Sub-chronic exposure to paroxetine disrupts ecologically relevant behaviours in fish.

The functional conservation of important selective serotonin reuptake inhibitor (SSRI) targets in non-target organisms raises concerns about their potential adverse effects on the ecosystems. Although the environmental levels of SSRIs like paroxetine (PAR) have risen, the knowledge regarding the effects of long-term exposure to PAR is limited. This study investigated the impact of sub-chronic exposure (21 days) to two sub-lethal concentrations of PAR (40 and 400 µg/L) on the behaviour of adult zebrafish in different scenarios: basal activity (under dark and light conditions), stress response (evoked by sudden light transitions) and stress response recovery. A new framework was employed for the integrative study of fish's swimming performance based on their innate ability to respond to light shifts. Several swimming-associated parameters (e.g., total swimming distance, time of inactivity, swimming angles) and thigmotaxis were monitored for an integrated analysis in each scenario. Data revealed reduced swimming activity, impaired behavioural response to stress and alterations in stress recovery of PAR-exposed fish. An anxiolytic effect was particularly noticeable in fish basal swimming activity in the dark at 400 µg/L and in the behavioural response to stress (from dark to light) and stress recovery (from light to dark) for organisms exposed to 40 µg/L. The detected PAR-induced behavioural modifications suggest a disruption of brain glucocorticoid signalling that may have implications at the individual level (e.g., changing behavioural responses to predators), with potential repercussions on the population and community levels. Therefore, the applied protocol proved sensitive in detecting behavioural changes induced by PAR.

Are early and young life stages of fish affected by paroxetine? A case study with Danio rerio.

Paroxetine (PAR) is a selective serotonin reuptake inhibitor (SSRI) antidepressant increasingly detected in surface waters worldwide. Its environmental presence raises concerns about the potential detrimental effects on non-target organisms. Thus, this study aimed to increase knowledge on PAR's potential environmental impacts, assessing the effects of commercial formulation (PAR-c) and active ingredient (PAR-a) on fish. Therefore, the short-term exposure effects of PAR-c and PAR-a were assessed on zebrafish (Danio rerio) embryos/larvae to determine the most toxic formulation [through median lethal (LC50) and effective concentrations (EC50)]. PAR-c and PAR-a induced morphological abnormalities (scoliosis) in a dose-dependent manner from 96 hours post-fertilization onwards, suggesting the involvement of a fully functional biotransformation system. As PAR-c exhibited higher toxicity, it was selected to be tested in the subsequent stage (juvenile stage), which was more sensitive (lower LC50). PAR-c significantly decreased fish swimming activity and disrupted fish stress response. Overall, the results highlight the ability of PAR-c to adversely affect fish swimming performance, an effect that persisted even after exposure ceases (21-day depuration), suggesting that PAR-c may impair individual fitness.

Isoliquiritigenin ameliorates paroxetine-induced sexual dysfunction in male albino mice.

Paroxetine (PRX), a widely prescribed antidepressant, often leads to sexual dysfunction. The available management options such as sildenafil (SDF), are associated with side effects. The present study investigates the fertility-boosting properties of isoliquiritigenin (ISL) on PRX-induced sexual dysfunction in male mice. We allocated fertile mice into six different groups (n = 5): group I- DMSO; group II- PRX; group III- co-administered PRX and SDF; group IV- ISL alone; group V- co-administered PRX and ISL (low dose); and, group VI- co-administered PRX and ISL (high dose). 14 days post treatment, animals were sacrificed, and the weights of the testis and epididymis were evaluated. Furthermore, sperm parameters, testicular and epididymal antioxidant levels, serum testosterone and nitric oxide (NO) levels, histoarchitecture of testis and epididymis, and markers of cellular toxicity were assessed. Results revealed that the PRX administration reduced organ weights, sperm count, intact acrosome, catalase (CAT), superoxide dismutase (SOD), glutathione (GSH), serum testosterone, and NO levels, and increased sperm abnormalities and MDA levels (a biomarker for lipid peroxidation). Additionally, we observed damage in the testis and epididymis. The toxicity biomarker study revealed a higher concentration of SGOT, SGPT, and ALP enzymes in the PRX-treated group. However, the co-administration of PRX with ISL ameliorated the adverse effect of PRX on the parameters mentioned above. The PRX+ISL (high) results were almost at par with the PRX+SDF group. The group that received ISL alone showed overall improvements. In conclusion, our comprehensive panel of tests indicates that ISL could be helpful in managing sexual dysfunction.

An overall assessment of the effects of antidepressant paroxetine on aquatic organisms and human cells.

Paroxetine (PRX) is one of the most used antidepressants and an emerging contaminant with potential harmful effects to the environment and human health. The present study investigates in detail the toxic potential of PRX using a battery of bioassays on fresh- and marine species, marine bacteria, and human lymphocytes. All the tested organisms and human lymphocytes were exposed at concentrations ranging from µg L-1 to mg L-1. It was found that PRX can cause toxic effects to aquatic organisms at environmental relevant concentrations (µg L-1 level). A significant effect of PRX was observed in all tested algal species especially at the first 24 h. However, differences in responses and sensitivities among the tested algal species were observed. The most sensitive organism was found to be Dunaliella tertiolecta with IC50 = 0.092 mg L-1 (72 h). In the case of Aliivibrio fischeri, EC50 values were determined to be 16.65, 14.31 and 14.41 mg L-1 for 5, 15 and 30 min of exposure, respectively. PRX also induced cytotoxic and genotoxic effects in human lymphocytes. A dose-dependent increase in micronucleus frequencies was occurred at all tested concentrations with a statistically significant increase in micronucleus frequencies at the medium to high PRX tested concentrations. The findings of the present study expand the available toxicity profile of PRX on aquatic organisms and the knowledge about the potential risk of PRX to induce genotoxic effects in cultured human lymphocytes.

Effects of the antidepressant paroxetine on migratory behaviour of meiobenthic nematodes: Computational and open experimental microcosm approach.

An open experimental setup was established in order to explore the toxic effects of the antidepressant paroxetine on meiobenthic nematodes. Three types of microcosms made from polyvinyl chloride tubes, each comprising two sediments compartments (upper and lower), were used in a laboratory experiment for 15 days. The experimental setup targeted the migratory behaviour of the nematofauna from the above compartments, which were exposed to paroxetine (0.4 and 40 µg.l-1), towards below compartments. The univariate indices significantly decrease in the contaminated compartments compared to controls. Multivariate analyses revealed also significant taxonomic dissimilarities between contaminated and uncontaminated compartments. Furthermore, SIMPER functional outcomes highlighted a significant decrease in 2A feeding groups, 'co' tail shape, 1-2 mm interval length, 'cr' amphid shape, and c-p2 life history in contaminated compartments. Computational approach showed that paroxetine bound GLD-3 and SDP with high affinities, which together with molecular interactions and toxicokinetics satisfactorily explain the experimental results.

Effect of paroxetine on intestinal motility in the presence of ondansetron.

Chemotherapy, radiotherapy, surgery and depression are the conditions that run in parallel fashions. All these conditions cause the release of an increased amount of serotonin in the body. Serotonin acts on these 5HT3 receptors and causes nausea and vomiting. Ondansetron acts by blocking serotonin from acting on the receptors and thus is useful in decreasing episodes of nausea and vomiting but when used concomitantly with SSRIs (selective serotonin reuptake inhibitors) as cancer patient also suffered from depression. This combination tends to decrease the efficacy of ondansetron. The present study was carried out to observe the modulatory role of ondansetron on ileal smooth muscle motility in vitro. Experiments were performed in four groups (n=6) and ileal smooth muscle activity was recorded on the power lab (USA). The effects of increasing concentrations of serotonin, ondansetron and paroxetine alone were observed. In the fourth group effects of paroxetine in the presence of fixed concentration (1ml) of ondansetron (10-6M) was observed. The maximum response obtained by serotonin served as a control for our study (100%). Paroxetine response on intestinal motility was completely blocked in the presence of ondansetron. Our findings hence, reinforce the hypothesis that paroxetine decreases the antiemetic activity of serotonin antagonist ondansetron, by super sensitization of serotonergic receptors resulting in an increased incidence of nausea and vomiting in cancer patient despite adequate antiemetic prophylaxis.

Effect of Pregnancy on Paroxetine-Induced Adiposity and Glucose Intolerance in Mice.

Long-term use of selective serotonin reuptake inhibitors (SSRIs) targeting the serotonin transporter (SERT) has been suggested to be associated with an increased risk for obesity and type 2 diabetes. Previously, using a murine knockout model of SERT, we showed that estrogen suppression is involved in SERT deficiency-induced obesity and glucose intolerance in nonpregnant mice. The present study investigated the effects of chronic paroxetine treatment on adiposity and glucose tolerance in mice before and during pregnancy. Chronic paroxetine treatment in nonpregnant mice resulted in visceral adiposity and glucose intolerance accompanied by reduced circulating 17ß-estradiol levels and ovarian expression of the aromatase (CYP19a1). Remarkably, pregnancy significantly reduced adiposity and improved glucose tolerance in paroxetine-treated mice by rebooting ovarian CYP19a1 expression and 17ß-estradiol production. These effects appear to be reversible as ovarian CYP19a1 expression and circulating 17ß-estradiol returned to prepregnancy levels soon after parturition. As in pregnant mice, 17ß-estradiol replacement treatment in nonpregnant mice reduced paroxetine-induced adiposity. Our findings further suggested that modulation of estrogen synthesis underlies the observed metabolic adverse effects of SSRIs. Although our data revealed a transient reversal effect of pregnancy on SSRI-induced metabolic abnormalities, these observations are experimental and limited to mice. The use of SSRIs during human pregnancy should be cautioned because of potential adverse effects to the fetuses.

Orange peels modulate antioxidant markers and key enzymes relevant to erection in the penile tissue of paroxetine-treated rats.

In comparison to other antidepressant drugs, erectile dysfunction (ED) is more pronounced in paroxetine use. On the other hand, orange (Citrus sinensis) peels commonly consumed in various forms are used in folkloric medicine for ED management. Thus, this study evaluated the effect of orange peels infusion on sexual behaviour, nitric oxide (NO) level and some enzymes (arginase, phosphodiesterase-5 [PDE-5], acetylcholinesterase [AChE] and adenosine deaminase [ADA]) in paroxetine-treated rats. Erectile dysfunction was induced with paroxetine (10 mg/kg body weight). The animals were grouped into five (n = 6): normal rats; paroxetine-induced rats; paroxetine-induced rats treated with sildenafil citrate (5 mg/kg); paroxetine-induced rats treated with orange peels infusion (50 mg/kg); Paroxetine induced rats treated with orange peel infusions (100 mg/kg). The results revealed a significant decrease in sexual behaviour, NO level and the activities of antioxidant enzymes, while there was a significant increase in arginase, PDE-5, AChE and ADA activities in paroxetine-induced rats. However, orange peel infusions ameliorated erectile dysfunction in paroxetine-treated rats. This study showed some possible biochemical basis underlying the use of orange peels infusion in erectile dysfunction management.

The effect of paroxetine, venlafaxine and bupropion administration alone and combined on spatial and aversive memory performance in rats.

BACKGROUND: The use of antidepressants in combination is common practice following non-response to single antidepressant agents. Nevertheless, the scientific literature lacks preclinical studies regarding the combined administration of antidepressants across multiple behavioral measures including, but not limited to, cognition. Hence, we aimed to determine the effects of paroxetine (PAR), venlafaxine (VEN) and bupropion (BUP) alone or combined (PAR+BUP or VEN+BUP) on spatial and affective memory tasks to advance the knowledge about the combined use of antidepressants in cognition. METHODS: Adult rats received daily injections (15 days) of PAR (20mg/kg, ip), VEN (20mg/kg, ip), BUP (20mg/kg, ip) alone or combined and were submitted to behavioral measures of spatial memory (radial-arm maze - RAM), aversive memory (passive avoidance - PA), open field (OF) and forced swimming (FST) tests. RESULTS: In the RAM, VEN or VEN+BUP impaired learning, while short-term memory (STM) was impaired by PAR, BUP and their combination. VEN+BUP improved STM as compared to BUP. PAR impaired long-term memory (LTM). VEN or BUP alone impaired STM and long-term fear memory, whilst PAR+BUP or VEN+BUP did not induce significant alterations. CONCLUSIONS: The effects of VEN, PAR or BUP alone and in combination on measures of memory are variable and vary as a function of the pharmacodynamics profile of each drug as well as the specific memory paradigm.

Modulatory effect of quercetin and its glycosylated form on key enzymes and antioxidant status in rats penile tissue of paroxetine-induced erectile dysfunction.

This study sought to compare the effects of quercetin and rutin on some enzymes linked to erectile function as well as antioxidant status in penile tissue of paroxetine - induced erectile dysfunction in rats. Animals were randomly divided into twelve groups: normal control (NC), sildenafil (SD), quercetin (QA) (25 and 50 mg/kg), rutin (RU) (25 and 50 mg/kg), PAR (10 mg/kg); PAR + SD; PAR + QA, PAR + RU (25 and 50 mg/kg). After 14 days' treatment, phosphodiesterase-5' (PDE-5'), arginase, adenosine deaminase (ADA), acetylcholinesterase (AChE) and angiotensin-I converting enzyme (ACE) activities as well as malondialdehyde (MDA) and non-protein thiol levels were determined in rat penile tissues. Elevated levels of PDE-5', arginase, AChE, ADA and ACE activities and MDA were observed in PAR-induced rats with concomitant decrease in non-protein thiol levels when compared to the NC group. However, treatment with SD, QA and RU significantly reduced the activities of AChE, PDE-5', arginase, ADA and ACE and MDA levels and elevated non-protein thiol levels in penile tissues of PAR-induced rats. Furthermore, administration of QA and RU in PAR-induced rats modulated the key enzymes relevant to erection, improved antioxidant status and could be potential functional food ingredients and nutraceuticals in the prevention and/or management of erectile dysfunction.

Impact of selective serotonin reuptake inhibitors on neural crest stem cell formation.

The use of antidepressants in pregnant women is rising, with rates up to 7.5% in the United States. Selective serotonin reuptake inhibitors (SSRIs) are currently the most common antidepressant prescribed to pregnant women. The teratogenic effects of SSRI exposure are debated because of discrepancies in epidemiological studies. As an alternative to epidemiological and animal studies, human embryonic stem cell research (hESC) provides a human-based experimental model to examine the risks of prenatal SSRI exposure. Neural crest stem cells (NCSCs) play an important role in craniofacial and cardiac development as precursors to craniofacial bones and heart septa. This study examines the effects of paroxetine (Paxil) and sertraline (Zoloft) exposure on proliferation, migration, and AP-2α protein expression of NCSC in vitro. hESCs were exposed to paroxetine and sertraline at three concentrations while undergoing directed differentiation into NCSCs. Our results indicate exposure to paroxetine significantly increased proliferation, migration, and AP-2α protein expression in NCSCs. Exposure to sertraline significantly decreased proliferation and significantly increased AP-2α protein expression in NCSC. This evidence suggests paroxetine and sertraline alter normal NCSC behavior and may thereby disrupt cardiac and craniofacial development.

Exposure to SSRI-type antidepressants increases righting time in the marine snail Ilyanassa obsoleta.

Exposure to human antidepressants has been shown to disrupt locomotion and other foot-mediated mechanisms in aquatic snails. We tested the effect of three selective serotonin reuptake inhibitor (SSRI)- and one selective serotonin-norepinephrine reuptake inhibitor (SNRI)-type antidepressants on the righting response in the marine snail, Ilyanassa obsoleta. All four antidepressants (fluoxetine, sertraline, paroxetine, venlafaxine) significantly increased righting time compared with controls with an exposure time as short as 1 h. Dose responses were nonmonotonic with effects seen mainly at the lowest exposure concentrations and shortest duration. The lowest concentration to show an effect was 3.45 µg/L fluoxetine with a 2-h exposure period and is about 3.71 times higher than environmental concentrations. Our results highlight rapid disruption of another foot-mediated behavior in aquatic snails by SSRI-type antidepressants. We discuss these and other reported nonmonotonic dose responses caused by antidepressants in terms of the various possible physiological mechanisms of action in nontarget aquatic species.

Early-life exposure to the SSRI paroxetine exacerbates depression-like behavior in anxiety/depression-prone rats.

Selective serotonin reuptake inhibitor (SSRI) antidepressants are the mainstay treatment for the 10-20% of pregnant and postpartum women who suffer major depression, but the effects of SSRIs on their children's developing brain and later emotional health are poorly understood. SSRI use during pregnancy can elicit antidepressant withdrawal in newborns and increase toddlers' anxiety and social avoidance. In rodents, perinatal SSRI exposure increases adult depression- and anxiety-like behavior, although certain individuals are more vulnerable to these effects than others. Our study establishes a rodent model of individual differences in susceptibility to perinatal SSRI exposure, utilizing selectively bred Low Responder (bLR) and High Responder (bHR) rats that were previously bred for high versus low behavioral response to novelty. Pregnant bHR/bLR females were chronically treated with the SSRI paroxetine (10 mg/kg/day p.o.) to examine its effects on offspring's emotional behavior and gene expression in the developing brain. Paroxetine treatment had minimal effect on bHR/bLR dams' pregnancy outcomes or maternal behavior. We found that bLR offspring, naturally prone to an inhibited/anxious temperament, were susceptible to behavioral abnormalities associated with perinatal SSRI exposure (which exacerbated their Forced Swim Test immobility), while high risk-taking bHR offspring were resistant. Microarray studies revealed robust perinatal SSRI-induced gene expression changes in the developing bLR hippocampus and amygdala (postnatal days 7-21), including transcripts involved in neurogenesis, synaptic vesicle components, and energy metabolism. These results highlight the bLR/bHR model as a useful tool to explore the neurobiology of individual differences in susceptibility to perinatal SSRI exposure.

A comparison of drug-induced cardiotoxicity in rat embryos cultured in human serum or protein free media.

INTRODUCTION: Although much reproductive toxicology research is performed in live animals there is increasing use of in vitro techniques primarily to identify potential hazards with human exposure. As many in vitro studies are undertaken using protein free media, the standard protocol is to compare the effect concentration determined in vitro with the predicted therapeutic free plasma concentration in humans. The aim of the present study was to test this rationale by comparing the effect of a small number of therapeutic drugs on heart rate of rodent embryos cultured in human sera or protein free serum. METHODS: Whole rat embryos were cultured in protein-free media or human serum to which drugs (amiodarone, citalopram, dofetilide, haloperidol, paroxetine, quetiapine, or trazodone) known to induce embryonic bradycardia were added. Embryonic heart rate was observed before and after addition of drugs. RESULTS: Most of the tested drugs (5/7) caused a greater decrease in embryonic heart rate in human sera than predicted based on the protein binding of the drug. DISCUSSION: The results suggest that there is less unbound drug in the protein free media and/or more unbound drug in the human sera than predicted. Variables such as saturated protein binding and pH cannot fully explain our results. Since the results did not validate the original rationale, reproductive toxicity results obtained using protein free in vitro techniques may not have the large safety factors predicted on the basis of protein binding.

Aggravation by paroxetine, a selective serotonin reuptake inhibitor, of antral lesions generated by nonsteroidal anti-inflammatory drugs in rats.

Recent clinical studies have suggested a risk of adverse gastric reactions from the concomitant use of selective serotonin (5-HT) reuptake inhibitors (SSRIs) with nonsteroidal anti-inflammatory drugs (NSAIDs). We examined the adverse effects of SSRIs on antral lesions produced by indomethacin in rats. Rats fasted for 24 h were refed for 1 h, then administered indomethacin (30 mg/kg s.c.) 1 h after the refeeding and killed 6 h later. Paroxetine (1-10 mg/kg) was given orally 30 min before indomethacin. Indomethacin caused antral lesions in refed rats. Paroxetine dose-dependently aggravated these lesions, despite provoking no damage by itself. Similar results were obtained when other NSAIDs such as diclofenac, flurbiprofen, and loxoprofen were coadministered with paroxetine or when indomethacin was coadministered with other antidepressants such as fluvoxamine and milnacipran, but not imipramine or maprotiline. Exogenous 5-HT also worsened the indomethacin-induced antral damage, whereas the aggravating effect of paroxetine was attenuated by ondansetron, a selective 5-HT(3) antagonist, but not antagonists for other 5-HT receptor subtypes. Indomethacin plus paroxetine had no effect on gastric secretion but significantly decreased mucosal superoxide dismutase (SOD) activity as well as GSH content. The antral damage induced by indomethacin plus paroxetine was significantly prevented by antisecretory (acid or pepsin) agents and mucosal protective agents as well as SOD and allopurinol. These results suggest that SSRIs aggravate NSAID-induced antral lesions, probably via the activation of 5HT(3) receptors, and the mechanism of aggravation may involve the corrosive action of acid/pepsin as well as an impaired antioxidative system.

S41744, a dual neurokinin (NK)1 receptor antagonist and serotonin (5-HT) reuptake inhibitor with potential antidepressant properties: a comparison to aprepitant (MK869) and paroxetine.

Though neurokinin(1) (NK(1)) receptors are implicated in depressed states and their treatment, selective antagonists have disappointed in clinical trials. Accordingly, we designed a novel ligand, S41744 (2-piperazin-1-yl-indan-2-carboxylic-acid-(3-chloro-5-fluoro-benzyl)-methyl-amide), which both blocks NK(1) receptors and interferes with serotonin (5-HT) reuptake. S41744 mimicked the selective antagonist aprepitant in binding human (h)NK(1) receptors and in antagonising Substance-P-mediated Extracellular-Regulated-Kinase phosphorylation (pK(B), 7.7). Further, it dose-dependently (0.63-40.0 mg/kg, i.p.) displaced ex vivo [(3)H]-[Sar(9),Met(O(2))(11)]-Substance P binding to gerbil striatum, attenuated formalin-induced hind-paw licking in gerbils, and antagonised locomotion induced by i.c.v. administration of the NK(1) agonist GR73632 to guinea pigs. Like paroxetine, S41744 recognised h5-HT transporters, reduced synaptosomal uptake of 5-HT (pK(B), 7.9), and dose-dependently (0.63-10.0 mg/kg) elevated dialysis levels of 5-HT in the hippocampus and frontal cortex of freely-moving guinea pigs. Further, S41744 increased extracellular levels of 5-HT in frontal cortex and hippocampus of rats to a greater extent than paroxetine, and its inhibitory influence upon serotonergic perikarya was blunted relative to its affinity for 5-HT transporters. S41744 more potently blocked stress-induced vocalizations in guinea pigs than aprepitant and paroxetine, and it was active in forced-swim and marble-burying procedures of putative antidepressant properties in mice. While aprepitant displayed anxiolytic actions in stress-induced foot-tapping and social interaction tests in gerbils, paroxetine was anxiogenic and S41744 "neutral", reflecting balanced NK(1) antagonism and suppression of 5-HT reuptake. Moreover, S41744 shared anxiolytic actions of aprepitant in the rat Vogel Conflict Test. In conclusion, S41744 is an innovative NK(1) antagonist/5-HT reuptake inhibitor justifying further evaluation for treatment of stress-related disorders.

Paroxetine inhibited the relaxations induced by EFS in mice corpus cavernosum: is it a NOS inhibition?

Selective serotonin reuptake inhibitors are used in the treatment of psychiatric disorders but are associated with high incidence of sexual dysfunction such as ejaculation disorders by sertraline and fluoxetine, erection disorders by paroxetine. The aim of this study is to evaluate the effects of paroxetine, sertraline and fluoxetine on relaxation of smooth muscle of corpus cavernosum on the basis of nitric oxide (NO). Male mice were killed by cervical dislocation and their penile tissues were immediately removed. The tissues were incubated in organ baths containing Krebs solution at 37 degrees C and bubbled with 95% O(2) and 5% CO(2). The corpus cavernosum strips were contracted with 10(-5 )m phenylephrine (PHE) and relaxed with either paroxetine, sertraline, fluoxetine (10(-8)-10(-4 )m) or electrical field stimulation (EFS). The effects of paroxetine, sertraline and fluoxetine were examined on EFS-induced relaxations. While paroxetine did not show any effect on the corpus cavernosum strips precontracted with PHE, sertraline and fluoxetine caused a relaxation at concentrations of 3 x 10(-5)-10(-4 )m. The relaxations induced by sertraline and fluoxetine were completely abolished by L-NAME, but not D-NAME. The relaxations induced by EFS could be inhibited by L-NAME but not D-NAME. Paroxetine inhibited the relaxations at high concentrations. L-arginine potentiated the relaxations induced by EFS; however in the presence of paroxetine these relaxations were not observed. In contrast, sertraline (10(-8)-10(-5 )m) and fluoxetine (10(-8)-10(-5)m) increased the relaxations induced by EFS. Sertraline and fluoxetine seem to be releasing some relaxing factor(s) and this factor may be NO. Paroxetine probably has a NOS inhibitory activity either on nNOS or eNOS, in contrast to sertraline and fluoxetine.

Are selective serotonin reuptake inhibitors cardiac teratogens? Echocardiographic screening of newborns with persistent heart murmur.

BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) have been suspected of cardiac teratogenicity, but reports have been inconsistent. Our aim was to investigate the rate of nonsyndromic congenital heart defects in newborns exposed in utero to SSRIs compared with unexposed controls. METHODS: This prospective study of women who gave birth at our tertiary center from 2000 to 2007 yielded 235 women who reported first-trimester SSRI use during pregnancy. All newborns born during the study period and found to have a persistent cardiac murmur on day 2 or 3 of life were referred for examination by a pediatric cardiologist and by echocardiography. The findings were compared between the newborns who were exposed to SSRIs and those who were not. RESULTS: Nonsyndromic congenital heart defects were identified by echocardiography in 8 of 235 (3.40%) newborns exposed in utero to SSRIs and in 1083 of 67,636 (1.60%) non-exposed newborns. The difference in prevalence between the two groups was significant (relative risk, 2.17; 95% confidence interval, 1.07-4.39). The prevalence rates for paroxetine and fluoxetine exposure were 4.3% and 3.0%, respectively. All cardiac defects in the study group were mild: ventricular septal defect (6), bicuspid aortic valve (1) and right superior vena cava to coronary sinus (1). CONCLUSIONS: Newborns exposed in utero to SSRIs, have a twofold higher risk of mild nonsyndromic heart defects than unexposed infants. The data suggest that women who require SSRI treatment during pregnancy can be reassured that the fetal risk is low and possible cardiac malformations will probably be mild. Late-targeted ultrasound and fetal echocardiography at 22 to 23 weeks' gestation are recommended in this patient group.

Mechanism of paroxetine-induced cell death in renal tubular cells.

Paroxetine belongs to the family of selective serotonin reuptake inhibitors. Much research has been performed on the in vitro effect of paroxetine; however, the effect of paroxetine on Madin-Darby canine kidney renal tubular cells is unknown. The present study was aimed at exploring how paroxetine affects viability and to examine the underlying mechanisms. Paroxetine (15-200 microM) was shown to reduce cell viability via inducing apoptosis in a concentration-dependent manner. Paroxetine-induced cytotoxicity and apoptosis were not changed by the p38 mitogen-activated protein kinase inhibitor SB203580 and the c-Jun NH2-terminal kinase inhibitor SP600125, but was potentiated by the extracellular signal-regulated kinase inhibitor PD98059; inhibited by GF 109203X, a protein kinase C inhibitor; and potentiated by phorbol 12-myristate 13-acetate, a protein kinase C activator. Paroxetine induced [Ca2+](i) rises; however, pre-treatment with 1,2-bis(o-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid tetra(acetoxymethyl)ester, a Ca2+ chelator, to prevent 20 microM paroxetine-induced [Ca2+](i) rises did not protect cells from death. H-89 (a protein kinase A inhibitor) and U73122 (a phospholipase C inhibitor) failed to alter paroxetine-induced cell death. The results suggest that in Madin-Darby canine kidney cells, paroxetine caused protein kinase C-dependent, Ca2+-independent apoptosis which was potentiated by inhibition of the extracellular signal-regulated kinase pathway.