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Jagtiani A, Gandhi R, Banga A, Blacker J, Joshi R, Bollu B, Kashyap R. Alpha-2 Agonists in Children and Adolescents With Post-traumatic Stress Disorder: A Systematic Review. Cureus 2024; 16:e53009. [PMID: 38410304 PMCID: PMC10895561 DOI: 10.7759/cureus.53009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/26/2024] [Indexed: 02/28/2024] Open
Abstract
Exposure to traumatic stress is common among children. Post-traumatic stress disorder (PTSD) is a debilitating chronic mental disorder that can develop following exposure to a traumatic event. Psychopharmacological research in pediatric PTSD is limited. There is some evidence supporting the use of alpha-2 (α2) agonists for symptoms associated with PTSD. This systematic review identified published studies evaluating the effectiveness of α2 agonists in treating PTSD symptoms in children and adolescents. We conducted an extensive literature search on PubMed, MEDLINE, EMBASE, Cochrane Collaboration, and PsycINFO databases for published articles that evaluated the use of α2 agonists (clonidine and guanfacine) for treating symptoms of PTSD in children and adolescents. The study protocol was registered in Prospero (ID: CRD42021273692) and followed the PRISMA guidelines. A total of 10 published articles about clonidine or guanfacine use in PTSD in children and adolescents were identified. Studies found clonidine effective in reducing PTSD symptoms; however, the effects were variable. Clonidine and guanfacine showed effectiveness in treating nightmares, hyperarousal, aggression, and sleep disturbances and reducing re-experiencing, avoidant, and hyperarousal symptom clusters. No randomized, double-blind, placebo-controlled trials were found during the literature search. α2 agonists' effectiveness in treating symptoms associated with PTSD in children and adolescents is preliminary. Future placebo-controlled trials are needed to assess the efficacy and safety of α2 agonists.
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Affiliation(s)
- Amit Jagtiani
- Psychiatry, Burrell Behavioral Health, Springfield, USA
| | - Raghu Gandhi
- Psychiatry, Abbott Northwestern Hospital, Minneapolis, USA
| | - Akshat Banga
- Internal Medicine, Sawai Man Singh Medical College, Jaipur, IND
| | - Jacquetta Blacker
- Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA
| | - Riecha Joshi
- Pediatrics, Government Medical College, Kota, Kota, IND
| | - Bhaswanth Bollu
- Emergency Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Rahul Kashyap
- Medicine, Drexel University College of Medicine, Philadelphia, USA
- Global Clinical Scholars Research Training (GCSRT), Harvard Medical School, Boston, USA
- Research, Global Remote Research Program, Saint Paul, USA
- Critical Care Medicine, Mayo Clinic, Rochester, USA
- Research, WellSpan Health, York, USA
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Brown JA, Petersen N, Centanni SW, Jin AY, Yoon HJ, Cajigas SA, Bedenbaugh MN, Luchsinger JR, Patel S, Calipari ES, Simerly RB, Winder DG. An ensemble recruited by α 2a-adrenergic receptors is engaged in a stressor-specific manner in mice. Neuropsychopharmacology 2023; 48:1133-1143. [PMID: 36085168 PMCID: PMC10267140 DOI: 10.1038/s41386-022-01442-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/08/2022]
Abstract
α2a-adrenergic receptor (α2a-AR) agonists are candidate substance use disorder therapeutics due to their ability to recruit noradrenergic autoreceptors to dampen stress system engagement. However, we recently found that postsynaptic α2a-ARs are required for stress-induced reinstatement of cocaine-conditioned behavior. Understanding the ensembles recruited by these postsynaptic receptors (heteroceptors) is necessary to understand noradrenergic circuit control. We utilized a variety of approaches in FosTRAP (Targeted Recombination in Active Populations) mice to define an ensemble of cells activated by the α2a-AR partial agonist guanfacine ("Guansembles") in the bed nucleus of the stria terminalis (BST/BNST), a region key to stress-induced reinstatement of drug seeking. We define BNST "Guansembles" and show they differ from restraint stress-activated cells. Guanfacine produced inhibition of cAMP-dependent signaling in Guansembles, while chronic restraint stress increased cAMP-dependent signaling. Guanfacine both excited and inhibited aspects of Guansemble neuronal activity. Further, while some stressors produced overall reductions in Guansemble activity, active coping events during restraint stress and exposure to unexpected shocks were both associated with Guansemble recruitment. Using viral tracing, we define a BNST Guansemble afferent network that includes regions involved in the interplay of stress and homeostatic functions. Finally, we show that activation of Guansembles produces alterations in behavior on the elevated plus maze consistent with task-specific anxiety-like behavior. Overall, we define a population of BNST neurons recruited by α2a-AR signaling that opposes the behavioral action of canonical autoreceptor α2a-AR populations and which are differentially recruited by distinct stressors. Moreover, we demonstrate stressor-specific physiological responses in a specific neuronal population.
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Affiliation(s)
- Jordan A Brown
- Department of Pharmacology, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA
| | - Nicholas Petersen
- Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
| | - Samuel W Centanni
- Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
| | - Allie Y Jin
- Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA
| | - Hye Jean Yoon
- Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
| | - Stephanie A Cajigas
- Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
| | - Michelle N Bedenbaugh
- Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA
- Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA
| | - Joseph R Luchsinger
- Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
| | - Sachin Patel
- Department of Pharmacology, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA
| | - Erin S Calipari
- Department of Pharmacology, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA
| | - Richard B Simerly
- Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA
| | - Danny G Winder
- Department of Pharmacology, Vanderbilt University, Nashville, TN, USA.
- Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA.
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA.
- Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA.
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Wu S, Morgenstern A, Rice T, Coffey B. Psychopharmacological Strategies Employing Guanfacine in an Adolescent Girl with Postural Orthostatic Tachycardia Syndrome and Severe Posttraumatic Stress Disorder. J Child Adolesc Psychopharmacol 2022; 32:244-248. [PMID: 35587210 PMCID: PMC9545804 DOI: 10.1089/cap.2022.29221.bjc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Stephanie Wu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ari Morgenstern
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Timothy Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barbara Coffey
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Psychiatry, Jackson Behavioral Health Hospital, Miami, Florida, USA.,Address correspondence to: Barbara J. Coffey, MD, MS, Clinical Research Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, USA
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Nikou AF, Lai M, Solmssen C, Bhargava M, Ben-David K, Ramsubick C, Rice T, Coffey B. Topiramate for Posttraumatic Symptoms in an Obese Adolescent Girl. J Child Adolesc Psychopharmacol 2021; 31:235-241. [PMID: 33890820 DOI: 10.1089/cap.2021.29199.bjc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Michelle Lai
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Meghaa Bhargava
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Timothy Rice
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barbara Coffey
- Department of Psychiatry, University of Miami, Miami, Florida, USA
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