Suicide is a serious public health problem around the world. Each year, approximately 800.000 people complete suicide and it is estimated that for each suicide committed, there must be another 20 attempts. Differences have been reported between individuals who attempted suicide and those who committed suicide. These tend to be male, older, less impulsive, using more lethal methods, leave suicidal note and are more depressed. The attempters tend to be female and use a non-violent method, such as poisoning. Despite these differences, a seasonal pattern has been described with peak in the spring / summer, but there are divergences in suicide attempts. This lack of consensus allowed us to evaluate through a systematic review if these attempts occur more frequently in the spring / summer as already described for cases of suicide. A seasonal profile similar to the occurrences of suicide was also found for suicide attempts. This seasonal behavior suggests the influence of an environmental modulator, and since light is the main synchronizing agent of the endogenous rhythm with the environment through the light-dark cycle, it is also likely to be an important agent of the circannual / seasonal rhythms. As Brazil is a country with great territorial extension, crossing the Equator line (latitude 0º) and the Tropic of Capricorn (latitude S24°14’), we investigated the influence of latitude and photoperiod in the seasonality of suicides in all Brazilian cities in the period from 2010 to 2015. A seasonal variation of suicides were find with peak in late spring / early summer and nadir in winter. This seasonal profile is better observed as latitude decreases. The further away from latitude 0 °, the higher the suicide rate and amplitude (Peak / Trough ratio), and the in-phase correlation between the seasonality of suicide occurrences and the photoperiod. As several diseases have been associated with disturbances in circadian rhythm, this environmental modulation of the circadian rhythm may play a relevant role in the formation of seasonal suicidal behavior in individuals with vulnerability. In animals, the manipulation of the photoperiod, simulating seasons, results in changes in the gene expression and behavioral profile. We studied, in C57BL / 6J mice, the effect of the photoperiod gradual variation, a simulation from winter to summer, to observe the molecular effect in brain structures related to human suicide and behavioral changes. A significant decrease in circadian gene expression and loss of rhythmicity were found, in addition to an antidepressant-like behavior in the forced swimming test. The photoperiodic influence observed in animal models associated with seasonal suicide reports only in countries distant from 0º latitude, where there are significant alterations in the photoperiod, reinforce the participation of light as an important modulator of the seasonality of suicidal behavior. / O suicídio é um grave problema de saúde pública em todo o mundo. A cada ano, aproximadamente 800.000 pessoas cometem suicídio e estima-se que para cada suicídio cometido, deve haver outras 20 tentativas. Foram relatadas diferenças entre indivíduos que tentaram suicídio e aqueles que consumaram o suicídio. Estes que consumaram tendem a ser do sexo masculino, mais velhos, menos impulsivos, usando métodos mais letais, deixam nota de suicídio e são mais deprimidos. Aqueles que tentam e não efetivam o suicídio, tendem a ser do sexo feminino e utilizam método não-violento, como o envenenamento. Apesar dessas diferenças, um padrão sazonal tem sido descrito com pico na primavera/verão, mas há divergências nas tentativas de suicídio. Esta ausência de consenso nos permitiu avaliar através de uma revisão sistemática, se essas tentativas ocorrem com maior frequência na primavera/verão assim como já descrito para os casos de suicídio. Um perfil sazonal semelhante às ocorrências de suicídio foi encontrado também para tentativas de suicídio. Este comportamento sazonal sugere a influência de um modulador ambiental, e como a luz é o principal agente sincronizador do ritmo endógeno com o ambiente através do ciclo claro-escuro, é provável que também seja um importante agente dos ritmos circanuais/sazonais. Como o Brasil é um país com grande extensão territorial, atravessando a linha do Equador (latitude 0º) e o Trópico de Capricórnio (latitude S24°14’), investigamos a influência da latitude e fotoperíodo na sazonalidade dos suicídios em todas as cidades brasileiras no período de 2010 a 2015. A variação sazonal dos suicídios teve pico no final da primavera/início do verão e nadir no inverno. Este perfil sazonal é melhor observado à medida que decresce a latitude. Quanto mais distante da latitude 0º, maiores as taxas de suicídio e amplitude (razão pico/vale), além de correlação em fase entre a sazonalidade das ocorrências de suicídio e o fotoperíodo. Assim como várias doenças têm sido associadas a perturbações no ritmo circadiano, esta modulação ambiental do ritmo circadiano pode ter papel relevante na formação do comportamento suicida sazonal em indivíduos com vulnerabilidade. Em animais, a manipulação do fotoperíodo, simulando estações do ano, resulta em alterações no perfil de expressão gênica e comportamental. Estudamos em camundongos C57BL/6J, o efeito da variação gradual do fotoperíodo, simulando do inverno ao verão em curto tempo, para observar o efeito molecular em estruturas cerebrais relacionadas ao suicídio em humanos e alterações comportamentais. Uma redução importante e perda de ritmicidade em genes circadianos foi encontrada, além de um efeito tipo antidepressivo no teste do nado forçado. A influência fotoperiódica observada em modelos animais associada a relatos de sazonalidade do suicídio apenas em países distantes da latitude 0º, onde há alterações significativas no fotoperíodo, reforçam a participação da luz como um importante modulador da sazonalidade do comportamento suicida.

The shortcomings of current antidepressant agents prompts the design of novel multimodal antidepressants and the identification of new antidepressant targets, especially those located at sub-cellular level. Such antidepressants should possess improved response rates as well as safety profiles. Methylene blue (MB) is reported to possess diverse pharmacological actions and is attracting increasing attention for the treatment of a variety of disorders including Alzheimer’s disease, bipolar disorder, anxiety and depression. MB acts on both monoamine oxidase (MAO) and the nitric oxide (NO)-cGMP pathway, and possesses antidepressant activity in rodents. The principal goal of this study was to design a close structural analogue of MB and to evaluate the effects of these structural changes on MAO inhibition, a well-known antidepressant target. Furthermore, MAO inhibition is also responsible for cardiovascular toxicity in clinically used MAOI inhibitors. For this purpose we investigated the antidepressant properties of the synthetic MB analogue (ethyl-thioniniumchloride; ETC) as well as azure B, the major metabolite of MB, in the forced swim test (FST). ETC was synthesized with a high degree of purity from diethyl-p-phenylenediamine with 6% yield. ETC was firstly evaluated as a potential inhibitor of recombinant human MAO-A and MAO-B. Azure B and ETC were evaluated over a dosage range of 4-30 mg/kg for antidepressant-like activity in the acute FST in rats, and the results were compared to those obtained with saline, imipramine (15 mg/kg) and MB (15 mg/kg) treated rats. Locomotor activity was evaluated to ensure that changes in swim motivation are based on antidepressant response and not due to an indirect effect of the drug on locomotor activity. The results document that ETC inhibits MAO-A and MAO-B with IC50 values of 0.51 μM and 0.592 μM, respectively. Furthermore, ETC inhibits MAO-A and MAO-B reversibly, while the mode of inhibition is most likely competitive. In the acute FST, azure B and ETC were more effective than imipramine and MB in reversing immobility, without inducing locomotor effects. Azure B and ETC increased swimming behaviour during acute treatment, which is indicative of enhanced serotonergic neurotransmission. Azure B and ETC did not affect noradrenergicmediated climbing behaviour. These results suggest that azure B may be a contributor to the antidepressant effect of MB, and acts via increasing serotonergic transmission. Secondly, small structural changes made to MB do not abolish its antidepressant effect even though ETC is a less potent MAO-A inhibitor than MB. / MSc (Pharmaceutical Chemistry), North-West University, Potchefstroom Campus, 2014

Les antidépresseurs de type Inhibiteur Sélectif de la Recapture de la Sérotonine (SSRI pour Selective Serotonin Reuptake Inhibitor), dont fait partie la fluoxétine (Prozac), ont été décrits comme capables de déclencher l'apoptose de cellules tumorales in vitro et in vivo, suggérant une potentielle utilisation de ces molécules pour le traitement des cancers. Cependant, leur mécanisme apoptotique n’a pas été élucidé à ce jour. Nous avons donc entrepris de déterminer les étapes de l'apoptose induite par la fluoxétine et les SSRI, en choisissant comme modèle d'étude des lignées cellulaires de lymphomes non-Hodgkiniens agressifs. Nous avons identifié plusieurs étapes de la signalisation apoptotique de la fluoxétine et des SSRI. Ainsi, via une inhibition de la chaîne respiratoire, la fluoxétine induit la production d'espèces réactives de l'oxygène conduisant à la surexpression des récepteurs de mort DR4 et DR5 ; la fluoxétine induit également l'activation de la caspase-8. DR4 et DR5 sont très probablement la cause de l'apoptose induite par la fluoxétine, de façon indépendante de leur ligand, TRAIL (TNF-Related Apoptosis-Inducing Ligand). Partant du constat que l'utilisation de TRAIL comme antitumoral pour le traitement des lymphomes présente des résultats prometteurs mais encore insuffisants, nous avons envisagé que la fluoxétine puisse augmenter l’apoptose induite par TRAIL dans ce type de tumeurs. Nous montrons en effet qu'une association de la fluoxétine avec TRAIL conduit à une augmentation de l'action apoptotique de TRAIL dans les lignées de lymphomes non-Hodgkiniens agressifs. De plus, nos résultats montrent que la fluoxétine induit la mort cellulaire d'une façon indépendante de la caspase-8. Cet effet semble trouver son origine dans une surcharge en calcium de la mitochondrie, alimentée par une stimulation maintenue de l'entrée de calcium par les canaux CRAC (Calcium Release Activated Calcium). En conclusion, les éléments de la signalisation calcique et apoptotique de la fluoxétine et des SSRI que nous avons identifiés encouragent leur utilisation en thérapie, et notamment dans le cadre d'associations avec TRAIL et d'autres molécules pour permettre une augmentation de l'apoptose des cellules tumorales, voire des cellules résistantes à l'apoptose induite par TRAIL. / Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants, such as fluoxetine (Prozac), have been shown to induce apoptosis in cancer cells in vitro and in vivo, suggesting a potential use for cancer treatment. However, their apoptotic mechanism has remained undetermined until now. Therefore, we have undertaken the determination of fluoxetine- and SSRIs-induced apoptotic signalling, our study model being aggressive Non-Hodgkin's Lymphoma (NHL) cell lines. We have identified several steps of the apoptotic signalling of fluoxetine and the SSRIs. Thus, via an inhibition of the respiratory chain, fluoxetine induces a reactive oxygen species production leading to the overexpression of the death receptors DR4 and DR5; fluoxetine also induces caspase-8 activation. DR4 and DR5 are probably the cause of fluoxetine-induced apoptosis, independently of their ligand TRAIL (TNF-Related Apoptosis-Inducing Ligand). Knowing that TRAIL as an antitumoral agent for lymphoma treatment has shown promising but insufficient results, we have hypothesized that fluoxetine could increase TRAIL-induced apoptosis in these tumors. Indeed, we show that fluoxetine in association with TRAIL leads to an increase in TRAIL-induced apoptosis in aggressive NHL cell lines. Furthermore, our results show that fluoxetine induces cell death in a caspase-8–independent manner. This effect seems to originate from a mitochondrial calcium overload fueled by a sustained calcium entry from the CRAC (Calcium Release Activated Calcium) channels. In conclusion, the calcium pathway and the apoptotic steps of the fluoxetine's and the SSRIs' signalling that we have delineated encourage their use in therapy, especially in association with TRAIL and other molecules in order to enable an increase in cancer cells' apoptosis, or even in cancer cells which are resistant to TRAIL-induced apoptosis.

A depressão é uma doença com alta incidência na população mundial e os antidepressivos atualmente disponíveis não são completamente eficazes. Esses fármacos apresentam uma latência de 2-4 semanas para induzir uma melhora significativa dos sintomas e cerca de 45% dos pacientes não respondem ao tratamento, cujo mecanismo é baseado na facilitação da neurotransmissão monoaminérgica no SNC. Por outro lado, recentemente tem sido demonstrado que a ketamina, antagonista do receptor de glutamato do tipo NMDA induz um efeito antidepressivo rápido e sustentado em animais e pacientes. No entanto, o uso dessa droga para o tratamento da depressão possui diversas limitações e, assim, o entendimento dos mecanismos subjacentes à sua ação antidepressiva pode contribuir para o desenvolvimento de novas e melhores alternativas terapêuticas. Estes mecanismos parecem ser mais complicados do que simplesmente o bloqueio do receptor NMDA, dado que tal bloqueio com o antagonista MK-801, por exemplo, induz efeito tipo-antidepressivo no teste do nado forçado (FST) por até 3 horas, mas sem reproduzir os efeitos prolongados da ketamina. Por isso, a cascata de eventos neuroquímicos iniciada após a administração de ketamina que culmina com a regulação da expressão gênica e síntese de proteínas relacionadas aos processos de plasticidade neural têm sido alvo de grande investigação a fim de se compreender o mecanismo de ação subjacente ao efeito antidepressivo rápido e sustentado dessa droga. A expressão desses genes pode ser modulada por mecanismos epigenéticos, como a metilação do DNA, um processo realizado por DNA metiltransferases (DNMTs), que também tem apresentado grande relevância para a neurobiologia da depressão. Diante disso, o presente estudo teve como objetivo avaliar os efeitos da administração de antagonistas do receptor NMDA, ketamina e MK-801, em doses e protocolos de tratamento que promovam efeito tipo-antidepressivo no FST, sobre a metilação do DNA em estruturas encefálicas importantes para a neurobiologia da depressão, em animais submetidos ou não ao estresse de nado forçado. Para tanto, primeiramente, foram delineados protocolos experimentais para análise do efeito tipo-antidepressivo destas drogas: Em ratos, administração sistêmica aguda de S(+)-ketamina 10 mg/Kg ou MK-801 0,025 mg/Kg 23 horas após a sessão pré-teste e 1 hora ou 7 dias antes da sessão teste do FST, permitiu a análise de um efeito tipo-antidepressivo rápido e sustentado induzido pela ketamina e apenas rápido pelo MK-801. Em seguida, utilizando estes protocolos, avaliou-se os efeitos do estresse do pré-teste do FST e do tratamento com tais antagonistas do receptor NMDA sobre os níveis de metilação global do DNA e expressão de DNMT3a e DNMT3b no córtex frontal, hipocampo ventral e dorsal dos animais. Foram encontradas alterações nas quantificações realizadas, sugerindo que o estresse e o tratamento podem induzir efeitos importantes sobre a metilação do DNA nas estruturas analisadas. Além disso, o tratamento com ketamina ou MK-801 parecem induzir efeitos diferenciais em algumas regiões, o que poderia estar associado aos efeitos também distintos que apresentam sobre a ação antidepressiva / Although depression presents a high incidence in the world population, currently available antidepressants exhibit a latency of 2-4 weeks to induce a significant improvement of symptoms and around 45% of patients do not respond to these drugs. On the other hand, it has been recently shown that ketamine, a NMDA receptor antagonist, induces a rapid and sustained antidepressant effect in animals and patients. However, the use of this drug for depression treatment has several limitations and, thus, the understanding of the mechanisms underlying its antidepressant action could present a significant importance for the development of new and better therapeutic alternatives. These mechanisms appear to be more complex than the initial blockade of the NMDA receptor, since such blockade by MK-801, for example, reduces the immobility time of mice submitted the forced swimming test (FST) for up to 3 hours, without reproducing the sustained effects of ketamine. Therefore, the cascade of neurochemical events that are initiated after ketamine administration that culminate in the regulation of gene expression and syntehsis of proteins related to neuronal plasticity has been the focus of intense investigation. These genes, in turn, can be modulated by epigenetic mechanisms such as DNA methylation, a process performed by DNA methyltransferase (DNMTs), which has also shown a high relevance to the neurobiology of depression and its treatment. Based on that, the present study aimed at investigating the effects induced by ketamine and MK-801, at doses and treatment protocols that promote antidepressant-like effect in the FST, upon DNA methylation in brain structures of animals submitted or not to the forced swim stress. The first experimental protocols were designed for the analysis of acute and sustained drug-induced antidepressant-like effects: In rats, acute systemic administration of S(+)-Ketamine 10 mg/Kg or MK-801 0.025 mg/Kg 23 hours after the pretest session and 1 hour or 7 days before the test session of FST was investigated. Based on these protocols, the effects of stress (FST) and of treatment with NMDA receptor antagonists were investigated on global DNA methylation levels and DNMT3a and Dnmt3b expression in the rat frontal cortex, ventral and dorsal hippocampus. Both, stress and treatment, induced changes in DNA methylation and DNMT3 expression in some of the brain regions analised. In addition, treatment with MK-801 and ketamine seem to induce differential effects in some areas, which could also be associated with different effects that they present on antidepressant action.

Diversas evidências indicam que o núcleo dorsal da rafe (NDR), principal fonte de inervação serotonérgica para estruturas límbicas, é uma estrutura heterogênea composta por populações de neurônios serotonérgicos anatômica e funcionalmente distintas, as quais têm sido diferentemente implicadas na fisiopatologia dos transtornos de ansiedade, como o transtorno do pânico. Fármacos antidepressivos são a primeira escolha para o tratamento de tais transtornos e o atraso para a manifestação dos efeitos terapêuticos desses fármacos tem sido, consistentemente, associado a alterações na neurotransmissão serotonérgica. Entretanto, ainda é desconhecido se estas alterações podem ser heterogêneas entre as diferentes sub-regiões do NDR e é este o foco de investigação do presente estudo. Inicialmente, foi investigado o perfil de ativação neuronal das diferentes sub-regiões do NDR, através da avaliação da expressão de proteína Fos, em ratos submetidos à tarefa de fuga no modelo do labirinto em T elevado, após administração aguda ou crônica com a fluoxetina ou a imipramina. Nestes mesmos animais, foram também avaliado o número de células triptofano hidroxilase positivas. Para fins comparativos, o efeito do tratamento com a imipramina em animais submetidos à esquiva inibitória também foi avaliado. A análise imunoistoquímica indicou que a tarefa de fuga promoveu um aumento na expressão da proteína Fos em neurônios nãoserotonérgicos localizados na sub-região das asas laterais do NDR. Efeito este que não foi observado em animais tratados cronicamente com a fluoxetina e a imipramina. Além disso, o tratamento prolongado com a fluoxetina, mas não com a imipramina, foi capaz de aumentar a ativação de neurônios serotonérgicos nesta mesma sub-região. Diferente do que foi observado na tarefa de fuga, a tarefa de esquiva inibitória promoveu um aumento na ativação de neurônios serotonérgicos nas sub-regiões DRC, DRD e DRV. Perfil que não foi observado nos grupos aguda e cronicamente tratados com imipramina. Além disso, somente o tratamento prolongado com a imipramina promoveu uma diminuição no recrutamento de neurônios não-serotonérgicos em diversas sub-regiões do NDR. Diante do resultado imunoistoquímico observado no experimento com a fluoxetina, avaliamos a participação dos autorreceptores 5-HT1A das asas laterais no efeito observado. Através da técnica whole-cell patch clamp, em uma linhagem de camundongos transgênicos que apresenta neurônios serotonérgicos fluorescentes, foi avaliada a responsividade destes receptores após o tratamento com a fluoxetina. Os resultados indicam que os animais tratados cronicamente com fluoxetina apresentam aumento na excitabilidade basal com diminuída sensibilidade ao agonista de receptores 5-HT1A, 8-OHDPAT. Assim, é possível sugerir que o efeito antipânico da fluoxetina administrada cronicamente parece estar relacionado com uma redução na ativação de neurônios não-serotonérgicos e um aumento no recrutamento de neurônios serotonérgicos localizados nas asas laterais, sendo que esta última pode ser explicada pela dessensibilização dos autorreceptores 5-HT1A. Com relação à imipramina, é possível sugerir que o efeito panicolítico promovido pelo tratamento prolongado pode ser devido à diminuição no recrutamento de neurônios não-serotonérgicos das asas laterais. Já para o efeito ansiolítico, tanto a diminuição no recrutamento de neurônios não-serotonérgicos em diferentes sub-regiões do NDR, quanto a diminuição na ativação de neurônios serotonérgicos no DRC, DRD e DRV parecem estar envolvidas. / A wealth of evidence indicates that the dorsal raphe nucleus (DR) is a heterogeneous structure, composed of anatomically and functionally distinct populations of serotonergic neurons, which have been differently implicated in the pathophysiology of anxiety, such as panic disorder. Antidepressant drugs are the first choice in treatment of anxiety disorders, and the delay for the therapeutic effect have consistently been associated with changes in serotonergic neurotransmission within the DR. However, it is unknown whether these alterations can be heterogeneous among the different subregions of the DR, and this is the focus of investigation of the present study. First, it was investigated the profile of neuronal activation of different subregions of the DR - by using the evaluation of Fos protein expression of rats exposed to the escape task in the elevated T-maze test, after acute or chronic administration of fluoxetine or imipramine. In the same animals, it was also investigated the number of positive triptophan hidroxylasis cells. For comparative reasons, it was evaluated the behavioral and immunohistochemical effects of imipramine treatment on inhibitory avoidance acquisition in the elevated T-maze, a response associated with anxiety. The results of the immunohistochemical analysis indicated that animals exposed to escape behavior exhibited higher expression of Fos protein in non-serotonergic neurons in the DR lateral wings. This effect was not observed in fluoxetine or imipramine chronically treated animals. Moreover, chronic treatment with fluoxetine, but not imipramine, was able to increase the activation of serotonergic neurons on this subregion. On the other hand, the inhibitory avoidance task promoted an increase in the activation of serotonergic neurons in the sub-regions DRC, DRD, and DRV. This profile was not observed after acute or chronic treatment with imipramine. Additionally, only the long-term treatment with imipramine showed a decrease in the activation of non-serotonergic neurons in different subregions of the DR. Based on the results obtained with fluoxetine experiment, we evaluated the role of the 5-HT1A autoreceptors located in the lateral wings. For this, we used the whole-cell patch clamp technique in a transgenic mouse line, which exhibit fluorescence in serotonergic neurons. The results indicate that the animals treated chronically with fluoxetine presented an increase in the basal excitability, with lower responsivity to the 5-HT1A agonist - 8-OH-DPAT. Altogether, the results suggest that the anti-panic effect caused by chronic fluoxetine treatment is associated with a reduction in the activation of non-serotonergic neurons, and an increase in the recruitment of non-serotonergic neurons in lateral wings. This last observation seems to be related to a 5-HT1A autoreceptor desensitization in the lateral wings. Regarding imipramine, this panicolytic effect caused by chronic administration of this drug seems to be related to a decreased activation of the non-serotonergic neurons in the lateral wings. Finally, the anxiolytic effect, of imipramine may be associated to a decrease in the recruitment of non-serotonergic neurons in different DR subregions, allied with a decreased activation of serotonergic neurons in the DRC, DRD and DRV.

A depressão, tal como compreendida pela Análise Experimental do Comportamento têm sido relacionada a taxa de reforço, operações estabelecedoras e sensibilidade a reforçadores positivos. O modelo biocomportamental de reforço tem implicado o envolvimento do sistema dopaminérgico (DA) no processo de reforço. Têm-se demonstrado, também, a influência de agentes DA sobre a eficácia de reforçadores condicionados. Por fim uma série de pesquisas sugerem a importância desse sistema na depressão e no mecanismo de ação de antidepressivos, embora sua ação primária seja sobre o sistema serotonérgico. O objetivo deste estudo foi investigar os efeitos do antidepressivo fluoxetina (FLX), um inibidor seletivo de recaptação de serotonina, sobre a eficácia de reforçadores condicionados em ratos. No Experimento 1 validou-se o procedimento de Reforço Condicionado (RC) chegando-se ao procedimento final: 1) Pré-exposição - eram medidas respostas de pressão a duas barras uma que produzia o estímulo LA (luzes de estímulo apagadas) e outra o estímulo TOM (campainha); 2) Condicionamento –o estímulo LA era pareado com alimento; e 3) Teste – igual à Pré-exposição. No Experimento 2 investigou-se o efeito do tratamento crônico com FLX (1,25, 2,50 e 5,00 mg/kg) e da exposição prolongada à privação de alimentos sobre o modelo de RC. Os resultados sugerem que a FLX não influencia diretamente a eficácia de reforçadores. Tampouco a privação de alimentos parece interagir com o tratamento. Sugere-se, no entanto, que a exposição a estressores crônicos poderia influenciar a eficácia de reforçadores condicionados, interagindo com o tratamento. / Depression, as seen by the Experimental Analysis of Behavior, has been related to reinforcement rate, establishing operations and decreased sensitivity to positive reinforcers. The biobehavioral approach to reinforcement has implicated the dopaminergic system (DA), in the neural basis of reinforcement. Also DA agents have been demonstrated to change the effectiveness of conditioned reinforcers. Finally, it has been suggested that the DA system plays an important role on depression and on antidepressant drugs action. The present study was aimed at investigating the effects of the antidepressant drug fluoxetine (FLX), a selective serotonin reuptake inhibitor, on the effectiveness of conditioned reinforcers. Experiment 1 validated the Conditioned Reinforcement (CR) procedure. The final procedure was: 1) Pre-exposure - 5 sessions in which presses on two levers were registered, each lever led to presentation of one out of two neutral stimuli (LO and TONE); 2) Conditioning – 4 sessions in which LO was paired with food pellets; e 3) Test – 2 sessions in which the procedure was the same as Pre-exposure. Experiment 2 investigated the effects of chronic fluoxetine and prolonged food deprivation on the effectiveness of CR. Results indicate that FLX does not directly influence CR effectiveness. Nor does prolonged deprivation appear to interact with treatment. It is suggested, however, that chronic exposure to mild stressors might alter the effectiveness of CR, interacting with antidepressant treatment.

O curso longitudinal do transtorno bipolar é altamente variável, mas um subconjunto de pacientes parece apresentar uma evolução progressiva associada a alterações cerebrais e comprometimento funcional. Em nosso primeiro artigo, discutimos a teoria da neuroprogressão no transtorno bipolar. Este conceito considera a resposta ao estresse que ocorre nos episódios de humor e déficits no funcionamento e cognição, bem como alterações neuroanatômicas nos estágios tardios da doença. Discutimos também refratariedade ao tratamento que pode ocorrer em alguns casos de transtorno bipolar. Foi executada uma busca na base de dados PubMed para artigos publicados em qualquer idioma até 04 de junho de 2016. Foram encontrados 315 resumos e 87 estudos foram incluídos em nossa revisão. Somos da opinião de que o uso de estratégias farmacológicas específicas e remediação funcional pode ser potencialmente útil em pacientes bipolares em estágios tardios. Novas abordagens analíticas que utilizam dados multimodais têm o potencial para ajudar na identificação de assinaturas de subgrupos de pacientes que irão desenvolver um curso neuroprogressivo. Com base em nossa hipótese de neuroprogressão, decidimos realizar um ensaio clínico randomizado com o antidepressivo tianeptina como tratamento adjuvante para o transtorno bipolar, a fim de melhorar o comprometimento funcional, desfechos clínicos e aumentar os níveis do Brain-Derived Neurothrofic Factor (BDNF). Tianeptina é um fármaco seguro, que atua sobre o sistema glutamatérgico e tem um efeito antidepressivo. Esse estudo teve como objetivo avaliar a eficácia e tolerabilidade da tianeptina como tratamento adjuvante para a depressão bipolar. Foi realizado um ensaio clínico duplo-cego randomizado de manutenção controlado por placebo com tianeptina 37,5 mg/dia. Os participantes (n = 161) tinham uma pontuação na Montgomery Asberg Depression Rating ≥12 no início do ensaio. Após oito semanas de tratamento com tianeptina na fase aberta, aqueles que responderam a tianeptina foram randomizados para o placebo ou tianeptina adjuvante. Os participantes foram recrutados na rede pública de saúde. Tempo para qualquer intervenção foi o desfecho primário do estudo. Mudanças nos sintomas de humor, funcionamento, ritmos biológicos, qualidade de vida, taxas de virada maníaca e níveis séricos de BDNF foram considerados como desfechos secundários. Houve uma diminuição importante nos sintomas depressivos, assim como melhoras no funcionamento, qualidade de vida e pontuações no ritmo biológico durante a fase aberta de tratamento com tianeptina por oito semanas. Durante as 24 semanas do ensaio duplo-cego randomizado e controlado por placebo, não houve diferença em relação ao desfecho primário: tempo para qualquer intervenção. Além disso, não houve diferenças significativas entre os grupos em relação aos sintomas de humor, funcionamento e níveis de BDNF. Tianeptina foi bem tolerada e não foi associada a virada maníaca em comparação com o placebo. Estes achados sugerem que tianeptina é um medicamento seguro e pode ser eficaz no tratamento da depressão bipolar aguda. No entanto, tianeptina não mostrou efeitos benéficos na fase de manutenção. Este é o primeiro ensaio clínico duplo-cego randomizado de manutenção e de longo prazo com antidepressivo no transtorno bipolar. / The longitudinal course of bipolar disorder is highly variable, and a subset of patients seems to present a progressive course associated with brain changes and functional impairment. In our first article, we discussed the theory of neuroprogression in bipolar disorder. This concept considers the systemic stress response that occurs within mood episodes and late-stage deficits in functioning and cognition as well as neuroanatomic changes. We also discuss treatment refractoriness that may take place in some cases of bipolar disorder. We searched PubMed for articles published in any language up to June 4th, 2016. We found 315 abstracts and included 87 studies in our review. We are of the opinion that the use of specific pharmacological strategies and functional remediation may be potentially useful in bipolar patients at late-stages. New analytic approaches using multimodal data hold the potential to help in identifying signatures of subgroups of patients who will develop a neuroprogressive course. Based on our hypothesis of neuroprogression, we decided to perform a randomized clinical trial with tianeptine as adjunctive treatment for bipolar disorder in order to improve functional impairment and increase serum Brain-Derived Neurothrophic Factor BDNF levels. Tianeptine is a safe medication that acts on the glutamatergic system and has an antidepressant effect. The present study aimed at assessing the efficacy and tolerability of tianeptine as an adjunctive treatment for bipolar depression. We performed an enriched maintenance multi-center double-blind randomized controlled trial of tianeptine 37•5mg/day. Participants (n = 161) had a Montgomery Asberg Depression Rating Score ≥12 at trial entry. After eight weeks of open-label tianeptine treatment, those who responded to tianeptine were randomized to adjunctive tianeptine or placebo in addition to usual treatment. Participants were recruited from public health services and through advertisement. Time to any intervention was the primary endpoint of the study. Changes in mood symptoms, functioning, biological rhythms, quality of life, rates of mania switch and serum BDNF assessments were considered as secondary outcomes. There was a robust decrease in depressive symptoms along with improvements in functioning, quality of life and biological rhythms scores during the eight-week open-label tianeptine treatment phase. During the subsequent 24-week double-blind controlled phase, there was no difference regarding the primary outcome: time to intervention. In addition, there were no significant differences between groups in mood symptoms, functioning and BDNF levels. Tianeptine was well tolerated and not associated with mania switch as compared to placebo. These findings suggest that tianeptine is a safe medication and may be effective in the treatment of acute bipolar depression. However, tianeptine did not show beneficial effects in the maintenance phase. This is the first long-term randomized, double-blind maintenance trial of antidepressant augmentation in bipolar disorder.

Il existe une comorbidité entre douleur et dépression. Si les antidépresseurs inhibiteurs de recapture de monoamines représentent le traitement de première intention des troubles dépressifs unipolaires, certains d’entre eux sont également recommandés en première ligne de traitement des douleurs neuropathiques. L’objectif de ce travail a été d’étudier les propriétés analgésiques de ces antidépresseurs dans des modèles animaux co-exprimant des éléments de phénotypes douloureux et dépressifs. Pour cela nous avons développé des tests d’évaluation comportementale de la douleur chez la souris. Ces tests permettent de décrire la sensibilité douloureuse des animaux et d’évaluer les effets pharmacologiques de substances de référence et innovantes.Nous avons ainsi démontré que la fluoxétine, inhibiteur sélectif de la recapture de sérotonine (ISRS), possède des effets antalgiques sur les altérations de sensibilité d’un modèle d’anxiété/dépression chez la souris : le modèle CORT. La caractérisation d’un phénotype douloureux chronique chez ces souris renforce la pertinence de ce modèle neuropsychopharmacologique, puisqu’il exprime une des comorbidités fréquentes des pathologies dépressives. De plus, l’efficacité antalgique de la fluoxétine dans ce modèle plaide en faveur d’une modulation de la composante affective de la douleur par les ISRS.De plus, nous avons caractérisé l’effet antalgique d’une nouvelle classe d’antidépresseurs monoaminergiques, les triples inhibiteurs de recapture des monoamines capables d’augmenter à la fois les concentrations intracérébrales de sérotonine, noradrénaline et dopamine. Pour ce faire, nous avons développé un modèle de douleurs induites par injections répétées d’oxaliplatine chez la souris et comparé l’efficacité de différents traitements sur ces douleurs. Les souris « oxaliplatine » développent une hyperalgie mécanique, ainsi qu’une allodynie et hyperalgie au froid. Ces altérations de la sensibilité douloureuse sont corrigées par l’administration aigüe d’un triple bloqueur (indatraline) en faisant intervenir des mécanismes probablement supra-spinaux. La composante dopaminergique de ces substances apporte un intérêt dans le profil antalgique. Par ailleurs, les souris « oxaliplatine » développent des traits caractéristiques d’un phénotype anxio-dépressif et l’indatraline semble avoir des effets antidépresseurs dans ce modèle, ouvrant la possibilité d’une participation de la DA à la composante affective de la douleur et plus d’effets sur l’influx somatosensoriel. L’ensemble de nos travaux fait ressortir l’importance du développement et de l’utilisation de modèles animaux co-exprimant douleurs et anxiété/dépression afin de mieux définir les mécanismes liant ces pathologies et d’optimiser les critères de développement des futurs antidépresseurs et analgésiques. / High comorbidity is described between depression and pain disorders. Monoaminergic reuptake inhibitors represent the first choice of treatment for depression and serotonin and norepinephrin reuptake inhibitors are also recommended for the treatment of neuropathic pain disorders. We aims at evaluating analgesic effects of these drugs in animal models sharing anxio-depressive and painful phenotype. We first developed tests to assess pain sensitivity in mice and analgesic properties of pharmacological compounds. Depressive phenotype was assessed using various behavioural paradigms of anxiety/depression.We thus show that fluoxetine, a selective serotonin reuptake inhibitor (SSRI), provide antinociceptive effects in a mice model of anxiety-depression: the CORT model. Fluoxetine may thus exert its analgesic effect by modulating the affective aspect of pain in addition to a putative influence on sensory mechanisms. Moreover we characterized analgesic effects of a new generation of antidepressant, the triple reuptake inhibitors, which simultaneously potentialisate serotoninergic, noradrenergic and dopaminergic neurotransmission, in a mice model of oxaliplatin-induced neuropathy. Our results support that indatraline provide a better analgesic profile than escitalopram and venlafaxine in pain relief in oxaliplatin-treated mice. Although other investigations are required to quantify the putative involvement of DA in the therapeutic action of indatraline, the benefit can be attributed to this additional component. Indeed, reinforcement of descending control pathways though 5-HT and NE systems has been proposed to participate in the analgesic properties of dual reuptake inhibitors. The fact that indatraline was able to enhance dopaminergic transmission in the Anterior Cingulate Cortex argues in favor of a more potent action upon this inhibitory descending control of pain. Results with indatraline in the depression paradigm cannot rule out the possibility that the antidepressant property of the TRI accounts for its analgesic effect.This work provides a support for the need of animal models sharing anxio/depressive and painful phenotype in order to define mechanism responsible for such co-mobidity and optimize the development of newer antidepressants and pain killers.

Les pathologies dépressives se définissent par des symptômes hétérogènes qui incluent les troubles du sommeil comme facteur de comorbidité. La comorbidité des troubles du sommeil dans la dépression est habituellement marquée d’une diminution de sommeil lent, d’une augmentation de sommeil paradoxal et d’une fragmentation du sommeil, tant chez l’Homme qu’au sein des modèles animaux de la pathologie.Le premier objectif de ce travail expérimental a été de caractériser les troubles du sommeil suspectés dans un modèle animal de souris adultes rendues anxio/dépressives par l’administration chronique de corticostérone. Les résultats obtenus ont montré qu’une administration chronique de corticostérone induit une hypersomnie avec augmentation de sommeil lent, une diminution du sommeil paradoxal et une fragmentation des états de veille et de sommeil. La description du sommeil du modèle de souris CORT enrichit la classification actuelle en modélisant des troubles du sommeil atypiques présents chez près de 20% des sujets dépressifs. Le second objectif a été de corriger ces troubles du sommeil par l’administration chronique d’antidépresseurs classique (fluoxétine) et innovant (agomélatine). Si chacune des molécules antidépressives testées a révélé un effet bénéfique vis-à-vis de la somnolence des souris CORT, l’agomélatine a montré sa supériorité pour prévenir l’inhibition du sommeil paradoxal induite par la corticostérone et accentuée par la fluoxétine. / Depressive disorders are definded by heterogeneous symptoms that include sleep disorders such as comorbid condition. Comorbidity of sleep disorders in depression is usually marked by a decrease in NREM sleep, increased REM sleep and sleep fragmentation, both in humans and within animal models of the disease. The first aim of this experimental work was to characterize sleep problems suspected in an animal model of adult mice rendered anxio/depressive by chronic administration of corticosterone. The results showed that chronic administration of corticosterone induced hypersomnia with increased NREM sleep, decreased REM sleep and led to fragmented sleep/wake states. The description of the sleep cycle of the CORT mouse model of anxiety/depression enriches the current classification by modeling atypical sleep disorders present in nearly 20% of the depressed subjects. The second aim was to correct these sleep disorders by chronic administration of classical (fluoxetine) and innovative (agomelatine) antidepressants. If each antidepressant molecules tested showed a beneficial effect towards drowsiness of CORT-treated mice, agomelatine has shown its superiority to prevent the inhibition of REM sleep induced by chronic corticosterone which was enhanced by chronic fluoxetine treatment.

Les troubles dépressifs constituent un problème majeur de santé publique puisqu’ils affectent plus de 350 millions de personnes dans le monde. La plupart des médicaments antidépresseurs prescrits actuellement ciblent les systèmes monaminergiques centraux. Cependant, ces molécules ont un délai d’action de plusieurs semaines et produisent des effets secondaires substantiels, souvent responsable de l’arrêt du traitement. De plus, un pourcentage non négligeable de patients ne répond que partiellement ou négativement à ces traitements. C’est pourquoi le développement de nouvelles molécules antidépressives constitue un axe majeur de recherche en psychopharmacologie. Le 3β-methoxyprégnénolone (MAP4343), un neurostéroide de synthèse, constitue une nouvelle molécule dont l’efficacité antidépressive a été récemment établie dans un modèle d’isolement social chez le rat. Le mode d’action du MAP4343 serait différent de celui des antidépresseurs conventionnels, puisqu’il a été montré in vitro qu’il pouvait se lier à la protéine associée aux microtubules de type 2 (MAP2) pour ainsi modifier la fonction microtubulaire, ce qui, in fine, favoriserait la plasticité cérébrale.L’objectif de cette thèse est de consolider les preuves de l’efficacité antidépressive du MAP4343 et d’élucider les mécanismes d’action cellulaires associés à son effet pharmacologique. Pour cela, nous avons utilisé un modèle animal, de dépression à savoir le Toupaye de Belanger (toupaia belangeri) soumis au stress psychosocial chronique qui développe des troubles comportementaux, fonctionnels et hormonaux similaires à ceux observés chez les patients dépressifs.Chez le Toupaye, l’administration chronique de MAP4343 (50 mg/kg/jour ; per os) pendant quatre semaines permet d’inhiber la diminution de l’activité locomotrice et le comportement d’évitement induit par le stress. De plus, les altérations physiologiques comme la diminution du poids corporel, l’hyperthermie ou encore les troubles du sommeil sont enrayés par le traitement au MAP4343. Enfin, la molécule agit en inhibant partiellement l’hyperactivation de l’axe adreno-corticotrope. Les mesures dans l’hippocampe de l’expression des isoformes de l’α-tubuline, élément constitutif des microtubules, montrent une diminution de l’α-tubuline tyrosinée, une isoforme plus abondante dans des microtubules néoformés. Ce phénomène n’est pas renversé par le MAP4343. Cependant, le stress chronique induit une réduction de l’expression de la forme acétylée de l’α-tubuline, un phénomène qui serait plus tardif lors d’une altération de la fonction microtubulaire. De façon intéressante, le MAP4343 permet de prévenir cette baisse de l’acétylation. Ce travail de thèse démontre un effet antidépresseur robuste du MAP4343, confirmant ainsi une première étude réalisée auparavant chez le rat. Son efficacité peut se maintenir lors d’un traitement prolongé chez le Toupaye. Cette molécule constituerait ainsi une nouvelle classe d’antidépresseurs ayant comme cible potentielle le système microtubulaires. Des expériences complémentaires seront nécessaires afin de préciser le mode d’action du MAP4343 sur les fonctions neuronales. / Depressive disorders affect more than 350 million people worlwide generating major public health. Most of the antidepressant drugs currently used target monaminergic systems. However, the onset of action of these drugs is delayed for several weeks and they produce important side effects responsible for the discontinuation of treatment. Furthermore, a large rate of patients responds poorly or not at all to this kind of treatment. Accordingly, the development of new antidepressant drugs constitutes a major axis of psychopharmacology research. 3ß-methoxypregnenolone (MAP4343) is a new synthetic neurosteroid whose antidepressant efficacy was recently established in a rat model of social isolation. The mechanism of action of MAP4343 is very likely different from that of conventional antidepressants, as it was shown in vitro that this compound can bind the type 2 microtubule associated protein (MAP2) and may promote in fine the neuronal plasticity. The objective of this thesis is to further demonstrate the antidepressant efficacy of MAP4343 and to elucidate the cellular mechanisms associated to its pharmacological effect. For this purpose, we used one animal models of depression: tree shrews (toupaia belangeri) subjected to a chronic psychosocial stress. Stressed tree shrews develop behavioral, functional and hormonal alterations similar to those observed in the depressive patients. Chronic administration (four weeks) of MAP4343 (50 mg / kg / day) inhibits both the decrease of locomotor activity and the avoidance behavior induced by chronic stress. Furthermore, physiological changes such as hyperthermia or sleep disorders are also reversed by MAP4343 treatment. Finally, the molecule acts by partially inhibiting the stress-induced hyper-activation of hypothalamo-pituitary-adrenal axis. The quantitative study of post-translational modifications of α-tubulin (a major component of microtubules) in the hippocampus shows a decrease of tyrosinated α-tubulin, a dynamic microtubules marker. This phenomenon is not reversed by MAP4343 treatment. However, chronic stress exposure decreases the expression of acetylated α-tubulin, a later phenomenon occurring during microtubular alteration. Interestingly, MAP4343 prevents this decrease. To conclude, this thesis demonstrates a strong antidepressant effect of MAP4343, reproducible in one relevant and translational animal model of depression, thus confirming a previous study realized in an isolated rat model. The efficacy of this compound is observed from the first day of treatment in the rat and persists during a prolonged treatment. This molecule belongs to a new class of antidepressants potentially targeting the microtubular system. Additional experiments will be necessary to well understand the mechanism of action of the MAP4343 on neuronal functions.