-
1.
Transcranial direct current stimulation for bipolar depression: systematic reviews of clinical evidence and biological underpinnings.
D'Urso, G, Toscano, E, Barone, A, Palermo, M, Dell'Osso, B, Di Lorenzo, G, Mantovani, A, Martinotti, G, Fornaro, M, Iasevoli, F, et al
Progress in neuro-psychopharmacology & biological psychiatry. 2023;:110672
Abstract
Despite multiple available treatments for bipolar depression (BD), many patients face sub-optimal responses. Transcranial direct current stimulation (tDCS) has been advocated in the management of different conditions, including BD, especially in treatment-resistant cases. The optimal dose and timing of tDCS, the mutual influence with other concurrently administered interventions, long-term efficacy, overall safety, and biological underpinnings nonetheless deserve additional assessment. The present study appraised the existing clinical evidence about tDCS for bipolar depression, delving into the putative biological underpinnings with a special emphasis on cellular and molecular levels, with the ultimate goal of providing a translational perspective on the matter. Two separate systematic reviews across the PubMed database since inception up to August 8th 2022 were performed, with fourteen clinical and nineteen neurobiological eligible studies. The included clinical studies encompass 207 bipolar depression patients overall and consistently document the efficacy of tDCS, with a reduction in depression scores after treatment ranging from 18% to 92%. The RCT with the largest sample clearly showed a significant superiority of active stimulation over sham. Mild-to-moderate and transient adverse effects are attributed to tDCS across these studies. The review of neurobiological literature indicates that several molecular mechanisms may account for the antidepressant effect of tDCS in BD patients, including the action on calcium homeostasis in glial cells, the enhancement of LTP, the regulation of neurotrophic factors and inflammatory mediators, and the modulation of the expression of plasticity-related genes. To the best of our knowledge, this is the first study on the matter to concurrently provide a synthesis of the clinical evidence and an in-depth appraisal of the putative biological underpinnings, providing consistent support for the efficacy, safety, and tolerability of tDCS.
-
2.
Possible Use of Minocycline in Adjunction to Intranasal Esketamine for the Management of Difficult to Treat Depression following Extensive Pharmacogenomic Testing: Two Case Reports.
Marcatili, M, Borgonovo, R, Cimminiello, N, Cornaggia, RD, Casati, G, Pellicioli, C, Maggioni, L, Motta, F, Redaelli, C, Ledda, L, et al
Journal of personalized medicine. 2022;(9)
Abstract
The advent of intra-nasal esketamine (ESK), one of the first so called fast-acting antidepressant, promises to revolutionize the management of treatment resistant depression (TRD). This NMDA receptor antagonist has proven to be rapidly effective in the short- and medium-term course of the illness, revealing its potential in targeting response in TRD. Although many TRD ESK responders are able to achieve remission, a considerable portion of them undergo a metamorphosis of their depression into different clinical presentations, characterized by instable responses and high recurrence rates that can be considered closer to the concept of Difficult to Treat Depression (DTD) than to TRD. The management of these DTD patients usually requires a further complex multidisciplinary approach and can benefit from the valuable contribution of new personalized medicine tools such as therapeutic drug monitoring and pharmacogenetics. Despite this, these patients usually come with long and complex previous treatments history and, often, advanced and sophisticated ongoing pharmacological schemes that can make the finding of new alternative options to face the current recurrences extremely challenging. In this paper, we describe two DTD patients-already receiving intranasal ESK but showing an instable course-who were clinically stabilized by the association with minocycline, a semisynthetic second-generation tetracycline with known and promising antidepressant properties.
-
3.
'In the night kitchen': A scoping review on the night eating syndrome.
Muscatello, MRA, Torre, G, Celebre, L, Dell'Osso, B, Mento, C, Zoccali, RA, Bruno, A
The Australian and New Zealand journal of psychiatry. 2022;(2):120-136
Abstract
BACKGROUND First described in 1955, night eating syndrome refers to an abnormal eating behavior clinically defined by the presence of evening hyperphagia (>25% of daily caloric intake) and/or nocturnal awaking with food ingestion occurring ⩾ 2 times per week. AIMS Although the syndrome is frequently comorbid with obesity, metabolic and psychiatric disorders, its etiopathogenesis, diagnosis, assessment and treatment still remain not fully understood. METHODS This review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines; PubMed database was searched until 31 October 2020, using the key terms: 'Night Eating Syndrome' AND 'complications' OR 'diagnosis' OR 'drug therapy' OR 'epidemiology' OR 'etiology' OR 'physiology' OR 'physiopathology' OR 'psychology' OR 'therapy'. RESULTS From a total of 239 citations, 120 studies assessing night eating syndrome met the inclusion criteria to be included in the review. CONCLUSION The inclusion of night eating syndrome into the Diagnostic and Statistical Manual of Mental Disorders-5 'Other Specified Feeding or Eating Disorders' category should drive the attention of clinician and researchers toward this syndrome that is still defined by evolving diagnostic criteria. The correct identification and assessment of NES could facilitate the detection and the diagnosis of this disorder, whose bio-psycho-social roots support its multifactorial nature. The significant rates of comorbid illnesses associated with NES and the overlapping symptoms with other eating disorders require a focused clinical attention. Treatment options for night eating syndrome include both pharmacological (selective serotonin reuptake inhibitors, topiramate and melatonergic drugs) and non-pharmachological approaches; the combination of such strategies within a multidisciplinary approach should be addressed in future, well-sized and long-term studies.
-
4.
Changes in eating behavior after deep brain stimulation for anorexia nervosa. A case study.
Manuelli, M, Franzini, A, Galentino, R, Bidone, R, Dell'Osso, B, Porta, M, Servello, D, Cena, H
Eating and weight disorders : EWD. 2020;(5):1481-1486
Abstract
PURPOSE The purpose of this study was to evaluate changes in the nutritional status, body image concerns, and eating behaviors occurring in a patient who underwent deep brain stimulation (DBS) of the bed nucleus of the stria terminalis for treatment-refractory anorexia nervosa (AN). METHODS Bilateral DBS of the bed nucleus of the stria terminalis was performed in a 37-year-old woman affected by refractory AN. Pre- and post-surgical evaluations were conducted via an array of validated testing instruments, which took into account the weight variations, body image concerns, eating behavior, quality of life, and nutritional status. RESULTS Overall, eating behavior-, body image concern-, and nutritional status-related testing instruments demonstrated improvements starting from the first post-operative month. Normal body weight was restored after 4 months of stimulation. DISCUSSION Only a few cases of DBS for AN have been conducted to determine the efficacy of surgery based upon weight variation and psychometric scales for anxiety and affective disorders. In contrast, we have designed a comprehensive approach taking into account the most important aspects of this disease. This approach should be considered in future studies dealing with the neurosurgical treatment of AN.
-
5.
Benzodiazepine ingestion as a way to die by suicide and related safety: the case of an elderly patient.
Cremaschi, L, Grancini, B, De Carlo, V, Pozzoli, S, Altamura, AC, Dell'Osso, B
Aging clinical and experimental research. 2019;(2):287-289
-
-
Free full text
-
Abstract
Benzodiazepines (BDZs) are widespread psychotropic compounds, often prescribed as first-line symptomatic option by general practitioners in patients with different psychiatric disorders. Sometimes, however, they contribute to delay the administration of the first appropriate psychopharmacological treatment, thus leading to a longer duration of untreated illness in patients with depressive and anxiety disorders. The well-established pros of BDZs use in clinical practice include efficacy, rapidity of action, versatility, and safety. Among the cons, BDZs can provoke cognitive side-effects, asthenia, and misuse/abuse. Although their overall safety has been traditionally viewed as one of their greatest strengths, BDZs massive ingestion for suicidal purposes may pose, in some cases, serious life-threatening conditions, as described in the present case report. Hence, particular attention needs to be paid in prescribing these compounds to special populations, such as elderly patients. Among these, their prescription should be limited to the short-term and particularly monitored in case of risk factors, as they may be unsafe in case of overdose.
-
6.
Correction: Roncoroni, L. et al. A Low FODMAP Gluten-Free Diet Improves Functional Gastrointestinal Disorders and Overall Mental Health of Celiac Disease Patients: A Randomized Controlled Trial. Nutrients 2018, 10, 1023.
Roncoroni, L, Bascuñán, KA, Doneda, L, Scricciolo, A, Lombardo, V, Branchi, F, Ferretti, F, Dell'Osso, B, Montanari, V, Bardella, MT, et al
Nutrients. 2019;(3)
Abstract
The authors have requested that the following changes be made to their paper [...].
-
7.
Food Bioactive Compounds and Their Interference in Drug Pharmacokinetic/Pharmacodynamic Profiles.
Briguglio, M, Hrelia, S, Malaguti, M, Serpe, L, Canaparo, R, Dell'Osso, B, Galentino, R, De Michele, S, Dina, CZ, Porta, M, et al
Pharmaceutics. 2018;(4)
Abstract
Preclinical and clinical studies suggest that many food molecules could interact with drug transporters and metabolizing enzymes through different mechanisms, which are predictive of what would be observed clinically. Given the recent incorporation of dietary modifications or supplements in traditional medicine, an increase in potential food-drug interactions has also appeared. The objective of this article is to review data regarding the influence of food on drug efficacy. Data from Google Scholar, PubMed, and Scopus databases was reviewed for publications on pharmaceutical, pharmacokinetic, and pharmacodynamic mechanisms. The following online resources were used to integrate functional and bioinformatic results: FooDB, Phenol-Explorer, Dr. Duke's Phytochemical and Ethnobotanical Databases, DrugBank, UniProt, and IUPHAR/BPS Guide to Pharmacology. A wide range of food compounds were shown to interact with proteins involved in drug pharmacokinetic/pharmacodynamic profiles, starting from drug oral bioavailability to enteric/hepatic transport and metabolism, blood transport, and systemic transport/metabolism. Knowledge of any food components that may interfere with drug efficacy is essential, and would provide a link for obtaining a holistic view for cancer, cardiovascular, musculoskeletal, or neurological therapies. However, preclinical interaction may be irrelevant to clinical interaction, and health professionals should be aware of the limitations if they intend to optimize the therapeutic effects of drugs.
-
8.
A Low FODMAP Gluten-Free Diet Improves Functional Gastrointestinal Disorders and Overall Mental Health of Celiac Disease Patients: A Randomized Controlled Trial.
Roncoroni, L, Bascuñán, KA, Doneda, L, Scricciolo, A, Lombardo, V, Branchi, F, Ferretti, F, Dell'Osso, B, Montanari, V, Bardella, MT, et al
Nutrients. 2018;10(8)
-
-
-
Free full text
Plain language summary
Coeliac disease (CD) is an autoimmune disorder in which gluten ingestion induces inflammation in the small intestines. While a gluten-free diet (GFD) alleviates gastrointestinal (GI) symptoms in the majority of CD patients, there is a subset of patients following a strict GFD that still experience GI symptoms. The aim of this study is to determine if a low fermentable, oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet would help reduce persistent symptoms in 44 CD patients following a strict GFD. Participants were randomised to receive a structured 21-day dietary plan of either a low-FODMAP GFD or a high-FODMAP GFD and were evaluated for GI symptoms, psychological wellbeing and quality of life at baseline and the end of the intervention. This study found quality of life and abdominal pain improved significantly in the low-FODMAP group compared to the high-FODMAP group. Based on these findings, the authors conclude a short-term low-FODMAP diet helps to improve persistent GI symptoms and enhance general wellbeing in this subgroup of CD patients. Further evaluation is recommended to better understand the long-term clinical effects of FODMAPs in CD patients.
Abstract
A subset of patients with celiac disease (CD) on a gluten-free diet (GFD) reported the persistence of functional gastrointestinal disorders. Foods containing fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) can trigger a broad range of gastrointestinal symptoms in sensitive individuals. We evaluated the effects of a low FODMAP diet (LFD) on gastrointestinal and psychological symptomatology in CD patients. A total of 50 celiac patients on GFDs and with persistence of gastrointestinal symptoms were included. The patients were randomly allocated to one of two dietary groups-one on a low FODMAP GFD (LF-GFD, n = 25) and the other on a regular GFD (R-GFD, n = 25)-for 21 days. Psychological symptomatology and quality of life were evaluated by the Symptom Checklist-90-R (SCL-90) and the Short Form (36) Health Survey (SF-36) questionnaires, respectively. Gastrointestinal symptomatology and general well-being were evaluated by visual analogue scale (VAS) scores. After 21 days, 21 and 23 patients completed the dietary treatment on LF-GFD and R-GFD, respectively. A reduced global SCL-90 index (p < 0.0003) was found in the LF-GFD group but not in the R-GFD one. However, the SF-36 scores did not differ between groups after treatment. The VAS for abdominal pain was much lower, and the VAS for fecal consistency enhanced after treatment in the LF-GFD group. General well-being increased in both groups but with a much higher improvement in the LF-GFD (p = 0.03). A short-term LFD regimen helps to improve the psychological health and gastrointestinal symptomatology with enhanced well-being of CD patients with persisting functional gastrointestinal symptomatology. The long-term clinical effects of LFD in particular subgroups of CD patients need further evaluation.
-
9.
Dietary Neurotransmitters: A Narrative Review on Current Knowledge.
Briguglio, M, Dell'Osso, B, Panzica, G, Malgaroli, A, Banfi, G, Zanaboni Dina, C, Galentino, R, Porta, M
Nutrients. 2018;10(5)
-
-
-
Free full text
Plain language summary
Neurotransmitters (NTs) are chemical messengers, found mainly within the nervous system. Common NTs are acetylcholine (ACh), glutamate, γ-aminobutyric acid (GABA), dopamine, serotonin (5-HT), and histamine. Many foods are natural sources of NTs that may influence the nervous system, and therefore mood and mental health. This review paper looked at books and studies and discusses the NT content of foods and the possible implications for human health. Acetylcholine is a NT involved in muscle movement, learning and memory. Its presence is documented in more than 50 plant species, including squash, aubergine spinach and nettles. Glutamate is the most abundant excitatory NT in the brain. Glutamic acid naturally occurs in foods with high protein content. Seaweeds, cheeses, fish sauces, soy sauces, fermented beans, and tomato showed high levels of free glutamic acid. Dried cod, salami, caviar, and instant coffee powder are other sources of this amino acid. Salts of glutamic acid, such as monosodium glutamate, are added to certain foods as flavour enhancers. GABA is a calming NT. Studies have found the highest contents of GABA in raw spinach, potato, sweet potato and cruciferous vegetables such as kale and broccoli. Shiitake mushrooms and chestnuts also contained a significant amount of GABA. Dopamine plays an essential role in the coordination of body movements, motivation, and reward. Information on the content of dopamine foods is very limited. Bananas, plantains and avocado were reported to contain high levels of dopamine. 5-HT pathways modulate behaviours, eating, and sleep, and in the gut are involved in the regulation of gastrointestinal motility. In recent years, the number of studies on the content of 5-HT in plants has increased. 5-HT appeared to be prevalent in the green bananas, with higher concentrations found in the peel compared with the flesh. 5-HT was also found in peppers, paprika, hazelnut, tomatoes, pineapple, plum, passion fruit, papaya and kiwi fruit. Histamine is involved in arousal, attention, and reactivity, as well as in local immune responses. The presence of histamine in processed foods, such as aged cheeses, contributes to characteristic flavours and textures. Wine and beer may contain a significant amount of histamine. Fermented foods contain histamine. The food industry generally aims to maintain the levels of amines in foods as low as possible; consumption of fish, cured meat products, sauerkraut, and cheese varieties such as Cheddar, Swiss, Gruyère, and Gouda have been associated with amine poisoning. The significance of dietary NTs intake needs to be further investigated, as there is little data about their bioavailability or clinical implications. New studies should consider if dietary NTs can be transported across the blood-brain barriers or act on the central nervous system via other organs. The authors suggest that in future, including or excluding particular foods containing NTs could be beneficial for patients suffering from Alzheimer’s disease or dementia (an ACh diet), epilepsy or migraines (a glutamate-free diet), anxiety or insomnia (a GABA diet), Parkinson’s disease (a dopamine diet), depressive disorders (a serotonin diet), and vascular headaches (a histamine-free diet).
Abstract
Foods are natural sources of substances that may exert crucial effects on the nervous system in humans. Some of these substances are the neurotransmitters (NTs) acetylcholine (ACh), the modified amino acids glutamate and γ-aminobutyric acid (GABA), and the biogenic amines dopamine, serotonin (5-HT), and histamine. In neuropsychiatry, progressive integration of dietary approaches in clinical routine made it necessary to discern the more about some of these dietary NTs. Relevant books and literature from PubMed and Scopus databases were searched for data on food sources of Ach, glutamate, GABA, dopamine, 5-HT, and histamine. Different animal foods, fruits, edible plants, roots, and botanicals were reported to contain NTs. These substances can either be naturally present, as part of essential metabolic processes and ecological interactions, or derive from controlled/uncontrolled food technology processes. Ripening time, methods of preservation and cooking, and microbial activity further contributes to NTs. Moreover, gut microbiota are considerable sources of NTs. However, the significance of dietary NTs intake needs to be further investigated as there are no significant data on their bioavailability, neuronal/non neuronal effects, or clinical implications. Evidence-based interventions studies should be encouraged.
-
10.
Coeliac disease and psychiatric comorbidity: epidemiology, pathophysiological mechanisms, quality-of-life, and gluten-free diet effects.
Cossu, G, Carta, MG, Contu, F, Mela, Q, Demelia, L, Elli, L, Dell'Osso, B
International review of psychiatry (Abingdon, England). 2017;(5):489-503
Abstract
Coeliac Disease (CD) is an autoimmune disease in which an environmental factor, gluten, triggers a pathological reaction. It results in intra- and entra-intestinal manifestations of disease, including, most frequently, diarrhoea, weight loss, and anaemia. CD occurs in ∼1% of the western population, being one of the most common autoimmune lifelong disorders, and may present with a variety of psychiatric comorbidities. Psychiatric comorbidity in CD often complicates the diagnosis, reduces the quality-of-life, and worsens the prognosis of affected patients. This review summarizes the epidemiological studies that underline this connection, and focuses on the potential mechanisms related to this comorbility, such as nutritional deficiencies, immune responses, interference in brain processes, and dysfunctions in the gut-brain axis. Factors that play a central role on patients' quality of life, psychological well-being and adherence are presented. Finally, evidence of regression in psychiatric symptoms following the introduction of a gluten-free diet is underlined as well.