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1.
New Drug Discovery from Medicinal Plants and Phytoconstituents for Depressive Disorders.
Dereli, FTG, Ilhan, M, Akkol, EK
CNS & neurological disorders drug targets. 2019;(2):92-102
Abstract
BACKGROUND & OBJECTIVE Depression, a risk factor for several serious diseases, is a highly prevalent and life-threatening psychiatric disorder. It can affect the individual's position in life and reduce the living standards. The research on the use of medicinal plants in treating this disease has increased enormously because of the possible low rehabilitation rate and side effects of available synthetic drugs, such as sexual dysfunction, nausea, fatigue, insomnia, hypersomnia, and weight gain. CONCLUSION Therefore, this review aimed to draw attention to the antidepressant effects of culinary herbs and traditional medicinal plants and their active components, thereby promoting their use in the development of more potent antidepressants with improved side effect profile.
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2.
Novel targets for parkinsonism-depression comorbidity.
Tizabi, Y, Getachew, B, Csoka, AB, Manaye, KF, Copeland, RL
Progress in molecular biology and translational science. 2019;:1-24
Abstract
With the aging population growing and the incidence of neurodegenerative diseases on the rise, the researchers in the field are yet more urgently challenged to slow and/or reverse the devastating consequences of such progression. The challenge is further enforced by psychiatric co-morbid conditions, particularly the feeling of despair in these population. Fortunately, as our understanding of the neurobiological substrates of maladies affecting the central nervous system increases, more therapeutic options are also presented. In this short review while providing evidence of shared biological substrates between Parkinson's disease and depression, novel therapeutic targets and drugs are suggested. The emphasis will be on neuroplasticity underscored by roles of neurotrophic and inflammatory factors. Examples of few therapeutic drugs as well as future directions are also touched upon.
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3.
Drug treatment strategies for depression in Parkinson disease.
Ryan, M, Eatmon, CV, Slevin, JT
Expert opinion on pharmacotherapy. 2019;(11):1351-1363
Abstract
INTRODUCTION Depression is a common non-motor symptom in Parkinson disease (PD), occurring in approximately 20% of patients with PD. While depression can occur anytime in the disease process, it predates PD diagnosis in about 30% of patients. Between 20% and 60% of depressed patients with PD are either without recognition or treatment of their depression. AREAS COVERED The pathophysiology of depression in PD is unclear. There are several structural changes seen in depressed patients with PD that are also seen in patients with depression. In addition, the neurotransmitters dopamine, serotonin, and norepinephrine are all depleted in PD. This article covers the pharmacological treatment of depression in PD; this involves standard antidepressant treatment such as selective serotonin reuptake inhibitors, tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, and monoamine oxidase inhibitors. As with depression not associated with PD, most treatment is partially successful. Non-pharmacological approaches are also touched upon. EXPERT OPINION Most antidepressant therapy shows partial efficacy in patients with PD. However, there is a need for better study design as well as more comparative studies for the treatment of depression in PD. Biomarkers will help identify patients with PD and depression earlier in the future.
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4.
Monoaminergic system and depression.
Perez-Caballero, L, Torres-Sanchez, S, Romero-López-Alberca, C, González-Saiz, F, Mico, JA, Berrocoso, E
Cell and tissue research. 2019;(1):107-113
Abstract
Major depressive disorder is a severe, disabling disorder that affects around 4.7% of the population worldwide. Based on the monoaminergic hypothesis of depression, monoamine reuptake inhibitors have been developed as antidepressants and nowadays, they are used widely in clinical practice. However, these drugs have a limited efficacy and a slow onset of therapeutic action. Several strategies have been implemented to overcome these limitations, including switching to other drugs or introducing combined or augmentation therapies. In clinical practice, the most often used augmenting drugs are lithium, triiodothyronine, atypical antipsychotics, buspirone, and pindolol, although some others are in the pipeline. Moreover, multitarget antidepressants have been developed to improve efficacy. Despite the enormous effort exerted to improve these monoaminergic drugs, they still fail to produce a rapid and sustained antidepressant response in a substantial proportion of depressed patients. Recently, new compounds that target other neurotransmission system, such as the glutamatergic system, have become the focus of research into fast-acting antidepressant agents. These promising alternatives could represent a new pharmacological trend in the management of depression.
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5.
Depression and Treatment with Effective Herbs.
Fathinezhad, Z, Sewell, RDE, Lorigooini, Z, Rafieian-Kopaei, M
Current pharmaceutical design. 2019;(6):738-745
Abstract
Depression is a common psychiatric disease and one of the main causes of disability worldwide. In spite of certain developments in this field, chemical and synthetic drugs used for the treatment of depression disrupt the treatment process due to numerous side effects and high cost. Today, the goal of using a potential method for treating depression involves the use of medicinal and phytochemical plants, which have many therapeutic benefits. Studies have shown that medicinal plants affect the nervous system and exert antidepressant effects in various ways, including synaptic regulation of serotonin, noradrenaline and dopamine, and inflammatory mediators. In this study, depression as well as the factors and mechanisms involved in its development are first addressed, and then medicinal plants effective in the treatment of depression along with their mechanisms of actions are reported.
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6.
Predictors of Response to Ketamine in Treatment Resistant Major Depressive Disorder and Bipolar Disorder.
Rong, C, Park, C, Rosenblat, JD, Subramaniapillai, M, Zuckerman, H, Fus, D, Lee, YL, Pan, Z, Brietzke, E, Mansur, RB, et al
International journal of environmental research and public health. 2018;(4)
Abstract
OBJECTIVES Extant evidence indicates that ketamine exerts rapid antidepressant effects in treatment-resistant depressive (TRD) symptoms as a part of major depressive disorder (MDD) and bipolar disorder (BD). The identification of depressed sub-populations that are more likely to benefit from ketamine treatment remains a priority. In keeping with this view, the present narrative review aims to identify the pretreatment predictors of response to ketamine in TRD as part of MDD and BD. METHOD Electronic search engines PubMed/MEDLINE, ClinicalTrials.gov, and Scopus were searched for relevant articles from inception to January 2018. The search term ketamine was cross-referenced with the terms depression, major depressive disorder, bipolar disorder, predictors, and response and/or remission. RESULTS Multiple baseline pretreatment predictors of response were identified, including clinical (i.e., Body Mass Index (BMI), history of suicide, family history of alcohol use disorder), peripheral biochemistry (i.e., adiponectin levels, vitamin B12 levels), polysomnography (abnormalities in delta sleep ratio), neurochemistry (i.e., glutamine/glutamate ratio), neuroimaging (i.e., anterior cingulate cortex activity), genetic variation (i.e., Val66Met BDNF allele), and cognitive functioning (i.e., processing speed). High BMI and a positive family history of alcohol use disorder were the most replicated predictors. CONCLUSIONS A pheno-biotype of depression more, or less likely, to benefit with ketamine treatment is far from complete. Notwithstanding, metabolic-inflammatory alterations are emerging as possible pretreatment response predictors of depressive symptom improvement, most notably being cognitive impairment. Sophisticated data-driven computational methods that are iterative and agnostic are more likely to provide actionable baseline pretreatment predictive information.
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7.
[The importance of the kynurenine pathway in depressive disorders].
Jasionowska, J, Filip, M, Talarowska, M, Gałecki, P
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 2018;(266):89-93
Abstract
Depressive disorders are the most frequently diagnosed mental disorder. It is assumed that the etiology of depression is multifactorial and the individual theories complement each other. Referring to the neurochemical hypothesis of the underlying depressive disorder, the relationship between lowering levels of serotonin, norepinephrine, dopamine and a change in mood is suggested. Particular attention has been given to serotonin, called the happiness hormone, which is synthesized from the exogenous amino acid tryptophan. The main methods of antidepressant treatment, in particular the use of serotonin reuptake inhibitors (SSRIs), take into account the concept of monoamine deficiency in patients with depression. However, an insufficient response in some patients to antidepressants (the existence of a refractory depression), indicates the importance of looking for other possible causes for the development of this disease and thus alternative treatment methods. It is indicated that in patients with depression there are disorders of tryptophan metabolism, ie the redirection of tryptophan from the serotonin synthesis pathway to the kynurenine pathway, which is the source of neuroactive compounds in the central nervous system, so-called. kynurenin m.in. kynurenic acid, 3-hydroxycinurenine, quinoline acid. It has been proved that certain metabolites of this cycle of transformations have neuroprotective and other neurotoxic properties. For this reason, it seems reasonable to summarize the research published so far on this subject.
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8.
Efficacy and Safety of Xiaoyao Formula as an Adjuvant Treatment for Post-Stroke Depression: A Meta-Analysis.
Jin, X, Jiang, M, Gong, D, Chen, Y, Fan, Y
Explore (New York, N.Y.). 2018;(3):224-229
Abstract
OBJECTIVE To systematically evaluate the efficacy and safety of Xiaoyao formula (XYF) as an adjuvant treatment of post-stroke depression (PSD) by conducting a meta-analysis. METHODS Pubmed, Embase, Cochrane Library, CNKI, VIP, and Wanfang databases were searched up to May 2016. Randomized controlled trials investigating XYF plus antidepressants versus antidepressants alone for patients with PSD were considered. RESULTS A total of 607 PSD patients were identified from 7 trials. Adjuvant treatment with XYF had additional benefits in terms of improved total response rates (risk ratio [RR] 1.21; 95% confidence interval [CI]: 1.12-1.30), reduced Hamilton's depressive scale (weighted mean difference [WMD] -5.21; 95% CI: -7.48 to -2.95), and decreased Scandinavian Stroke Scale (WMD -6.35; 95% CI: -8.27 to -4.43). No serious adverse events were observed in any of the included trials. CONCLUSIONS Adjuvant treatment with XYF appears to have additional benefits in the treatment of PSD, without increasing serious adverse events.
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9.
Pharmacotherapy of alcoholism - an update on approved and off-label medications.
Soyka, M, Müller, CA
Expert opinion on pharmacotherapy. 2017;(12):1187-1199
Abstract
Only a few medications are available for the treatment of alcohol use disorders (AUDs). Areas covered: This paper discusses approved AUD medications, including the opioid antagonists naltrexone and nalmefene (the latter is licensed for reduction of alcohol consumption only), the putative glutamate receptor antagonist acamprosate and the aldehyde dehydrogenase inhibitor disulfiram. It also covers off-label medications of interest, including topiramate, gabapentin, ondansetron, varenicline, baclofen, sodium oxybate and antidepressants. Clinical implications, benefits and risks of treatment are discussed. Expert opinion: Acamprosate, naltrexone, nalmefene and disulfiram are the only approved 'alcohol-specific' drugs. Acamprosate and naltrexone have been evaluated in numerous clinical trials and represent evidence-based treatments in AUDs. Nalmefene use, however, is controversial. Supervised disulfiram is a second-line treatment approach. Compounds developed and licensed for different neuropsychiatric disorders are potential alternatives. Encouraging results have been reported for topiramate, gabapentin and also varenicline, which might be useful in patients with comorbid nicotine dependence. The GABA (γ-aminobutyric acid)-B receptor agonist baclofen has shown mixed results; it is currently licensed for the treatment of AUDs in France only. Gabapentin may be close to approval in the USA. Further studies of these novel treatment approaches in AUDs are needed.
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10.
Advances in antidepressants for treating post-stroke depression.
Paolucci, S
Expert opinion on pharmacotherapy. 2017;(10):1011-1017
Abstract
Post-stroke depression (PSD) is a common and serious complication after stroke, occurring in nearly one third of stroke survivors, and affecting mortality rate, functional outcome, rehabilitation results and quality of life. However, in the common clinical practice only a minority of patients are properly treated. A relatively small number of scientific reports are available on clinical usefulness and safety of antidepressants (ADs) in PSD. Areas covered: This report provides an updated review about pharmacological state of art of PSD, including efficacy and safety of different drugs and their role on prevention, treatment and functional outcome. Expert opinion: Even if currently an antidepressant treatment can improve depressive symptoms, neither the optimal drug nor the optimal lengths of treatment, have been identified. Serotonergic drugs are preferable because of their better safety profile, but in the recent years there has been an important debate on possible association between selective serotonin reuptake inhibitor use and increased mortality. Another issue is the potential role of ADs for improving functional recovery. Newer ADs have interesting properties, in particular vortioxetine, due to its properties of enhancing cognitive functions, but further research is needed to clarify its/their role in treatment of PSD.