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Broeders TAA, Linsen F, Louter TS, Nawijn L, Penninx BWJH, van Tol MJ, van der Wee NJA, Veltman DJ, van der Werf YD, Schoonheim MM, Vinkers CH. Dynamic reconfigurations of brain networks in depressive and anxiety disorders: The influence of antidepressants. Psychiatry Res 2024; 334:115774. [PMID: 38341928 DOI: 10.1016/j.psychres.2024.115774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/30/2024] [Accepted: 02/04/2024] [Indexed: 02/13/2024]
Abstract
Major Depressive Disorder (MDD) and anxiety disorders are highly comorbid recurrent psychiatric disorders. Reduced dynamic reconfiguration of brain regions across subnetworks may play a critical role underlying these deficits, with indications of normalization after treatment with antidepressants. This study investigated dynamic reconfigurations in controls and individuals with a current MDD and/or anxiety disorder including antidepressant users and non-users in a large sample (N = 207) of adults. We quantified the number of subnetworks a region switched to (promiscuity) as well as the total number of switches (flexibility). Average whole-brain (i.e., global) values and subnetwork-specific values were compared between diagnosis and antidepressant groups. No differences in reconfiguration dynamics were found between individuals with a current MDD (N = 49), anxiety disorder (N = 46), comorbid MDD and anxiety disorder (N = 55), or controls (N = 57). Global and sensorimotor network (SMN) promiscuity and flexibility were higher in antidepressant users (N = 49, regardless of diagnosis) compared to non-users (N = 101) and controls. Dynamic reconfigurations were considerably higher in antidepressant users relative to non-users and controls, but not significantly altered in individuals with a MDD and/or anxiety disorder. The increase in antidepressant users was apparent across the whole brain and in the SMN when investigating subnetworks. These findings help disentangle how antidepressants improve symptoms.
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Affiliation(s)
- T A A Broeders
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - F Linsen
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - T S Louter
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - L Nawijn
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - B W J H Penninx
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M J van Tol
- Department of Neuroscience, University Medical Center Groningen, Groningen, The Netherlands
| | - N J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - D J Veltman
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Y D van der Werf
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M M Schoonheim
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C H Vinkers
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands; GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
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Linsen F, Broeder C, Sep MSC, Verhoeven JE, Bet PM, Penninx BWJH, Meijer OC, Vinkers CH. Glucocorticoid Receptor (GR) antagonism as disease-modifying treatment for MDD with childhood trauma: protocol of the RESET-medication randomized controlled trial. BMC Psychiatry 2023; 23:331. [PMID: 37170109 PMCID: PMC10173560 DOI: 10.1186/s12888-023-04830-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/29/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a heterogeneous psychiatric disorder. Childhood trauma (CT, emotional/physical/sexual abuse or neglect before the age of 18) is one of the largest and most consistent risk factors for development and poor course of MDD. Overactivity of the HPA-axis and the stress hormone cortisol is thought to play a role in the vulnerability for MDD following exposure to CT. Rodent experiments showed that antagonism of the glucocorticoid receptor (GR) at adult age reversed the effects of early life stress. Similarly, we aim to target MDD in individuals with CT exposure using the GR antagonist mifepristone. METHODS The RESET-medication study is a placebo-controlled double-blind randomized controlled trial (RCT) which aims to include 158 adults with MDD and CT. Participants will be randomized (1:1) to a 7-day treatment arm of mifepristone (1200 mg/day) or a control arm (placebo). Participants are allowed to receive usual care for MDD including antidepressants. Measurements include three face-to-face meetings at baseline (T0), day 8 (T1), week 6 (T2), and two online follow-up meetings at 12 weeks (T3) and 6 months (T4). A subgroup of participants (N = 80) are included in a fMRI sub-study (T0, T2). The main study outcome will be depressive symptom severity as measured with the Inventory of Depressive Symptomatology-Self Rated (IDS-SR) at T2. Secondary outcomes include, among others, depressive symptom severity at other time points, disability, anxiety, sleep and subjective stress. To address underlying mechanisms mifepristone plasma levels, cortisol, inflammation, epigenetic regulation and fMRI measurements are obtained. DISCUSSION The RESET-medication study will provide clinical evidence whether GR antagonism is a disease-modifying treatment for MDD in individuals exposed to CT. If effective, this hypothesis-driven approach may extend to other psychiatric disorders where CT plays an important role. TRIAL REGISTRATION The trial protocol has been registered 01-02-2022 on ClinicalTrials.gov with ID "NCT05217758".
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Affiliation(s)
- F Linsen
- Department of Psychiatry, Amsterdam University Medical Center Location Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands.
- Department of Anatomy & Neurosciences, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands.
| | - C Broeder
- Department of Psychiatry, Amsterdam University Medical Center Location Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- Department of Anatomy & Neurosciences, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
| | - M S C Sep
- Department of Psychiatry, Amsterdam University Medical Center Location Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- GGZ inGeest Mental Health Care, Amsterdam, 1081 HJ, The Netherlands
| | - J E Verhoeven
- Department of Psychiatry, Amsterdam University Medical Center Location Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- GGZ inGeest Mental Health Care, Amsterdam, 1081 HJ, The Netherlands
| | - P M Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, the Netherlands
| | - B W J H Penninx
- Department of Psychiatry, Amsterdam University Medical Center Location Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- Amsterdam Public Health, Mental Health Program and Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands
| | - O C Meijer
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden University, Leiden, 2333 ZA, the Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden University, Leiden, 2333 ZA, the Netherlands
| | - C H Vinkers
- Department of Psychiatry, Amsterdam University Medical Center Location Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- Department of Anatomy & Neurosciences, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- GGZ inGeest Mental Health Care, Amsterdam, 1081 HJ, The Netherlands
- Amsterdam Public Health, Mental Health Program and Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands
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Vinkers CH, Penninx BWJH. [De uitdaging om de prevalentie van depressie te verminderen]. Tijdschr Psychiatr 2023; 65:464-465. [PMID: 37755924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
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Bonapersona, Born FJ, Bakvis P, Branje S, Elzinga B, Evers A, van Eysden M, Fernandez G, Habets PC, Hartman CA, Hermans EJ, Meeus W, van Middendorp H, Nelemans S, Oei NY, Oldehinkel AJ, Roelofs K, de Rooij SR, Smeets T, Tollenaar MS, Joëls M, Vinkers CH. The STRESS-NL database: A resource for human acute stress studies across the Netherlands. Psychoneuroendocrinology 2022; 141:105735. [PMID: 35447495 DOI: 10.1016/j.psyneuen.2022.105735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/10/2022] [Accepted: 03/17/2022] [Indexed: 10/18/2022]
Abstract
Stress initiates a cascade of (neuro)biological, physiological, and behavioral changes, allowing us to respond to a challenging environment. The human response to acute stress can be studied in detail in controlled settings, usually in a laboratory environment. To this end, many studies employ acute stress paradigms to probe stress-related outcomes in healthy and patient populations. Though valuable, these studies in themselves often have relatively limited sample sizes. We established a data-sharing and collaborative interdisciplinary initiative, the STRESS-NL database, which combines (neuro)biological, physiological, and behavioral data across many acute stress studies in order to accelerate our understanding of the human acute stress response in health and disease (www.stressdatabase.eu). Researchers in the stress field from 12 Dutch research groups of 6 Dutch universities created a database to achieve an accurate inventory of (neuro)biological, physiological, and behavioral data from laboratory-based human studies that used acute stress tests. Currently, the STRESS-NL database consists of information on 5529 individual participants (2281 females and 3348 males, age range 6-99 years, mean age 27.7 ± 16 years) stemming from 57 experiments described in 42 independent studies. Studies often did not use the same stress paradigm; outcomes were different and measured at different time points. All studies currently included in the database assessed cortisol levels before, during and after experimental stress, but cortisol measurement will not be a strict requirement for future study inclusion. Here, we report on the creation of the STRESS-NL database and infrastructure to illustrate the potential of accumulating and combining existing data to allow meta-analytical, proof-of-principle analyses. The STRESS-NL database creates a framework that enables human stress research to take new avenues in explorative and hypothesis-driven data analyses with high statistical power. Future steps could be to incorporate new studies beyond the borders of the Netherlands; or build similar databases for experimental stress studies in rodents. In our view, there are major scientific benefits in initiating and maintaining such international efforts.
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Affiliation(s)
- Bonapersona
- Department of Translational Neuroscience, University Medical Center Utrecht Brain Center, Utrecht University,Utrecht, The Netherlands
| | - F J Born
- Department of Translational Neuroscience, University Medical Center Utrecht Brain Center, Utrecht University,Utrecht, The Netherlands; Charité University, Berlin,Germany
| | - P Bakvis
- Clinical Psychology unit, Institute of Psychology and Leiden Institute for Brain and Cognition, Leiden University,The Netherlands; SEIN, Epilepsy Institute in the Netherlands,Heemstede,The Netherlands
| | - S Branje
- Department of Youth & Family, Utrecht University,Utrecht,The Netherlands
| | - B Elzinga
- Clinical Psychology unit, Institute of Psychology and Leiden Institute for Brain and Cognition, Leiden University,The Netherlands
| | - Awm Evers
- Health, Medical & Neuropsychology unit, Institute of Psychology and Leiden Institute for Brain and Cognition, Leiden University, The Netherlands
| | - M van Eysden
- Department of Translational Neuroscience, University Medical Center Utrecht Brain Center, Utrecht University,Utrecht, The Netherlands
| | - G Fernandez
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center,Nijmegen,The Netherlands
| | - P C Habets
- Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry,DeBoelelaan 1117, Amsterdam,The Netherlands; Amsterdam Neurosciences, Mood, Anxiety, Psychosis, Stress, and Sleep (MAPSS),Amsterdam, The Netherlands
| | - C A Hartman
- Department of Psychiatry and Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen,Groningen,The Netherlands
| | - E J Hermans
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center,Nijmegen,The Netherlands
| | - W Meeus
- Department of Youth & Family, Utrecht University,Utrecht,The Netherlands
| | - H van Middendorp
- Health, Medical & Neuropsychology unit, Institute of Psychology and Leiden Institute for Brain and Cognition, Leiden University, The Netherlands
| | - S Nelemans
- Department of Youth & Family, Utrecht University,Utrecht,The Netherlands
| | - N Y Oei
- Amsterdam Brain and Cognition (ABC), University of Amsterdam,Amsterdam,The Netherlands; Department of Developmental Psychology, Addiction Development and Psychopathology(ADAPT)-Lab, University of Amsterdam, Amsterdam, The Netherlands, University of Amsterdam,Amsterdam,The Netherlands
| | - A J Oldehinkel
- Department of Psychiatry and Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen,Groningen,The Netherlands
| | - K Roelofs
- Radboud University Nijmegen: Donders Institute for Brain Cognition and Behaviour and Behavioural Science Institute
| | - S R de Rooij
- Department of Epidemiology and Data Science, University of Amsterdam, Amsterdam UMC,Amsterdam,The Netherlands
| | - T Smeets
- Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg School of Social and Behavioral Sciences, Tilburg University,Tilburg,The Netherlands
| | - M S Tollenaar
- Clinical Psychology unit, Institute of Psychology and Leiden Institute for Brain and Cognition, Leiden University,The Netherlands
| | - M Joëls
- University of Groningen, University Medical Center Groningen,Groningen,The Netherlands
| | - C H Vinkers
- Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry,DeBoelelaan 1117, Amsterdam,The Netherlands; Amsterdam Neurosciences, Mood, Anxiety, Psychosis, Stress, and Sleep (MAPSS),Amsterdam, The Netherlands.
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Dozeman E, van der Lande HJ, Bet PM, Fransen K, Jager I, Jonker J, Philippo E, Reisman-Dolman J, van Schaik DJF, Scholten W, van de Velde I, Verheijen V, van der Wart M, van Zon M, Batelaan N, Vinkers CH. [Guided discontinuation of antidepressants: approach and first results of a Dutch multidisciplinary outpatient clinic]. Tijdschr Psychiatr 2022; 64:574-579. [PMID: 36349853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Discontinuation of antidepressant medication can be difficult due to withdrawal symptoms and relapse risk. Scientific evidence on the questions of who, when, and how to stop antidepressants is limited. In Amsterdam a multidisciplinary outpatient clinic was started to provide advice and guidance. AIM To substantiate the design of the clinic. Central questions relate to knowing which patients are referred, the background of their request, and their experiences with the outpatient clinic. METHOD The first 51 patients of the clinic were described on the basis of file research, in addition a survey was conducted into patient experiences. RESULTS Half of the patients <a id="_idTextAnchor005"></a>(55%) actually started discontinuation, 39% were advised not to do so (yet). Patients at the clinic had used antidepressants for an average of 10 years, and 76% had previously attempted to stop. 21% had now successfully stopped and 25% were satisfied with a lower dose. One patient relapsed during tapering. CONCLUSION So far, patients with long-term antidepressant use and multiple quit attempts have been referred. Our experiences are aimed at helping individual patients but can also result in more knowledge about who can stop at what moment, and how this should be done.
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Bruining H, Vinkers CH. [How the DSM helps psychiatry move forward]. Ned Tijdschr Geneeskd 2021; 165:D5967. [PMID: 34346632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The prospect of 'disease' in psychiatry has been debated for centuries. In the 21st century, this discussion often focusses on the usefulness of DSM classifications, the diagnostic manual of psychiatry. This criticism on the DSM is exemplary for our struggle to understand, classify and treat psychiatric problems. However, we tend to forget that the DSM system has provided a wealth of knowledge and structure to psychiatric care and science. Moreover, there is no elaborated alternative and an abolishment of the DSM will lead to confusion and polarisation. We should not throw the baby out with the bathwater. In this perspective, we argue how we can build on decades of experience with the DSM and how historical weighting and accurate use of the DSM can offer fertile grounds for refinement and precision of diagnostics in psychiatry.
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Affiliation(s)
- H Bruining
- Amsterdam UMC, locatie AMC, afd. Kinder- en Jeugdpsychiatrie, Amsterdam
- Contact: H. Bruining
| | - C H Vinkers
- Amsterdam UMC, locatieVUmc, afd. Psychiatrie, Amsterdam
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Broeders TAA, Schoonheim MM, Vink M, Douw L, Geurts JJG, van Leeuwen JMC, Vinkers CH. Dorsal attention network centrality increases during recovery from acute stress exposure. Neuroimage Clin 2021; 31:102721. [PMID: 34134017 PMCID: PMC8214139 DOI: 10.1016/j.nicl.2021.102721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/19/2021] [Accepted: 06/04/2021] [Indexed: 12/17/2022]
Abstract
Stress is a major risk factor for the development of almost all psychiatric disorders. In addition to the acute stress response, an efficient recovery in the aftermath of stress is important for optimal resilience. Increased stress vulnerability across psychiatric disorders may therefore be related to altered trajectories during the recovery phase following stress. Such recovery trajectories can be quantified by changes in functional brain networks. This study therefore evaluated longitudinal functional network changes related to stress in healthy individuals (N = 80), individuals at risk for psychiatric disorders (healthy siblings of schizophrenia patients) (N = 39), and euthymic bipolar I disorder (BD) patients (N = 36). Network changes were evaluated before and at 20 and 90 min after onset of an experimental acute stress task (Trier Social Stress Test) or a control condition. Whole-brain functional networks were analyzed using eigenvector centrality as a proxy for network importance, centrality change over time was related to the acute stress response and recovery for each group. In healthy individuals, centrality of the dorsal attention network (DAN; p = 0.007) changed over time in relation to stress. More specifically, DAN centrality increased during the recovery phase after acute stress exposure (p = 0.020), while no DAN centrality change was observed during the initial stress response (p = 0.626). Such increasing DAN centrality during stress recovery was also found in healthy siblings (p = 0.016), but not in BD patients (p = 0.554). This study highlights that temporally complex and precise changes in network configuration are vital to understand the response to and recovery from stress.
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Affiliation(s)
- T A A Broeders
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - M M Schoonheim
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M Vink
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Experimental, Utrecht University, Utrecht, The Netherlands; Department Developmental Psychology, Utrecht University, Utrecht, The Netherlands
| | - L Douw
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J J G Geurts
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J M C van Leeuwen
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C H Vinkers
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
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Vinkers CH. [Antipsychotics with no dopamine receptor blockade; promise or hype?]. Ned Tijdschr Geneeskd 2020; 164:D5325. [PMID: 33332053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Over twenty different antipsychotics are available in the treatment of schizophrenia. All antipsychotics are generally effective, although differences exist in terms of efficacy but also in side effect profile. So far, all antipsychotics block the dopamine-2 (D2) receptor in the brain, including recently available antipsychotics such as lurasidone, cariprazine and brexpiprazole. However large differences exist in binding strength to the D2 receptor that influence dosage ranges. Thus, there seems to be a rock-solid law of antipsychotics: D2 receptor blockade is necessary for an antipsychotic to be effective. Hitherto, the effects of molecules that do not block the D2 receptor for the treatment of psychotic disorders are either disappointing or equivocal, e.g. glutamate system modulators as the metabotropic mGLu2/3 agonist LY2140023. This is disappointing because there is a great need for antipsychotics with novel mechanisms of action. This is pivotal as a proportion of patients with schizophrenia do not sufficiently benefit from currently available dopamine-blocking antipsychotics with limited effects on negative and cognitive symptoms of schizophrenia. In addition, side effects of antipsychotics sometimes prevent its long-term use. Recently, a randomized controlled trial evaluated SEP-363856 for the treatment of acute schizophrenia, a molecule that does not bind to the D2 receptor but binds to trace amine-associated (TAAR) receptors and 5-HT1A receptors. SEP-363856 was more effective compared to placebo after 4 weeks of treatment (effect size 0.45). This is encouraging, although the duration of the RCT and relatively selected group of patients preclude firm conclusions on its efficacy. We may be hopeful that antipsychotics with a novel mechanism of action are investigated, but only the future will learn whether SEP-363856 will have true added value to improve the life of patients suffering from psychotic disorders.
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Affiliation(s)
- C H Vinkers
- Amsterdam UMC, locatie VUmc, afd. Psychiatrie, Amsterdam
- Contact: C.H. Vinkers
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Vinkers CH. [The underestimated value of science in psychiatry]. Tijdschr Psychiatr 2020; 62:291-297. [PMID: 32388851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Psychiatry is a special but complicated medical specialty as it focuses on the most elusive of all suffering in medicine: mental suffering. <br/> AIM: Description of the (desired) role of science in psychiatry.<br/> METHOD: Essay based on relevant literature.<br/> RESULTS: Science constitutes the basis of psychiatry and is essential for daily practice. A methodologically broad view on science can provide new knowledge and better care in psychiatry without falling prey to reductionism. The doubt and nuance inherent in science is also valuable to avoid unnecessary ideological debates in psychiatry and to give room to meaningful discussions. Nevertheless, investments in science within psychiatry are relatively limited, particularly in view of the suffering and costs related to psychiatric disorders.<br/> CONCLUSION: Psychiatry has greatly benefited from science. However, science should also lead to modesty and doubt about the current state of knowledge. This paradox should be an incentive to embrace science as the basis of psychiatry while avoiding reductionism. This essay discusses a number of ways how this could be realized.
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Vinkers CH. [Why the discussion about antidepressants won't stop]. Tijdschr Psychiatr 2020; 62:178-179. [PMID: 32207126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Luykx JJ, Tijdink JK, van Veen SMP, Naarding P, Risselada A, Vinkers CH. [Attention to psychiatry and pharmacotherapy during the COVID-19 pandemic]. Tijdschr Psychiatr 2020; 62:427-432. [PMID: 32902836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Pandit R, Cianci D, ter Hark SE, Winter‐van Rossum I, Ebdrup BH, Broberg BV, Garcia‐Portilla MP, Bobes J, Vinkers CH, Kahn RS, Guloksuz S, Huitema ADR, Luykx JJ. Phenotypic factors associated with amisulpride-induced weight gain in first-episode psychosis patients (from the OPTiMiSE cohort). Acta Psychiatr Scand 2019; 140:283-290. [PMID: 31323113 PMCID: PMC6771865 DOI: 10.1111/acps.13074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Antipsychotic-induced weight gain (AiWG) is a debilitating adverse effect of most antipsychotics. First-episode psychosis patients are particularly vulnerable to the detrimental consequences of AiWG. Amisulpride has good efficacy and tolerability. We here aimed to identify the phenotypic factors associated with amisulpride-induced weight gain in first-episode psychosis patients. METHOD Data were collected from the Optimization of Treatment and Management of Schizophrenia in Europe trial. Multivariable regression models with various phenotypic variables (N = 305) were performed with absolute AiWG and clinically relevant AiWG (≥7% AiWG) as outcomes. RESULTS Four weeks of amisulpride treatment increased body weight from 69.7 to 72.4 kg (P < 0.001). In the regression model of absolute AiWG, unemployment (β = 0.94, P = 0.016), younger age (β = -0.07, P = 0.031) and absence of current comorbid major depression disorder (β = -1.61, P = 0.034) were positively associated with absolute AiWG. In the regression model of clinically relevant AiWG, unemployment (OR = 2.83, P = 0.001), schizophreniform disorder (OR = 2.00, P = 0.025) and low baseline weight (OR = 0.97, P = 0.032) increased the likelihood of clinically relevant AiWG. CONCLUSIONS Clinicians prescribing amisulpride should consider the relatively high susceptibility to AiWG in unemployed first-episode patients with psychosis, in particular young subjects with a diagnosis of schizophreniform disorder. We advise to carefully monitor these patients and, when needed, implement weight-reducing strategies.
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Affiliation(s)
- R. Pandit
- Department of Translational NeuroscienceBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - D. Cianci
- Department of Biostatistics and Research SupportJulius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUniversity of UtrechtUtrechtthe Netherlands
| | - S. E. ter Hark
- Department of Translational NeuroscienceBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - I. Winter‐van Rossum
- Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - B. H. Ebdrup
- Centre for Neuropsychiatric Schizophrenia ResearchCNSR & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINSMental Health Centre GlostrupCopenhagen University HospitalGlostrupDenmark,Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - B. V. Broberg
- Centre for Neuropsychiatric Schizophrenia ResearchCNSR & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINSMental Health Centre GlostrupCopenhagen University HospitalGlostrupDenmark
| | - M. P. Garcia‐Portilla
- Department of Psychiatry and CIBERSAMUniversity of OviedoOviedoSpain,Instituto de Investigación Biosanitaria del Principado de Asturias (ISPA)OviedoSpain
| | - J. Bobes
- Department of Psychiatry and CIBERSAMUniversity of OviedoOviedoSpain,Instituto de Investigación Biosanitaria del Principado de Asturias (ISPA)OviedoSpain
| | - C. H. Vinkers
- Department of PsychiatryAmsterdam UMC (location VUmc)Amsterdamthe Netherlands,Department of Anatomy and NeurosciencesAmsterdam UMC (location VUmc)Amsterdamthe Netherlands
| | - R. S. Kahn
- Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,Department of PsychiatryIcahn School of MedicineMount SinaiNew YorkUSA
| | - S. Guloksuz
- Department of Psychiatry and NeuropsychologySchool for Mental HealthNeuroscience Maastricht University Medical CenterMaastrichtthe Netherlands,Department of PsychiatryYale School of MedicineNew HavenCTUSA
| | - A. D. R. Huitema
- Department of Pharmacy PharmacologyThe Netherlands Cancer InstituteAmsterdamthe Netherlands,Department of Clinical PharmacyUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - J. J. Luykx
- Department of Translational NeuroscienceBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,GGNet Mental HealthApeldoornthe Netherlands
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13
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Luykx JJ, Jacobs G, Vinkers CH. [Reaction on 'Hypomania induced by intranasal corticosteroid fluticasone spray']. Tijdschr Psychiatr 2019; 61:362-364. [PMID: 31243754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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14
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Vinkers CH. [Too early for pharmacogenetics in psychiatric practice]. Tijdschr Psychiatr 2019; 61:298-300. [PMID: 31180566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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15
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Boks MP, Houtepen LC, Xu Z, He Y, Ursini G, Maihofer AX, Rajarajan P, Yu Q, Xu H, Wu Y, Wang S, Shi JP, Hulshoff Pol HE, Strengman E, Rutten BPF, Jaffe AE, Kleinman JE, Baker DG, Hol EM, Akbarian S, Nievergelt CM, De Witte LD, Vinkers CH, Weinberger DR, Yu J, Kahn RS. Genetic vulnerability to DUSP22 promoter hypermethylation is involved in the relation between in utero famine exposure and schizophrenia. NPJ Schizophr 2018; 4:16. [PMID: 30131491 PMCID: PMC6104043 DOI: 10.1038/s41537-018-0058-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/29/2018] [Accepted: 07/03/2018] [Indexed: 01/27/2023]
Abstract
Epigenetic changes may account for the doubled risk to develop schizophrenia in individuals exposed to famine in utero. We therefore investigated DNA methylation in a unique sample of patients and healthy individuals conceived during the great famine in China. Subsequently, we examined two case-control samples without famine exposure in whole blood and brain tissue. To shed light on the causality of the relation between famine exposure and DNA methylation, we exposed human fibroblasts to nutritional deprivation. In the famine-exposed schizophrenia patients, we found significant hypermethylation of the dual specificity phosphatase 22 (DUSP22) gene promoter (Chr6:291687-293285) (N = 153, p = 0.01). In this sample, DUSP22 methylation was also significantly higher in patients independent of famine exposure (p = 0.025), suggesting that hypermethylation of DUSP22 is also more generally involved in schizophrenia risk. Similarly, DUSP22 methylation was also higher in two separate case-control samples not exposed to famine using DNA from whole blood (N = 64, p = 0.03) and postmortem brains (N = 214, p = 0.007). DUSP22 methylation showed strong genetic regulation across chromosomes by a region on chromosome 16 which was consistent with new 3D genome interaction data. The presence of a direct link between famine and DUSP22 transcription was supported by data from cultured human fibroblasts that showed increased methylation (p = 0.048) and expression (p = 0.019) in response to nutritional deprivation (N = 10). These results highlight an epigenetic locus that is genetically regulated across chromosomes and that is involved in the response to early-life exposure to famine and that is relevant for a major psychiatric disorder.
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Affiliation(s)
- M P Boks
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - L C Houtepen
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Z Xu
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Y He
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G Ursini
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, USA
| | - A X Maihofer
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - P Rajarajan
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Q Yu
- Department of Epidemiology and Health Statistics, School of Public Health, Jilin University, Changchun, China
| | - H Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Jilin University, Changchun, China
| | - Y Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Jilin University, Changchun, China
| | - S Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Jilin University, Changchun, China
| | - J P Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Jilin University, Changchun, China
| | - H E Hulshoff Pol
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Strengman
- Molecular Pathology, Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B P F Rutten
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A E Jaffe
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, USA
| | - J E Kleinman
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, USA
| | - D G Baker
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - E M Hol
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Akbarian
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, USA
| | - C M Nievergelt
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - L D De Witte
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C H Vinkers
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D R Weinberger
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, USA
| | - J Yu
- Department of Epidemiology and Health Statistics, School of Public Health, Jilin University, Changchun, China
| | - R S Kahn
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.,Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, USA
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16
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van Leeuwen JMC, Vink M, Fernández G, Hermans EJ, Joëls M, Kahn RS, Vinkers CH. At-risk individuals display altered brain activity following stress. Neuropsychopharmacology 2018; 43:1954-1960. [PMID: 29483659 PMCID: PMC6046038 DOI: 10.1038/s41386-018-0026-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/30/2018] [Accepted: 02/05/2018] [Indexed: 12/17/2022]
Abstract
Stress is a major risk factor for almost all psychiatric disorders, however, the underlying neurobiological mechanisms remain largely elusive. In healthy individuals, a successful stress response involves an adequate neuronal adaptation to a changing environment. This adaptive response may be dysfunctional in vulnerable individuals, potentially contributing to the development of psychopathology. In the current study, we investigated brain responses to emotional stimuli following stress in healthy controls and at-risk individuals. An fMRI study was conducted in healthy male controls (N = 39) and unaffected healthy male siblings of schizophrenia patients (N = 39) who are at increased risk for the development of a broad range of psychiatric disorders. Brain responses to pictures from the International Affective Picture System (IAPS) were measured 33 min after exposure to stress induced by the validated trier social stress test (TSST) or a control condition. Stress-induced levels of cortisol, alpha-amylase, and subjective stress were comparable in both groups. Yet, stress differentially affected brain responses of schizophrenia siblings versus controls. Specifically, control subjects, but not schizophrenia siblings, showed reduced brain activity in key nodes of the default mode network (PCC/precuneus and mPFC) and salience network (anterior insula) as well as the STG, MTG, MCC, vlPFC, precentral gyrus, and cerebellar vermis in response to all pictures following stress. These results indicate that even in the absence of a psychiatric disorder, at-risk individuals display abnormal functional activation following stress, which in turn may increase their vulnerability and risk for adverse outcomes.
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Affiliation(s)
- J M C van Leeuwen
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - M Vink
- Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - G Fernández
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands
| | - E J Hermans
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands
| | - M Joëls
- Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R S Kahn
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C H Vinkers
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
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17
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Rutten BPF, Vermetten E, Vinkers CH, Ursini G, Daskalakis NP, Pishva E, de Nijs L, Houtepen LC, Eijssen L, Jaffe AE, Kenis G, Viechtbauer W, van den Hove D, Schraut KG, Lesch KP, Kleinman JE, Hyde TM, Weinberger DR, Schalkwyk L, Lunnon K, Mill J, Cohen H, Yehuda R, Baker DG, Maihofer AX, Nievergelt CM, Geuze E, Boks MPM. Longitudinal analyses of the DNA methylome in deployed military servicemen identify susceptibility loci for post-traumatic stress disorder. Mol Psychiatry 2018; 23:1145-1156. [PMID: 28630453 PMCID: PMC5984086 DOI: 10.1038/mp.2017.120] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 11/08/2022]
Abstract
In order to determine the impact of the epigenetic response to traumatic stress on post-traumatic stress disorder (PTSD), this study examined longitudinal changes of genome-wide blood DNA methylation profiles in relation to the development of PTSD symptoms in two prospective military cohorts (one discovery and one replication data set). In the first cohort consisting of male Dutch military servicemen (n=93), the emergence of PTSD symptoms over a deployment period to a combat zone was significantly associated with alterations in DNA methylation levels at 17 genomic positions and 12 genomic regions. Evidence for mediation of the relation between combat trauma and PTSD symptoms by longitudinal changes in DNA methylation was observed at several positions and regions. Bioinformatic analyses of the reported associations identified significant enrichment in several pathways relevant for symptoms of PTSD. Targeted analyses of the significant findings from the discovery sample in an independent prospective cohort of male US marines (n=98) replicated the observed relation between decreases in DNA methylation levels and PTSD symptoms at genomic regions in ZFP57, RNF39 and HIST1H2APS2. Together, our study pinpoints three novel genomic regions where longitudinal decreases in DNA methylation across the period of exposure to combat trauma marks susceptibility for PTSD.
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Affiliation(s)
- B P F Rutten
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E Vermetten
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
- Research Centre for Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - C H Vinkers
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G Ursini
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - N P Daskalakis
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai and Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center, New York, NY, USA
| | - E Pishva
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L de Nijs
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L C Houtepen
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Eijssen
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A E Jaffe
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - G Kenis
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - W Viechtbauer
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - D van den Hove
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Division of Molecular Psychiatry, Laboratory of Translational Neuroscience, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - K G Schraut
- Division of Molecular Psychiatry, Laboratory of Translational Neuroscience, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - K-P Lesch
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Division of Molecular Psychiatry, Laboratory of Translational Neuroscience, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - J E Kleinman
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - T M Hyde
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - D R Weinberger
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
- Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Neurology and Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - L Schalkwyk
- Molecular and Cellular Biosciences Research Group, University of Essex, Colchester, UK
| | - K Lunnon
- University of Exeter Medical School, Exeter University, Exeter, UK
| | - J Mill
- University of Exeter Medical School, Exeter University, Exeter, UK
| | - H Cohen
- Anxiety and Stress Research Unit, Ministry of Health Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - R Yehuda
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai and Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center, New York, NY, USA
| | - D G Baker
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - A X Maihofer
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - C M Nievergelt
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - E Geuze
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
- Research Centre for Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands
| | - M P M Boks
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
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18
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Luykx JJ, Tijdink JK, Tempelaar W, Vinkers CH, de Witte L. [In- and out-of-hospital emergency psychiatry: what is the best approach?]. Ned Tijdschr Geneeskd 2018; 162:D2387. [PMID: 29451111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A range of clinical syndromes may present with psychiatric symptoms, both in and out of hospital settings. In such situations agitation, suicidality, communication difficulties and legal aspects often play a role, making diagnosis and treatment a challenge. Based on several case studies, we illustrate how the recently-published Dutch open access source 'Acute Psychiatry' (www.acutepsychiatrie.com) can be of help in acute psychiatric presentations both within and outside psychiatric hospitals.
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Affiliation(s)
- J J Luykx
- UMC Utrecht, Hersencentrum Rudolf Magnus, afd. Psychiatrie, Utrecht
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19
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Houtepen LC, Schür RR, Wijnen JP, Boer VO, Boks MPM, Kahn RS, Joëls M, Klomp DW, Vinkers CH. Acute stress effects on GABA and glutamate levels in the prefrontal cortex: A 7T 1H magnetic resonance spectroscopy study. Neuroimage Clin 2017; 14:195-200. [PMID: 28180078 PMCID: PMC5280001 DOI: 10.1016/j.nicl.2017.01.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/23/2016] [Accepted: 01/02/2017] [Indexed: 12/17/2022]
Abstract
There is ample evidence that the inhibitory GABA and the excitatory glutamate system are essential for an adequate response to stress. Both GABAergic and glutamatergic brain circuits modulate hypothalamus-pituitary-adrenal (HPA)-axis activity, and stress in turn affects glutamate and GABA levels in the rodent brain. However, studies examining stress-induced GABA and glutamate levels in the human brain are scarce. Therefore, we investigated the influence of acute psychosocial stress (using the Trier Social Stress Test) on glutamate and GABA levels in the medial prefrontal cortex of 29 healthy male individuals using 7 Tesla proton magnetic resonance spectroscopy. In vivo GABA and glutamate levels were measured before and 30 min after exposure to either the stress or the control condition. We found no associations between psychosocial stress or cortisol stress reactivity and changes over time in medial prefrontal glutamate and GABA levels. GABA and glutamate levels over time were significantly correlated in the control condition but not in the stress condition, suggesting that very subtle differential effects of stress on GABA and glutamate across individuals may occur. However, overall, acute psychosocial stress does not appear to affect in vivo medial prefrontal GABA and glutamate levels, at least this is not detectable with current practice 1H-MRS. Psychosocial stress did not alter glutamate and GABA levels in the medial prefrontal cortex in healthy male individuals. Moreover, cortisol stress reactivity was not associated with medial prefrontal glutamate and GABA level change over time. Together, acute stress does not seem to affect in vivo medial prefrontal 7T MRI GABA and glutamate levels in humans.
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Affiliation(s)
- L C Houtepen
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - R R Schür
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - J P Wijnen
- Department of Radiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - V O Boer
- Department of Radiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - M P M Boks
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - R S Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - M Joëls
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - D W Klomp
- Department of Radiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - C H Vinkers
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
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20
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Vinkers CH. [A rose is a rose is a rose]. Ned Tijdschr Geneeskd 2017; 161:D1939. [PMID: 29145906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Over a century ago in 1913, the poet Gertrude Stein wrote these famous words: sometimes things are just what they are. There has been a recent debate centred around the question whether or not schizophrenia exists. Is there a brain disease that can be called schizophrenia? What difference does it make to patients how we define schizophrenia? This editorial explores said questions, concluding that there is still much to be done to improve the recovery of patients diagnosed with disorders of the schizophrenia spectrum. Regardless of these discussion items, the reality is that it will not significantly change the clinical reality. There remains a subset of patients with severe symptoms that limits their quality of life. Going forward, what should we do with the schizophrenia debate? The challenge is to focus on better understanding and treatment of these patients by all means and through various types of research.
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21
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van Dijk HG, Dapper EA, Vinkers CH. [SSRIs and depressive symptoms in schizophrenia: a systematic review]. Tijdschr Psychiatr 2017; 59:40-46. [PMID: 28098923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Patients with schizophrenia frequently have depressive symptoms. Current guidelines do not provide specific recommendations regarding the treatment of these symptoms, nor do they mention the role that selective serotonin reuptake inhibitors (ssris) can play in the treatment.<br/> AIM: To investigate whether ssris are more effective than placebo in treating depressive symptoms in patients with schizophrenia.<br/> METHOD: We searched the literature systematically using PubMed, embase, Cochrane Library and Psycinfo. We selected articles on the basis of inclusion and exclusion criteria and the methodologies used and compared the severity of patients symptoms before and after treatment.<br/> RESULTS: We found only four published studies of randomised, double blind, placebo-controlled trials. These showed that an ssri was significantly more effective than a placebo (the difference being 0.4 - 6.7 points on the Hamilton Depression Rating Scale and 0.2 - 2.6 on the Calgary Depression Scale for Schizophrenia).<br/> CONCLUSION: There are indications that ssris are effective for the treatment of depressive symptoms in patients with schizophrenia. However, the total sample size was limited and individual studies had several methodological limitations.
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22
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Seldenrijk A, Vis R, Henstra M, Ho Pian K, van Grootheest D, Salomons T, Overmeire F, de Boer M, Scheers T, Doornebal-Bakker R, Ruhé HG, Vinkers CH. [Systematic review of the side effects of benzodiazepines]. Ned Tijdschr Geneeskd 2017; 161:D1052. [PMID: 29076441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
- Benzodiazepines are used frequently, despite the risk of severe side effects.- The Generic module 'Side effects; prevention, monitoring and treatment of side effects of drugs for psychiatric disorders' will be published soon. This contains recommendations for reduction in the risk for falls and fractures, cognitive problems and dependency related to the use of benzodiazepines or Z-drugs (zopiclone, zolpidem).- Prescribing physicians and pharmacists are compulsorily required to provide extensive information to patients on the anticipated effects and side effects of benzodiazepines, and on the limited prescription period.- A lot of information has become available from systematic literature reviews by the Benzodiazepines working group. Different benzodiazepines present similar risks of falls and fractures; higher doses present a higher risk, and Z-drugs are no safer.- In comparison with placebo, benzodiazepines and Z-drugs soon cause cognitive problems, even at low doses and in drugs with a short half-life. There is almost no development of tolerance for these cognitive problems.- Tailored patient education letters for ceasing benzodiazepine use are more effective than the standard letters. Different dose-tapering schemes have comparable success rates (on average 50%). Augmentation with cognitive behavioural therapy is effective for dose reduction.- It is therefore important to carefully consider the use of benzodiazepines before using them.
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Affiliation(s)
- A Seldenrijk
- Werkgroep Benzodiazepinen - Generieke module 'Bijwerkingen; preventie, monitoring en behandeling van bijwerkingen bij geneesmiddelen voor psychiatrische aandoeningen'
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23
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De Sain-Van der Velden MGM, Jans JJ, Figee M, Engelen M, Prinsen HCMT, Verhoeven-Duif NM, van Kuilenburg ABP, Visser G, Vinkers CH. [Metabolic diseases in psychiatry]. Tijdschr Psychiatr 2016; 58:402-406. [PMID: 27213640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Metabolic diseases can be associated with psychiatric symptoms. We present two case histories that demonstrate the importance of correctly diagnosing a metabolic disease as being the cause of psychiatric symptoms. We also discuss which symptoms or signals may indicate a metabolic disease.
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24
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de Witte LD, Dekker D, Veraart J, Kromkamp M, Kaasjager K, Vinkers CH. [Aggression and restlessness following baclofen overdose: the narrow line between intoxication and withdrawal symptoms]. Ned Tijdschr Geneeskd 2016; 160:A9604. [PMID: 27484417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Baclofen is increasingly prescribed for alcohol dependency. Subsequently, the risk of self-intoxication with this medicinal product is increasing. CASE DESCRIPTION A 23-year-old man with a history of alcohol dependence was admitted to our hospital after self-intoxication with 2700 mg baclofen and 330 mg mirtazapine. Respiratory insufficiency as a result of the baclofen intoxication required intubation and admission to the ICU. During the first day, despite the use of sedatives, the patient became intermittently agitated and aggressive. In the following days, he developed severe delirium, probably due to baclofen withdrawal. The reintroduction of baclofen quickly resolved these symptoms. CONCLUSION In the case of baclofen, in practice it is difficult to differentiate between intoxication and withdrawal. To prevent potentially severe withdrawal symptoms, we recommend reintroduction of baclofen when the first signs of restlessness and agitation arise following intoxication.
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de Witte LD, Smits RB, Bartel M, Kleijweg M, Valk GD, Vinkers CH, Vergeer M. [Cushing's syndrome in a manic patient with a long-standing bipolar disorder: cause or coincidence?]. Tijdschr Psychiatr 2015; 57:757-761. [PMID: 26479256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Hypercortisolism is associated with mood disorders such as depression and bipolar disorder. A 75-year-old female patient who had been diagnosed with bipolar disorder forty years ago was admitted to our hospital with a severe, therapy-resistant mania. Careful diagnostic considerations, resulted in the patient being diagnosed with Cushing's syndrome. Treatment with metyrapone led to a swift improvement of the patient's symptoms. Could Cushing's syndrome underlie this patient's psychiatric history? Or are two co-existing, intertwining causes responsible for the psychiatric symptoms? The case illustrates that even if a patient has a long history of psychiatric problems that have been plausibly diagnosed over time, clinicians and psychiatrists should always consider the possibility that there may be an underlying somatic cause for the patient's psychiatric symptoms.
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Vinkers CH, Sommer IE. [Amisulpride: a treatment option for psychotic disorders soon to be available in the Netherlands]. Tijdschr Psychiatr 2015; 57:830-834. [PMID: 26552930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The antipsychotic drug amisulpride has not yet been officially approved for use in the Netherlands, although it is already available in other European countries , including Belgium, the UK and Germany. However, a fast-track procedure has recently been initiated so that amisulpride will soon become available in the Netherlands as well. AIM To summarise the efficacy and side effects of amisulpride. METHOD We discuss the evidence presented in the scientific literature. RESULTS The scientific literature assures us that amisulpride is an effective antipsychotic drug with an acceptable range of side-effects. This means that there are two main advantages that ensue from the use of amisulpride: a patient's psychosis is more likely to go into remission and patients are less likely to stop taking the drug. CONCLUSION The availability of amisulpride in the Netherlands will constitute a valuable addition to the pharmacotherapeutic options for treating psychotic disorders in our county.
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Houtepen LC, Boks MPM, Kahn RS, Joëls M, Vinkers CH. Antipsychotic use is associated with a blunted cortisol stress response: a study in euthymic bipolar disorder patients and their unaffected siblings. Eur Neuropsychopharmacol 2015; 25:77-84. [PMID: 25453485 DOI: 10.1016/j.euroneuro.2014.10.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 09/09/2014] [Accepted: 10/13/2014] [Indexed: 11/30/2022]
Abstract
There is ample evidence that the acute stress response is altered in schizophrenia and bipolar disorder. However, it is not clear whether such changes are related to the illness, a genetic vulnerability, or is the result of medication that is used in the majority of these patients. Therefore, we investigated determinants of the acute endocrine and autonomic stress response in healthy controls (n=48), euthymic BD1 patients (n=49) and unaffected siblings of BD1 patients (n=27). All participants completed a validated psychosocial stress task, the Trier Social Stress Test for Groups (TSST-G). Saliva levels of alpha-amylase and cortisol were measured before, during, and after exposure to stress. Compared to controls, we found a significantly blunted cortisol stress response in BD1 patients. Conversely, BD1 patients displayed exaggerated alpha-amylase levels in response to stress. Antipsychotic use was a significant contributing factor to the blunted cortisol stress response in BD1 patients. Unaffected BD1 siblings displayed similar stress-induced cortisol and alpha-amylase levels as controls, suggesting that familial risk for BD1 did not have a large effect on the functionality of the stress system. In conclusion, this study shows that euthymic BD1 patients have a substantially blunted endocrine stress response but an exaggerated autonomic stress response and that the endocrine stress response differences can be largely contributed to antipsychotic use rather than constitute a specific BD1 phenotype or vulnerability.
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Affiliation(s)
- L C Houtepen
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
| | - M P M Boks
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - R S Kahn
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - M Joëls
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - C H Vinkers
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
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Vis R, Hassink JJM, Vinkers CH. [Tricyclic antidepressant plasma levels in depression: a practical guide]. Tijdschr Psychiatr 2013; 55:695-705. [PMID: 24046248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Plasma levels can be used to monitor the clinical efficacy of tricyclic antidepressants (TCAs). In practice, the interpretation of plasma levels can be problematical, for several reasons: varying time-intervals between ingestion and blood sampling, the number of times per day a particular antidepressant is administered, the presence of active metabolites and the use of slow-release substances. AIM To present realistic recommendations regarding the interpretation of plasma levels of TCA in clinical practice. METHOD We studied the relevant literature. CONCLUSION On the basis of the literature we make the following recommendations:
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Affiliation(s)
- R Vis
- Klinische Farmacie, St. Antonius Ziekenhuis, Nieuwegein.
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