The investigation of antidepressant and anxiolytic effects of pregabalin and its mechanisms of action in rats.

OBJECTIVES: Pregabalin (PGB) is used in drug-resistant epilepsy. Also, it has analgesic effects in painful syndromes. Depression and anxiety are commonly seen in epilepsy and neuropathic pain patients. PGB is often combined with anxiolytics and antidepressants. We aimed to investigate the antidepressant and anxiolytic effects of PGB and compare its effects with those of antidepressant and anxiolytic drugs and their combined use. METHODS: Wistar Albino rats were used, and PGB (5, 10, 20, and 40 mg/kg), amitriptylin (AMT), fluoxetine (FLX), ketamine (KET), and diazepam (DZM), as well as combinations of PGB (20 mg/kg) with AMT, FLX, KET, and DZM, were administered. Elevated plus maze, forced swimming, and locomotor activity tests were performed. RESULTS: In the elevated plus maze, PGB10, 20, 40, AMT, FLX, and DZM increased open arm time. The PGB20+FLX combination increased compared to PGB20. In forced swimming, PGB doses increased immobility time. AMT, FLX, DZM, and KET decreased compared to control and PGB doses. Other combinations of PGB20 reversed immobility time, except FLX. In locomotor activity, PGB20, AMT, KET, and DZM decreased distance. CONCLUSION: PGB had a depressant effect in all doses and a dose-dependently anxiolytic effect. In combinations of PGB with AMT, KET, and DZM, it reversed their antidepressant effects. We assumed FLX could be preferred instead of AMT in patients using PGB. When PGB is used in combination, drug interactions should be considered. These results are also very remarkable in terms of pharmacoeconomics.

Acute administration of fluoxetine increases social avoidance and risk assessment behaviors in a sex- and social stress-dependent manner in Syrian hamsters (Mesocricetus auratus).

Most studies investigating the effects of acute administration of selective serotonin reuptake inhibitors (SSRI) on responses to social stress have been conducted with males. This is despite the fact that SSRIs remain the primary pharmacotherapy for social stress-related disorders for both sexes and that the prevalence of these disorders is twofold higher in women than in men. To determine whether acute treatment with the SSRI, fluoxetine, alters behavioral responses to social defeat stress in a sex- or social stress-dependent manner, male and female Syrian hamsters were subjected to one of three social defeat conditions: no defeat (placed into an empty resident aggressor (RA) cage), a single defeat by one RA for 15 min, or three consecutive defeats using different RAs for 5 min each. The day following social defeat, subjects were infused with either vehicle or fluoxetine (20 mg/kg, I.P.) 2 h prior to a 5 min social avoidance test. Overall, we found that fluoxetine increased social vigilance regardless of sex or defeat condition. We also found that fluoxetine affected social avoidance in a sex by stress intensity interaction, such that fluoxetine increased avoidance in no defeat males and in males defeated once but significantly increased avoidance in females only after three defeats. These data suggest that treatment with an SSRI could initially exacerbate the effects of social stress in both sexes. These data also emphasize the importance of including sex as a biological variable when investigating the efficacy of pharmacotherapy for stress-related disorders.

Garlic passion fruit (Passiflora tenuifila Killip): Assessment of eventual acute toxicity, anxiolytic, sedative, and anticonvulsant effects using in vivo assays.

Several Passiflora species are known for their sedative and anxiolytic properties. However, the functional properties of Passiflora tenuifila Killip are still unexplored. The objective of this work was to evaluate the phenolic composition and acute toxicity, anxiolytic, sedative, and anticonvulsant effects using in vivo assays. The whole fruit (peel, pulp, and seed) was lyophilized and used for all assays. LC-MS showed 19 phenolic compounds, tentatively identified as flavonoids and phenolic acids. Acute treatment with single doses of up to 2000 mg kg-1 in Wistar rats showed no signs of mortality or toxicity over 14 days. The assay of functional effects was performed with Swiss mice, four groups, received by gavage, doses of P. tenuifila (200 or 400 mg kg-1 body weight), water, and diazepam (as negative and positive control), and behavior tests were performed after 60 min of the treatments. The animals treated with P. tenuifila fruit showed a significant decrease in locomotor activity, indicating a sedative and anxiolytic activity. No significant changes were observed in the rotarod apparatus, suggesting that the P. tenuifila fruit did not cause muscle relaxation. The 400 mg kg-1 dose of P. tenuifila exerted a protective effect against pentylenetetrazole-induced seizures, decreasing the severity and not causing the death of the animals. In conclusion, P. tenuifila showed no acute toxicity and had a promising effect as an anxiolytic agent, hypnotic-sedative and anticonvulsant, which could be related to its composition of flavonoids and phenolic acids.

A preclinical assessment to repurpose drugs to target type 1 diabetes-associated type B coxsackieviruses.

AIM: To screen several antiviral drugs systematically for their efficacy against type B coxsackieviruses. METHODS: Ten drugs with different antiviral mechanisms were analysed for their efficacy against prototype strains of type B coxsackieviruses in A549 cells. Cell viability was quantified in fixed cells using a colorimetric assay. Median effective dose was interpolated from the triplicated experiments and the dose-response curves were generated for each drug-virus combination. Drug cytotoxicity was similarly quantified and selectivity indices calculated. RESULTS: Hizentra, pleconaril, fluoxetine, norfluoxetine, ribavirin, favipiravir, and guanidine hydrochloride were able to abrogate infection by all tested viruses, with the exception of complete inefficacy of pleconaril against coxsackievirus B3 and favipiravir against coxsackievirus B2. The effective doses for Hizentra, enviroxime, ribavirin, favipiravir, and pleconaril were clearly below their therapeutic serum concentrations, while the effective concentrations of fluoxetin, norfluoxetine and itraconazole exceeded their therapeutic serum concentrations. Lovastatin and azithromycin did not efficiently block type B coxsackieviruses. CONCLUSION: Hizentra, enviroxime, pleconaril, ribavirin, and favipiravir are effective against type B coxsackieviruses in vitro in their therapeutic serum concentrations. These antiviral drugs are therefore attractive candidates for type 1 diabetes prevention/treatment trials. They can also be used in other clinical conditions caused by type B coxsackieviruses.

Stress-induced changes in social dominance are scaled by AMPA-type glutamate receptor phosphorylation in the medial prefrontal cortex.

The establishment and maintenance of social dominance are critical for social stability and the survival and health of individual animals. Stress lead to depression and a decrease in the social status of depressed persons is a risk factor for suicide. Therefore, we explored the mechanistic and behavioral links among stress, depression, and social dominance and found that mice subjected to chronic restraint stress (CRS), an animal model of stress-induced depression, showed decreased social dominance as measured by a dominance tube test. Importantly, this submissive behavior was occluded by the antidepressant, fluoxetine, a selective serotonin reuptake inhibitor. It is known that social dominance is controlled by synaptic efficacy in the medial prefrontal cortex (mPFC) and that AMPA-type glutamate receptor (AMPA-R) is a key molecule for synaptic efficacy. We found that the phosphorylation on AMPA-R was bidirectionally changed by CRS and fluoxetine in the mPFC of mice with CRS. Moreover, we found a strong correlation between social dominance and AMPA-R phosphorylation that regulates synaptic efficacy by modulating the synaptic targeting of AMPA-R. Our correlational analysis of the behavior and biochemistry of the CRS model suggests that AMPA-R phosphorylation in the mPFC may serve as a biomarker of social dominance related to stress.

A simple assessment model to quantifying the dynamic hippocampal neurogenic process in the adult mammalian brain.

Adult hippocampal neurogenesis is a highly dynamic process in which new cells are born, but only some of which survive. Of late it has become clear that these surviving newborn neurons have functional roles, most notably in certain forms of memory. Conventional methods to look at adult neurogenesis are based on the quantification of the number of newly born neurons using a simple cell counting methodology. However, this type of approach fails to capture the dynamic aspects of the neurogenic process, where neural proliferation, death and differentiation take place continuously and simultaneously. In this paper, we propose a simple mathematical approach to better understand the adult neurogenic process in the hippocampus which in turn will allow for a better analysis of this process in disease states and following drug therapies.

So you think you can jump? A novel long jump assessment to detect deficits in stroked mice.

BACKGROUND: Stroke survivors suffer from persistent disability, as well as severe sensorimotor and cognitive deficits. The preclinical assessment of such deficits is important for the development of novel interventions and therapeutics. NEW METHOD: The aim of this study was to develop a quantitative behavioral measure of hindlimb functionality in rodents, which could be used to assess deficits after a neural injury, such as stroke. Here we introduce a test to measure long jump behavior in mice. RESULTS: Using this test we first showed that while male and female mice exhibited no differences in jump success rate, the female mice showed lower baseline jumping latencies. Next we demonstrated that the induction of a cerebral stroke via middle cerebral artery occlusion (MCAO) for 45min did not affect the jump success rate in either group; however, it did significantly increase jump latencies in both male and female mice. Finally, we used therapeutic interventions to explore mechanisms that may be involved in producing this increase in jump latency by administering the anti-depressant fluoxetine prior to the long jump assay, and also tested for potential changes in anxiety levels after stroke. COMPARISON WITH EXISTING METHODS: Other methods to assess hindlimb functionality are not specific, because they measure behaviors that rely not only on hindlimbs, but also on forelimbs and tail. CONCLUSIONS: This study introduces a novel assay that can be used to measure a stroke induced behavioral deficit with great sensitivity, and raises interesting questions about potential mechanisms regulating this effect.

Assessment of depression in a rodent model of spinal cord injury.

Despite an increased incidence of depression in patients after spinal cord injury (SCI), there is no animal model of depression after SCI. To address this, we used a battery of established tests to assess depression after a rodent contusion injury. Subjects were acclimated to the tasks, and baseline scores were collected before SCI. Testing was conducted on days 9-10 (acute) and 19-20 (chronic) postinjury. To categorize depression, subjects' scores on each behavioral measure were averaged across the acute and chronic stages of injury and subjected to a principal component analysis. This analysis revealed a two-component structure, which explained 72.2% of between-subjects variance. The data were then analyzed with a hierarchical cluster analysis, identifying two clusters that differed significantly on the sucrose preference, open field, social exploration, and burrowing tasks. One cluster (9 of 26 subjects) displayed characteristics of depression. Using these data, a discriminant function analysis was conducted to derive an equation that could classify subjects as "depressed" on days 9-10. The discriminant function was used in a second experiment examining whether the depression-like symptoms could be reversed with the antidepressant, fluoxetine. Fluoxetine significantly decreased immobility in the forced swim test (FST) in depressed subjects identified with the equation. Subjects that were depressed and treated with saline displayed significantly increased immobility on the FST, relative to not depressed, saline-treated controls. These initial experiments validate our tests of depression, generating a powerful model system for further understanding the relationships between molecular changes induced by SCI and the development of depression.

Stereoselective inhibition of CYP2C19 and CYP3A4 by fluoxetine and its metabolite: implications for risk assessment of multiple time-dependent inhibitor systems.

Recent guidance on drug-drug interaction (DDI) testing recommends evaluation of circulating metabolites. However, there is little consensus on how to quantitatively predict and/or assess the risk of in vivo DDIs by multiple time-dependent inhibitors (TDIs) including metabolites from in vitro data. Fluoxetine was chosen as the model drug to evaluate the role of TDI metabolites in DDI prediction because it is a TDI of both CYP3A4 and CYP2C19 with a circulating N-dealkylated inhibitory metabolite, norfluoxetine. In pooled human liver microsomes, both enantiomers of fluoxetine and norfluoxetine were TDIs of CYP2C19, (S)-norfluoxetine was the most potent inhibitor with time-dependent inhibition affinity constant (KI) of 7 µM, and apparent maximum time-dependent inhibition rate (k(inact,app)) of 0.059 min(-1). Only (S)-fluoxetine and (R)-norfluoxetine were TDIs of CYP3A4, with (R)-norfluoxetine being the most potent (K(I) = 8 µM, and k(inact,app) = 0.011 min(-1)). Based on in-vitro-to-in-vivo predictions, (S)-norfluoxetine plays the most important role in in vivo CYP2C19 DDIs, whereas (R)-norfluoxetine is most important in CYP3A4 DDIs. Comparison of two multiple TDI prediction models demonstrated significant differences between them in in-vitro-to-in-vitro predictions but not in in-vitro-to-in-vivo predictions. Inclusion of all four inhibitors predicted an in vivo decrease in CYP2C19 (95%) and CYP3A4 (60-62%) activity. The results of this study suggest that adequate worst-case risk assessment for in vivo DDIs by multiple TDI systems can be achieved by incorporating time-dependent inhibition by both parent and metabolite via simple addition of the in vivo time-dependent inhibition rate/cytochrome P450 degradation rate constant (λ/k(deg)) values, but quantitative DDI predictions will require a more thorough understanding of TDI mechanisms.

A novel IV cocaine self-administration procedure in rats: differential effects of dopamine, serotonin, and GABA drug pre-treatments on cocaine consumption and maximal price paid.

RATIONALE: Behavior occurring during cocaine self-administration can be classified as either consummatory or appetitive. These two concepts are usually addressed independently using separate reinforcement schedules. For example, appetitive behavior can be assessed with a progressive ratio schedule, whereas consummatory behavior is typically measured using a fixed ratio schedule. OBJECTIVES: Depending on the schedule used, it is often difficult to determine whether a particular drug pretreatment is affecting self-administration through an effect on appetitive responding, consummatory responding, or perhaps both. In the present study, we tested the effect of pretreating rats with four different drugs on appetitive and consummatory behaviors. MATERIALS AND METHODS: We recently developed a technique that provides an independent assessment of both behavioral concepts within the same experimental session. In this threshold procedure, rats are offered a descending series of 11 unit doses (422-1.3 µg/injection) during consecutive timed intervals under a fixed-ratio schedule. Consummatory behavior can be analyzed by assessing intake at high unit doses; an estimate of appetitive responding can be determined from responding occurring at the threshold dose. Applying behavioral economics to these data provides dependent measures of consumption when minimally constrained by price and the maximal price paid (P (max)) for cocaine. RESULTS: Haloperidol increased cocaine consumption when minimally constrained by price but decreased P (max). In contrast, D: -amphetamine increased P (max). Fluoxetine decreased P (max) and consumption when minimally constrained by price. Baclofen selectively decreased P (max). CONCLUSIONS: These data suggest that drug pretreatments can alter consummatory and appetitive behavior differently because each concept involves distinct neural mechanisms.

Cost-effectiveness of quetiapine plus mood stabilizers compared with mood stabilizers alone in the maintenance therapy of bipolar I disorder: results of a Markov model analysis.

OBJECTIVE: The aim of this study was to estimate the following: (1) the number of acute mood events prevented by adjunctive quetiapine therapy, and the potential cost savings; (2) the number of acute mood event-associated hospitalizations avoided by using adjunctive quetiapine therapy, and the potential cost savings of this intervention; and (3) the economic value of adjunctive quetiapine therapy in the maintenance treatment of bipolar I disorder. METHODS: A Markov model was developed to simulate the transitions of newly stabilized adult patients with bipolar I disorder across 4 possible health states: euthymia, acute mania, acute depression, and discontinued/ no active therapy. Clinical data were obtained from 2 randomized, double-blind, Phase III trials of up to 2 years' duration (D1447C00126 and D1447C00127) that evaluated the efficacy and tolerability of quetiapine (versus placebo) when coadministered with lithium or valproate in increasing the time to recurrence of acute mood events in patients with bipolar I disorder. The model evaluated clinical and economic outcomes in 8 quarterly cycles (24 months). Outcome measures included the number of acute mood events, number of hospitalizations related to acute mood events, and their costs. Quality-adjusted life-years (QALYs) were calculated as a secondary outcome. The model was conducted from the perspective of the UK National Health Service, base year 2007. RESULTS: In the model analysis, adjunctive quetiapine with lithium or valproate was associated with a 54% reduction in the occurrence of acute mood events, a 29% reduction in acute mood event-related hospitalization costs, and a 4% improvement in QALY gains, with 5% lower total direct costs than placebo + lithium/valproate. The incremental cost-effectiveness ratios (in year-2007 pound) were 506 per additional acute mood event avoided, 4261 per additional acute mood event-related hospitalization prevented, and -7453 per additional QALY gained. The sensitivity analyses indicated that these results were robust. CONCLUSIONS: The results of this Markov model with a 2-year time horizon suggest that adjunctive quetiapine and mood-stabilizer therapy with lithium or valproate, compared with mood-stabilizer therapy alone in the maintenance treatment of patients with bipolar I disorder, were associated with fewer acute mood events, fewer acute mood event-related hospitalizations, and lower total costs, thereby improving patient mental health outcomes and minimizing impact on payer budgets, from the perspective of the UK National Health Service.

Fluoxetine effects assessment on the life cycle of aquatic invertebrates.

Fluoxetine is a serotonin re-uptake inhibitor, generally used as an antidepressant. It is suspected to provoke substantial effects in the aquatic environment. This study reports the effects of fluoxetine on the life cycle of four invertebrate species, Daphnia magna, Hyalella azteca and the snail Potamopyrgus antipodarum exposed to fluoxetine spiked-water and the midge Chironomus riparius exposed to fluoxetine-spiked sediments. For D. magna, a multi-generational study was performed with exposition of newborns from exposed organisms. Effects of fluoxetine could be found at low measured concentrations (around 10microgl(-1)), especially for parthenogenetic reproduction of D. magna and P. antipodarum. For daphnids, newborns length was impacted by fluoxetine and the second generation of exposed individuals showed much more pronounced effects than the first one, with a NOEC of 8.9microgl(-1). For P. antipodarum, significant decrease of reproduction was found for concentrations around 10microgl(-1). In contrast, we found no effect on the reproduction of H. azteca but a significant effect on growth, which resulted in a NOEC of 33microgl(-1), expressed in nominal concentration. No effect on C. riparius could be found for measured concentrations up to 59.5mgkg(-1). General mechanistic energy-based models showed poor relevance for data analysis, which suggests that fluoxetine targets specific mechanisms of reproduction.

Como viver sem meu Prozac?: uma análise antropológica dos discursos sobre o consumo de fluoxetina em um site de relacionamentos / How can I live without Prozac?: an anthropological investigation of fluoxetine consumption in a social network website

Neste trabalho enfocaremos o consumo de antidepressivos, buscando questionar a posição mais comumente aceita para explicar o alto consumo dessas substâncias, que geralmente responsabiliza os ardilosos estratagemas das indústrias farmacêuticas ou a hegemonia da psiquiatria biológica na medicina. Acreditamos que as respostas devem ser buscadas em análises mais profundas, e não simplesmente na demonização desse ou daquele ator social considerado isoladamente, pois admitimos que no consumo se constrói parte da racionalidade integrativa e comunicativa de uma sociedade, logo, pensar o consumo implica em um enfoque dos sujeitos enquanto consumidores, indivíduos e cidadãos. Partindo dessas considerações, analisaremos o consumo de antidepressivos pela ótica dos usuários através da análise do conteúdo de um site de relacionamentos muito popular na internet brasileira, conhecido como Orkut.

Specific in vitro binding of (S,S)-[3H]MeNER to norepinephrine transporters.

The aim of this study was to determine the selectivity of (S,S)-2-(alpha-(2-methoxyphenoxy)benzyl)morpholine (MeNER) binding to norepinephrine transporters (NET). Quantitative autoradiography studies of NET binding were performed in brains of wildtype mice and those of mutant mice lacking one or two alleles of the NET gene. [3H]MeNER binding in the wildtype mouse brains was consistent with previously reported distributions of NET. Highest levels were found in the locus coeruleus, thalamus, hypothalamus, and bed nucleus of stria terminalis. Specific binding in these regions was approximately 50% in the heterozygous NET mice and negligible in the NET knockout mice. Binding in the wildtype mouse brains was displaced by the NET ligand, nisoxetine, but not by the serotonin or dopamine transporter blockers, citalopram or GBR 12935. [3H]MeNER displayed much higher affinity for NET than for SERT or DAT in homogenate binding studies. Each of these features supports the binding specificity of this candidate in vivo NET ligand.

Phenotypic assessment of galanin overexpressing and galanin receptor R1 knockout mice in the tail suspension test for depression-related behavior.

RATIONALE: Galanin and its receptors exert inhibitory neuromodulatory control over brain monoamines. Rat studies revealed that galanin expression is upregulated by exposure to stressors and that galanin manipulations modify neuroendocrine and behavioral responses to stress, leading to the hypothesis that galanin mediates depression-related behaviors. METHODS: In the present study, we examined the role of galanin in modulating antidepressant-related behavior in galanin overexpressing transgenic (GAL-tg) mice and galanin receptor R1 knockout (GAL-R1 KO) mice, using the tail suspension test (TST). Quantitative autoradiography for 5-HT(1A)-R and serotonin transporter binding density tested for changes in these two major regulatory components of the 5-HT system in galanin mutant mice. RESULTS: Baseline TST behavior was normal in GAL-tg and GAL-R1 KO mice, and intracerebroventricular administration of galanin failed to alter TST behavior in normal C57BL/6J mice. The TST anti-immobility effects of acute treatment with the serotonin reuptake inhibitor, fluoxetine (0-30 mg/kg), and the norepinephrine reuptake inhibitor, desipramine (0-30 mg/kg), were unaltered in galanin mutant mice. Hippocampal 5-HT(1A)-R density was significantly elevated in GAL-tg and GAL-R1 KO mice, while hippocampal 5-HTT density was reduced in GAL-R1 KO mice, relative to controls. CONCLUSION: Neither pharmacological nor molecular genetic manipulations of galanin altered depression-related profiles in the TST. Possible functional alterations in hippocampal 5-HT neurotransmission may have contributed to these negative results. These preliminary findings provide evidence against the hypothesis that galanin plays a central role in mouse depression-related behaviors. It remains possible that galanin modulates depression-related responses in other experimental paradigms and species.

Voltammetric assessment of dopamine clearance in the absence of the dopamine transporter: no contribution of other transporters in core or shell of nucleus accumbens.

Cocaine elevates dopamine (DA) in the nucleus accumbens (NAc) by blocking the uptake of DA through the DA transporter (DAT). It is commonly believed that the reinforcing properties of cocaine depend upon interaction with the DAT, however, cocaine is still reinforcing in mice with a genetic deletion of the DAT (DAT-KO mice). Although cocaine continues being able to elevate DA in the NAc of these mice, this mechanism is unclear. The present voltammetric study in brain slices was designed to examine the role of the norepinephrine and serotonin transporters in removing DA from the extracellular space in the NAc of DAT-KO mice. We found no effects of any monoamine uptake inhibitors, including cocaine (10 microM), desipramine (10 microM) or fluoxetine (10 microM) on the clearance of DA in these mice. Therefore, it appears that there is no compensatory uptake of DA by alternative transporters either in core or shell of the nucleus accumbens of DAT-KO mice.

Actions of amphetamine derivatives and cathinone at the noradrenaline transporter.

We have recently shown that methylenedioxymethamphetamine (MDMA), methylenedioxyamphetamine (MDA), cathinone and methylenedioxyethylamphetamine (MDEA) have a cocaine-like action to potentiate the contractile actions of noradrenaline but not isoprenaline in the 1-Hz paced rat right ventricle. The purpose of this study was to directly test the actions of these compounds at the noradrenaline transporter. In rat left ventricular slices, potency (-log IC50) values at inhibiting uptake of [3H]noradrenaline were: cocaine 6.16+/-0.15, cathinone 6.03+/-0.16, MDMA 6.05+/-0.07, MDA 5.68+/-0.06 and MDEA 5.56+/-0.08. MDEA and MDA were significantly less potent. In rat cerebral cortex membranes, MDMA was significantly less potent at displacing [3H]nisoxetine binding; -log EC50 values: cocaine 5.04+/-0.08, cathinone 5.40+/-0.14, MDA 4.66+/-0.11, MDEA 4.99+/-0.15, MDMA 4.22+/-0.07. The noradrenaline uptake studies showed that MDEA was least potent: MDEA was also least potent functionally in the paced rat right ventricle. The [3H]nisoxetine displacement studies did not compare with the functional studies.

Vasopressin as a target for antidepressant development: an assessment of the available evidence.

Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis is one of the key biological abnormalities described in major depressive disorder, occurring in 30-50% of depressed subjects. Corticotropin-releasing hormone (CRH) and vasopressin (AVP) are the main regulators of this stress system, with the two neuropeptides acting synergistically in bringing about adrenocorticotropin (ACTH) release from the anterior pituitary and cortisol from the adrenal gland. Based on the demonstration of elevated cerebrospinal fluid levels of CRH in depressives, and other evidence, it has been postulated that excess CRH and the resultant increased HPA forward drive form the basis of neuroendocrine dysregulation in depression. However, there is an accumulating body of evidence to support a significant role for AVP in the regulation of pituitary-adrenal activity in health and also in depressive disorder. This review, based on a Medline search from 1980 to 2001, focuses on the functional neuroanatomy, receptor pharmacology, VP synergism with CRH, and the data from clinical and pre-clinical studies that support an important role for AVP in the pathophysiology of major depression. We suggest that future antidepressants may target the vasopressinergic system.

Review of fluoxetine and its clinical applications in premenstrual dysphoric disorder.

The largest number of antidepressant treatment trials in premenstrual syndrome and premenstrual dysphoric disorder (PMDD) have been conducted with fluoxetine. Fluoxetine and other selective serotonin re-uptake inhibitors (SSRIs) clearly reduce premenstrual emotional and physical symptoms and improve premenstrual psychosocial functioning. Fluoxetine was the first SSRI to be approved by the FDA as a treatment for the emotional and physical symptoms of PMDD. Fluoxetine 20 mg has been reported to be effective for emotional and physical premenstrual symptoms with continuous daily dosing (every day of the menstrual cycle) and with luteal phase daily dosing (from ovulation to menses). In addition, premenstrual emotional symptoms have been reported to improve with fluoxetine 10 mg in luteal phase daily dosing and with 90 mg 2 and 1 weeks prior to menses. Fluoxetine is generally a well-tolerated treatment for PMDD and discontinuation effects have not been reported with intermittent dosing regimens.

Global benefit-risk assessment of antidepressants: venlafaxine XR and fluoxetine.

BACKGROUND: Quantifying efficacy and safety differences between drugs is difficult because rigorous statistical methods to assess benefit and risk simultaneously are lacking. METHODS: Global benefit-risk (GBR) analysis of clinical trial data was used retrospectively to compare venlafaxine extended release (XR) and fluoxetine. Of 301 outpatients with moderate to severe depression given venlafaxine XR 75-225 mg/day (n=100), fluoxetine 20-60 mg/day (n=103), or placebo (n=98) for up to 8 weeks, 295 qualified for analysis. Primary efficacy variables were Hamilton Rating Scale for Depression (HAM-D) remission (final on-therapy score risk category were 2.1 (1.1-4.0) and 2.2 (1.1-4.3) for venlafaxine XR vs. fluoxetine and placebo, respectively. For CGI response, relative gains of venlafaxine XR were 1.39 (P<0.01) and 1.45 (P<0.01) vs. fluoxetine and placebo; benefit exceeded risk in 66, 53, and 52% of patients given venlafaxine XR, fluoxetine, and placebo (P=0.041 vs. venlafaxine XR), respectively. CONCLUSIONS: GBR analysis can be applied to a wide array of efficacy and safety data to form statistical tests of clinically meaningful treatment comparisons. In this comparison, the GBR assessments on response and remission significantly favored venlafaxine XR.