DOCSLIB.ORG

Trazodone-Induced Mania in a Unipolar Depressed Patient with Stable Sertraline Treatment

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Trazodone-Induced Mania in a Unipolar Depressed Patient with Stable Sertraline Treatment Journal name: Neuropsychiatric Disease and Treatment Article Designation: Case report Year: 2017 Volume: 13 Neuropsychiatric Disease and Treatment Dovepress Running head verso: Hu et al Running head recto: Trazodone-induced mania in a unipolar depressed patient open access to scientific and medical research DOI: http://dx.doi.org/10.2147/NDT.S143965 Open Access Full Text Article CASE REPORT Fan the flame: trazodone-induced mania in a unipolar depressed patient with stable sertraline treatment Jianbo Hu1,2,* Abstract: Depressed patients often complain of sleep disturbance. Routine antidepressive Jianbo Lai1,2,* strategies sometimes fail to deal with this intractable issue. Indeed, the supplementation of Hanzhi Zheng3 sleep promoting antidepressants (eg, trazodone, mirtazapine, and agomelatine) is prevalent Shaohua Hu1,2 in clinical practice. However, the combination of different antidepressants may increase the Yi Xu1,2 affective lability. Herein, we document a patient with unipolar depression who was compliant with sertraline treatment and who dramatically switched to mania after adding trazodone as a 1Department of Psychiatry, First sleeping aid. This case extended our understanding of the potential manic-switching risk when Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, trazodone is used to promote sleep. 2 China; The Key Laboratory of Keywords: trazodone, sertraline, depression, mania Mental Disorder’s Management in For personal use only. Zhejiang Province, Hangzhou, China; 3Department of Clinical Medicine, Zhejiang University School of Introduction Medicine, Hangzhou, China Difficulty in initiating or maintaining sleep is not uncommon among patients with affective 1 *These authors contributed equally disorders. Comorbid insomnia is associated with severe psychiatric symptoms and sig- to this work nificantly impairs the quality of life.1,2 Nevertheless, typical antidepressants (eg, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors) can help to improve the mood, but sometimes fail to handle the sleep problem properly.1,3 As was shown in a recent large-scale survey, off-label use of trazodone for insomnia accounted for nearly a quarter of all off-label antidepressant use.4 However, the potential risk associated with off-label trazodone use received limited attention. Furthermore, due to weak evidence of the outcome and appropriateness, the use of trazodone for sleep onset and maintenance difficulties in adult patients was not recommended by the Neuropsychiatric Disease and Treatment downloaded from https://www.dovepress.com/ by 54.70.40.11 on 16-Dec-2018 recently updated guidelines of American Academy of Sleep Medicine.5 Correspondence: Shaohua Hu According to published data, common adverse events of trazodone are gastroin- Department of Psychiatry, the First testinal, cardiovascular, and neurologic effects.6 As an antidepressant approved by the Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, US Food and Drug Administration, the risk of trazodone inducing manic-switching Hangzhou 310003, China was relatively low in patients with bipolar disorder when coprescribed with mood Tel +86 571 5672 3002 7 Fax +86 571 5672 3001 stabilizers. To date, there are sparse cases of trazodone-induced mania reported, Email [email protected] mostly in patients with predisposing factors.7 Herein, we present a middle-aged male Yi Xu patient with unipolar depression who was in remission with compliance to sertraline Department of Psychiatry, the First treatment and switched to mania after adding trazodone to promote sleep. Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou 310003, China Case presentation Tel +86 138 0574 6579 A 36-year-old male patient was taken to our hospital by his family members because Fax +86 571 5672 3001 Email [email protected] of elevated mood and aggressive behaviors. His medical history was collected by submit your manuscript | www.dovepress.com Neuropsychiatric Disease and Treatment 2017:13 2251–2254 2251 Dovepress © 2017 Hu et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you http://dx.doi.org/10.2147/NDT.S143965 hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Powered by TCPDF (www.tcpdf.org) 1 / 1 Hu et al Dovepress detailed inquiry. In his early adolescence, the patient expe- hormone, tumor and infectious biomarkers, were all within rienced his first episode of depression, which was ascribed the normal limits. Cranial magnetic resonance scanning to the bad relationship between his parents. Since then, he was also normal. The patient was diagnosed with bipolar I complained that his mood had swung frequently, with declined disorder, manic episode, according to the Diagnostic and interest in daily activities and loss of appetite. This patient Statistical Manual of Mental Disorders, 5th edition. Quetia- condemned himself as solitary, endocentric, and cowardly. pine was gradually titrated to 700 mg per night over 1 week He had been a Christian for approximately 10 years. After accompanied with 5 mg of haloperidol twice a day for 5 con- graduating from university, he worked as a physics teacher secutive days. His emotional state gradually stabilized after in a local high school. His job performance at school was about 2 weeks of hospitalization. After discharging from proficient. Not until this patient heard of health education hospital, the patient took quetiapine 700 mg every night and on mental illnesses did he first come to a local clinic for remained euthymic during outpatient follow-ups. psychiatric counseling (nearly 8 months prior to admission). On that occasion, he complained of feeling upset, irritable, Ethics and fatigued. He was diagnosed with generalized anxiety This case study obtained approval from the Institute Ethical disorder and was prescribed tandospirone and propranolol. Committee of the First Affiliated Hospital, Zhejiang University Nonetheless, these regimens were discontinued by the patient School of Medicine. The patient and his family members after 2 weeks because of the unsatisfactory outcome. He then signed informed consent to publish case details. visited our hospital and the psychiatrist revised the diagnosis to major depressive disorder. He was given sertraline at a dose Discussion of 100 mg/day. About 2 months after initiating sertraline treat- We present an interesting case in which a small dose of ment, this patient still felt depressed and was not interested in trazodone augmentation to sertraline treatment dramati- daily activities. The dose of sertraline was, therefore, increased cally induced mood-switching. Of note, trazodone was into 150 mg/day. From then on, our patient had felt at ease used as a hypnotic agent in our patient. Given its massive For personal use only. with sertraline treatment for nearly 4 months. His performance use in the general population, this case study is of practi- at work and interpersonal relationships also improved. cal importance when coprescribing trazodone with other About 1 week prior to admission, the patient revisited our antidepressants. hospital and complained of waking up early in the morning, As a serotonin receptor antagonist and serotonin reuptake however his emotional state was stable. Trazodone at a dose inhibitor (SARI), trazodone was classically used as an anti- of 25 mg/night was added to promote sleep. He felt extremely depressant agent. Nevertheless, off-label use of trazodone is excited after taking trazodone for the first time; he slept only commonly found in patients with various medical conditions, 2 hours that night, and became talkative and conceited. In the including anxiety disorder, obsessive-compulsive disorder, following 2 days, he continued to take trazodone, however on substance use disorder, eating disorder, sexual dysfunc- day 3 he discontinued trazodone due to abnormal behavior. tion, and certain pain conditions.6 Besides, trazodone is He preached Christianity during his class which was forbid- often used to cope with insomnia in clinical practice.4,8 Two Neuropsychiatric Disease and Treatment downloaded from https://www.dovepress.com/ by 54.70.40.11 on 16-Dec-2018 den according to the school disciplines. He even sent emails mechanisms may underlie the sleep-enhancing effects of to the White House to seek protection. Also, our patient trazodone, including the blockage of serotonergic 5-HT2A 9 professed that he was conferred superpowers by God. The receptors and histamine H1 receptors. It is noteworthy that day before admission, the patient felt that he was possessed off-label use of trazodone should be cautiously evaluated on by a supernatural spirit and was told to save the world before the basis of individual differences. the coming doomsday. He abused his superiors at a public To date, less than 20 cases of manic-switching associated occasion because of their insincerity. Consequently, he was with trazodone treatment have been documented.7 According sent
Load more

Recommended publications
  • Strategies for Managing Sexual Dysfunction Induced by Antidepressant Medication
    King’s Research Portal DOI: 10.1002/14651858.CD003382.pub3 Document Version Publisher's PDF, also known as Version of record Link to publication record in King's Research Portal Citation for published version (APA): Taylor, M. J., Rudkin, L., Bullemor-Day, P., Lubin, J., Chukwujekwu, C., & Hawton, K. (2013). Strategies for managing sexual dysfunction induced by antidepressant medication. Cochrane Database of Systematic Reviews, (5). https://doi.org/10.1002/14651858.CD003382.pub3 Citing this paper Please note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections. General rights Copyright and moral rights for the publications made accessible in the Research Portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognize and abide by the legal requirements associated with these rights. •Users may download and print one copy of any publication from the Research Portal for the purpose of private study or research. •You may not further distribute the material or use it for any profit-making activity or commercial gain •You may freely distribute the URL identifying the publication in the Research Portal Take down policy If you believe that this document breaches copyright please contact [email protected] providing details, and we will remove access to the work immediately and investigate your claim.
    [Show full text]
  • Original Article E€Ects of Serotonin 1A Agonist on Acute Spinal Cord Injury
    Spinal Cord (2002) 40, 519 ± 523 ã 2002 International Spinal Cord Society All rights reserved 1362 ± 4393/02 $25.00 www.nature.com/sc Original Article Eects of serotonin 1A agonist on acute spinal cord injury Y Saruhashi*,1, Y Matsusue1 and S Hukuda2 1Department of Orthopedic Surgery, Shiga University of Medical Science, Otsu, Japan; 2Tane-daini Hospital, Osaka, Japan Study design: We evaluated the eects of serotonin (5-HT) agonists on in vitro models of spinal cord compressive injury. Evoked potentials in injured rat spinal cords (n=24) were recorded during perfusion with 5-HT agonists. Objectives: To evaluate the therapeutic eects of 5-HT agonists on the recovery of compound action potentials in injured spinal cords. Methods: Rat dorsal columns were isolated, placed in a chamber, and injured by extradural compression with a clip. Conducting action potentials were activated by supramaximal constant current electrical stimuli and recorded during perfusion with 5-HT agonists and antagonists. Results: After inducing compression injuries, mean action potential amplitudes were reduced to 33.9+5.4% of the pre-injury level. After 120 min of perfusion with Ringer's solution, the mean amplitudes recovered to 62.8+8.4% of the pre-injury level. At a concentration of 100 mM, perfusion with tandospirone (a 5-HT1A agonist) resulted in a signi®cantly greater recovery of mean action potential amplitudes at 2 h after the injury (86.2+6.9% of pre-injury value) as compared with the control Ringer's solution (62.8+8.4% of pre-injury value, P50.05). In contrast, quipazine (a 5-HT2A agonist) accelerated the decrease of amplitude (54.5+11.7% of pre-injury value).
    [Show full text]
  • Antipsychotics
    The Fut ure of Antipsychotic Therapy (page 7 in syllabus) Stepp,,hen M. Stahl, MD, PhD Adjunct Professor, Department of Psychiatry Universityyg of California, San Diego School of Medicine Honorary Visiting Senior Fellow, Cambridge University, UK Sppyonsored by the Neuroscience Education Institute Additionally sponsored by the American Society for the Advancement of Pharmacotherapy This activity is supported by an educational grant from Sunovion Pharmaceuticals Inc. Copyright © 2011 Neuroscience Education Institute. All rights reserved. Individual Disclosure Statement Faculty Editor / Presenter Stephen M. Stahl, MD, PhD, is an adjunct professor in the department of psychiatry at the University of California, San Diego School of Medicine, and an honorary visiting senior fellow at the University of Cambridge in the UK. Grant/Research: AstraZeneca, BioMarin, Dainippon Sumitomo, Dey, Forest, Genomind, Lilly, Merck, Pamlab, Pfizer, PGxHealth/Trovis, Schering-Plough, Sepracor/Sunovion, Servier, Shire, Torrent Consultant/Advisor: Advent, Alkermes, Arena, AstraZeneca, AVANIR, BioMarin, Biovail, Boehringer Ingelheim, Bristol-Myers Squibb, CeNeRx, Cypress, Dainippon Sumitomo, Dey, Forest, Genomind, Janssen, Jazz, Labopharm, Lilly, Lundbeck, Merck, Neuronetics, Novartis, Ono, Orexigen, Otsuka, Pamlab, Pfizer, PGxHealth/Trovis, Rexahn, Roche, Royalty, Schering-Plough, Servier, Shire, Solvay/Abbott, Sunovion/Sepracor, Valeant, VIVUS, Speakers Bureau: Dainippon Sumitomo, Forest, Lilly, Merck, Pamlab, Pfizer, Sepracor/Sunovion, Servier, Wyeth Copyright © 2011 Neuroscience Education Institute. All rights reserved. Learninggj Objectives • Differentiate antipsychotic drugs from each other on the basis of their pharmacological mechanisms and their associated therapeutic and side effects • Integrate novel treatment approaches into clinical practice according to best practices guidelines • Identify novel therapeutic options currently being researched for the treatment of schizophrenia Copyright © 2011 Neuroscience Education Institute.
    [Show full text]
  • 5-HT1A Receptor-Dependent Modulation of Emotional
    www.nature.com/scientificreports OPEN 5-HT1A receptor-dependent modulation of emotional and neurogenic defcits elicited by Received: 8 May 2017 Accepted: 19 January 2018 prolonged consumption of alcohol Published: xx xx xxxx Arnauld Belmer 1,2, Omkar L. Patkar1,2, Vanessa Lanoue3 & Selena E. Bartlett 1,2 Repeated episodes of binge-like alcohol consumption produce anxiety, depression and various deleterious efects including alterations in neurogenesis. While the involvement of the serotonin receptor 1 A (5-HT1A) in the regulation of anxiety-like behavior and neurogenesis is well documented, its contribution to alcohol withdrawal-induced anxiety and alcohol-induced defcits in neurogenesis is less documented. Using the Drinking-In-the-Dark (DID) paradigm to model chronic long-term (12 weeks) binge-like voluntary alcohol consumption in mice, we show that the selective partial activation of 5-HT1A receptors by tandospirone (3 mg/kg) prevents alcohol withdrawal-induced anxiety in a battery of behavioral tests (marble burying, elevated-plus-maze, open-feld), which is accompanied by a robust decrease in binge-like ethanol intake (1 and 3 mg/kg). Furthermore, using triple immunolabelling of proliferation and neuronal diferentiation markers, we show that long-term DID elicits profound defcits in neurogenesis and neuronal fate specifcation in the dorsal hippocampus that are entirely reversed by a 2-week chronic treatment with the 5-HT1A partial agonist tandospirone (3 mg/kg/day). Together, our results confrm previous observations that 5-HT1A receptors play a pivotal role in alcohol drinking behavior and the associated emotional and neurogenic impairments, and suggest that 5-HT1A partial agonists represent a promising treatment strategy for alcohol abuse.
    [Show full text]
  • Antidepressant Potential of Nitrogen-Containing Heterocyclic Moieties: an Updated Review
    Review Article Antidepressant potential of nitrogen-containing heterocyclic moieties: An updated review Nadeem Siddiqui, Andalip, Sandhya Bawa, Ruhi Ali, Obaid Afzal, M. Jawaid Akhtar, Bishmillah Azad, Rajiv Kumar Department of ABSTRACT Pharmaceutical Chemistry, Depression is currently the fourth leading cause of disease or disability worldwide. Antidepressant is Faculty of Pharmacy, Jamia Hamdard approved for the treatment of major depression (including paediatric depression), obsessive-compulsive University, Hamdard disorder (in both adult and paediatric populations), bulimia nervosa, panic disorder and premenstrual Nagar, New Delhi - dysphoric disorder. Antidepressant is a psychiatric medication used to alleviate mood disorders, such as 110 062, India major depression and dysthymia and anxiety disorders such as social anxiety disorder. Many drugs produce an antidepressant effect, but restrictions on their use have caused controversy and off-label prescription a Address for correspondence: risk, despite claims of superior efficacy. Our current understanding of its pathogenesis is limited and existing Dr. Sandhya Bawa, E-mail: sandhyabawa761@ treatments are inadequate, providing relief to only a subset of people suffering from depression. Reviews of yahoo.com literature suggest that heterocyclic moieties and their derivatives has proven success in treating depression. Received : 08-02-11 Review completed : 15-02-11 Accepted : 17-02-11 KEY WORDS: Antidepressant, depression, heterocyclic epression is a chronic, recurring and potentially life- monoamine oxidase inhibitors (MAOIs, e.g. Nardil®) tricyclic D threatening illness that affects up to 20% of the population antidepressants (TCAs, e.g. Elavil). They increases the synaptic across the globe.[1] The etiology of the disease is suboptimal concentration of either two (5-HT and NE) or all three (5-HT, concentrations of the monoamine neurotransmitters serotonin NE and dopamine (DA)) neurotransmitters.
    [Show full text]
  • A Systematic Review of the Effectiveness of Antianxiety and Antidepressive Agents for Functional Dyspepsia
    doi: 10.2169/internalmedicine.9099-17 Intern Med 56: 3127-3133, 2017 http://internmed.jp 【 ORIGINAL ARTICLE 】 A Systematic Review of the Effectiveness of Antianxiety and Antidepressive Agents for Functional Dyspepsia Mariko Hojo 1, Akihito Nagahara 2, Daisuke Asaoka 1, Yuji Shimada 2, Hitoshi Sasaki 3, Kohei Matsumoto 1, Tsutomu Takeda 1, Hiroya Ueyama 1, Kenshi Matsumoto 1 and Sumio Watanabe 1 Abstract: Objective Functional dyspepsia (FD) is defined as persistent or recurrent pain or discomfort centered in the upper abdomen without organic disease. Psychosocial factors have been proposed as an important element in the pathophysiology of FD. Therefore, psychotropic agents having antianxiety or antidepressive action are ex- pected to alleviate FD. We previously reported on the treatment of FD using such agents in a systematic re- view, wherein the effectiveness of the agents on FD was suggested, although there were several limitations. We searched for articles on this subject after our systematic review and re-reviewed them systematically. Methods Articles were searched for in MEDLINE from 2003 to 2014 using terms related to antianxiety or antidepressive agents. Clinical studies in which the effectiveness of such agents was clearly stated were se- lected from the retrieved articles. The newly selected and previously selected studies were combined, and sta- tistical analyses were carried out. Results Nine studies were selected. Five of the studies indicated a significant symptomatic improvement us- ing psychotropic drugs. A statistical analysis suggested a significant treatment effect of psychotropic agents having antianxiety or antidepressive action [pooled relative risk (PRR), 0.72; 95% confidence interval (95% CI), 0.52-0.99; p=0.0406] but did not show a significant benefit of treatment with agents having an antide- pressive action alone (PRR, 0.63; 95% CI, 0.38-1.03; p=0.0665).
    [Show full text]
  • Synergistic Action of 5-HT2A Antagonists and Selective Serotonin Reuptake Inhibitors in Neuropsychiatric Disorders
    Neuropsychopharmacology (2003) 28, 402–412 & 2003 Nature Publishing Group All rights reserved 0893-133X/03 $25.00 www.neuropsychopharmacology.org Synergistic Action of 5-HT2A Antagonists and Selective Serotonin Reuptake Inhibitors in Neuropsychiatric Disorders ,1 2 3 2 Gerard J Marek* , Linda L Carpenter , Christopher J McDougle and Lawrence H Price 1Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; 2Department of Psychiatry and Human, Brown Medical School, Mood 3 Disorders Program, Behavior, Butler Hospital, Providence, RI, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA Recently, the addition of drugs with prominent 5-HT2 receptor antagonist properties (risperidone, olanzapine, mirtazapine, and mianserin) to selective serotonin reuptake inhibitors (SSRIs) has been shown to enhance therapeutic responses in patients with major depression and treatment-refractory obsessive–compulsive disorder (OCD). These 5-HT antagonists may also be effective in 2 ameliorating some symptoms associated with autism and other pervasive developmental disorders (PDDs). At the doses used, these drugs would be expected to saturate 5-HT2A receptors. These findings suggest that the simultaneous blockade of 5-HT2A receptors and activation of an unknown constellation of other 5-HT receptors indirectly as a result of 5-HT uptake inhibition might have greater therapeutic efficacy than either action alone. Animal studies have suggested that activation of 5-HT1A and 5-HT2C receptors may counteract the effects of activating 5-HT2A receptors. Additional 5-HT receptors, such as the 5-HT1B/1D/5/7 receptors, may similarly counteract the effects of 5-HT receptor activation. These clinical and preclinical observations suggest that the combination of highly 2A selective 5-HT antagonists and SSRIs, as well as strategies to combine high-potency 5-HT receptor and 5-HT transporter blockade in 2A 2A a single compound, offer the potential for therapeutic advances in a number of neuropsychiatric disorders.
    [Show full text]
  • Neuromodulators for Functional Gastrointestinal Disorders (Disorders of Gutlbrain Interaction): a Rome Foundation Working Team Report Douglas A
    Gastroenterology 2018;154:1140–1171 SPECIAL REPORT Neuromodulators for Functional Gastrointestinal Disorders (Disorders of GutLBrain Interaction): A Rome Foundation Working Team Report Douglas A. Drossman,1,2 Jan Tack,3 Alexander C. Ford,4,5 Eva Szigethy,6 Hans Törnblom,7 and Lukas Van Oudenhove8 1Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina; 2Center for Education and Practice of Biopsychosocial Care and Drossman Gastroenterology, Chapel Hill, North Carolina; 3Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium; 4Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom; 5Leeds Gastroenterology Institute, St James’s University Hospital, Leeds, United Kingdom; 6Departments of Psychiatry and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; 7Departments of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and 8Laboratory for BrainÀGut Axis Studies, Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium BACKGROUND & AIMS: Central neuromodulators (antide- summary information and guidelines for the use of central pressants, antipsychotics, and other central nervous neuromodulators in the treatment of chronic gastrointestinal systemÀtargeted medications) are increasingly used for treat- symptoms and FGIDs. Further studies are needed to confirm ment
    [Show full text]
  • Proneurogenic Effects of Trazodone in Murine and Human Neural
    This is an open access article published under an ACS AuthorChoice License, which permits copying and redistribution of the article or any adaptations for non-commercial purposes. Research Article pubs.acs.org/chemneuro Proneurogenic Effects of Trazodone in Murine and Human Neural Progenitor Cells † § ∥ ∥ † § † § Valeria Bortolotto, , Francesca Mancini, Giorgina Mangano, Rita Salem, , Er Xia, , ‡ § ‡ § § ∥ Erika Del Grosso, , Michele Bianchi, , Pier Luigi Canonico, Lorenzo Polenzani, † § and Mariagrazia Grilli*, , † ‡ § Laboratory of Neuroplasticity, Laboratory of Pharmaceutical Analysis, and Department of Pharmaceutical Sciences, University of Piemonte Orientale “Amedeo Avogadro”, Via Bovio 6, Novara 28100, Italy ∥ Angelini S.p.A, RR&D, Angelini Research Center, Piazzale della Stazione, 00071 S. Palomba-Pomezia, Roma, Italy ABSTRACT: Several antidepressants increase adult hippocampal neurogenesis (ahNG) in rodents, primates, and, potentially, humans. This effect may at least partially account for their therapeutic activity. The availability of antidepressants whose mechanism of action involves different neurotransmitter receptors represents an opportunity for increasing our knowledge on their distinctive peculiarities and for dissecting the contribution of receptor subtypes in ahNG modulation. The aim of this study was to evaluate, in vitro, the effects of the antidepressant trazodone (TZD) on ahNG by using primary cultures of murine adult hippocampal neural progenitor cells (ahNPCs) and human induced pluripotent stem cell (iPSC)-derived NPCs. We demonstrated that TZD enhances neuronal differentiation of murine as well as human NPCs. TZD is a multimodal antidepressant, which binds with high ffi α ffi a nity to 5-HT2a, 1, and 5-HT1a and with lower a nity to 5-HT2c, α ff 2 and 5-HTT. We demonstrated that TZD proneurogenic e ects were mediated by 5-HT2a antagonism both in murine and in κ human NPCs and by 5-HT2c antagonism in murine cells.
    [Show full text]
  • The Role of Psychotropic Medications in the Management of Anorexia Nervosa: Rationale, Evidence and Future Prospects
    The Role of Psychotropic Medications in the Management of Anorexia Nervosa: Rationale, Evidence and Future Prospects Guido K. W. Frank & Megan E. Shott CNS Drugs ISSN 1172-7047 CNS Drugs DOI 10.1007/s40263-016-0335-6 1 23 Your article is protected by copyright and all rights are held exclusively by Springer International Publishing Switzerland. This e- offprint is for personal use only and shall not be self-archived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com”. 1 23 Author's personal copy CNS Drugs DOI 10.1007/s40263-016-0335-6 REVIEW ARTICLE The Role of Psychotropic Medications in the Management of Anorexia Nervosa: Rationale, Evidence and Future Prospects 1,2 1 Guido K. W. Frank • Megan E. Shott Ó Springer International Publishing Switzerland 2016 Abstract Anorexia nervosa (AN) is a severe psychiatric disorder without approved medication intervention. Every Key Points class of psychoactive medication has been tried to improve treatment outcome; however, randomized controlled trials Anorexia nervosa (AN) is a severe psychiatric illness have been ambiguous at best and across studies have not with a complex interplay of bio-psycho-social shown robust improvements in weight gain and recovery.
    [Show full text]
  • Multi-Target Approach for Drug Discovery Against Schizophrenia
    Review Multi-Target Approach for Drug Discovery against Schizophrenia Magda Kondej 1, Piotr Stępnicki 1 and Agnieszka A. Kaczor 1,2,* 1 Department of Synthesis and Chemical Technology of Pharmaceutical Substances, Faculty of Pharmacy with Division of Medical Analytics, Medical University of Lublin, 4A Chodźki St., Lublin PL-20093, Poland; [email protected] (M.K.); [email protected] (P.S.) 2 School of Pharmacy, University of Eastern Finland, Yliopistonranta 1, P.O. Box 1627, Kuopio FI-70211, Finland * Correspondence: [email protected]; Tel.: +48-81-448-7273 Received: 3 September 2018; Accepted: 6 October 2018; Published: 10 October 2018 Abstract: Polypharmacology is nowadays considered an increasingly crucial aspect in discovering new drugs as a number of original single-target drugs have been performing far behind expectations during the last ten years. In this scenario, multi-target drugs are a promising approach against polygenic diseases with complex pathomechanisms such as schizophrenia. Indeed, second generation or atypical antipsychotics target a number of aminergic G protein-coupled receptors (GPCRs) simultaneously. Novel strategies in drug design and discovery against schizophrenia focus on targets beyond the dopaminergic hypothesis of the disease and even beyond the monoamine GPCRs. In particular these approaches concern proteins involved in glutamatergic and cholinergic neurotransmission, challenging the concept of antipsychotic activity without dopamine D2 receptor involvement. Potentially interesting compounds include ligands interacting with glycine modulatory binding pocket on N-methyl-D-aspartate (NMDA) receptors, positive allosteric modulators of α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, positive allosteric modulators of metabotropic glutamatergic receptors, agonists and positive allosteric modulators of α7 nicotinic receptors, as well as muscarinic receptor agonists.
    [Show full text]
  • Effectiveness of Risperidone for The
    LETTERS TO THE EDITORS Effect of Tandospirone on and anxiolytic,12,13 was effective for en- occasionally reported anxiety, which be- hancing MMN and improving cognitive came more frequent and severe when she Mismatch Negativity and performance. began to take care of her nephew whose Cognitive Performance in mother had obtained a job. At this time, the patient was able to help the household Schizophrenia CASE REPORT of her brother’s family, which she lived A Case Report The patient is a 37-year-old woman with, but was not motivated enough to go meeting Diagnostic and Statistical Manual out by herself. For anxiolytic purpose, tan- To the Editors: of Mental Disorders, Fourth Edition crite- dospirone, 30 mg/d as initial dose, was isturbances of cognitive function, eval- ria for schizophrenia. She graduated from added, which was titrated to 60 mg/d (re- D uated by neurophysiological1Y3 and a mainstream high school and entered a commended maximum dose) during the psychological4 measures, have been shown university. At age 20, she experienced au- initial month, because of the insufficient to predict outcome in patients with schizo- ditory hallucinations, delusion of persecu- effect of the lower dose. The dose of olan- phrenia. Mismatch negativity (MMN) is an tion, and emotional instability and was zapine was unchanged. By 3 months after event-related potential (ERP) generated in admitted to a local psychiatric hospital im- the start of tandospirone, her anxiety symp- response to occasional variations of acoustic mediately after the police spotted her wan- toms almost disappeared, and remained so stimuli and is suggested to reflect preatten- dering around in the rain.
    [Show full text]