Effect of single and repeated electroshock applications on brain acetylcholine levels and choline acetyltransferase activity in the rat

Acetylcholinesterase inhibitors for electroconvulsive therapy-induced cognitive side effects: a systematic review

OBJECTIVE

Electroconvulsive therapy (ECT) is an effective treatment for severe late-life depression; however, ECT-induced cognitive side effects frequently occur. The cholinergic system is thought to play an important role in the pathogenesis. We systematically reviewed the evidence for acetylcholinesterase inhibitors (Ache-I) to prevent or reduce ECT-induced cognitive side effects.

METHODS

A systematic search was performed in Pubmed, EMBASE, PsychINFO, and the Cochrane database to identify clinical trials investigating the effect of Ache-I on ECT-induced cognitive side effects. Key search terms included all synonyms for ECT and Ache-I. Risk of bias assessment was conducted by using the Cochrane Collaboration's tool.

RESULTS

Five clinical trials were eligible for inclusion. All studies focused on cognitive functioning as primary endpoint, but assessment of cognitive functioning varied widely in time point of assessment and in cognitive tests that were used. There was also great variety in study medication, route and time of administration and dosages, duration of drug administration, and ECT techniques. Finally, only two out of five studies were considered at low risk of bias. Despite the aforementioned shortcomings, without exception, all studies demonstrated significantly better cognitive performance in individuals treated with Ache-I.

CONCLUSIONS

Despite large heterogeneity in studies, Ache-I appear to have beneficial effects on ECT-induced cognitive side effects, supporting an association with the cholinergic system in ECT-induced cognitive impairment. Methodological sound studies controlling for putative confounders are warranted. Copyright © 2017 John Wiley & Sons, Ltd.

Does electroconvulsive therapy cause brain damage?

Although the use of ECT has declined dramatically from its inception, this decrease has recently shown signs of leveling out because of ECT's powerful therapeutic effect in severely ill depressed individuals who either do not respond to pharmacologic alternatives or are too ill to tolerate a relatively lengthy drug trial. Notwithstanding its therapeutic benefits, ECT has also remained a controversial treatment modality, particularly in the eye of the public. Given the unsavory qualities associated with the word “electroconvulsive,” claims of possible, probable, or even certain brain damage with ECT have easily found listeners. A careful, nonselective assessment of data covering the areas of pathology, radiology, electrophysiology, biochemistry, and neuropsychology leads both to certain conclusions and to certain unanswered questions. ECT is not the devastating purveyor of wholesale brain damage that some of its detractors claim. For the typical individual receiving ECT, no detectable correlates of irreversible brain damage appear to occur. Still, there remains the possibility that either subtle, objectively undetectable persistent deficits, particularly in the area of autobiographic memory function, occur, or that a rarely occurring syndrome of more pervasive persistent deficits related to ECT use may be present. Clearly, more research directed toward answering these questions needs to be carried out so that the role of ECT can be more rigorously defined. While such research is pending, however, we cannot expect that the conditions that predispose to clinical referrals for ECT will disappear. Given the misery, anguish, and risk of death by suicide, starvation, or debilitation associated with severe depressive illness, for example, it still appears that ECT, at least for the present, must continue to be available.

Antidepressant effects of Soyo-san on Immobilization stress in ovariectomized female rats

Soyo-san is a traditional oriental medicinal formula, a mixture of 9 crude drugs, and it has been clinically used for treating mild depressive disorders. The purpose of the study was to examine the effect of Soyo-san on repeated stress-induced alterations of learning and memory on a Morris water maze (MWM) task and also the anxiety-related behavior on the elevated pulse maze (EPM) in ovariectomized female rats. We assessed the changes in the reactivity of the cholinergic system by measuring the immunoreactive neurons of choline acetyltransferase (ChAT) and reactivity of acetylcholinesterase (AChE) in the hippocampus, and the serum levels of corticosterone were assessed after behavioral testing. The female rats were randomly divided into three groups: the nonoperated and nonstressed group (normal), the ovariectomized and stressed group (control), and the ovariectomized, stressed and Soyo-san treated group (SOY). The rats were exposed to immobilization stress (IMO) for 14 d (2 h/d), and Soyo-san (400 mg/kg, i.p.) was administered 30 min before IMO stress. Treatments with SOY caused significant reversals of the stress-induced deficits in learning and memory on a spatial memory task, and it also produced an anxiolytic-like effect on the EPM, and increased the ChAT and AChE reactivities (p<0.05, respectively). The serum level of corticosterone in the SOY group was significantly lower than that in the control group (p<0.05). These results suggest that Soyo-san might prove to be an effective antidepressant agent.

Switch to mania upon discontinuation of antidepressants in patients with mood disorders: a review of the literature

OBJECTIVE

To review the literature for reported cases of mania related to discontinuing antidepressant treatment, as well as for possible explanations of this phenomenon, and to present a case report.

METHOD

We undertook a literature review through the PubMed index, using the key words mania, antidepressant withdrawal, and antidepressants in bipolar disorder. We reviewed 11 articles featuring 23 cases. Where available, we noted and tabulated certain parameters for both bipolar disorder (BD) and unipolar depression. We use a case example to illustrate the phenomenon of mania induced by antidepressant withdrawal.

RESULTS

For patients with unipolar depression, we found 17 reported cases of mania induced by antidepressant withdrawal. Antidepressants implicated included tricyclic antidepressants (TCAs) (12/17), monoamine oxidase inhibitors (MAOIs) (2/17), trazodone (1/17), mirtazapine (1/17), and paroxetine (1/17). For patients with BD, we found 19 reported cases of mania induced by antidepressant withdrawal, including our own case example. Of these, selective serotonin reuptake inhibitors (SSRIs) (10/19), TCAs (4/19), MAOIs (2/19), and serotonin norepinephrine reuptake inhibitors (SNRIs) (2/19) were implicated.

CONCLUSION

Our case report supports the observation of antidepressant withdrawal-induced mania in patients with BD. It is distinguishable from antidepressant-induced mania, physiological drug withdrawal, and mania as a natural course of the illness. Many theories have been put forward to explain this occurrence. Noradrenergic hyperactivity and "withdrawal-induced cholinergic overdrive and the cholinergic-monoaminergic system" are the 2 most investigated and supported models. The former is limited by poor clinical correlation and the latter by its applicability only to anticholinergic drugs.

Characterization of a novel muscarinic receptor agonist, YM796: comparison with cholinesterase inhibitors in in vivo pharmacological studies

Previous reports have shown that (+/-)-YM796 (2,8-dimethyl-3-methylene-1-oxa-8-azaspiro[4.5]decane) exhibits M1 agonistic activity and ameliorates cognitive impairment, and that the (-)-S isomer is active in in vitro studies. We report here the characterization of the (-)-S isomer, YM796 ((-)-(S)-2,8-dimethyl-3-methylene-1-oxa-8-azaspiro[4.5]decane L-tartrate monohydrate), and its (+)-R isomer in in vivo pharmacological studies in comparison with the cholinesterase inhibitors tacrine, amiridine and E-2020. YM796 (0.031-0.5 mg/kg p.o.), like the racemate, reversed the cognitive impairment in passive avoidance tasks of rats with nucleus basalis magnocellularis lesions, whereas (+)-R-YM796 was ineffective in this experimental amnesia. YM796 exhibited only weak effects on mouse salivation and hypothermia, a peripheral cholinergic response and a central cholinergic response, respectively. The (+)-R isomer, however, failed to induce these cholinergic responses. YM796 also ameliorated the memory deficits induced by scopolamine in rats and electroconvulsive shock in mice. The potency of YM796 in these experimental amnesia models was over a 100 times greater than that of tacrine, over 10 times greater than that of E-2020, and 6 times greater than that of amiridine. In salivary secretion and hypothermia, YM796 was 2-4 times weaker than tacrine and E-2020, and 1-2 times stronger than amiridine. Thus, YM796's ratio of anti-amnesic effects to salivary secretion and hypothermia was much greater than that of the cholinesterase inhibitors tested.(ABSTRACT TRUNCATED AT 250 WORDS)

Can ECT-induced cognitive effects be altered pharmacologically?

1. A systematic review of the literature revealed twelve clinical trials that evaluated nine different drugs, and used three different conceptual models to prevent, restore or treat ECT-induced cognitive deficits. 2. This review indicated inconclusive results regarding clinical utility of any of the drugs. 3. Major factors discussed include the complexities involved in the evaluation of ECT-induced cognitive deficits, and the techniques of evaluating changes in cognitive functions. 4. Our conclusion is that future research should emphasize understanding the neural mechanisms related to ECT-induced cognitive deficits. We suggest several areas for future exploration.

Effect of stress on choline acetyltransferase activity of the brain and the adrenal of the rat

Choline acetyltransferase (ChAT) activity was determined in cerebral cortex, hypothalamus, hippocampus, cerebellum, medulla oblongata, midbrain and adrenal gland of rats exposed to acute or chronic stress. The exposure of animals to acute immobilization and cold stress (4 degrees C) for one hour resulted in a significant decline of ChAT activity in all brain regions examined except for the medulla oblongata. Moreover, the exposure to acute stress resulted in significant increase of the same enzyme in the adrenal gland. However, chronic exposure of animals to cold stress (4 degrees C) for 7 days resulted in no significant changes of ChAT activity in all tissues examined except for a decline in the midbrain and an increase in the medulla oblongata. The administration of corticosterone (2.0 mg/kg) 1 h prior to sacrificing caused an effect similar to that of acute stress on ChAT activity in all brain regions except for the hypothalamus and the cerebellum. It was concluded from this experiment that stress-induced changes in the ChAT activity of specific brain regions might be mediated by the adrenal steroids.

Effect of cholinesterase inhibitor and exercise on choline acetyltransferase and acetylcholinesterase activities in rat brain regions

This study sought to determine whether the choline acetyltransferase (ChAT) and acetylcholinesterase (AChE) enzymes in the brain were affected in a regionally selective manner by chemical and physical stressors: 1) subacute administration of physostigmine (Phy); 2) exercise; and 3) the combination of these two stressors. ChAT and AChE activities in corpus striatum were significantly decreased due to Phy as well as Phy + exercise. This suggests that corpus striatum is affected by chemical stressors but more so by the combination of chemical and physical stressors. The brainstem is the only region which showed inhibition of ChAT activity due to exercise. Subacute Phy also inhibited brainstem ChAT activity. The hippocampus showed significant decrease in ChAT activity due to Phy + exercise but not due to Phy alone. These results suggest that the brain regions involved with control of motor, autonomic and cognitive functions were affected by subacute Phy and exercise. These data are consistent with the hypothesis that the responsiveness of these brain regions to different stressors is a function of the level of ongoing cholinergic activity and that elevations in ACh levels due to AChE inhibition may have long-term effects on the regulation of ChAT and AChE activities through a negative feedback mechanism.

Dopamine and ACh involvement in plastic learning by hypothalamic neurons in rats

Unit activity in the rat lateral hypothalamus (LHA) was recorded during discrimination learning of cue tone stimuli (CTS). CTS+ predicted reward (glucose or intracranial self-stimulation); CTS- predicted aversion (electric shock or tail pinch); and all behavior responses were by the same act, licking. Roles of the LHA dopaminergic and cholinergic systems in CTS learning were investigated by electrophoretic application of dopamine (DA) and acetylcholine (ACh), and their antagonists. The CTS+, the predicted reward and DA, all had similar effects (inhibition) on many LHA neurons; and these were all opposite to the effects (excitation) of CTS-, the predicted aversion, and ACh. Neural responses to CTS+ were blocked by spiperone, and responses to CTS- were blocked by atropine. Sensitivity of LHA neurons to DA was reduced by extinction of CTS+ learning for reward, and sensitivity to ACh was reduced by CTS- learning for aversion. The data suggest that afferent DA and ACh inputs to LHA neurons are essential for plastic CTS+ and CTS- learning.

Electroconvulsive treatment: effects on phospholipase C activity and GTP binding activity in rat brain

The effect of electroconvulsive treatment (ECT) on activities of phospholipase C hydrolyzing phosphatidylinositol (PI-PLC) and phosphatidylinositol 4,5-bisphosphate (PIP2-PLC) and guanosine-5'-(3-O-thio)triphosphate (GTP gamma S) binding activity were examined in membrane and cytosol fractions from four discrete areas (prefrontal cortex, hippocampus, striatum, and amygdala) of the rat brain. A single ECT resulted in an increase in cytosolic activities of PI-PLC in the prefrontal cortex and of PIP2PLC in all 4 brain regions examined. There were no significant changes in either PI-PLC or PIP2-PLC activity in membrane fractions after a single ECT. Repeated ECT caused regionally specific changes in PLC activities as follows: in the prefrontal cortex, both cytosolic PI-PLC and PIP2-PLC and membranous PI-PLC activities were decreased; in the hippocampus, no changes in any PLC activities were seen; in the striatum, only membranous PI-PLC activities were increased; and, in the amygdala, cytosolic and membranous PI-PLC and cytosolic PIP2-PLC activities were increased. The pattern of changes in GTP gamma S binding activity following repeated ECT resembled those found in PLC activity as follows: in the prefrontal cortex, GTP gamma S binding activities were significantly reduced in both membrane and cytosol; in the hippocampus, the activity was decreased in membrane; in the striatum, no changes in GTP gamma S binding activity were seen in any fraction; and, in the amygdala, the activity was increased in cytosol. These findings suggest that ECT has complex effects on the G protein-phospholipase C system, possibly affecting neuronal signal transduction.

Effect of a novel CNS-selective cholinesterase inhibitor, SM-10888, on habituation and passive avoidance responses in mice

The effects of the tacrine (THA) derivative SM-10888 (9-amino-8-fluoro-1,2,3,4-tetrahydro-2,4-methanoacridine citrate) on habituation and passive avoidance responses were studied in mice. We examined its effects on habituation of exploratory activity, measured by photo-cell beam interruptions in a small, simple cage and cycloheximide (CXM)- or electroconvulsive shock (ECS)-induced stepdown type passive avoidance response (PAR) failures in comparison with those of THA, amiridin, HP-029 and physostigmine. SM-10888 (6 mg/kg, p.o.) administered post-acquisition session enhanced the retention of habituation. CXM- and ECS-induced PAR failures were improved by SM-10888 (6 mg/kg, p.o.) administered at pre-training or post-training, respectively. THA enhanced the retention of habituation and improved CXM-induced PAR failure at 30 mg/kg, p.o., but did not affect ECS-induced PAR failure at 1-15 mg/kg, p.o. Amiridin and HP-029 were also effective on habituation and CXM-induced PAR failure at 40-50 mg/kg, p.o., but did not affect ECS-induced PAR failure at the tested doses. Physostigmine showed a moderate improvement only in CXM-induced PAR failure. The results indicate that SM-10888 enhanced habituation and improved PAR failures at much lower doses than THA. This seems to depend on its high selectivity to the central nervous system.

Increased activity of choline acetyltransferase and acetylcholinesterase in actively epileptic human cerebral cortex

We measured the activities of the cholinergic marker synthetic and catabolic enzymes choline acetyltransferase (ChAT) and acetylcholinesterase (AChE) in surgical specimens obtained from 38 patients immediately following anterior temporal lobectomy for intractable epilepsy. Samples from patients with actively spiking lateral temporal cortex were compared to non-spiking lateral temporal cortex obtained from patients in whom the epileptic discharges were confined to the hippocampus. Mean activities of ChAT and AChE were increased by 25% (P less than 0.01) and 30% (P less than 0.025) respectively in the spiking vs. non-spiking cortex. We suggest that the above-normal activity of these cholinergic marker enzymes may reflect sprouting of cholinergic nerve terminals in spontaneously spiking cortex of some patients and/or increased acetylcholine metabolism secondary to the stimulatory effect of the ongoing epileptic discharge.

Temperature as a dependent variable in the study of cholinergic mechanisms

1. Change in core temperature over time can be used as a dependent variable when studying the effects of manipulations on neurotransmitter systems. This article focuses on the measurement of core temperature as a strategy for detecting changes in the status of cholinergic systems. 2. Cholinergic neurons participate in the process of thermoregulation and interventions affecting them alter the thermal response to cholinomimetics. For example, chronic treatment with amitriptyline, chronic swim stress and inescapable footshock supersensitize rats to the hypothermic effects of oxotremorine. 3. This is consistent with the hypothesis that the pathophysiologies of tricyclic antidepressant withdrawal phenomena and stress involve supersensitivity of muscarinic mechanisms. 4. Uses of thermoregulation paradigms for investigating the actions of lithium ion, electroconvulsive shock and substances of abuse on muscarinic mechanisms are discussed. Applications to problems in the arena of clinical research are highlighted.

Acetylcholine and its enzymes in some brain areas of the rat under stress

A period of 1 or 24 h of cold stress (5 degrees C) resulted in a significant decrease of acetylcholine (ACh) concentration in the hypothalamus and hippocampus in rats. In the hippocampus the activity of the choline acetyltransferase (ChAT) was significantly increased after 24 h and that of acetylcholinesterase (AChE) after 1 and 24 h exposure to cold, whereas in the hypothalamus, AChE activity was found to be decreased, albeit only after 24 h exposure. Separate investigation of the dorsal and ventral hippocampus under 24 h of cold revealed that the ACh decreased in the dorsal hippocampus only, where no change in ChAT activity was observed. On the other hand, ACh showed no change in the ventral hippocampus where an increase of ChAT activity was found. Forced swimming for 20 min also induced a significant decrease of ACh in the hippocampus and cerebral cortex, along with a significant increase of choline concentration in the given regions. We conclude that under certain stress situations the cholinergic system in rat brain areas, mainly in the hippocampus and hypothalamus, is activated.

Acetylcholine content in rat brain is elevated by status epilepticus induced by lithium and pilocarpine

The effects of status epilepticus on the concentration, synthesis, release, and subcellular localization of acetylcholine, the concentration of choline, and the activity of acetylcholinesterase in rat brain regions were studied. Generalized convulsive status epilepticus was induced by the administration of pilocarpine to lithium-treated rats. The concentration of acetylcholine in the cortex, hippocampus, and striatum decreased prior to the onset of spike activity or status epilepticus. Once status epilepticus began, the concentration of acetylcholine increased over time in the cortex and hippocampus, reaching peak levels that were 461% and 304% of control levels, respectively, after 2 h of seizures. Such high in vivo levels of acetylcholine had not been reported previously following any treatment. During status epilepticus, the concentration of acetylcholine in the striatum returned to control levels after the initial depression, but did not accumulate to high levels as it did in the other two regions. The in vivo cortical efflux of acetylcholine was also increased during the seizures. Choline levels were increased by status epilepticus in all three brain regions. Inhibition of seizures by pretreatment with atropine blocked the increases of acetylcholine and choline. Synaptosomes prepared from the cortex and from the hippocampus of rats with status epilepticus had elevated concentrations of acetylcholine: in the hippocampus the acetylcholine was principally in the cytoplasmic fraction, whereas in the cortex the acetylcholine was elevated in both the cytoplasmic and the vesicular fractions. The extra acetylcholine was in a releasable compartment, since increased K+ in the media or ouabain increased the release of acetylcholine from cortical slices to a greater extent in tissue from seized rats than from controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Neurochemical consequences of status epilepticus induced in rats by coadministration of lithium and pilocarpine

Status epilepticus was produced in rats by administering pilocarpine (30 mg/kg, s.c.) 16 h after treatment with LiCl (3 meq/kg, i.p.). After 35 min of status epilepticus, several parameters of cholinergic activity were measured. Seizures had no effect on the in vivo concentration of acetylcholine or choline in cerebellum, cortex, hippocampus, or striatum. Synaptosomal high-affinity choline transport was also not changed by seizures in hippocampus, cortex, or striatum. Cortical slices from seizing rats had elevated concentrations of acetylcholine and released acetylcholine at a greater rate than did controls, but these effects seemed to be due to a reduction in the postmortem hydrolysis of acetylcholine. Synaptosomal 45calcium uptake during 2 to 60 s of incubation was no different from control rates in tissue prepared from seizing rats. These results indicate that presynaptic cholinergic activity is not markedly altered by 35 min of continuous seizure activity induced by lithium and pilocarpine. In contrast, the in vivo concentration of cyclic guanosine 5'-monophosphate was elevated above control values in seizing rats by 57 to 170% in cerebellum, cortex, hippocampus, and striatum.

Oxiracetam prevents electroshock-induced decrease in brain acetylcholine and amnesia

In the rat, 1 min following electroshock (ECS) a 46 and 39% decrease in acetylcholine levels was found in the hippocampus and cerebral cortex, respectively. The decrease in the hippocampus was still statistically significant 30 min after ECS. The ECS applied 1 min after training also disrupted the performance of a passive avoidance conditioned response ('step down') tested 30 min later. Oxiracetam (100 and 300 mg/kg i.p.) administered 90 min before training prevented, in a dose-dependent manner, the decrease of acetylcholine in the cerebral cortex and hippocampus. Oxiracetam prevented the ECS disruption of the acquisition of a passive avoidance response. At the dose of 300 mg/kg the acetylcholine level 1 min after ECS was significantly higher than in the sham-treated rats. Piracetam at the same doses was inactive. These results support the hypothesis that oxiracetam may prevent the disruption of the conditioned response by acting on cortical and hippocampal cholinergic mechanisms.

Effect of chronic lithium on cholinergically mediated responses and [3H]QNB binding in rat brain

Lithium (Li) has been previously reported to increase acetylcholine turnover and release in rat brain and to potentiate the neurotoxicity of cholinergic agents. We studied the effect of chronic Li administration, alone and in combination with the muscarinic antagonist, scopolamine, on two cholinergically-mediated responses and on muscarinic cholinergic receptor (MCR) binding in rat brain. Administered separately, Li and scopolamine enhanced the cataleptic and hypothermic responses to pilocarpine; combined administration resulted in an additive effect on both these measures. [3H]Quinuclidinyl benzilate ([3H]QNB) binding was increased by Li in the corpus striatum but not in the cortex, hippocampus and hypothalamus. Scopolamine increased [3H]QNB binding in the striatum, cortex and hippocampus; Li and scopolamine effects on striatal MCR were not additive. Contrary to a previous report, antagonist-induced MCR supersensitivity was not prevented by concurrent Li administration in any of the brain areas studied. The additive effect of Li and scopolamine on pilocarpine-induced catalepsy and a trend in this direction for pilocarpine-induced hypothermia suggest that the actions of the two agents to enhance cholinergically mediated responses may be achieved by different mechanisms. Supersensitive responses following scopolamine may be attributed to antagonist-induced up-regulation of postsynaptic muscarinic receptors as demonstrated in the binding studies. The effects of Li to enhance cholinergically-mediated catalepsy and hypothermia are interpreted as extending previous reports that Li stimulates brain cholinergic function by a presynaptic increase in acetylcholine turnover and release.

Studies on the role of brain cholinergic systems in the therapeutic mechanisms and adverse effects of ECT and lithium

Brain cholinergic systems are thought to play an important role in memory function and mood regulation. Electroconvulsive therapy (ECT) and lithium (Li) have substantial therapeutic effects on abnormal mood and may adversely affect cognitive processes. The effects of chronic electroconvulsive shock (ECS) and Li administration on brain muscarinic cholinergic receptors (MCR), and on functional correlates of altered brain cholinergic activity, were therefore studied. ECS reduced MCR number in the cerebral cortex and diminished cataleptic responses to the muscarinic agonist, pilocarpine. MCR down-regulation may have therapeutic implications in depression which has been putatively linked to central cholinergic supersensitivity. Alternatively, ECS effects on brain cholinergic function may be involved in the pathogenesis of ECT-induced memory deficits. Both ECS-induced MCR subsensitivity and a clinically equivalent model of ECT-induced anterograde amnesia were not demonstrable after a single ECS, were cumulatively induced by repeated treatments, and may be reversible by administration concurrently with ECS of a muscarinic antagonist. Li increased MCR binding marginally in the cortex and hippocampus and significantly in the corpus striatum. Li substantially enhanced cataleptic and hypothermic responses to pilocarpine. Combined Li-scopolamine pretreatment had an additive effect on these cholinergically mediated responses. Effects of Li and scopolamine on MCR binding were not additive, a finding supporting the conclusion that Li enhances brain cholinergic function by its presynaptic effects on acetylcholine turnover and release. Possible implications for the therapeutic mechanisms and adverse effects of Li are considered.

Electroconvulsive shock and brain muscarinic receptors: relationship to anterograde amnesia

Rats were administered one electroconvulsive shock daily for 7 days (ECS X 7) and were killed 24 hours after the last treatment. Muscarinic cholinergic receptor number, as determined by [3H] quinuclidinyl benzilate [( 3H]QNB) binding, was significantly reduced in the cerebral cortex. A parallel group of rats was trained on a passive avoidance task 24 hours following the last ECS and tested for retention of the original avoidance response 24 hours later; these animals exhibited a profound amnesia. Animals tested 1 hour following training were not amnestic, indicating that learning was unimpaired. Animals trained 7 days following ECS X 7 were not amnestic and [3H] QNB binding changes were not demonstrable at this time. A single ECS which does not significantly affect cortical [3H] QNB binding, did not induce amnesia in rats trained 24 hours after the treatment and tested 24 hours later. The parallel, cumulative nature of ECS-induced muscarinic receptor down-regulation and ECS-induced anterograde amnesia suggests a possible causative relationship.

Enhancement of memory by a cholinesterase inhibitor associated with muscarinic receptor down-regulation

Rats trained on a passive avoidance task 24 hours following a single intraperitoneal injection of diisopropyl fluorophosphate (DFP, 1.2 mg/kg) showed enhanced retention when tested 7 days later. In a parallel group of rats, reduced cortical [3H] quinuclidinyl benzilate binding was demonstrable 24 hours following DFP administration. The association of reduced muscarinic receptor binding and enhanced performance on a memory task contradicts previous reports which suggested that retention was impaired by treatments which down-regulate muscarinic receptors. This contradiction may be reconciled if pre-synaptic factors such as agonist availability are considered in conjunction with post-synaptic receptor effects.

Antidepressant withdrawal-induced activation (hypomania and mania): mechanism and theoretical significance

Electrocortical and behavioral arousal are separate phenomena subserved by different neural substrata operating in parallel. A comprehensive theory of 'activation' must take into account the relationships between the electrical and behavioral activating systems. In pathological or experimentally induced states paradoxes, resolvable by a theory positing functional interaction between these systems, arise. EEG arousal is directly mediated, in both the waking and sleeping state, by cholinergic mechanisms. Antidepressant withdrawal precipitates cholinergic overdrive; this would account for the apparent disturbances of REM sleep occurring when antidepressants are stopped. Generally, cholinergic overdrive would produce behavioral inhibition but in particular instances it triggers marked psychomotor arousal by mobilizing a 'limbic activating system'. The existence of a monoaminergic 'limbic activating system', system 'A', with the properties attributed to it in this paper, is supported by both clinical and laboratory observations. System 'A' theory provides a parsimonious means of adequately explaining many phenomena. This theory also has in its favor explanatory power and scope. The Cholinergic-Monoaminergic Interaction Theory of antidepressant withdrawal induced activation and of rapidly-cycling manic-depressive illness maintains that system 'A' and a cholinergic inhibitory system interact dynamically, and that excessive monoaminergic function can precipitate excessive cholinergic function and a dearth of monoaminergic function (due to autoregulation) and hence depression. Likewise, excessive cholinergic function is posited to activate monoaminergic systems and hence to secondarily cause behavioral activation. Rapidly-cycling manic-depressive patients, according to the model, develop alternating cholinergic and monoaminergic overdrive states because the homeostatic mechanisms which should serve to maintain, within normal limits, the composite of cholinergic inhibitory and monoaminergic activating influences are defective. Consequently, rather than reaching a reasonable balance compatible with adaptive function there is oscillation between extremes. Each oscillatory movement is actually a move towards the 'golden mean' and is induced by deviation from this ideal but the defective homeostatic mechanisms promote ' perpetual ' overshooting. Lithium and ECT may be useful in the treatment of rapidly-cycling patients as both treatments may down-regulate muscarinic receptors, and otherwise modify cholinergic and monoaminergic systems in ways promoting homeostasis.(ABSTRACT TRUNCATED AT 400 WORDS)

Seizures down-regulate muscarinic cholinergic receptors in hippocampal formation

Muscarinic cholinergic receptors (MCR) have been previously shown to decline in the hippocampal formation (HPF) of amygdala-kindled rats. Seizures have been proposed as the process responsible for this down-regulation. We now demonstrate similar down-regulation of MCR within HPF in 3 additional methods of inducing seizures: electroconvulsive shock, entorhinal kindling and entorhinal lesion. Two key parameters which causally link the MCR declines with seizures are their time course and reversal with anticonvulsants. The transient decline of MCR induced by entorhinal lesion-induced seizures parallels the time course established in amygdala kindling. Further, phenobarbital could block both these seizures and the MCR declines. Together, this supports the relationship of seizures causing the declines. We postulate that the MCR down-regulation represents an endogenous inhibitory response of neurons that are intensely and repeatedly depolarized during the seizures.