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Abstract
Effective pharmacological and psychotherapeutic treatments are well established for obsessive-compulsive disorder (OCD). Serotonin reuptake inhibitors (SRIs) are first-line treatment and are of benefit to about half of patients. Augmentation of SRI treatment with low-dose neuroleptics is an evidence-based second-line strategy. Specialty psychotherapy is also used as both first-line and second-line treatment and can benefit many. However, a substantial number of patients do not respond to these treatments. New alternatives are urgently needed. This review summarizes evidence for these established pharmacotherapeutic strategies, and for others that have been investigated in refractory disease but are not supported by the same level of evidence. We focus on three neurotransmitter systems in the brain: serotonin, dopamine, and glutamate. We summarize evidence from genetic, neuroimaging, animal model, and other lines of investigation that probe these three systems in patients with OCD. We also review recent work on predictors of response to current treatments. While many studies suggest abnormalities that may provide insight into the pathophysiology of the disorder, most studies have been small, and non-replication of reported findings has been common. Nevertheless, the gradual accrual of evidence for neurotransmitter dysregulation may in time lead the way to new pharmacological strategies.
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2
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Pittenger C, Adams TG, Gallezot JD, Crowley MJ, Nabulsi N, Ropchan J, Gao H, Kichuk SA, Simpson R, Billingslea E, Hannestad J, Bloch M, Mayes L, Bhagwagar Z, Carson RE. OCD is associated with an altered association between sensorimotor gating and cortical and subcortical 5-HT1b receptor binding. J Affect Disord 2016; 196:87-96. [PMID: 26919057 PMCID: PMC4808438 DOI: 10.1016/j.jad.2016.02.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/02/2015] [Accepted: 02/07/2016] [Indexed: 01/04/2023]
Abstract
Obsessive-compulsive disorder (OCD) is characterized by impaired sensorimotor gating, as measured using prepulse inhibition (PPI). This effect may be related to abnormalities in the serotonin (5-HT) system. 5-HT1B agonists can impair PPI, produce OCD-like behaviors in animals, and exacerbate OCD symptoms in humans. We measured 5-HT1B receptor availability using (11)C-P943 positron emission tomography (PET) in unmedicated, non-depressed OCD patients (n=12) and matched healthy controls (HC; n=12). Usable PPI data were obtained from 20 of these subjects (10 from each group). There were no significant main effects of OCD diagnosis on 5-HT1B receptor availability ((11)C-P943 BPND); however, the relationship between PPI and (11)C-P943 BPND differed dramatically and significantly between groups. 5-HT1B receptor availability in the basal ganglia and thalamus correlated positively with PPI in controls; these correlations were lost or even reversed in the OCD group. In cortical regions there were no significant correlations with PPI in controls, but widespread positive correlations in OCD patients. Positive correlations between 5-HT1B receptor availability and PPI were consistent across diagnostic groups only in two structures, the orbitofrontal cortex and the amygdala. Differential associations of 5-HT1B receptor availability with PPI in patients suggest functionally important alterations in the serotonergic regulation of cortical/subcortical balance in OCD.
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Affiliation(s)
- Christopher Pittenger
- Department of Psychiatry, Yale University School of Medicine, USA; Department of Psychology, Yale University School of Medicine, USA; Child Study Center, Yale University School of Medicine, USA; Interdepartmental Neuroscience Program, Yale University School of Medicine, USA.
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Orsolini L, Tomasetti C, Valchera A, Iasevoli F, Buonaguro EF, Vellante F, Fornaro M, Fiengo A, Mazza M, Vecchiotti R, Perna G, de Bartolomeis A, Martinotti G, Di Giannantonio M, De Berardis D. New advances in the treatment of generalized anxiety disorder: the multimodal antidepressant vortioxetine. Expert Rev Neurother 2016; 16:483-95. [PMID: 27050932 DOI: 10.1586/14737175.2016.1173545] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Generalized Anxiety Disorder (GAD) is a persistent condition characterized by chronic anxiety, exaggerated worry and tension, mainly comorbid with Major Depressive Disorder (MDD). Currently, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are recommended as first-line treatment of GAD. However, some patients may not respond to the treatment or discontinue due to adverse effects. Vortioxetine (VRX) is a multimodal antidepressant with a unique mechanism of action, by acting as 5-HT3A, 5-HT1D and 5-HT7 receptor antagonist, partial agonist at the 5-HT1A and 5-HT1B receptors and inhibitor at the 5-HT transporter. Preliminary clinical trials showed contrasting findings in terms of improvement of the anxiety symptomatology and/or cognitive impairment. Here, we aim to systematically review the evidence currently available on the efficacy, safety and tolerability of VRX in the treatment of GAD. The generalizability of results on the efficacy of VRX in patients with anxiety symptomatology and GAD is limited due to few and contrasting RCTs so far available. Only two studies, of which one prevention relapse trial, reported a significant improvement in anxiety symptomatology compared to three with negative findings.
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Affiliation(s)
- Laura Orsolini
- a School of Life and Medical Sciences , University of Hertfordshire , Hatfield , UK.,b Villa San Giuseppe Hospital , Hermanas Hospitalarias , Ascoli Piceno , Italy.,c Polyedra Research Group , Teramo , Italy.,d Department of Psychiatry and Neuropsychology , University of Maastricht , Maastricht , The Netherlands
| | - Carmine Tomasetti
- c Polyedra Research Group , Teramo , Italy.,e NHS, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment , Hospital 'Maria SS dello Splendore' , Giulianova , Italy.,f Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatogical Sciences , University of Naples 'Federico II' , Napoli , Italy
| | - Alessandro Valchera
- b Villa San Giuseppe Hospital , Hermanas Hospitalarias , Ascoli Piceno , Italy.,c Polyedra Research Group , Teramo , Italy
| | - Felice Iasevoli
- c Polyedra Research Group , Teramo , Italy.,f Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatogical Sciences , University of Naples 'Federico II' , Napoli , Italy
| | - Elisabetta Filomena Buonaguro
- c Polyedra Research Group , Teramo , Italy.,f Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatogical Sciences , University of Naples 'Federico II' , Napoli , Italy
| | - Federica Vellante
- c Polyedra Research Group , Teramo , Italy.,g NHS, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment , Hospital 'G. Mazzini' , Teramo , Italy.,h Department of Neuroscience and Imaging , University 'G. d'Annunzio' , Chieti , Italy
| | - Michele Fornaro
- c Polyedra Research Group , Teramo , Italy.,i New York Psychiatric Institute , Columbia University , New York , NY , USA
| | | | - Monica Mazza
- c Polyedra Research Group , Teramo , Italy.,j Department of Life, Health and Environmental Sciences , University of L'Aquila , L'Aquila , Italy
| | - Roberta Vecchiotti
- b Villa San Giuseppe Hospital , Hermanas Hospitalarias , Ascoli Piceno , Italy.,c Polyedra Research Group , Teramo , Italy.,d Department of Psychiatry and Neuropsychology , University of Maastricht , Maastricht , The Netherlands
| | - Giampaolo Perna
- d Department of Psychiatry and Neuropsychology , University of Maastricht , Maastricht , The Netherlands.,k Hermanas Hospitalarias, FoRiPsi, Department of Clinical Neurosciences , Villa San Benedetto Menni , Albese con Cassano , Como , Italy.,l Department of Psychiatry and Behavioral Sciences , Leonard Miller School of Medicine, University of Miami , Coral Gables , Florida , USA
| | - Andrea de Bartolomeis
- f Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatogical Sciences , University of Naples 'Federico II' , Napoli , Italy
| | - Giovanni Martinotti
- i New York Psychiatric Institute , Columbia University , New York , NY , USA
| | | | - Domenico De Berardis
- c Polyedra Research Group , Teramo , Italy.,g NHS, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment , Hospital 'G. Mazzini' , Teramo , Italy.,i New York Psychiatric Institute , Columbia University , New York , NY , USA
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Koo MS, Kim EJ, Roh D, Kim CH. Role of dopamine in the pathophysiology and treatment of obsessive–compulsive disorder. Expert Rev Neurother 2014; 10:275-90. [DOI: 10.1586/ern.09.148] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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de Rezende MG, Garcia-Leal C, Graeff FG, Del-Ben CM. The 5-HT1D/1B receptor agonist sumatriptan enhances fear of simulated speaking and reduces plasma levels of prolactin. J Psychopharmacol 2013; 27:1124-33. [PMID: 23325368 DOI: 10.1177/0269881112472560] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study measured the effects of the preferential 5-HT1D/1B receptor agonist sumatriptan in healthy volunteers who performed the Simulated Public Speaking Test (SPST), which recruits the neural network involved in panic disorder and social anxiety disorder. In a double-blind, randomised experiment, 36 males received placebo (12), 50 mg (12) or 100 mg (12) of sumatriptan 2 h before the SPST. Subjective, physiological and hormonal measures were taken before, during and after the test. The dose of 100 mg of sumatriptan increased speech-induced fear more than either a 50mg dose of the drug or placebo. The largest dose of sumatriptan also enhanced vigilance more than placebo, without any change in blood pressure, heart rate or electrical skin conductance. Sumatriptan decreased plasma levels of prolactin. A significant but moderate increase in plasma cortisol after SPST occurred, independent of treatment. Because sumatriptan decreases 5-HT release into the extracellular space, the potentiation of SPST-induced fear caused by the drug supports the hypothesis that 5-HT attenuates this emotional state. As acute administration of antidepressants has also been shown to enhance speaking fear and increase plasma prolactin, in contrast to sumatriptan, the 5-HT regulation of stress-hormone release is likely to be different from that of emotion.
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Affiliation(s)
- Marcos Gonçalves de Rezende
- 1Department of Neuroscience and Behaviour, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Napoletano F, Lionetto L, Martelletti P. Sumatriptan in clinical practice: effectiveness in migraine and the problem of psychiatric comorbidity. Expert Opin Pharmacother 2013; 15:303-5. [PMID: 24206090 DOI: 10.1517/14656566.2014.858120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Migraine is a multifactorial and disabling syndrome often in comorbidity with psychiatric illnesses. Triptans are the first-line treatment in acute attacks and the most effective drugs in various types of migraine. Sumatriptan was the first medication of this group. Thanks to multiple types of formulations that greatly increase patient's compliance, sumatriptan is so far the most commonly used drug for moderate-to-severe acute migraine attacks. Although generally safe and well tolerated, sumatriptan has to be carefully administered in patients suffering from various types of medical conditions (such as cardiovascular and cerebrovascular disease and some psychiatric illnesses) and/or treated with various medications (such as monoamine oxidase inhibitors and selective serotonin reuptake inhibitors). The administration of sumatriptan in some psychiatric condition in which serotonin plays an important role (i.e., major depressive disorder and obsessive-compulsive disorder) has been underestimated so far. In fact, at present, literature studies are few, with non-conclusive and often contrasting findings. Thus, sumatriptan should continue to be used with caution in patients diagnosed with psychiatric illness and/or treated with drugs where serotonin is crucially involved in, until further data demonstrating complete safety become available.
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Affiliation(s)
- Flavia Napoletano
- Sapienza University, Department of Clinical and Molecular Medicine , Rome , Italy
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Nardo M, Casarotto PC, Gomes FV, Guimarães FS. Cannabidiol reverses the mCPP-induced increase in marble-burying behavior. Fundam Clin Pharmacol 2013; 28:544-50. [DOI: 10.1111/fcp.12051] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/13/2013] [Accepted: 09/27/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Mirella Nardo
- Department of Pharmacology; University of Sao Paulo; Bandeirantes Av. 3900 Ribeirao Preto 140490-900 Brazil
| | - Plinio C. Casarotto
- Department of Pharmacology; University of Sao Paulo; Bandeirantes Av. 3900 Ribeirao Preto 140490-900 Brazil
| | - Felipe V. Gomes
- Department of Pharmacology; University of Sao Paulo; Bandeirantes Av. 3900 Ribeirao Preto 140490-900 Brazil
| | - Francisco S. Guimarães
- Department of Pharmacology; University of Sao Paulo; Bandeirantes Av. 3900 Ribeirao Preto 140490-900 Brazil
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Neisewander JL, Cheung THC, Pentkowski NS. Dopamine D3 and 5-HT1B receptor dysregulation as a result of psychostimulant intake and forced abstinence: Implications for medications development. Neuropharmacology 2013; 76 Pt B:301-19. [PMID: 23973315 DOI: 10.1016/j.neuropharm.2013.08.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 07/24/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
Abstract
Addiction to psychostimulants, including cocaine and amphetamine, is associated with dysregulation of dopamine and serotonin (5-HT) neurotransmitter systems. Neuroadaptations in these systems vary depending on the stage of the drug taking-abstinence-relapse cycle. Consequently, the effects of potential treatments that target these systems may vary depending on whether they are given during abstinence or relapse. In this review, we discuss evidence that dopamine D3 receptors (D3Rs) and 5-HT1B receptors (5-HT1BRs) are dysregulated in response to both chronic psychostimulant use and subsequent abstinence. We then review findings from preclinical self-administration models which support targeting D3Rs and 5-HT1BRs as potential medications for psychostimulant dependence. Potential side effects of the treatments are discussed and attention is given to studies reporting positive treatment outcomes that depend on: 1) whether testing occurs during self-administration versus abstinence, 2) whether escalation of drug self-administration has occurred, 3) whether the treatments are given repeatedly, and 4) whether social factors influence treatment outcomes. We conclude that D3/D2 agonists may decrease psychostimulant intake; however, side effects of D3/D2R full agonists may limit their therapeutic potential, whereas D3/D2R partial agonists have fewer undesirable side effects. D3-selective antagonists may not reduce psychostimulant intake during relapse, but nonetheless, may decrease motivation for seeking psychostimulants with relatively few side-effects. 5-HT1BR agonists provide a striking example of treatment outcomes that are dependent on the stage of the addiction cycle. Specifically, these agonists initially increase cocaine's reinforcing effects during maintenance of self-administration, but after a period of abstinence they reduce psychostimulant seeking and the resumption of self-administration. In conclusion, we suggest that factors contributing to dysregulation of monoamine systems, including drug history, abstinence, and social context, should be considered when evaluating potential treatments to better model treatment effects in humans. This article is part of a Special Issue entitled 'NIDA 40th Anniversary Issue'.
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Affiliation(s)
- Janet L Neisewander
- School of Life Sciences, P.O. Box 874501, Arizona State University, Tempe, AZ 85287-4501, USA.
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Zohar J, Greenberg B, Denys D. Obsessive-compulsive disorder. HANDBOOK OF CLINICAL NEUROLOGY 2012; 106:375-90. [DOI: 10.1016/b978-0-444-52002-9.00021-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Tfelt-Hansen PC. Does sumatriptan cross the blood-brain barrier in animals and man? J Headache Pain 2009; 11:5-12. [PMID: 20012125 PMCID: PMC3452191 DOI: 10.1007/s10194-009-0170-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 10/27/2009] [Indexed: 11/05/2022] Open
Abstract
Sumatriptan, a relatively hydrophilic triptan, based on several animal studies has been regarded to be unable to cross the blood–brain barrier (BBB). In more recent animal studies there are strong indications that sumatriptan to some extent can cross the BBB. The CNS adverse events of sumatriptan in migraine patients and normal volunteers also indicate a more general effect of sumatriptan on CNS indicating that the drug can cross the BBB in man. It has been discussed whether a defect in the BBB during migraine attacks could be responsible for a possible central effect of sumatriptan in migraine. This review suggests that there is no need for a breakdown in the BBB to occur in order to explain a possible central CNS effect of sumatriptan.
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Affiliation(s)
- Peer Carsten Tfelt-Hansen
- Department of Neurology, Faculty of Health Sciences, Danish Headache Center, Glostrup Hospital, University of Copenhagen, Glostrup, 2600 Copenhagen, Denmark.
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Shanahan NA, Holick KA, Masten VL, Waeber C, Ansorge M, Gingrich JA, Geyer MA, Hen R, Dulawa SC. Chronic reductions in serotonin transporter function prevent 5-HT1B-induced behavioral effects in mice. Biol Psychiatry 2009; 65:401-8. [PMID: 19013555 PMCID: PMC2674010 DOI: 10.1016/j.biopsych.2008.09.026] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 08/26/2008] [Accepted: 09/16/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts, images, or impulses and/or repetitive stereotypical behavior. Obsessive-compulsive disorder patients exhibit reduced prepulse inhibition (PPI) and symptom exacerbation after challenge with 5-HT1B receptor agonists. Recently, gain-of-function alleles of the serotonin transporter (5-HTT) have been associated with OCD. We tested the hypothesis that reducing 5-HTT function chronically, either genetically or via serotonin reuptake inhibitor (SRI) treatment, attenuates PPI deficits and perseverative hyperlocomotion induced by 5-HT1B agonists in mice. METHODS Mice received subchronic or chronic pretreatment with the SRI fluoxetine and acute treatment with RU24969 (5-HT1A/1B agonist) or 8-OH-DPAT (5-HT1A agonist) and were assessed for PPI, locomotor activity, and spatial patterns of locomotion. The same measures were evaluated in 5-HTT wild-type (WT), heterozygous (HT), and knockout (KO) mice after RU24969 treatment. The effects of WAY100635 (5-HTA antagonist) or GR127935 (5-HT1B/D antagonist) pretreatment on RU24969-induced effects were evaluated. Finally, 5-HT1B binding and functional coupling were assessed in 5-HTT-WT, -HT, and -KO mice, and normal fluoxetine-treated mice. RESULTS Chronic, but not subchronic, fluoxetine treatment prevented RU24969-induced PPI deficits and perseverative hyperlocomotion. These RU24969-induced effects were mediated via 5-HT1B and not 5-HT1A receptors. 5-HTT-KO mice showed no effects of RU24969, and 5-HTT-HT mice exhibited intermediate phenotypes. 5-HT1B binding and functional coupling were reduced in the globus pallidus and substantia nigra of 5-HTT-KO mice. CONCLUSIONS Our results demonstrate that chronic, but not subchronic, fluoxetine treatment and 5-HTT knockout robustly attenuate 5-HT1B agonist-induced PPI deficits and perseverative hyperlocomotion. These results may have implications for the etiology and treatment of OCD.
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Affiliation(s)
- Nancy A. Shanahan
- Committee on Neurobiology, University of Chicago, Chicago, IL, 60637
| | - Kerri A. Holick
- Department of Psychiatry, Columbia University, New York, NY 10032
| | - Virginia L. Masten
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093
| | - Christian Waeber
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129
| | - Mark Ansorge
- Department of Psychiatry, Columbia University, New York, NY 10032
| | - Jay A. Gingrich
- Department of Psychiatry, Columbia University, New York, NY 10032
| | - Mark A. Geyer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093
| | - Rene Hen
- Department of Psychiatry, Columbia University, New York, NY 10032, Department of Pharmacology, Columbia University, New York, NY 10032, Center for Neurobiology and Behavior, Columbia University, New York, NY 10032
| | - Stephanie C. Dulawa
- Department of Psychiatry, University of Chicago, Chicago, IL, 60637, Committee on Neurobiology, University of Chicago, Chicago, IL, 60637,Correspondence should be addressed to: Dr. Stephanie Dulawa, Department of Psychiatry, 924 East 57 Street, Room R018, MC 3077, Chicago, IL 60637, Tel: 773-834-0241, Fax: 773-834-2970,
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Abstract
Obsessive–compulsive disorder (OCD) is a psychiatric disorder consisting of obsessions and compulsions. Over the past two decades, it has been suggested that OCD might be related to the functioning of brain serotonin systems, mainly because of the antiobsessional efficacy of selective serotonin-reuptake inhibitors (SSRIs). Although the efficacy of SSRIs suggests a role of the serotonergic system in OCD, the exact function of serotonin is still unclear. Is the serotonergic system implicated in the pathophysiology of OCD, or is it implicated in the treatment effect in OCD? Do SSRIs compensate for a fundamental abnormality of the serotonergic system, or do SSRIs modulate an intact serotonergic system to compensate for another neurotransmitter mechanism? This review summarizes evidence supporting a role for the serotonin transporter and serotonin receptor subtypes in the pathophysiology and treatment of OCD.
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Affiliation(s)
- Addy van Dijk
- University of Amsterdam, Department of Psychiatry, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Andre Klompmakers
- University of Amsterdam, Department of Psychiatry, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Damiaan Denys
- University of Amsterdam, PA.2–179, PO Box 75867, 1070 AW Amsterdam, The Netherlands
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Goddard AW, Shekhar A, Whiteman AF, McDougle CJ. Serotoninergic mechanisms in the treatment of obsessive–compulsive disorder. Drug Discov Today 2008; 13:325-32. [DOI: 10.1016/j.drudis.2007.12.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 12/19/2007] [Accepted: 12/20/2007] [Indexed: 11/29/2022]
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El Mansari M, Blier P. Mechanisms of action of current and potential pharmacotherapies of obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2006; 30:362-73. [PMID: 16427729 DOI: 10.1016/j.pnpbp.2005.11.005] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A significant body of evidence documented that the orbitofrontal cortex (OFC) and the head of caudate nucleus are involved in the mediation of obsessive-compulsive disorder (OCD) symptoms. Potent serotonin (5-HT) reuptake inhibitors (SRIs) are the only antidepressant agents thus far shown to be effective in the treatment of OCD. The present review summarizes information on 5-HT release and the adaptive changes in pre- and postsynaptic 5-HT receptors sensitivity induced by SRI treatment in rat and guinea pig structures involved in OCD. It emphasizes that the time course for the occurrence of increased 5-HT release and terminal 5-HT1D desensitization is congruent with the delayed therapeutic response to SRI in OCD. In addition, a greater dose of SRI inducing a greater degree of reuptake inhibition may play an essential role in this phenomenon. This is consistent with the common clinical observation that high doses of SRIs are sometimes necessary to obtain an anti-OCD effect, and with the results of some fixed-dose double blind trials showing a dose-dependent therapeutic effect of SRIs. It is hypothesized that enhanced 5-HT release in the OFC is mediated by the activation of normosensitive postsynaptic 5-HT2-like receptors and underlies the therapeutic action of SRI in OCD. This is supported by the beneficial effect of some hallucinogens with 5-HT2 agonistic properties in obtaining a more rapid therapeutic response. Finally, based on this knowledge, new strategies aimed at producing more rapid, effective and safe anti-OCD drugs, such as a selective action on terminal 5-HT1D receptors, on 5-HT2 receptors as well as on the glutamate system, are discussed.
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Affiliation(s)
- Mostafa El Mansari
- University of Ottawa Institute of Mental Health Research, Lady Grey Building, 1145 Carling Avenue, Ottawa, ON, Canada K1Z 7K4
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Amital D, Fostick L, Sasson Y, Kindler S, Amital H, Zohar J. Anxiogenic effects of Sumatriptan in panic disorder: a double-blind, placebo-controlled study. Eur Neuropsychopharmacol 2005; 15:279-82. [PMID: 15820416 DOI: 10.1016/j.euroneuro.2004.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2004] [Accepted: 12/02/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several lines of evidence point to serotonergic abnormalities in patients with panic disorder (PD). Our goal was to further examine central serotonergic function in panic patients using autonomic and subjective responses to the postsynaptic serotonin 5-HT1D receptor agonist Sumatriptan. METHOD Using a double-blind, randomized, placebo-controlled design, we assessed autonomic and subjective responses to oral Sumatriptan (100 mg) and placebo in 15 patients with PD, free of medication. Subjective responses were measured using the Hamilton Anxiety Rating Scale (HAM-A), National Institute of Mental Health Anxiety Scale (NIMHA), a modified version of the Panic Symptom Inventory (PI), Hamilton Depression Rating Scale (HAM-D), and Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS PD patients exhibited significantly enhanced autonomic and subjective responses following challenge with Sumatriptan. We observed an increased pulse rate and augmentation of various parameters measured on different anxiety scales. A constant inclination of aggravation of the measured parameters was detected during the hour post challenge. CONCLUSION Oral administration of Sumatriptan, a 5-HT1D agonist, has been associated with an anxiogenic effect in PD patients.
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Affiliation(s)
- Daniella Amital
- Department of Psychiatry, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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Gross-Isseroff R, Hermesh H, Weizman A. Obsessive compulsive behaviour in autism--towards an autistic-obsessive compulsive syndrome? World J Biol Psychiatry 2001; 2:193-7. [PMID: 12587149 DOI: 10.3109/15622970109026809] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A portion of autistic patients exhibit compulsive-like behaviours. In addition it has been suggested that serotonin plays a major role in both obsessive compulsive disorder (OCD) and autistic disorder. Other neurohumors such as endogenous opioids and oxytocin have also been implicated in the two disorders. There is also some pharmacological overlap between the two disorders, as well as some similar neuroimaging studies. These similarities and overlaps have led us to propose a putative OCD-autistic disorder, which should be studied in greater detail.
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Affiliation(s)
- R Gross-Isseroff
- Outpatient Department, Geha Psychiatric Hospital, P.O.B. 102, Petach Tikva 49100, Israel.
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Abstract
BACKGROUND After considering the effects of 5-HT receptor agonists with different binding profiles on the symptoms of obsessive-compulsive disorder (OCD), Zohar and Kindler hypothesized that the 5-HT(1D) receptor was implicated in this disorder's pathophysiology. METHODS We explored the 5-HT(1D) hypothesis in a 5-day, random, double-blind, placebo-controlled trial of oral sumatriptan 100 mg/day in medication-free adults with OCD. We hypothesized that sumatriptan, a 5-HT(1D) agonist, would diminish 5-HT release, thereby worsening OCD symptoms. We further hypothesized that by beginning to desensitize 5-HT(1D) receptors, sumatriptan pretreatment would promote a faster response or an increased likelihood of response to subsequent treatment with a selective serotonin reuptake inhibitor. RESULTS The five sumatriptan subjects' OCD symptom worsening, as measured by the Yale-Brown scale ( upward arrow 17.6% (S.D. 14.6)), was significant when compared to the slight symptom decrease in the five placebo subjects ( downward arrow 5.2% (S.D. 4.9), P<0.015). The sumatriptan group did not exhibit a faster response or greater likelihood of response to a 90-day, open label trial of paroxetine. CONCLUSIONS Longer term studies of the effects of 5-HT(1D) agonists on OCD symptoms are indicated. Zolmitriptan, a potent 5-HT(1D) receptor agonist with better penetration of the blood-brain barrier, may be a preferred challenge agent.
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Affiliation(s)
- L M Koran
- Department of Psychiatry and Behavioral Sciences, Stanford Medical Center, Stanford, CA, USA.
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Moret C, Briley M. The possible role of 5-HT(1B/D) receptors in psychiatric disorders and their potential as a target for therapy. Eur J Pharmacol 2000; 404:1-12. [PMID: 10980257 DOI: 10.1016/s0014-2999(00)00581-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Serotonin (5-hydroxytryptamine, 5-HT) is implicated in several psychiatric diseases. Is this also true for 5-HT(1B/D) receptors? These receptors are found in high density in substantia nigra, globus pallidus, striatum and basal ganglia and in other brain regions. This ubiquity makes 5-HT(1B/D) receptors responsible for many physiological and behavioural functions. This review focuses on the role of 5-HT(1B) receptors in the regulation of 5-HT release and synthesis. Microdialysis experiments performed on freely moving animals are an interesting in vivo model to study the function of the terminal 5-HT(1B) autoreceptor. Synthesis of 5-HT, estimated by the measurement of the accumulation of 5-hydroxytryptophan (5-HTP) ex vivo or in vitro, is modulated by the 5-HT(1B) autoreceptors. Many reports have shown that chronic administration with selective serotonin reuptake inhibitors leads to the desensitisation of the terminal 5-HT(1B) autoreceptors. With the help of some animal models of depression and anxiety and with some data from clinical studies it has been hypothesised that 5-HT(1B) receptors may be supersensitive in depression, anxiety and obsessive compulsive disorder. Thus, since the dysfunction of 5-HT(1B) receptors may be involved in some pathological states, particularly in the psychiatric field, these receptors represent important potential targets for drugs to treat mental diseases.
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Affiliation(s)
- C Moret
- NeuroBiz BioConsulting, Les Grèzes, La Verdarié, 81100, Castres, France
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