Depression Treatment: Antidepressant Treatment and Emotional Processing: Can We Dissociate the Roles of Serotonin and Noradrenaline?

Antidepressant treatment and emotional processing: can we dissociate the roles of serotonin and noradrenaline?

Filed under: Depression Treatment

J Psychopharmacol. 2013 Feb 7;
Pringle A, McCabe C, Cowen P, Harmer C

The ability to match individual patients to tailored treatments has the potential to greatly improve outcomes for individuals suffering from major depression. In particular, while the vast majority of antidepressant treatments affect either serotonin or noradrenaline or a combination of these two neurotransmitters, it is not known whether there are particular patients or symptom profiles which respond preferentially to the potentiation of serotonin over noradrenaline or vice versa. Experimental medicine models suggest that the primary mode of action of these treatments may be to remediate negative biases in emotional processing. Such models may provide a useful framework for interrogating the specific actions of antidepressants. Here, we therefore review evidence from studies examining the effects of drugs which potentiate serotonin, noradrenaline or a combination of both neurotransmitters on emotional processing. These results suggest that antidepressants targeting serotonin and noradrenaline may have some specific actions on emotion and reward processing which could be used to improve tailoring of treatment or to understand the effects of dual-reuptake inhibition. Specifically, serotonin may be particularly important in alleviating distress symptoms, while noradrenaline may be especially relevant to anhedonia. The data reviewed here also suggest that noradrenergic-based treatments may have earlier effects on emotional memory that those which affect serotonin.
HubMed – depression

Effects of Monocarboxylate Transporter Inhibition on the Oral Toxicokinetics/Toxicodynamics of ?-hydroxybutyrate and ?-butyrolactone.

Filed under: Depression Treatment

J Pharmacol Exp Ther. 2013 Feb 7;
Morse BL, Morris ME

Respiratory depression and death secondary to respiratory arrest have occurred following oral overdoses of ?-hydroxybutyrate (GHB) and its precursor, ?-butyrolactone (GBL). GHB is a substrate for monocarboxylate transporters (MCTs), and increasing GHB renal clearance or decreasing GHB absorption via MCT inhibition represent potential treatment strategies for GHB/GBL overdose. In these studies, GHB and GBL were administered in doses of 1.92, 5.77 and 14.4 mmol/kg orally, with and without MCT inhibition, to determine effects of this treatment strategy on oral toxicokinetics and toxicodynamics of GHB and GBL. The competitive MCT inhibitor L-lactate was administered by intravenous infusion, starting 1 hr after GHB and GBL. Oral administration of L-lactate and the MCT inhibitor luteolin was also evaluated. Respiratory depression was measured using plethysmography. IV L-lactate, but not oral treatments, significantly increased GHB renal and/or oral clearances. At the low dose of GHB and GBL, IV L-lactate increased GHB renal clearance. Due to the increased contribution of renal clearance to total clearance at the moderate dose, increased renal clearance translated to an increase in oral clearance. At the highest GHB dose, oral clearance was increased without a significant change in renal clearance. A lack of effect of IV L-lactate on renal clearance following a high oral GHB dose suggests possible effects of IV L-lactate on MCT-mediated absorption. The resulting increases in oral clearance improved respiratory depression. IV L-lactate also reduced mortality with the high GBL dose. These data indicate IV L-lactate represents a potential treatment strategy in oral overdose of GHB and GBL.
HubMed – depression

Medical hypnosis as a tool to acclimatize children to non-invasive positive pressure ventilation: a pilot study.

Filed under: Depression Treatment

Chest. 2013 Feb 7;
Delord V, Khirani S, Ramirez A, Joseph EL, Gambier C, Belson M, Gajan F, Fauroux B

ABSTRACT BACKGROUND Patient cooperation is crucial for success of non-invasive positive pressure ventilation (NPPV). This study evaluated the efficacy of medical hypnosis to reduce the anticipatory anxiety and the acclimatization time in children candidates for long-term NPPV. METHODS Medical hypnosis was performed by a trained nurse. The acclimatization time and long-term compliance with NPPV were evaluated. RESULTS Hypnosis was performed in 9 children, aged 2 to 15 years old; 7 children with a high level of anticipatory anxiety because of a tracheotomy since birth (2 patients), a history of maxillofacial surgery (2 patients), severe dyspnea due to lung disease (2 patients), morbid obesity and depression (1 patient), and 2 children with obstructive sleep apnea who failed standard NPPV initiation. The hypnosis techniques were based on distraction in the youngest patient and indirect or direct hypnotic suggestions in the older children, in order to obtain a progressive psycho-corporal relaxation. All the patients accepted the interface and the NPPV after the first hypnosis session. A median of three sessions was needed for overnight (> 6 hours) NPPV acceptance. The 6-months compliance with NPPV was excellent with a median use of 7.5 hours/night. CONCLUSION Medical hypnosis is a very effective, safe, non-invasive, and cheap tool for reducing the anticipatory distress and acclimatizing time for NPPV. This therapy is particularly useful in children with traumatic experiences such as a tracheotomy or facial surgical procedures.
HubMed – depression

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