Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna (R.F.); Janssen Research and Development, New Jersey (D.-J.F.); Janssen EMEA, High Wycombe (T.I.), the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham (A.H.Y.) - all in the United Kingdom; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal, Clermont-Ferrand (P.-M.L.), and Janssen EMEA, Paris (B.R.) - both in France; Champalimaud Research and Clinical Center, Champalimaud Foundation, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa - both in Lisbon, Portugal (A.J.O.-M.); Janssen EMEA, Dublin (S.M.-H.); and Janssen EMEA, Sofia, Bulgaria (Y.G.)
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Ma S, Chen M, Jiang Y, Xiang X, Wang S, Wu Z, Li S, Cui Y, Wang J, Zhu Y, Zhang Y, Ma H, Duan S, Li H, Yang Y, Lingle CJ, Hu H. Sustained antidepressant effect of ketamine through NMDAR trapping in the LHb. Nature 2023; 622:802-809. [PMID: 37853123 PMCID: PMC10600008 DOI: 10.1038/s41586-023-06624-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/08/2023] [Indexed: 10/20/2023]
Abstract
Ketamine, an N-methyl-D-aspartate receptor (NMDAR) antagonist1, has revolutionized the treatment of depression because of its potent, rapid and sustained antidepressant effects2-4. Although the elimination half-life of ketamine is only 13 min in mice5, its antidepressant activities can last for at least 24 h6-9. This large discrepancy poses an interesting basic biological question and has strong clinical implications. Here we demonstrate that after a single systemic injection, ketamine continues to suppress burst firing and block NMDARs in the lateral habenula (LHb) for up to 24 h. This long inhibition of NMDARs is not due to endocytosis but depends on the use-dependent trapping of ketamine in NMDARs. The rate of untrapping is regulated by neural activity. Harnessing the dynamic equilibrium of ketamine-NMDAR interactions by activating the LHb and opening local NMDARs at different plasma ketamine concentrations, we were able to either shorten or prolong the antidepressant effects of ketamine in vivo. These results provide new insights into the causal mechanisms of the sustained antidepressant effects of ketamine. The ability to modulate the duration of ketamine action based on the biophysical properties of ketamine-NMDAR interactions opens up new opportunities for the therapeutic use of ketamine.
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Affiliation(s)
- Shuangshuang Ma
- Department of Psychiatry and International Institutes of Medicine, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University, Hangzhou, China
| | - Min Chen
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University, Hangzhou, China
- Department of Affiliated Mental Health Center and Hangzhou Seventh People's Hospital and School of Brain Science and Brain Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Yihao Jiang
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University, Hangzhou, China
- Department of Affiliated Mental Health Center and Hangzhou Seventh People's Hospital and School of Brain Science and Brain Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinkuan Xiang
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University, Hangzhou, China
| | - Shiqi Wang
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University, Hangzhou, China
| | - Zuohang Wu
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University, Hangzhou, China
| | - Shuo Li
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University, Hangzhou, China
| | - Yihui Cui
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University, Hangzhou, China
| | - Junying Wang
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University, Hangzhou, China
| | - Yanqing Zhu
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University, Hangzhou, China
| | - Yan Zhang
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University, Hangzhou, China
| | - Huan Ma
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University, Hangzhou, China
| | - Shumin Duan
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University, Hangzhou, China
| | - Haohong Li
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University, Hangzhou, China
| | - Yan Yang
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University, Hangzhou, China
- Department of Affiliated Mental Health Center and Hangzhou Seventh People's Hospital and School of Brain Science and Brain Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Christopher J Lingle
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
| | - Hailan Hu
- Department of Psychiatry and International Institutes of Medicine, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China.
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University, Hangzhou, China.
- Department of Affiliated Mental Health Center and Hangzhou Seventh People's Hospital and School of Brain Science and Brain Medicine, Zhejiang University School of Medicine, Hangzhou, China.
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Rubin R. A Fast-Acting Pill Received Approval for Postpartum Depression-Is It a Game Changer? JAMA 2023; 330:902-904. [PMID: 37610758 DOI: 10.1001/jama.2023.16499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
This Medical News article discusses zuranolone, the first pill approved for postpartum depression.
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Anand A, Mathew SJ, Sanacora G, Murrough JW, Goes FS, Altinay M, Aloysi AS, Asghar-Ali AA, Barnett BS, Chang LC, Collins KA, Costi S, Iqbal S, Jha MK, Krishnan K, Malone DA, Nikayin S, Nissen SE, Ostroff RB, Reti IM, Wilkinson ST, Wolski K, Hu B. Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression. N Engl J Med 2023; 388:2315-2325. [PMID: 37224232 DOI: 10.1056/nejmoa2302399] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) and subanesthetic intravenous ketamine are both currently used for treatment-resistant major depression, but the comparative effectiveness of the two treatments remains uncertain. METHODS We conducted an open-label, randomized, noninferiority trial involving patients referred to ECT clinics for treatment-resistant major depression. Patients with treatment-resistant major depression without psychosis were recruited and assigned in a 1:1 ratio to receive ketamine or ECT. During an initial 3-week treatment phase, patients received either ECT three times per week or ketamine (0.5 mg per kilogram of body weight over 40 minutes) twice per week. The primary outcome was a response to treatment (i.e., a decrease of ≥50% from baseline in the score on the 16-item Quick Inventory of Depressive Symptomatology-Self-Report; scores range from 0 to 27, with higher scores indicating greater depression). The noninferiority margin was -10 percentage points. Secondary outcomes included scores on memory tests and patient-reported quality of life. After the initial treatment phase, the patients who had a response were followed over a 6-month period. RESULTS A total of 403 patients underwent randomization at five clinical sites; 200 patients were assigned to the ketamine group and 203 to the ECT group. After 38 patients had withdrawn before initiation of the assigned treatment, ketamine was administered to 195 patients and ECT to 170 patients. A total of 55.4% of the patients in the ketamine group and 41.2% of those in the ECT group had a response (difference, 14.2 percentage points; 95% confidence interval, 3.9 to 24.2; P<0.001 for the noninferiority of ketamine to ECT). ECT appeared to be associated with a decrease in memory recall after 3 weeks of treatment (mean [±SE] decrease in the T-score for delayed recall on the Hopkins Verbal Learning Test-Revised, -0.9±1.1 in the ketamine group vs. -9.7±1.2 in the ECT group; scores range from -300 to 200, with higher scores indicating better function) with gradual recovery during follow-up. Improvement in patient-reported quality-of-life was similar in the two trial groups. ECT was associated with musculoskeletal adverse effects, whereas ketamine was associated with dissociation. CONCLUSIONS Ketamine was noninferior to ECT as therapy for treatment-resistant major depression without psychosis. (Funded by the Patient-Centered Outcomes Research Institute; ELEKT-D ClinicalTrials.gov number, NCT03113968.).
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Affiliation(s)
- Amit Anand
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Sanjay J Mathew
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Gerard Sanacora
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - James W Murrough
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Fernando S Goes
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Murat Altinay
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Amy S Aloysi
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Ali A Asghar-Ali
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Brian S Barnett
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Lee C Chang
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Katherine A Collins
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Sara Costi
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Sidra Iqbal
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Manish K Jha
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Kamini Krishnan
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Donald A Malone
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Sina Nikayin
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Steven E Nissen
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Robert B Ostroff
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Irving M Reti
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Samuel T Wilkinson
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Kathy Wolski
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Bo Hu
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
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Harris E. Combining Drugs Improved Hard-to-Treat Depression in Older Adults. JAMA 2023; 329:1053. [PMID: 36920436 DOI: 10.1001/jama.2023.3309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Wang W, Xu H, Ling B, Chen Q, Lv J, Yu W. Effects of esketamine on analgesia and postpartum depression after cesarean section: A randomized, double-blinded controlled trial. Medicine (Baltimore) 2022; 101:e32010. [PMID: 36451452 PMCID: PMC9704928 DOI: 10.1097/md.0000000000032010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/03/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The aim of this randomized double-blind placebo controlled clinical trial was to investigate the effects of different doses of esketamine combined with sufentanil for postoperative intravenous controlled analgesia after cesarean section and the incidence of postpartum depression. METHODS One hundred and sixty patients undergoing elective cesarean section, with a singleton term pregnancy and American Society of Anesthesiologists physical status II were selected. All patients were treated by a combined epidural with spinal anesthesia. They were randomly divided into 4 groups according to patient controlled intravenous analgesia formula. The consumption of sufentanil, times of effective press and remediate analgesia at 48 hours after cesarean section, incidence of postpartum depression (PPD) at 1 week and 6 weeks after the operation were recorded. RESULTS Comparison of cumulated dosage of sufentanil, times of effective press and rescue analgesia at 48 hours after operation: Group H was significantly lower than Group M, Group L, and Group C (P < .05), Group M significantly lower than group L and Group C (P < .05), and Group L significantly lower than Group C (P < .05). Comparison of the incidence of PPD at 1 week and 6 weeks later: Group H was significantly lower than Group M, Group L, and Group C (P < .01), Group M significantly lower than Group L and Group C (P < .01) and Group L significantly lower than Group C (P < .01). Compared with Group C, the incidence of nausea and vomiting was significantly reduced in Group H, Group M, and Group L (P < .05). CONCLUSION Esketamine combined with sufentanil used for patient controlled intravenous analgesia after elective cesarean section can reduce the consumption of sufentanil, improve postoperative analgesia, decrease the incidence of PPD at 1 week and 6 weeks and postoperative nausea and vomiting.
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Affiliation(s)
- Wei Wang
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
| | - Hua Xu
- Department of Gynaecology and Obstetrics, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
| | - Bin Ling
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
| | - Qing Chen
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
| | - Jie Lv
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
| | - Wanyou Yu
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
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Gericke J, Lekhooa M, Steyn SF, Viljoen AM, Harvey BH. An acute dose-ranging evaluation of the antidepressant properties of Sceletium tortuosum (Zembrin®) versus escitalopram in the Flinders Sensitive Line rat. J Ethnopharmacol 2022; 284:114550. [PMID: 34454055 DOI: 10.1016/j.jep.2021.114550] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/07/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Sceletium tortuosum (L.) N.E.Br. (ST) has been used by the Khoisan people of South Africa as a mood elevator. Its various pharmacological mechanisms of action suggest distinct potential as an antidepressant. Clinical studies in healthy individuals suggest beneficial effects on mood, cognition, and anxiety. AIM OF THE STUDY To obtain a chromatographic fingerprint of a standardized extract of S. tortuosum (Zembrin®), and to evaluate the acute antidepressant-like properties of Zembrin® versus the reference antidepressant, escitalopram, in the Flinders Sensitive Line (FSL) rat, a genetic rodent model of depression. MATERIALS AND METHODS The chemical profile of Zembrin® was determined by ultra-performance liquid chromatography-mass spectrometry (UPLC-MS) chromatogram method using alkaloid standards. Twelve saline treated FSL and six Flinders Resistant Line (FRL) control rats were used to confirm face validity of the FSL model using the forced swim test (FST). Thereafter, FSL rats (n = 10) received either 5, 10, 25, 50 or 100 mg/kg of Zembrin®, or 5, 10 or 20 mg/kg escitalopram oxalate (ESC), both via oral gavage, and subjected to the open field test (OFT) and FST. RESULTS Four main ST alkaloids were identified and quantified in Zembrin® viz. mesembrenone, mesembrenol, mesembrine, and mesembranol (47.9%, 32%, 13.2%, and 6.8% of the total alkaloids, respectively). FSL rats showed significantly decreased swimming and climbing (coping) behaviours, and significantly increased immobility (despair), versus FRL controls. ESC 5 mg/kg and Zembrin® 25 mg/kg and 50 mg/kg showed significant dose-dependent reversal of immobility in FSL rats and variable effects on coping behaviours. Zembrin® 50 mg/kg was the most effective antidepressant dose, showing equivalence to ESC 5. CONCLUSIONS Zembrin® (25 and 50 mg/kg) and ESC (5 mg/kg) are effective antidepressants after acute treatment in the FST, as assessed in FSL rats. Moreover, Zembrin® 50 mg/kg proved equivalent to ESC 5. Further long-term bio-behavioural studies on the antidepressant properties of Zembrin® are warranted.
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Affiliation(s)
- Johané Gericke
- Center of Excellence for Pharmaceutical Sciences (Pharmacen), North West University, Private Bag X6001, Potchefstroom, 2520, South Africa.
| | - Makhotso Lekhooa
- Center of Excellence for Pharmaceutical Sciences (Pharmacen), North West University, Private Bag X6001, Potchefstroom, 2520, South Africa.
| | - Stephan F Steyn
- Center of Excellence for Pharmaceutical Sciences (Pharmacen), North West University, Private Bag X6001, Potchefstroom, 2520, South Africa.
| | - Alvaro M Viljoen
- Department of Pharmaceutical Sciences, Tshwane University of Technology, Private Bag X680, Pretoria, 0001, South Africa; SAMRC Herbal Drugs Research Unit, Faculty of Science, Tshwane University of Technology, Private Bag X680, Pretoria, 0001, South Africa.
| | - Brian H Harvey
- Center of Excellence for Pharmaceutical Sciences (Pharmacen), North West University, Private Bag X6001, Potchefstroom, 2520, South Africa; SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health and Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
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Wong J, Kurteva S, Motulsky A, Tamblyn R. Association of Antidepressant Prescription Filling With Treatment Indication and Prior Prescription Filling Behaviors and Medication Experiences. Med Care 2022; 60:56-65. [PMID: 34882109 PMCID: PMC8663531 DOI: 10.1097/mlr.0000000000001658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Given the wide range of uses for antidepressants, understanding indication-specific patterns of prescription filling for antidepressants provide valuable insights into how patients use these medications in real-world settings. OBJECTIVE The objective of this study was to determine the association of antidepressant prescription filling with treatment indication, as well as prior prescription filling behaviors and medication experiences. DESIGN This retrospective cohort study took place in Quebec, Canada. PARTICIPANTS Adults with public drug insurance prescribed antidepressants using MOXXI (Medical Office of the XXIst Century)-an electronic prescribing system requiring primary care physicians to document treatment indications and reasons for prescription stops or changes. MEASURES MOXXI provided information on treatment indications, past prescriptions, and prior medication experiences (treatment ineffectiveness and adverse drug reactions). Linked claims data provided information on dispensed medications and other patient-related factors. Multivariable logistic regression models estimated the independent association of not filling an antidepressant prescription (within 90 d) with treatment indication and patients' prior prescription filling behaviors and medication experiences. RESULTS Among 38,751 prescriptions, the prevalence of unfilled prescriptions for new and ongoing antidepressant therapy was 34.2% and 4.1%, respectively. Compared with depression, odds of not filling an antidepressant prescription varied from 0.74 to 1.57 by indication and therapy status. The odds of not filling an antidepressant prescription was higher among adults filling < 50% of their medication prescriptions in the past year and adults with an antidepressant prescription stopped or changed in the past year due to treatment ineffectiveness. CONCLUSION Antidepressant prescription filling behaviors differed by treatment indication and were lower among patients with a history of poor prescription filling or ineffective treatment with antidepressants.
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Affiliation(s)
- Jenna Wong
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Siyana Kurteva
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
| | - Aude Motulsky
- Research Center, University of Montreal Health Centre (CHUM)
- Department of Management, Evaluation & Health Policy, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Robyn Tamblyn
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
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Su S, Kay G, Hochadel T, Rojo J, Christopher Stein J, Boinpally R, Periclou A. A randomized, multicenter trial assessing the effects of rapastinel compared to ketamine, alprazolam, and placebo on simulated driving performance. Clin Transl Sci 2022; 15:255-266. [PMID: 34423904 PMCID: PMC8742651 DOI: 10.1111/cts.13145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/20/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022] Open
Abstract
N-methyl-D-aspartate ionotropic glutamatergic receptor (NMDAR) modulators, including rapastinel and ketamine, elicit rapid and sustained antidepressant responses in patients with treatment-resistant major depressive disorder. This phase I, randomized, multicenter, placebo-controlled, five-period, crossover, single-dose study evaluated simulated driving performance of healthy participants (N = 107) after single doses of rapastinel slow intravenous (i.v.) bolus 900 and 1800 mg, alprazolam oral 0.75 mg (positive control), ketamine i.v. infusion 0.5 mg/kg (clinical comparator), and placebo ~ 45 min before driving. The primary end point was SD of lateral position (SDLP) during the 60-min 100-km simulated driving scenario. Additional measures of driving performance, sleepiness, and cognition were also evaluated. To assess effects over time, mean SDLP was calculated for each 10-min interval of driving. Sensitivity of the assays was confirmed with alprazolam (all placebo comparisons p < 0.02). Rapastinel 900 and 1800 mg did not significantly affect simulated driving performance compared to placebo (both p > 0.5). Both rapastinel doses resulted in significantly less impaired driving compared to alprazolam or ketamine (all p < 0.002); ketamine significantly impaired driving compared to placebo (p = 0.0001). Results for the additional measures were similar to the primary end point. No new safety signals were observed for any study interventions. This first study of rapastinel effects on simulated driving found that rapastinel 900 and 1800 mg did not impair driving performance, but ketamine 0.5 mg/kg resulted in significantly impaired driving performance. Ketamine's effects on driving were maintained for at least 105 min, indicating that clinicians should be vigilant to prevent or postpone driving in patients after ketamine treatment.
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Affiliation(s)
- Shengfang Su
- Allergan plc (now AbbVie, Inc.)MadisonNew JerseyUSA
| | - Gary Kay
- Cognitive Research CorporationSt. PetersburgFloridaUSA
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Tshifularo M. Migraine induced recurrent bloody otorrhea: A spontaneous extra-cranial hemorrhagic phenomena: Case series. Am J Otolaryngol 2022; 43:103218. [PMID: 34563800 DOI: 10.1016/j.amjoto.2021.103218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/05/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Mashudu Tshifularo
- Department of Otorhinolaryngology, Head, and Neck, University of Pretoria, Steve Biko Academic Hospital, Private Bag X323, Pretoria 0001, Republic of South Africa (RSA).
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Zhang L, Wang L, Huang L, Zhao Y, Ding H, Li B, Wen L, Xiong W, Liu Y, Zhang T, Zhang L, Wu L, Xu Q, Fan Y, Wei G, Yin Q, Chen Y, Zhang T, Yan Z. Antidepressant effects of total iridoids of Valeriana jatamansi via the intestinal flora-blood-brain barrier pathway. Pharm Biol 2021; 59:912-921. [PMID: 34236293 PMCID: PMC8274535 DOI: 10.1080/13880209.2021.1944222] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 05/08/2023]
Abstract
CONTEXT Valeriana jatamansi Jones [syn. V. wallichii DC, (Valerianaceae)] (VJJ) is used to treat depression. OBJECTIVE To explore the effects of total iridoids of VJJ extract (TIV) on chronic unpredictable mild stress (CUMS) in mice. MATERIALS AND METHODS VJJ roots and rhizomes were extracted with 70% ethanol. CUMS rats were treated daily with fluoxetine (2.6 mg/kg, i.g.) or TIV (5.7, 11.4, and 22.8 mg/kg, i.g.) for 14 days. Male Kun Ming mice on normal chow and 0.5% CMC-Na solution were used as a control. Behavioural tests included the tail suspension (TST) and sucrose preference tests (SPT). Evans blue staining was used to evaluate blood-brain barrier (BBB) permeability. Western blotting was used to measure zonula occludens-1 (ZO-1) and occludin expression. 16S rRNA sequencing was used to analyse intestinal flora abundance. Tax4Fun was used to predict KEGG metabolic pathways. RESULTS TIV treatment reduced TST time (117.35 ± 8.23 or 108.95 ± 6.76 vs. 144.45 ± 10.30 s), increased SPT (55.83 ± 7.24 or 53.12 ± 13.85 vs. 38.98 ± 5.43%), increased the abundance of phylum Firmicutes (86.99 ± 0.03 vs. 60.88 ± 0.19%) and genus Lactobacillus (75.20 ± 0.19 vs. 62.10 ± 0.13%), reduced the abundance of phylum Bacteroidetes (6.69 ± 0.06 or 11.50 ± 0.09 vs. 25.07 ± 0.20%). TIV increased carbohydrate metabolism (14.50 ± 3.00 × 10-3 or 14.60 ± 2.00 × 10-3 or 14.90 ± 2.00 × 10-3 vs.13.80 ± 4.00 × 10-3%), replication and repair functions (5.60 ± 1.00 × 10-3 or 5.60 ± 1.00 × 10-3 vs. 5.10 ± 4.00 × 10-3%), reduced the frequency of infectious disease (1.60 ± 2.00 × 10-4 or 1.90 ± 5.00 × 10-4 or 1.80 ± 3.00 × 10-4 vs. 2.20 ± 7.00 × 10-3%), BBB permeability (0.77 ± 0.30 vs. 1.81 ± 0.33 μg/g), and up-regulated the expression of ZO-1 (1.42-fold, 1.60-fold, 1.71-fold) and occludin (1.79-fold, 2.20-fold). CONCLUSIONS TIV may modulate the intestinal flora, thereby inducing the expression of ZO-1 and occludin, protecting the BBB and exerting an antidepressant effect.
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Affiliation(s)
- Li Zhang
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, PR China
| | - Liwen Wang
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, PR China
| | - Li Huang
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, PR China
| | - Yanni Zhao
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, PR China
| | - Hongling Ding
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, PR China
| | - Binglong Li
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, PR China
| | - Lingmiao Wen
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, PR China
| | - Wei Xiong
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, PR China
| | - Yanjun Liu
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, PR China
| | - Tinglan Zhang
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, PR China
| | - Liudai Zhang
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, PR China
| | - Lanlan Wu
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, PR China
| | - Qing Xu
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, PR China
| | - Yuqing Fan
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, PR China
| | - Guihua Wei
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, PR China
| | - Qiaozhi Yin
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Yunhui Chen
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Tiane Zhang
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Zhiyong Yan
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, PR China
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Zhu Y, Qu Y, Zhang J, Hou J, Fang J, Shen J, Xu C, Huang M, Qiao H, An S. Phencynonate hydrochloride exerts antidepressant effects by regulating the dendritic spine density and altering glutamate receptor expression. Behav Pharmacol 2021; 32:660-672. [PMID: 34751176 DOI: 10.1097/fbp.0000000000000660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Phencynonate hydrochloride (PCH) is a drug that crosses the blood-brain barrier. Cellular experiments confirmed that PCH protects against glutamate toxicity and causes only weak central inhibition and limited side effects. As shown in our previous studies, PCH alleviates depression-like behaviours induced by chronic unpredictable mild stress (CUMS). Here we administered PCH at three different doses (4, 8 and 16 mg/kg) to male rats for two continuous days after CUMS and conducted behavioural tests to assess the dose-dependent antidepressant effects of PCH and its effects on the neuroplasticity in the hippocampus and medial prefrontal cortex (mPFC). Meanwhile, we measured the spine density and expression of related proteins to illustrate the mechanism of PCH. PCH treatment (8 mg/kg) significantly alleviated depression-like behaviours induced by CUMS. All doses of PCH treatment reversed the spine loss in prelimbic and CA3 regions induced by CUMS. Kalirin-7 expression was decreased in the hippocampus and mPFC of the CUMS group. The expression of the NR1 and NR2B subunits in the hippocampus, and NR2B in mPFC are increased by CUMS. PCH treatment (8 and 16 mg/kg) reversed all of these changes of Kalirin-7 in PFC and hippocampus, as well as NR1 and NR2B expression in the hippocampus. PCH is expected to be developed as a new type of rapid antidepressant. Its antidepressant effect may be closely related to the modulation of dendritic spine density in the prelimbic and CA3 regions and the regulation of Kalilin-7 and N-methyl-D-aspartic acid receptor levels in the hippocampus.
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Affiliation(s)
- Yingqi Zhu
- Institute of Brain and Behavioural Sciences, College of Life Science, Shaanxi Normal University, Xi'an, Shaanxi
| | - Yishan Qu
- Institute of Brain and Behavioural Sciences, College of Life Science, Shaanxi Normal University, Xi'an, Shaanxi
| | - Jing Zhang
- Institute of Brain and Behavioural Sciences, College of Life Science, Shaanxi Normal University, Xi'an, Shaanxi
| | - Jun Hou
- Institute of Brain and Behavioural Sciences, College of Life Science, Shaanxi Normal University, Xi'an, Shaanxi
| | - Jie Fang
- Institute of Brain and Behavioural Sciences, College of Life Science, Shaanxi Normal University, Xi'an, Shaanxi
| | - Jingxuan Shen
- Institute of Brain and Behavioural Sciences, College of Life Science, Shaanxi Normal University, Xi'an, Shaanxi
| | - Chang Xu
- Institute of Brain and Behavioural Sciences, College of Life Science, Shaanxi Normal University, Xi'an, Shaanxi
| | - Minyi Huang
- College of Agriculture and Biotechnology, Hunan University of Humanities, Science and Technology, Loudi, Hunan, China
| | - Hui Qiao
- Institute of Brain and Behavioural Sciences, College of Life Science, Shaanxi Normal University, Xi'an, Shaanxi
| | - Shucheng An
- Institute of Brain and Behavioural Sciences, College of Life Science, Shaanxi Normal University, Xi'an, Shaanxi
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Yu Y, Wang J, Huang X. The anti-depressant effects of a novel PDE4 inhibitor derived from resveratrol. Pharm Biol 2021; 59:418-423. [PMID: 33847209 PMCID: PMC8049461 DOI: 10.1080/13880209.2021.1907422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/23/2021] [Accepted: 03/18/2021] [Indexed: 06/01/2023]
Abstract
CONTEXT Resveratrol has shown anti-stress and anti-depressant-like abilities involved in inhibiting phosphodiesterase-4 (PDE4) enzyme. However, its application is limited due to its low efficacy, bioavailability and selectivity. OBJECTIVE This study synthesized a new resveratrol derivative RES003 and evaluated its PDE4 inhibitory and anti-depressant-like activities in vitro and in vivo, respectively. MATERIALS AND METHODS PDEs inhibitory activities were evaluated by radioactive tracer method. Anti-depressant-like activities of novel resveratrol analogue (RES003) at doses of 2.5, 5.0 and 10 mg/kg was investigated by sugar water consumption and forced swimming tests using male ICR mice under chronic unpredictable stress procedure for 10 days. A total of 84 mice were randomly distributed into seven groups (n = 12). Drugs and vehicle were administered (intra-gastric or intra-peritoneal) once a day from the first to the last day. The molecular mechanisms were identified by western blot. RESULTS RES003 showed more potent PDE4 inhibitory activity (half maximal inhibitory concentration (IC50), 0.87 μM) and better selectivity than resveratrol (IC50, 18.8 μM). RES003 could significantly increase the consumption of sugar water (p < 0.01) and immobility time (p < 0.01) compared to vehicle-treated stressed groups at doses of 5 and 10 mg/kg. Furthermore, RES003 could significantly increase the levels of cyclic adenosine monophosphate response element binding protein phosphorylation (10 mg/kg, p < 0.05) and brain-derived neurotrophic factor (BDNF) expression (5 and 10 mg/kg, p < 0.05 and 0.01) in mouse brain. DISCUSSION AND CONCLUSIONS RES003 could ameliorate chronic stress induced depression-like behaviours through inhibition of PDE4 and activation of cAMP-triggered phosphorylation of cAMP response element binding protein/BDNF signalling pathway. Consequently, RES003 is a promising lead compound for the treatment of depression.
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Affiliation(s)
- Yingcong Yu
- Wenzhou People’s Hospital, Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, PR China
| | - Jinhui Wang
- Wenzhou People’s Hospital, Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, PR China
| | - Xianfeng Huang
- School of Pharmacy & School of Medicine, Changzhou University, Changzhou, PR China
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Wu CS, Hsu LY, Pan YJ, Wang SH. Associations Between Antidepressant Use and Advanced Diabetes Outcomes in Patients with Depression and Diabetes Mellitus. J Clin Endocrinol Metab 2021; 106:e5136-e5146. [PMID: 34259856 DOI: 10.1210/clinem/dgab443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/09/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Comorbid depression in patients with diabetes deteriorates the prognosis. Antidepressants might attenuate the adverse effects of depression; however, they are associated with cardiometabolic adverse effects. OBJECTIVE This study aimed to explore the association between antidepressant treatment and advanced diabetic complications and mortality among patients with depression and diabetes mellitus. METHODS We conducted a nationwide retrospective cohort study of 36 276 patients with depression and newly treated diabetes mellitus using Taiwan's universal health insurance database. Antidepressant treatment patterns within a 6-month window were classified into none, poor, partial, and regular use, and we accounted for time-dependent variables in the Cox proportional hazards regression analysis with adjustment for time-dependent comorbidity and concomitant use of medications. Different classes of antidepressants were compared. Macro- and microvascular complications, as well as all-cause mortality, were the main outcomes. Benzodiazepines were chosen as negative control exposure. RESULTS Compared with poor use of antidepressants, regular use was associated with a 0.92-fold decreased risk of macrovascular complications and a 0.86-fold decreased risk of all-cause mortality but not associated with microvascular complications. Regular use of selective serotonin reuptake inhibitors was associated with a 0.83- and 0.75-fold decreased risk of macrovascular complications and all-cause mortality, respectively. Regular use of tricyclic or tetracyclic antidepressants was associated with a 0.78-fold decreased risk of all-cause mortality. Regular use of benzodiazepine showed no association with diabetic outcomes. CONCLUSION Regular antidepressant use was associated with lower risk of advanced diabetic complications compared with poor adherence. Clinicians should emphasize antidepressant treatment adherence among patients with depression and diabetes mellitus.
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Affiliation(s)
- Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, 100, Taiwan
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, 350, Taiwan
| | - Le-Yin Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, 100, Taiwan
| | - Yi-Jiun Pan
- School of Medicine, China Medical University, Taichung, 404, Taiwan
| | - Shi-Heng Wang
- Department of Occupational Safety and Health, China Medical University, Taichung, 406, Taiwan
- Department of Public Health, China Medical University, Taichung, 406, Taiwan
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Bis-Humbert C, García-Cabrerizo R, García-Fuster MJ. Dose-dependent opposite effects of nortriptyline on affective-like behavior in adolescent rats: Comparison with adult rats. Eur J Pharmacol 2021; 910:174465. [PMID: 34464602 DOI: 10.1016/j.ejphar.2021.174465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 11/19/2022]
Abstract
Antidepressant drugs elicit different behavioral and neurochemical responses with age. In fact, the use of antidepressants during adolescence is associated with an increased risk of suicidal thinking, being the best pharmacological treatment during this critical period a matter of constant debate in terms of its risk-benefit outcome. In this regard, the present study compared the effects of nortriptyline (3-10 mg/kg, 7 days) on regulating different aspects of affective-like behavior by screening adolescent and adult Sprague-Dawley rats through several consecutive tests (forced-swim, open field, sucrose preference). Brains were later collected to evaluate hippocampal neurogenesis and mBDNF protein content as potential molecular correlates of the observed behavioral responses. The main results in adolescent rats showed that nortriptyline induced dose-dependent opposite effects: while 3 mg/kg decreased immobility and increased mBDNF (indicative of an antidepressant-like response), 10 mg/kg decreased exploratory time in the open field and mBDNF (suggestive of an anxiogenic-like response). These effects were not associated with changes in neurogenesis regulation. In adult rats, nortriptyline failed to modulate affective-like behavior or the neuroplasticity markers evaluated at the doses tested. In conclusion, clear behavioral and neurochemical differences were observed between adolescent and adult rats in response to nortriptyline treatment. Interestingly, while nortriptyline displayed an antidepressant-like potential at the lowest dose examined in adolescence, a higher dose shifted these results towards a negative outcome, thus reinforcing the need to extreme caution when considering this treatment for our younger population.
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Affiliation(s)
- Cristian Bis-Humbert
- IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Rubén García-Cabrerizo
- IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - M Julia García-Fuster
- IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.
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Ding C, Xu M, Gao L, Wang X, Xu W, Guo M, Yao J. Clinical efficacy of Danzhi Xiaoyao Powder in the treatment of post-stroke depression: A protocol for randomized, double-blind clinical study. Medicine (Baltimore) 2021; 100:e27318. [PMID: 34678863 PMCID: PMC8542130 DOI: 10.1097/md.0000000000027318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/07/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Depression is a common complication after stroke and is closely related to the poor prognosis of stroke. Antidepressants are the priority drug in the treatment of post-stroke depression (PSD), but there are dependence and adverse reactions. Danzhi Xiaoyao Powder has a good effect on depression without obvious adverse reactions. At present, there is a lack of rigorous randomized controlled trials to evaluate the clinical efficacy of Danzhi Xiaoyao Powder in the treatment of PSD. METHODS This is a prospective, randomized, double-blind, parallel controlled trial to explore the efficacy and safety of Danzhi Xiaoyao Powder in the treatment of PSD. The participants were randomly divided into treatment group and control group. The treatment group used Danzhi Xiaoyao Powder combined with escitalopram oxalate, and the control group used Danzhi Xiaoyao Powder simulant combined with citalopram oxalate. The two groups were both treated for 8 weeks and followed up for 3 months. Observational index includes: Total response rate, Hamilton depression scale, Barthel index, national institutes of health stroke scale, the modified Edinburgh-Scandinavian stroke scale, Incidence of adverse reactions. Finally, SPASS 22.0 software was used for statistical analysis of the data. DISCUSSION This study will evaluate the clinical efficacy of Danzhi Xiaoyao Powder in the treatment of PSD. The results of this study will provide reliable evidence for the clinical use of Xiaoyao Powder in the treatment of PSD. TRIAL REGISTRATION Open Science Framework Registration number: DOI 10.17605/OSF.IO/5V926.
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Rajamäki TJ, Moilanen T, Puolakka PA, Hietaharju A, Jämsen E. Is the Preoperative Use of Antidepressants and Benzodiazepines Associated with Opioid and Other Analgesic Use After Hip and Knee Arthroplasty? Clin Orthop Relat Res 2021; 479:2268-2280. [PMID: 33982976 PMCID: PMC8445559 DOI: 10.1097/corr.0000000000001793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/05/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mental health disorders can occur in patients with pain conditions, and there have been reports of an increased risk of persistent pain after THA and TKA among patients who have psychological distress. Persistent pain may result in the prolonged consumption of opioids and other analgesics, which may expose patients to adverse drug events and narcotic habituation or addiction. However, the degree to which preoperative use of antidepressants or benzodiazepines is associated with prolonged analgesic use after surgery is not well quantified. QUESTION/PURPOSES (1) Is the preoperative use of antidepressants or benzodiazepine medications associated with a greater postoperative use of opioids, NSAIDs, or acetaminophen? (2) Is the proportion of patients still using opioid analgesics 1 year after arthroplasty higher among patients who were taking antidepressants or benzodiazepine medications before surgery, after controlling for relevant confounding variables? (3) Does analgesic drug use decrease after surgery in patients with a history of antidepressant or benzodiazepine use? (4) Does the proportion of patients using antidepressants or benzodiazepines change after joint arthroplasty compared with before? METHODS Of the 10,138 patients who underwent hip arthroplasty and the 9930 patients who underwent knee arthroplasty at Coxa Hospital for Joint Replacement, Tampere, Finland, between 2002 and 2013, those who had primary joint arthroplasty for primary osteoarthritis (64% [6502 of 10,138] of patients with hip surgery and 82% [8099 of 9930] who had knee surgery) were considered potentially eligible. After exclusion of another 8% (845 of 10,138) and 13% (1308 of 9930) of patients because they had revision or another joint arthroplasty within 2 years of the index surgery, 56% (5657 of 10,138) of patients with hip arthroplasty and 68% (6791 of 9930) of patients with knee arthroplasty were included in this retrospective registry study. Patients who filled prescriptions for antidepressants or benzodiazepines were identified from a nationwide drug prescription register, and information on the filled prescriptions for opioids (mild and strong), NSAIDs, and acetaminophen were extracted from the same database. For the analyses, subgroups were created according to the status of benzodiazepine and antidepressant use during the 6 months before surgery. First, the proportions of patients who used opioids and any analgesics (that is, opioids, NSAIDs, or acetaminophen) were calculated. Then, multivariable logistic regression adjusted with age, gender, joint, Charlson Comorbidity Index, BMI, laterality (unilateral/same-day bilateral), and preoperative analgesic use was performed to calculate odds ratios for any analgesic use and opioid use 1 year postoperatively. Additionally, the proportion of patients who used antidepressants and benzodiazepines was calculated for 2 years before and 2 years after surgery. RESULTS At 1 year postoperatively, patients with a history of antidepressant or benzodiazepine use were more likely to fill prescriptions for any analgesics than were patients without a history of antidepressant or benzodiazepine use (adjusted odds ratios 1.9 [95% confidence interval 1.6 to 2.2]; p < 0.001 and 1.8 [95% CI 1.6 to 2.0]; p < 0.001, respectively). Similarly, patients with a history of antidepressant or benzodiazepine use were more likely to fill prescriptions for opioids than patients without a history of antidepressant or benzodiazepine use (adjusted ORs 2.1 [95% CI 1.7 to 2.7]; p < 0.001 and 2.0 [95% CI 1.6 to 2.4]; p < 0.001, respectively). Nevertheless, the proportion of patients who filled any analgesic prescription was smaller 1 year after surgery than preoperatively in patients with a history of antidepressant (42% [439 of 1038] versus 55% [568 of 1038]; p < 0.001) and/or benzodiazepine use (40% [801 of 2008] versus 55% [1098 of 2008]; p < 0.001). The proportion of patients who used antidepressants and/or benzodiazepines was essentially stable during the observation period. CONCLUSION Surgeons should be aware of the increased risk of prolonged opioid and other analgesic use after surgery among patients who were on preoperative antidepressant and/or benzodiazepine therapy, and they should have candid discussions with patients referred for elective joint arthroplasty about this possibility. Further studies are needed to identify the most effective methods to reduce prolonged postoperative opioid use among these patients. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Tuomas J Rajamäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | | | - Pia A Puolakka
- Department of Anaesthesia, Tampere University Hospital, Tampere, Finland
| | - Aki Hietaharju
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Neurology, Tampere University Hospital, Tampere, Finland
| | - Esa Jämsen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Coxa Hospital for Joint Replacement, Tampere, Finland
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Martínez-Hernández GB, Jiménez-Ferrer E, González-Cortazar M, Román-Ramos R, Tortoriello J, Vargas-Villa G, Herrera-Ruiz M. Antidepressant and anxiolytic compounds isolated from Salvia elegans interact with serotonergic drugs. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:2419-2428. [PMID: 34568977 DOI: 10.1007/s00210-021-02155-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/17/2020] [Indexed: 11/25/2022]
Abstract
Salvia elegans belongs to a genus plants with biological activities in central nervous system. In this work, the purpose was to evaluate the anxiolytic and antidepressant effects of fractions and compounds isolated from S. elegans and its interaction with serotoninergic drugs by using behavioral tests in mice. Fractions from aerial parts of S. elegans were obtained by column chromatography, SeF1, SeF2, SeF3, and SeF4. Each of them was administered to 25 mg/k in ICR mice subject to forced swimming test (FST), or elevated plus maze test (EPM), or open field test (OFT). The most active fractions were chemically separated until compounds, which were analyzed as anxiolytic or antidepressant and the coadministration of these treatments with 5-HT1A and 5-HT2 drugs was measured in the different biological tests. All fractions were anxiolytic and antidepressant, oleanolic acid (OA) was found in SeF2, and from SeF3, a mixture of terpenes was found; a GC-MS analysis confirmed the presence of two main compounds: rosifoliol and agaraspirol (TM, mixture of terpenes). TM (doses-response curve, 0.01, 0.1, 0.5, 1.0, and 2.0 mg/kg) and OA (5 mg/kg) were also evaluated demonstrating an antidepressant and anxiolytic effect, respectively. The combination of TM (0.5 mg/kg) with 8-OH (selective 5-HT1A receptor agonist) induced an increment of antidepressant activity, while with the antagonist WAY-100635, the effect diminished. But with DOI (5-HT1c/5-HT2 receptor agonist), there was no change, and with KET (5-HT2 receptor antagonist), the activity was increased. When OA is co-administered with 8-OH or with DOI, the anxiolytic activity of this terpene, diminished; but with the combination with antagonists, the effect of OA shows no change. TM and OA were antidepressant and anxiolytic, respectively, on mice exposed to different tests, and these are able to interact with serotoninergic drugs.
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Affiliation(s)
- Gabriela Belen Martínez-Hernández
- Centro de Investigación Biomédica del Sur, Instituto Mexicano del Seguro Social (IMSS), Argentina 1, 62790, Xochitepec, Morelos, México
- Doctorado en Ciencias Biológicas Y de La Salud, División de Ciencias Biológicas Y de La Salud, Universidad Autónoma Metropolitana (UAM), México City, México
- Departamento de Ciencias de La Salud, División de Ciencias Biológicas Y de La Salud, Universidad Autónoma Metropolitana-Iztapalapa, Av. San Rafael Atlixco No.186, Col. Vicentina C.P.09340, Iztapalapa, México D.F., México
| | - Enrique Jiménez-Ferrer
- Centro de Investigación Biomédica del Sur, Instituto Mexicano del Seguro Social (IMSS), Argentina 1, 62790, Xochitepec, Morelos, México
| | - Manases González-Cortazar
- Centro de Investigación Biomédica del Sur, Instituto Mexicano del Seguro Social (IMSS), Argentina 1, 62790, Xochitepec, Morelos, México
| | - Rubén Román-Ramos
- Departamento de Ciencias de La Salud, División de Ciencias Biológicas Y de La Salud, Universidad Autónoma Metropolitana-Iztapalapa, Av. San Rafael Atlixco No.186, Col. Vicentina C.P.09340, Iztapalapa, México D.F., México
| | - Jaime Tortoriello
- Centro de Investigación Biomédica del Sur, Instituto Mexicano del Seguro Social (IMSS), Argentina 1, 62790, Xochitepec, Morelos, México
| | - Gabriela Vargas-Villa
- Centro de Investigación Biomédica del Sur, Instituto Mexicano del Seguro Social (IMSS), Argentina 1, 62790, Xochitepec, Morelos, México
| | - Maribel Herrera-Ruiz
- Centro de Investigación Biomédica del Sur, Instituto Mexicano del Seguro Social (IMSS), Argentina 1, 62790, Xochitepec, Morelos, México.
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Canuso CM, Ionescu DF, Li X, Qiu X, Lane R, Turkoz I, Nash AI, Lopena TJ, Fu DJ. Esketamine Nasal Spray for the Rapid Reduction of Depressive Symptoms in Major Depressive Disorder With Acute Suicidal Ideation or Behavior. J Clin Psychopharmacol 2021; 41:516-524. [PMID: 34412104 PMCID: PMC8407443 DOI: 10.1097/jcp.0000000000001465] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/30/2021] [Accepted: 05/30/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE/BACKGROUND Numerous health authority approvals of esketamine nasal spray, combined with oral antidepressant, to treat depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior were based on 2 identically designed, double-blind, phase 3 studies. METHODS/PROCEDURES Across both ASPIRE studies (NCT03039192, NCT03097133), patients (N = 456) were randomized to esketamine 84 mg or placebo nasal spray twice weekly for 4 weeks plus comprehensive standard of care, including hospitalization and newly initiated or optimized antidepressant(s). In post hoc analyses of pooled data, changes from baseline at 24 hours after the first dose in Montgomery-Åsberg Depression Rating Scale total score and Clinical Global Impression-Severity of Suicidality-Revised, in the full cohort and in subgroups, were analyzed using analysis of covariance. FINDINGS/RESULTS Esketamine plus standard of care demonstrated significantly greater improvement in Montgomery-Åsberg Depression Rating Scale total score versus placebo plus standard of care at 24 hours (least square mean difference [95% confidence interval], -3.8 [-5.75 to -1.89]) and at earlier (4 hours: -3.4 [-5.05 to -1.71]) and later time points (day 25: -3.4 [-5.36 to -1.36]). The between-group difference (95% confidence interval) for change in Clinical Global Impression-Severity of Suicidality-Revised at 24 hours was -0.20 (-0.43 to 0.04) for all patients and -0.31 (-0.61 to -0.01) for those with a history of suicide attempt. Common adverse events (≥20%) during esketamine treatment were dizziness, dissociation, nausea, somnolence, and headache. IMPLICATIONS/CONCLUSIONS Esketamine plus comprehensive standard of care rapidly reduces depressive symptoms in patients with major depressive disorder who have acute suicidal ideation or behavior, especially in those with a history of suicide attempt, providing a new treatment option for this particularly ill and vulnerable population.
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Affiliation(s)
- Carla M. Canuso
- From the Department of Neuroscience, Janssen Research & Development, LLC, Titusville, NJ
| | - Dawn F. Ionescu
- Department of Neuroscience, Janssen Research & Development, LLC, San Diego, CA
| | - Xiang Li
- Department of Clinical Statistics, Janssen Research & Development, LLC, Raritan, NJ
| | - Xin Qiu
- Department of Clinical Statistics, Janssen Research & Development, LLC, Raritan, NJ
| | - Rosanne Lane
- Department of Clinical Statistics, Janssen Research & Development, LLC, Raritan, NJ
| | - Ibrahim Turkoz
- Department of Clinical Statistics, Janssen Research & Development, LLC, Raritan, NJ
| | | | - Tricia J. Lopena
- Medical Information, Janssen Scientific Affairs, LLC, Titusville, NJ
| | - Dong-Jing Fu
- From the Department of Neuroscience, Janssen Research & Development, LLC, Titusville, NJ
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Morris PJ, Burke RD, Sharma AK, Lynch DC, Lemke-Boutcher LE, Mathew S, Elayan I, Rao DB, Gould TD, Zarate CA, Zanos P, Moaddel R, Thomas CJ. A comparison of the pharmacokinetics and NMDAR antagonism-associated neurotoxicity of ketamine, (2R,6R)-hydroxynorketamine and MK-801. Neurotoxicol Teratol 2021; 87:106993. [PMID: 33945878 PMCID: PMC8440345 DOI: 10.1016/j.ntt.2021.106993] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/20/2022]
Abstract
With the increasing use of ketamine as an off-label treatment for depression and the recent FDA approval of (S)-ketamine for treatment-resistant depression, there is an increased need to understand the long-term safety profile of chronic ketamine administration. Of particular concern is the neurotoxicity previously observed in rat models following acute exposure to high doses of ketamine, broadly referred to as 'Olney's lesions'. This type of toxicity presents as abnormal neuronal cellular vacuolization, followed by neuronal death and has been associated with ketamine's inhibition of the N-methyl-d-aspartate receptor (NMDAR). In this study, a pharmacological and neuropathological analysis of ketamine, the potent NMDAR antagonist MK-801, and the ketamine metabolite (2R,6R)-hydroxynorketamine [(2R,6R)-HNK)] in rats is described following both single dose and repeat dose drug exposures. Ketamine dosing was studied up to 20 mg/kg intravenously for the single-dose neuropathology study and up to 60 mg/kg intraperitoneally for the multiple-dose neuropathology study. MK-801 dosing was studied up to 0.8 mg/kg subcutaneously for both the single and multiple-dose neuropathology studies, while (2R,6R)-HNK dosing was studied up to 160 mg/kg intravenously in both studies. These studies confirm dose-dependent induction of 'Olney's lesions' following both single dose and repeat dosing of MK-801. Ketamine exposure, while showing common behavioral effects, did not induce wide-spread Olney's lesions. Treatment with (2R,6R)-HNK did not produce behavioral effects, toxicity or any evidence of Olney's lesion formation. Based on these results, future NMDAR-antagonist neurotoxicity studies should strongly consider taking pharmacokinetics more thoroughly into account.
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Affiliation(s)
- Patrick J Morris
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA.
| | | | | | | | | | - Shiny Mathew
- Division of Pharmacology/Toxicology Neuroscience, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Ikram Elayan
- Division of Pharmacology/Toxicology Neuroscience, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Deepa B Rao
- Division of Pharmacology/Toxicology Neuroscience, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Todd D Gould
- Departments of Psychiatry, Pharmacology, and Anatomy & Neurobiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Panos Zanos
- Department of Psychiatry, Pharmacology, and Physiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Ruin Moaddel
- Biomedical Research Center, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Craig J Thomas
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
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Capuzzi E, Caldiroli A, Capellazzi M, Tagliabue I, Marcatili M, Colmegna F, Clerici M, Buoli M, Dakanalis A. Long-Term Efficacy of Intranasal Esketamine in Treatment-Resistant Major Depression: A Systematic Review. Int J Mol Sci 2021; 22:9338. [PMID: 34502248 PMCID: PMC8430977 DOI: 10.3390/ijms22179338] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/14/2021] [Accepted: 08/23/2021] [Indexed: 12/02/2022] Open
Abstract
Esketamine (ESK) has been approved as a rapid-acting intranasal treatment for treatment-resistant depression (TRD). Although existing studies have investigated the efficacy of ESK in the 4-week induction phase, our knowledge about long-term ESK efficacy remains poor. The aim of this systematic review was to summarize the available data on long-term ESK efficacy for TRD. A systematic search was performed including articles in English, up to 31 March 2021. The search found 7 relevant studies, involving 1024 adult TRD patients. Continuing treatment with ESK after the 4-week induction phase may be associated with stable efficacy in relapse prevention among TRD patients. Conversely, the long-term antidepressant effectiveness upon discontinuation of ESK might be limited, although data from three studies had a moderate to high risk of bias. Overall, the results on the effectiveness of this compound in the long term are mixed. According to our findings, ESK treatment should be continued following the induction phase to reach a stable efficacy in relapse prevention, while the long-term antidepressant and anti-suicidal effects of ESK after discontinuation are inconsistent. Currently, the level of proof of ESK efficacy in long-term TRD treatment remains low and more RCTs with larger sample sizes and active comparators are needed.
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Affiliation(s)
- Enrico Capuzzi
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, via G.B. Pergolesi 33, 20900 Monza, Italy; (E.C.); (M.M.); (F.C.); (M.C.)
| | - Alice Caldiroli
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, via G.B. Pergolesi 33, 20900 Monza, Italy; (E.C.); (M.M.); (F.C.); (M.C.)
| | - Martina Capellazzi
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 38, 20900 Monza, Italy; (M.C.); (I.T.); (A.D.)
| | - Ilaria Tagliabue
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 38, 20900 Monza, Italy; (M.C.); (I.T.); (A.D.)
| | - Matteo Marcatili
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, via G.B. Pergolesi 33, 20900 Monza, Italy; (E.C.); (M.M.); (F.C.); (M.C.)
| | - Fabrizia Colmegna
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, via G.B. Pergolesi 33, 20900 Monza, Italy; (E.C.); (M.M.); (F.C.); (M.C.)
| | - Massimo Clerici
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, via G.B. Pergolesi 33, 20900 Monza, Italy; (E.C.); (M.M.); (F.C.); (M.C.)
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 38, 20900 Monza, Italy; (M.C.); (I.T.); (A.D.)
| | - Massimiliano Buoli
- Department of Pathophysiology and Transplantation, University of Milan, via Festa del Perdono 7, 20122 Milan, Italy;
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20122 Milan, Italy
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 38, 20900 Monza, Italy; (M.C.); (I.T.); (A.D.)
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Głuch-Lutwin M, Sałaciak K, Gawalska A, Jamrozik M, Sniecikowska J, Newman-Tancredi A, Kołaczkowski M, Pytka K. The selective 5-HT 1A receptor biased agonists, F15599 and F13714, show antidepressant-like properties after a single administration in the mouse model of unpredictable chronic mild stress. Psychopharmacology (Berl) 2021; 238:2249-2260. [PMID: 33973045 PMCID: PMC8292235 DOI: 10.1007/s00213-021-05849-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/12/2021] [Indexed: 01/12/2023]
Abstract
RATIONALE The prevalence of depression is ever-increasing throughout the population. However, available treatments are ineffective in around one-third of patients and there is a need for more effective and safer drugs. OBJECTIVES The antidepressant-like and procognitive effects of the "biased agonists" F15599 (also known as NLX-101) which preferentially targets postsynaptic 5-HT1A receptors and F13714, which targets 5-HT1A autoreceptors, were investigated in mice. METHODS Antidepressant-like properties of the compounds and their effect on cognitive functions were assessed using the forced swim test (FST) and the novel object recognition (NOR), respectively. Next, we induced a depressive-like state by an unpredictable chronic mild stress (UCMS) procedure to test the compounds' activity in the depression model, followed by measures of sucrose preference, FST, and locomotor activity. Levels of phosphorylated cyclic AMP response element-binding protein (p-CREB) and phosphorylated extracellular signal-regulated kinase (p-ERK1/2) were also determined. RESULTS F15599 reduced immobility time in the FST over a wider dose-range (2 to 16 mg/kg po) than F13714 (2 and 4 mg/kg po), suggesting accentuated antidepressant-like properties in mice. F15599 did not disrupt long-term memory consolidation in the NOR at any dose tested, while F13714 impaired memory formation, notably at higher doses (4-16 mg/kg). In UCMS mice, a single administration of F15599 and F13714 was sufficient to robustly normalize depressive-like behavior in the FST but did not rescue disrupted sucrose preference. Both F15599 and F13714 rescued cortical and hippocampal deficits in p-ERK1/2 levels of UCMS mice but did not influence the p-CREB levels. CONCLUSIONS Our studies showed that 5-HT1A receptor biased agonists such as F13714 and especially F15599, due to its less pronounced side effects, might have potential as fast-acting antidepressants.
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Affiliation(s)
- Monika Głuch-Lutwin
- Department of Pharmacobiology, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | - Kinga Sałaciak
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | - Alicja Gawalska
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Jamrozik
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Sniecikowska
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | | | - Marcin Kołaczkowski
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | - Karolina Pytka
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland.
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Bae D, Lee JY, Ha N, Park J, Baek J, Suh D, Lim HS, Ko SM, Kim T, Som Jeong D, Son WC. CKD-506: A novel HDAC6-selective inhibitor that exerts therapeutic effects in a rodent model of multiple sclerosis. Sci Rep 2021; 11:14466. [PMID: 34262061 PMCID: PMC8280216 DOI: 10.1038/s41598-021-93232-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/14/2021] [Indexed: 11/27/2022] Open
Abstract
Despite advances in therapeutic strategies for multiple sclerosis (MS), the therapy options remain limited with various adverse effects. Here, the therapeutic potential of CKD-506, a novel HDAC6-selective inhibitor, against MS was evaluated in mice with myelin oligodendrocyte glycoprotein35-55 (MOG35-55)-induced experimental autoimmune encephalitis (EAE) under various treatment regimens. CKD-506 exerted prophylactic and therapeutic effects by regulating peripheral immune responses and maintaining blood-brain barrier (BBB) integrity. In MOG35-55-re-stimulated splenocytes, CKD-506 decreased proliferation and downregulated the expression of IFN-γ and IL-17A. CKD-506 downregulated the levels of pro-inflammatory cytokines in the blood of EAE mice. Additionally, CKD-506 decreased the leakage of intravenously administered Evans blue into the spinal cord; CD4+ T cells and CD4-CD11b+CD45+ macrophage/microglia in the spinal cord was also decreased. Moreover, CKD-506 exhibited therapeutic efficacy against MS, even when drug administration was discontinued from day 15 post-EAE induction. Disease exacerbation was not observed when fingolimod was changed to CKD-506 from day 15 post-EAE induction. CKD-506 alleviated depression-like behavior at the pre-symptomatic stage of EAE. In conclusion, CKD-506 exerts therapeutic effects by regulating T cell- and macrophage-mediated peripheral immune responses and strengthening BBB integrity. Our results suggest that CKD-506 is a potential therapeutic agent for MS.
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Affiliation(s)
- Daekwon Bae
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.
- Department of Pharmacology, CKD Research Institute, CKD Pharmaceutical Co, Yongin, 16995, Republic of Korea.
| | - Ji-Young Lee
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Nina Ha
- Department of Pharmacology, CKD Research Institute, CKD Pharmaceutical Co, Yongin, 16995, Republic of Korea
| | - Jinsol Park
- Department of Pharmacology, CKD Research Institute, CKD Pharmaceutical Co, Yongin, 16995, Republic of Korea
| | - Jiyeon Baek
- Department of Pharmacology, CKD Research Institute, CKD Pharmaceutical Co, Yongin, 16995, Republic of Korea
| | - Donghyeon Suh
- Department of Pharmacology, CKD Research Institute, CKD Pharmaceutical Co, Yongin, 16995, Republic of Korea
| | - Hee Seon Lim
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Soo Min Ko
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Taehee Kim
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Da Som Jeong
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Woo-Chan Son
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.
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Lipman ZM, Ingrasci G, Yosipovitch G. Approach to the Patient with Chronic Pruritus. Med Clin North Am 2021; 105:699-721. [PMID: 34059246 DOI: 10.1016/j.mcna.2021.04.007] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chronic pruritus (itch lasting ≥6 weeks) is a bothersome chief complaint that may present in a broad variety of diseases. Most itch-causing diagnoses fit into 1 of 5 categories (inflammatory, secondary to systemic disease, neuropathic, chronic pruritus of undetermined origin, and psychogenic itch) and this broad differential can be narrowed using key findings in the history and physical. In this article, we discuss which key findings are most pertinent for narrowing this differential and guiding further workup and treatment, as well as how to treat many itchy conditions.
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Affiliation(s)
- Zoe M Lipman
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, University of Miami Hospital, 1600 Northwest 10th Avenue RMSB Building, 10th Street, 2067B Miami, FL, USA
| | - Giuseppe Ingrasci
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, University of Miami Hospital, 1600 Northwest 10th Avenue RMSB Building, 10th Street, 2067B Miami, FL, USA
| | - Gil Yosipovitch
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, University of Miami Hospital, 1600 Northwest 10th Avenue RMSB Building, 10th Street, 2067B Miami, FL, USA.
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Sartim AG, Marques J, Silveira KM, Gobira PH, Guimarães FS, Wegener G, Joca SR. Co-administration of cannabidiol and ketamine induces antidepressant-like effects devoid of hyperlocomotor side-effects. Neuropharmacology 2021; 195:108679. [PMID: 34157363 DOI: 10.1016/j.neuropharm.2021.108679] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/04/2021] [Accepted: 06/17/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Although useful as a rapid-acting antidepressant drug, ketamine is known to induce psychotomimetic effects, which may interfere with its therapeutic use. Cannabidiol (CBD) is a non-psychostimulant compound from Cannabis sativa, which has shown promising antidepressant effects without inducing hyperlocomotion. AMPA receptor activation is involved in the antidepressant effect induced by ketamine, but its relevance for the effects of CBD is not known. Moreover, given that CBD has antipsychotic and antidepressant properties, it is unknown whether adding CBD to ketamine could potentiate the antidepressant properties of ketamine while also attenuating its psychostimulant effects. EXPERIMENTAL APPROACH S-Ketamine (2.5, 3, 5, 10, 30 mg/kg) and cannabidiol (3, 10, 30 mg/kg) were administered alone or in combination to male Swiss mice. Independent groups received NBQX (AMPA receptor antagonist) 5 min before administration of CBD or S-ketamine. The antidepressant-like effect was assessed in the forced swimming test (FST), and the open field test (OFT) evaluated the psychostimulant effect. KEY RESULTS CBD induced significant dose-dependent antidepressant effects without causing hyperlocomotion in the OFT. S-ketamine produced an antidepressant effect associated with hyperlocomotion in the higher dose. NBQX inhibited the antidepressant effect of both ketamine and CBD. Pretreatment with CBD (10 mg/kg) attenuated the ketamine-induced hyperlocomotion while preserving its antidepressant effect. CONCLUSION AND IMPLICATIONS: Similar to ketamine, the antidepressant-like effect elicited by CBD involves AMPA receptor activation. Additionally, CBD prevents the hyperlocomotion induced by S-ketamine without affecting its antidepressant-like effect. Our findings suggest that CBD and ketamine's combined administration can be a promising therapeutic strategy for achieving an appropriate antidepressant effect without unwanted side-effects. This article is part of the special issue on 'Cannabinoids'.
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Affiliation(s)
- A G Sartim
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - J Marques
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - K M Silveira
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil; Translational Neuropsychiatry Unit (TNU), Department of Clinical Medicine, Aarhus University, Denmark
| | - P H Gobira
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - F S Guimarães
- Department of Pharmacology, School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, SP, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil
| | - G Wegener
- Translational Neuropsychiatry Unit (TNU), Department of Clinical Medicine, Aarhus University, Denmark
| | - S R Joca
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Translational Neuropsychiatry Unit (TNU), Department of Clinical Medicine, Aarhus University, Denmark; Department of Biomedicine, Aarhus University, Denmark.
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Allen S, Thomas J, Harrison K, Emery RL, Petersen A, Winickoff JP, Japuntich S. Bupropion for postpartum smoking relapse: A remote protocol for a two-arm, double-blind, placebo-controlled randomized clinical trial. Contemp Clin Trials 2021; 105:106352. [PMID: 33706003 PMCID: PMC8499393 DOI: 10.1016/j.cct.2021.106352] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/21/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022]
Abstract
Cigarette smoking among postpartum women remains a significant public health problem despite known health risks to women and their newborns. It is estimated that over 50% of women quit smoking during pregnancy but 90% relapse by one year. Safe and effective postpartum relapse prevention strategies are urgently needed. In an attempt to address this deficit, we will investigate the efficacy of bupropion vs. placebo as a smoking relapse prevention aid in postpartum women. The objective of this paper is to detail an approach to investigate bupropion's efficacy for preventing postpartum smoking relapse among women who quit smoking during pregnancy. Specifically, we designed a two-arm, double-blind, placebo-controlled randomized trial testing the efficacy of bupropion vs. placebo as a relapse prevention tool. Mothers of healthy infants who quit smoking while pregnant will be stratified based on current or past history of major depressive disorder or persistent depressive disorder and randomized to receive either active (bupropion XL 300 mg/day) or placebo medication for 12 weeks. To respond to safety concerns associated with participant and staff exposure to COVID-19, we revised our original protocol and present procedures which allow our trial to be conducted entirely remotely. Primary and secondary outcomes will be assessed at weeks 12, 24, 36 and 52 post-randomization. The primary outcome is 7-day point prevalence abstinence at 24 weeks. Results of this work have the potential to positively impact women and their children by promoting lifelong cessation, eliminating secondhand smoke exposure, and modelling of abstinence to children.
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Affiliation(s)
- Sharon Allen
- University of Minnesota, Department of Family Medicine and Community Health, 516 Delaware Street SE, Minneapolis, MN 55455, USA.
| | - Janet Thomas
- University of Minnesota, Department of Medicine, Division of General Internal Medicine, Program in Health Disparities Research, 717 Delaware Street, SE, Suite 166, Minneapolis, MN 55414, USA.
| | - Katherine Harrison
- University of Minnesota, Department of Family Medicine and Community Health, 717 Delaware Street SE, Minneapolis, MN 55455, USA.
| | - Rebecca L Emery
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, 300 West Bank Office Building, Minneapolis, MN 55455, USA.
| | - Ashley Petersen
- University of Minnesota School of Public Health, Division of Biostatistics, 420 Delaware St SE, Minneapolis, MN 55455, USA.
| | - Jonathan P Winickoff
- MassGeneral Hospital for Children, Division of General Pediatrics, 125 Nashua Street, Boston, MA 02114, USA.
| | - Sandra Japuntich
- Hennepin Healthcare, Department of Clinical Pharmacology and Toxicology, University of Minnesota Medical School, Department of Medicine, 701 Park Ave. S.9.303, Minneapolis, MN 55415, USA.
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47
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Kohtala S. Ketamine-50 years in use: from anesthesia to rapid antidepressant effects and neurobiological mechanisms. Pharmacol Rep 2021; 73:323-345. [PMID: 33609274 PMCID: PMC7994242 DOI: 10.1007/s43440-021-00232-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 12/11/2022]
Abstract
Over the past 50 years, ketamine has solidified its position in both human and veterinary medicine as an important anesthetic with many uses. More recently, ketamine has been studied and used for several new indications, ranging from chronic pain to drug addiction and post-traumatic stress disorder. The discovery of the rapid-acting antidepressant effects of ketamine has resulted in a surge of interest towards understanding the precise mechanisms driving its effects. Indeed, ketamine may have had the largest impact for advancements in the research and treatment of psychiatric disorders in the past few decades. While intense research efforts have been aimed towards uncovering the molecular targets underlying ketamine's effects in treating depression, the underlying neurobiological mechanisms remain elusive. These efforts are made more difficult by ketamine's complex dose-dependent effects on molecular mechanisms, multiple pharmacologically active metabolites, and a mechanism of action associated with the facilitation of synaptic plasticity. This review aims to provide a brief overview of the different uses of ketamine, with an emphasis on examining ketamine's rapid antidepressant effects spanning molecular, cellular, and network levels. Another focus of the review is to offer a perspective on studies related to the different doses of ketamine used in antidepressant research. Finally, the review discusses some of the latest hypotheses concerning ketamine's action.
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Affiliation(s)
- Samuel Kohtala
- Laboratory of Neurotherapeutics, Drug Research Program, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, P. O. Box 56, 00014, Helsinki, Finland.
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Feil Family Brain and Mind Research Institute, Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.
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48
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Misztak P, Sowa-Kućma M, Szewczyk B, Nowak G. Vorinostat (SAHA) May Exert Its Antidepressant-Like Effects Through the Modulation of Oxidative Stress Pathways. Neurotox Res 2021; 39:170-181. [PMID: 33400178 DOI: 10.1007/s12640-020-00317-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 02/08/2023]
Abstract
Suberoylanilide hydroxamic acid (SAHA/Vorinostat), a potent inhibitor of histone deacetylases (HDACs), is known to possess antidepressant properties. However, the exact mechanisms underlying this activity are unknown. In this study, we evaluated the effect of SAHA on the expression of GluN2A, GluN2B (NMDA receptor subunits), (p-)AMPK, and ΔFos proteins which are an integral part of the signal transduction pathways in the brain and also involved in the pathophysiology of depression as well as the mechanism of antidepressant action. We also measured the concentration of malondialdehyde (MDA - a product of lipid peroxidation). The study was carried out in the prefrontal cortex (PFC) and hippocampus (Hp), brain regions implicated in depression. Although SAHA induced changes in the expression of all the proteins and MDA concentration, the effects differed depending on the drug dose, time, and brain structure involved. SAHA reduced MDA concentration and significantly increased p-AMPK protein expression, indicating it may prevent oxidative stress. SAHA also increased the levels of HDAC3 and NMDA subunits (GluN2A and GluN2B), implying it is neuroprotective and may play a crucial role in synaptic plasticity. Moreover, ΔFosB and FosB levels were significantly elevated, suggesting that SAHA may modulate learning and memory processes. Overall, the data indicate that the Hp might play a pivotal role in the mechanism of action of SAHA, hinting at novel mechanisms it play in the antidepressant and neuroprotective effects of SAHA.
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Affiliation(s)
- Paulina Misztak
- Department of Pharmacobiology, Jagiellonian University Medical College, Kraków, Poland
- Maj Institute of Pharmacology, Polish Academy of Sciences, Laboratory of Trace Elements Neurobiology, Smetna 12, 31-343, Krakow, Poland
| | - Magdalena Sowa-Kućma
- Department of Human Physiology, Institute of Medical Sciences, Medical College of Rzeszow University, Kopisto 2a, 35-959, Rzeszow, Poland
| | - Bernadeta Szewczyk
- Maj Institute of Pharmacology, Polish Academy of Sciences, Laboratory of Trace Elements Neurobiology, Smetna 12, 31-343, Krakow, Poland
| | - Gabriel Nowak
- Department of Pharmacobiology, Jagiellonian University Medical College, Kraków, Poland.
- Maj Institute of Pharmacology, Polish Academy of Sciences, Laboratory of Trace Elements Neurobiology, Smetna 12, 31-343, Krakow, Poland.
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Qu Y, Shan J, Wang S, Chang L, Pu Y, Wang X, Tan Y, Yamamoto M, Hashimoto K. Rapid-acting and long-lasting antidepressant-like action of (R)-ketamine in Nrf2 knock-out mice: a role of TrkB signaling. Eur Arch Psychiatry Clin Neurosci 2021; 271:439-446. [PMID: 33180200 DOI: 10.1007/s00406-020-01208-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/27/2020] [Indexed: 12/20/2022]
Abstract
The transcription nuclear factor-erythroid factor 2-related factor 2 (Nrf2) plays a key role in inflammation that is involved in depression. We previously reported that Nrf2 knock-out (KO) mice exhibit depression-like phenotypes through systemic inflammation. (R)-ketamine, an enantiomer of ketamine, has rapid-acting and long-lasting antidepressant-like effects in rodents. We investigated whether (R)-ketamine can produce antidepressant-like effects in Nrf2 KO mice. Effects of (R)-ketamine on the depression-like phenotypes in Nrf2 KO mice were examined. Furthermore, the role of TrkB in the antidepressant-like actions of (R)-ketamine was also examined. In the tail-suspension test (TST) and forced swimming test (FST), (R)-ketamine (10 mg/kg) significantly attenuated the increased immobility times of TST and FST in the Nrf2 KO mice. In the sucrose preference test (SPT), (R)-ketamine significantly ameliorated the reduced preference of SPT in Nrf2 KO mice. Decreased expression of synaptic proteins (i.e., GluA1 and PSD-95) in the medial prefrontal cortex (mPFC) of Nrf2 KO mice was significantly ameliorated after a single injection of (R)-ketamine. Furthermore, the pre-treatment with the TrkB antagonist ANA-12 (0.5 mg/kg) significantly blocked the rapid and long-lasting antidepressant-like effects of (R)-ketamine in Nrf2 KO mice. Furthermore, ANA-12 significantly antagonized the beneficial effects of (R)-ketamine on decreased expression of synaptic proteins in the mPFC of Nrf2 KO mice. These findings suggest that (R)-ketamine can produce rapid and long-lasting antidepressant-like actions in Nrf2 KO mice via TrkB signaling.
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Affiliation(s)
- Youge Qu
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, 260-8670, Japan
| | - Jiajing Shan
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, 260-8670, Japan
| | - Siming Wang
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, 260-8670, Japan
| | - Lijia Chang
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, 260-8670, Japan
| | - Yaoyu Pu
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, 260-8670, Japan
| | - Xingming Wang
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, 260-8670, Japan
| | - Yunfei Tan
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, 260-8670, Japan
| | - Masayuki Yamamoto
- Departments of Medical Biochemistry and Respiratory Medicine, Tohoku University Graduate School of Medicine, SendaiMiyagi, Miyagi, 980-8575, Japan
| | - Kenji Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, 260-8670, Japan.
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Tian H, Li G, Xu G, Liu J, Wan X, Zhang J, Xie S, Cheng J, Gao S. Inflammatory cytokines derived from peripheral blood contribute to the modified electroconvulsive therapy-induced cognitive deficits in major depressive disorder. Eur Arch Psychiatry Clin Neurosci 2021; 271:475-485. [PMID: 32361811 DOI: 10.1007/s00406-020-01128-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/14/2020] [Indexed: 12/20/2022]
Abstract
Little is known about the pathophysiology of memory deficits in patients with major depressive disorder (MDD) treated with modified electroconvulsive therapy (MECT). This study examined the profiles of cytokines, the memory function, and their association in MECT-treated MDD patients. Forty first-episode, drug-free MDD patients and 40 healthy controls were recruited. MECT was started with antidepressant treatment at a stable initial dose. The Wechsler Memory Scale (WMS) and Hamilton Rating Scale for Depression 17 (HRSD-17) were used to assess the cognitive function. MDD patients were divided into the memory impairment group (WMS < 50) and the non-memory impairment group (WMS ≥ 50) based on the total WMS scores after MECT. The levels of NOD-like receptor 3 (NLRP3) inflammasome, interleukin-18 (IL-18) and nuclear factor kappa-B (NF-κB) in the serum were measured. MDD patients showed significantly higher levels of NLRP3 inflammasome, IL-18 and NF-κB than that in the controls prior to MECT, and the levels also significantly increased after MECT. In MDD patients, the serum levels of these inflammatory cytokines were negatively associated with the total WMS scores and likely contributed to the scores independently. The receiver operating characteristic curve showed that the serum levels of these inflammatory cytokines may predict the cognitive impairment risk in MDD patients receiving MECT. Abnormal levels of NLRP3 inflammasome, IL-18 and NF-κB reflecting the disturbed balance of pro-inflammatory and anti-inflammatory mechanisms likely contribute to the MECT-induced cognitive deficits in MDD patients.
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Affiliation(s)
- Haihua Tian
- Department of Affective Disorder, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China
| | - Guangxue Li
- Department of Affective Disorder, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China
| | - Guoan Xu
- Department of Affective Disorder, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China
| | - Jimeng Liu
- Department of Affective Disorder, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China
| | - Xiaohan Wan
- Department of Affective Disorder, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, 315211, Zhejiang, China
| | - Jiao Zhang
- Department of Affective Disorder, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, 315211, Zhejiang, China
| | - Shuguang Xie
- Department of Affective Disorder, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China
| | - Jia Cheng
- Department of Affective Disorder, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China.
- Zhongshan Hospital, Xiamen University, Xiamen, 361004, China.
| | - Shugui Gao
- Department of Affective Disorder, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China.
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