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Les troubles reliés à la dépression, l’épuisement professionnel et l’anxiété sont de plus en plus répandus dans notre société moderne. La consommation croissante d’antidépresseurs dans les différents pays du monde est responsable de la récente détection de résidus à l’état de traces dans les rejets urbains municipaux. Ainsi, ces substances dites « émergentes » qui possèdent une activité pharmacologique destinée à la régulation de certains neurotransmetteurs dans le cerveau suscitent maintenant de nombreuses inquiétudes de la part de la communauté scientifique. L’objectif principal de ce projet de doctorat a été de mieux comprendre le devenir de plusieurs classes d’antidépresseurs présents dans diverses matrices environnementales (i.e. eaux de surfaces, eaux usées, boues de traitement, tissus biologiques) en développant de nouvelles méthodes analytiques fiables capables de les détecter, quantifier et confirmer par chromatographie liquide à haute performance couplée à la spectrométrie de masse en tandem (LC-QqQMS, LC-QqToFMS). Une première étude complétée à la station d’épuration de la ville de Montréal a permis de confirmer la présence de six antidépresseurs et quatre métabolites N-desmethyl dans les affluents (2 - 330 ng L-1). Pour ce traitement primaire (physico-chimique), de faibles taux d’enlèvement (≤ 15%) ont été obtenus. Des concentrations d’antidépresseurs atteignant près de 100 ng L-1 ont également été détectées dans le fleuve St-Laurent à 0.5 km du point de rejet de la station d’épuration. Une seconde étude menée à la même station a permis l’extraction sélective d’antidépresseurs dans trois tissus (i.e. foie, cerveau et filet) de truites mouchetées juvéniles exposées à différentes concentrations d’effluent dilué traité et non-traité à l’ozone. Un certain potentiel de bioaccumulation dans les tissus (0.08-10 ng g-1) a été observé pour les spécimens exposés à l’effluent non-traité (20% v/v) avec distribution majoritaire dans le foie et le cerveau. Une intéressante corrélation a été établie entre les concentrations de trois antidépresseurs dans le cerveau et l’activité d’un biomarqueur d’exposition (i.e. pompe N/K ATPase impliquée dans la régulation de la sérotonine) mesurée à partir de synaptosomes de truites exposées aux effluents. Une investigation de l’efficacité de plusieurs stations d’épuration canadiennes opérant différents types de traitements a permis de constater que les traitements secondaires (biologiques) étaient plus performants que ceux primaires (physico-chimiques) pour enlever les antidépresseurs (taux moyen d’enlèvement : 30%). Les teneurs les plus élevées dans les boues traitées (biosolides) ont été obtenues avec le citalopram (1033 ng g-1), la venlafaxine (833 ng g-1) et l’amitriptyline (78 ng g-1). Des coefficients de sorption expérimentaux (Kd) calculés pour chacun des antidépresseurs ont permis d’estimer une grande sorption des composés sertraline, desméthylsertraline, paroxetine et fluoxetine sur les solides (log Kd > 4). Finalement, un excellent taux d’enlèvement moyen de 88% a été obtenu après ozonation (5 mg L-1) d’un effluent primaire. Toutefois, la caractérisation de nouveaux sous-produits N-oxyde (venlafaxine, desmethylvenlafaxine) par spectrométrie de masse à haute résolution (LC-QqToFMS) dans l’effluent traité à l’ozone a mis en lumière la possibilité de formation de multiples composés polaires de toxicité inconnue. / Mood disorders such as depression, burn-out and anxiety have increased in our modern society. Increasing amounts of antidepressant prescriptions around the world are now suspected to be the main cause of the recent detection of traces of antidepressant residues within urban wastewaters. These so-called “emerging” substances that possess pharmacological activity towards neurotransmitter regulation in the brain have raised serious concerns from the scientific community. The initial goal of the study was to better understand the fate of various classes of antidepressants present in different environmental matrices (e.g. surface waters, wastewaters, treatment sludge, and biological tissues) by developing novel reliable analytical methods that can detect, quantify and confirm antidepressants using high performance liquid chromatography coupled to tandem-mass spectrometry (LC-QqQMS,LC- QqToFMS). A preliminary study completed at the Montreal sewage treatment plant (STP) confirmed the presence of six antidepressants and four N-desmethyl metabolites in raw sewage (2 – 330 ng L-1). For this primary treatment (physico-chemical), low removal rates (≤ 15%) were obtained. Concentrations of antidepressant close to 100 ng L-1 were also detected directly in the St. Lawrence River at 0.5 km of the effluent outfall. A second study conducted at the same STP allowed the selective extraction of antidepressants in three biological tissues (e.g. liver, brain, and filet) dissected from juvenile brook trouts previously exposed to diluted untreated and treated effluents with ozone. Bioaccumulation of antidepressants was readily observed in fish tissues (0.08-10 ng g-1) for the specimens exposed to untreated effluent (20% v/v), with major distribution in liver and brain. During experiments, a significant correlation was established between the concentrations of three antidepressant detected in brain tissues and the activity of a selected biomarker of exposition (e.g. an N/K ATPase pump involved in the serotonin regulation) measured within dissected synaptosomes from trout exposed to effluents. Investigation of estimated treatment removal efficiencies from various Canadian STPs operating different disinfection modes showed that secondary treatments (biological) were more efficient than primary (physico- chemical) to remove antidepressants (mean removal rates : 30%). The highest amounts detected in treated sludge (biosolids) were obtained respectively with citalopram (1033 ng g-1), venlafaxine (833 ng g-1), and amitriptyline (78 ng g-1). Experimental calculated sorption coefficients (Kd) of each antidepressant predicted fairly good sorption capacities for sertraline, desmethylsertraline, paroxetine, and fluoxetine to solid matters (log Kd > 4). Finally, an excellent mean removal rate of 88% was obtained after ozonation (5 mg L-1) of a primary effluent. However, the characterization of new N-oxide side-products (venlafaxine, desmethylvenlafaxine) in ozonized effluent by high-resolution mass spectrometry (LC-QqToFMS) highlighted the possibility of formation of multiple polar compounds with unknown toxicity.

Les antidépresseurs actuels sont très similaires au niveau de leur mécanisme d’action et sont plus ou moins efficaces. Un des problèmes majeurs est leur long temps de latence à fournir une action thérapeutique dû aux adaptations des sites pré et post synaptiques. Dans un modèle animal, nous avons récemment découvert que l’agoniste RS67333 des récepteurs 5-HT4 était en mesure de produire en trois jours les mêmes effets antidépresseurs qui normalement prennent de deux à trois semaines à apparaître avec les antidépresseurs actuellement disponibles. De plus, nous avons constaté que les effets antidépresseurs de cet agoniste possédaient une résistance à la tolérance. Il y a d’autres agonistes du même récepteur, tel que le prucalopride qui ne produit pas d’effets antidépresseurs comme RS67333. Étant donné que l’efficacité du Prucalopride à stimuler les 5-HT4Rs est similaire sinon plus grande que celle de RS67333, nous avons énoncé l’hypothèse que le récepteur 5-HT4 pourrait adopter différentes conformations actives suite à son activation par différents agonistes. Nous avons ainsi décidé d’explorer les principales réponses fonctionnelles des récepteurs 5-HT4B en observant leurs propriétés de régulation et de signalisation. Nous avons montré que l’isoforme B du récepteur 5-HT4, étant hautement exprimé dans le système limbique, détient une signalisation et une régulation différentes dépendant du ligand activateur. Nos résultats indiquent que chacun des agonistes testés (5-HT, RS67333, ML10302, Zacopride, Prucalopride) modulent distinctivement la production d’AMPc et l’internalisation du récepteur. Les résultats nous ont clairement permis de déterminer que les agonistes possèdent une efficacité et ou puissance différentes les uns par rapport aux autres. De plus, l’ordre d’efficacité des agonistes à moduler la voie de l’AMPc était (Prucalopride > Zacopride = ML10302 = 5-HT > RS67333) et est différente de leur ordre d’efficacité à induire la régulation du récepteur par internalisation (5-HT > Zacopride > Prucalopride > ML10302 = RS67333). Ainsi, nous avons montré que les 5-HT4Rs adoptent des conformations qui sont ligand-spécifiques. Cela implique que la sélectivité fonctionnelle serait un facteur important à considérer dans les mécanismes d’action antidépresseur des agonistes de ce récepteur. / Antidepressants currently available are very similar toward their mechanism of action and are more or less effective. One major problem is their long latency to provide a therapeutic effect due to adaptations of pre and post synaptic locations. In an animal model, we recently discovered that the agonist RS67333 of the 5-HT4 receptors was able to produce in three days the same antidepressant effects that normally take two to three weeks to appear with the currently available antidepressants. In addition, we found that the antidepressant effects of this agonist had a resistance to tolerance. There are others agonists of the same receptor such as prucalopride, which does not produce antidepressant effects as RS67333. Since the effectiveness of prucalopride to stimulate 5-HT4Rs is similar if not greater than RS67333, we stated the hypothesis that the 5-HT4 receptor could adopt different active conformations following its activation by various agonists. We decided to explore the major functional responses of 5-HT4B by observing their regulatory and signaling properties. We showed that the B isoform of the 5-HT4, being highly expressed in the limbic system, has a different signaling and regulation depending on the ligand. Our results indicate that each of the agonists tested (5-HT, RS67333, ML10302, Zacopride, Prucalopride) distinctively modulate cAMP production and receptor internalization. The results have clearly identified that agonists differed in potency and efficacy. Moreover, the order of effectiveness of agonists to modulate the cAMP pathway was (prucalopride> zacopride = 5-HT = ML10302> RS67333) different from their order of effectiveness in inducing receptor regulation by internalization (5-HT> Zacopride> Prucalopride> RS67333 = ML10302). Thus, we have shown that 5-HT4Rs adopt conformations that are ligand-specific. This implies that functional selectivity is an important factor in the mechanisms of antidepressant action of this receptor agonists.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

Suite aux notifications de cas de comportements suicidaires associés aux antidépresseurs (ADs) chez les jeunes, une mise en garde réglementaire a été émise en mai 2004 au Canada, et deux guides de pratique clinique ont été publiés dans la littérature en novembre 2007. L'objectif de ce mémoire fut d'évaluer l’association entre ces interventions de communication et le suivi médical de la population pédiatrique traitée par ADs au Québec. Une étude de cohorte rétrospective (1998-2008) a été menée chez 4 576 enfants (10-14 ans) et 12 419 adolescents (15-19 ans) membres du régime public d’assurance médicaments du Québec, ayant débuté un traitement par AD. Le suivi médical dans les trois premiers mois de traitement a été mesuré par l’occurrence et la fréquence de visites médicales retrouvées dans les banques de données de la RAMQ. Les facteurs associés à un suivi conforme aux recommandations ont été évalués à partir de modèles de régression logistique multivariés. Seuls 20% des enfants ou adolescents ont eu au moins une visite de suivi à chaque mois, en conformité avec les recommandations. La probabilité de recevoir un suivi médical conforme était plus élevée lorsque le prescripteur initial était un psychiatre. L’occurrence et la fréquence des visites n’ont pas changé après la publication de la mise en garde ou des recommandations. De ce mémoire on conclut que d'autres interventions visant à optimiser le suivi médical devraient être envisagées. / Following reports of a potential association between antidepressants (ADs) and suicidal behaviour in youth, a regulatory warning was issued in Canada in May 2004, and clinical practice guidelines on recommended medical follow-up were published in the literature in November 2007. This Master's thesis aimed at assessing the association between these communication interventions and medical follow-up practices. A retrospective cohort study (1998-2008) was conducted among 4,576 children (10-14 years) and 12,419 adolescents (15-19 years) members of the Quebec public drug plan. Medical follow-up was ascertained through patterns of physician billing practices found in the RAMQ medical services databases. Study outcomes consisted of occurrence and frequency of visits in the first three months of AD treatment. Factors associated with follow-up consistent with recommendations were identified through multivariate logistic regression models. The main independent variable was exposure to each of the communication interventions. Covariates included: gender, class of AD, number of concomitant chronic diseases, psychiatric conditions, prescriber’s specialty, and potential exposure to each intervention. Only 20% of children or adolescents received at least one visit each month. The probability of receiving adequate follow-up was greater when treatment was initiated by a psychiatrist. Occurrence and frequency of visits did not change after the warning nor the publication of the recommendations. From this thesis, one may conclude that further interventions to optimize medical follow-up practices should be envisaged.

For more than half a decade, lithium has been successfully used to treat bipolar disorder. Worldwide, it is considered the first-line mood stabilizer. Apart from its proven antimanic and prophylactic effects, considerable evidence also suggests an antisuicidal effect in affective disorders. Lithium is also effectively used to augment antidepressant drugs in the treatment of refractory major depressive episodes and prevent relapses in recurrent unipolar depression. In contrast to many psychiatric drugs, lithium has outlasted various pharmacotherapeutic ‘fashions’, and remains an indispensable element in contemporary psychopharmacology. Nevertheless, data from pharmacogenetic studies of lithium are comparatively sparse, and these studies are generally characterized by small sample sizes and varying definitions of response. Here, we present an international effort to elucidate the genetic underpinnings of lithium response in bipolar disorder. Following an initiative by the International Group for the Study of Lithium-Treated Patients (www.IGSLI.org) and the Unit on the Genetic Basis of Mood and Anxiety Disorders at the National Institute of Mental Health,lithium researchers from around the world have formed the Consortium on Lithium Genetics (www.ConLiGen.org) to establish the largest sample to date for genome-wide studies of lithium response in bipolar disorder, currently comprising more than 1,200 patients characterized for response to lithium treatment. A stringent phenotype definition of response is one of the hallmarks of this collaboration. ConLiGen invites all lithium researchers to join its efforts. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Submitted by Maria Eneide de Souza Araujo (mearaujo@ipen.br) on 2017-03-10T16:49:56Z No. of bitstreams: 0 / Made available in DSpace on 2017-03-10T16:49:56Z (GMT). No. of bitstreams: 0 / A saúde do meio ambiente vem sendo comprometida devido ao descarte incorreto de produtos e seus subprodutos. Dentre os contaminantes emergentes encontram-se os fármacos, causadores de problemas ambientais por serem descartados no meio ambiente através dos efluentes. As técnicas convencionais de tratamento são insuficientes na remoção de diversos fármacos, por apresentarem resíduos resistentes e baixa biodegradabilidade. Sendo assim os processos oxidativos avançados vêm sendo estudados como alternativa para o tratamento de diferentes tipos de efluentes. O objetivo desse trabalho foi aplicar o processo de irradiação com feixe de elétrons para reduzir os efeitos tóxicos do propranolol, e de sua mistura com cloridrato de fluoxetina, em solução aquosa. Foram realizados ensaios ecotoxicológicos com o fármaco propranolol, e de sua mistura com o cloridrato de fluoxetina, utilizando como organismos-teste o microcrustáceo Daphnia similis, e a bactéria Vibrio fischeri. Observamos que o organismo D. similis mostrou-se mais sensível as amostras de fármacos quando comparado à bactéria V.fischeri. Após serem submetidas ao tratamento com radiação ionizante, todas as doses aplicadas para o propranolol e a mistura, mostraram significativa redução de toxicidade, tendo como organismo-teste D. similis. Para a bactéria V. fischeri apenas na dose de 5,0 kGy foi verificada a redução da toxicidade para o fármaco propranolol. Quanto à mistura dos fármacos, apenas as doses de 2,5 e 5,0 kGy apresentaram eficiência de remoção da toxicidade. A dose 5,0 kGy mostrou-se a melhor, apresentando redução de 79,94% para D. similis, e 15,64% para V. fischeri, quando expostas ao fármaco propranolol. Quanto à mistura, apresentou 81,59% e 26,93%, para D.similis e V.fischeri, respectivamente. / Dissertação (Mestrado em Tecnologia Nuclear) / IPEN/D / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

A monitorização terapêutica tem sido descrita como um recurso clínico valioso, na individualização do regime de dosagem, de acordo com a concentração do fármaco em amostras de plasma ou soro. O objetivo da monitorização terapêutica é assegurar a eficácia clínica e minimizar os efeitos adversos dos fármacos prescritos na clínica. A química analítica moderna tem sido direcionada para a simplificação dos métodos através da miniaturização dos sistemas analíticos, minimização do consumo de solvente orgânico e do volume da amostra. Neste contexto, metodologias analíticas utilizando as técnicas de microextração, extração sortiva em barra de agitação (SBSE) e microextração em sorvente empacotado (MEPS), juntamente com a eletroforese capilar em solução não-aquosa (NACE) foram desenvolvidas para fins monitorização terapêutica de antidepressivos inibidores seletivos da recaptação de serotonina (ISRSs: fluoxetina, sertralina, paroxetina e citalopram) em amostras de plasma de pacientes em terapia com ISRSs. Inicialmente foram padronizadas as condições eletroforéticas com detecção espectrofotométrica (UV) para análise simultânea dos ISRSs em amostras de plasma. Dentre as condições avaliadas (diferentes soluções de eletrólitos em meio aquoso e não aquoso, cromatografia eletrocinética micelar e NACE), a técnica NACE-UV foi a única que apresentou resolução dos fármacos adequada. Em seguida, otimizou-se as variáveis inerentes das técnicas de microextração (SBSE e MEPS), visando minimizar o tempo de análise e aumento da sensibilidade analítica. Para o método SBSE/NACE, as variáveis tempo e temperatura de extração, pH da amostra biológica e processo de dessorção foram otimizadas, já para o método MEPS/NACE, as variáveis, pH da amostra biológica, volume da amostra e número dos ciclos aspirar/dispensar foram otimizadas. A validação analítica foi realizada segundo as normas preconizadas pela Agência Nacional de Vigilância Sanitária (ANVISA), com adição de padrão de padrão interno às amostras de plasma enriquecidas com os antidepressivos em diferentes concentrações plasmáticas que contemplam o intervalo terapêutico dos ISRSs. Para avaliar a aplicabilidade das metodologias padronizadas, amostras de plasma de pacientes em terapia com os ISRSs foram analisadas. Os métodos padronizados (SBSE/NACE e MEPS/NACE) foram comparados ao método de referência (LLE/NACE), utilizando a extração líquido-líquido. As técnicas de microextração, quando comparadas à LLE, apresentaram as seguintes vantagens: a reutilização das fases extratoras, procedimentos de extração com reduzido número de etapas, menores volumes de amostras biológicas e de solventes orgânicos. Segundo os parâmetros de validação avaliados, os métodos SBSE/NACE e MEPS/NACE padronizados podem ser empregados nas análises dos antidepressivos (ISRSs) em amostras de plasma, para fins de monitorização terapêutica. / Therapeutic monitoring allows individualization of the dose regimen and has been indicated for the monitoring of well-established therapeutic intervals. In psychiatric disorders, most of the patients require that the plasmatic concentrations to be within a fixed range, so the disorders are kept under control and the adverse effects are acceptable. The aim of the therapeutic monitoring is ensure clinical effectiveness and minimization of adverse effects of drugs prescribed at the clinic. New trends in analytical chemistry have been directed towards simplification and miniaturization of analytical systems, and minimization of organic solvents and sample volume. In this work, analytical methodologies using microextraction techniques, such as stir bar sorptive extraction (SBSE) and microextraction by packed sorbent (MEPS), in conjunction with capillary electrophoresis in a nonaqueous background electrolyte (NACE) were developed for therapeutic drug monitoring of selective serotonin reuptake inhibitors (SSRIs: fluoxetine, sertraline, paroxetine and citalopram) in plasma sample of patients in therapy with SSRIs. First, the optimization of electrophoretic separation of the SSRIs was carried out to obtain simultaneous analysis of all antidepressants. Among the conditions evaluated (different background electrolytes in aqueous and nonaqueous medium, micellar electrokinetic capillary chromatography, and NACE), NACE-UV gave the best results. In the sequence, the optimization of the inherent variables of microextraction techniques (SBSE and MEPS)aiming analyses time minimization and increase of analytical sensibilitywas carried out. For SBSE/NACE methodology development the variables such as time of extraction, temperature of extraction, and matrix pH were optimized. For MEPS/NACE methodology the variables matrix pH and the volume of draw-eject cycles were optimized. Analytical validation was carried out in agreement with the norms of National Health Surveillance Agency (ANVISA) for both of the proposed methods, in different plasmatic concentrations, which completed the therapeutic interval. The developed methods (SBSE/NACE e MEPS/NACE) were compared to the reference method, using liquid-liquid extraction (LLE/NACE). Microextraction techniques, compared to LLE, gave the following advantages: reutilization of the extraction phase, fewer numbers of steps for extraction, reduction of sample volume, and less consumption of organic solvents. According to the evaluated validation parameters, the standardized methods SBSE/NACE and MEPS/NACE can be used in the analyses of antidepressants (SSRIs) in plasma sample for therapeutic drug monitoring purposes.

Neste trabalho, os anticorpos policlonais e monoclonais anti-fluoxetina foram produzidos em coelhos e camundongos, respectivamente, por imunização com o conjugado fluoxetina-soroalbumina bovina. Os anticorpos obtidos foram caracterizados em função da especificidade contra o fármaco por ELISA (enzyme linked immunosorbent assay) e posteriormente, purificados por afinidade em coluna fluoxetina-agarose labmade. Os anticorpos purificados foram imobilizados covalentemente na superfície vítrea das barras SBSE (extração sortiva em barra de agitação) labmade. Após a derivatização das barras com 3-aminopropiltrietoxisilano, dois métodos distintos de acoplamento dos anticorpos às barras SBSE foram avaliados: ativação com glutaraldeído e succinilação seguida de ativação via éster N-hidroxisuccinimida (NHS). A funcionalização das barras SBSE foi comprovada através da imobilização de enzima peroxidase (HRP) em lugar do anticorpo e posterior ensaio enzimático com as barras. Várias barras SBSE com diferentes áreas (1,2; 2,4; e 4,0 cm2) foram preparadas, dentre as quais, as com maior área imunosorvente apresentaram maiores taxas de recuperação do fármaco. A avaliação da morfologia da superfície da barra SBSE imunosorvente foi realizada através de Microscopia Eletrônica de Varredura (MEV). As variáveis do processo SBSE de imunoafinidade foram otimizadas para estabelecer o equilíbrio de sorção antígeno-anticorpo em um menor tempo de análise e obtenção de limite de quantificação compatível com o intervalo terapêutico do fármaco. As capacidades adsortivas das barras imunosorventes foram de 1,2 e 8 microgramas por cm2 para anticorpos policlonais e monoclonais, respectivamente. Os imunosorventes desenvolvidos apresentaram reatividade-cruzada apenas com norfluoxetina (metabólito ativo de fluoxetina). As barras imunosorventes foram reutilizadas aproximadamente 30 vezes, sem perda significativa da eficiência das extrações. Baseados nos parâmetros de validação analítica avaliados, os métodos de SBSE/LC-FD de imunoafinidade desenvolvidos são adequados para a determinação de fluoxetina em amostras de plasma de pacientes em terapia com o fármaco, para fins de monitorização terapêutica. Por conseguinte, esses métodos foram aplicados com êxito para análises de amostras de plasma de pacientes idosos em terapia com Prozac®. Neste trabalho, o método MEPS (microextração em sorvente empacotado)/LC-UV também foi desenvolvido e validado para análise simultânea de sertralina, paroxetina, citalopram, fluoxetina e mirtazapina em amostras de plasma para fins de monitorização terapêutica. As variáveis do processo MEPS foram otimizadas (pH e volume da amostra, força iônica, volume dos ciclos aspirar-dispensar e condições de dessorção) para estabelecer o equilíbrio de sorção em menor tempo de análise e obter sensibilidade analítica adequada para a determinação dos antidepressivos no intervalo terapêutico. O método MEPS/LC-UV desenvolvido permitiu integração da dessorção dos analitos e injeção da amostra no sistema cromatográfico (LC-UV) em uma única etapa, usando a microsseringa de extração MEPS. A fase extratora MEPS, M1 (C8/SCX), foi reutilizada mais de 50 vezes com perda mínima da eficiência da extração, comprovando a robustez do material sorvente. Segundo os parâmetros de validação analítica avaliados, o método MEPS/LC-UV desenvolvido é adequado para a determinação de antidepressivos em amostras de plasma para fins de monitorização terapêutica. / In this work, polyclonal and monoclonal anti-fluoxetine antibodies were developed in rabbits and mice by immunization with fluoxetine-bovine albumin conjugate, respectively. The developed antibodies were characterized on the basis of the specificity against the drug by ELISA (enzyme linked immunosorbent assay) and, subsequently they were purified by labmade fluoxetine-agarose affinity column. The purified antibodies were covalently immobilized onto the glass surface of labmade SBSE (stir bar sorptive extraction) bars. After derivatization of the bars with 3-aminopropyltriethoxysilane, two distinct methods were evaluated for the antibodies coupling to the SBSE bars: activation with glutaraldehyde and succinylation activation via ester N-hydroxysuccinimide (NHS). The functionalization of SBSE bars was confirmed by the immobilization of peroxidase (HRP) instead of the antibody and, subsequent enzymatic assay with the bars. Several SBSE bars with different areas (1.2, 2.4, and 4.0 cm2) were prepared, among of them the largest immunosorbent area showed higher recovery rates of the drug. The evaluation of surface morphology of the SBSE immunosorbent bar was performed using scanning electron microscopy (SEM). The SBSE immunoaffinity variables were optimized to establish sorption equilibrium of antigen-antibody in a short time analysis and to obtain the limit of quantification compatible with the therapeutic range of the drug. The adsorptive capacities of the immunosorbent bars were 1.2 and 8 micrograms per cm2 for polyclonal and monoclonal antibodies, respectively. The developed immunosorbents showed cross-reactivity only with norfluoxetine (active metabolite of fluoxetine). The immunosorbent bars were reused approximately 30 times without significant loss of the extraction efficiency. Based on evaluated analytical validation parameters, the developed immunoaffinity SBSE/LC-FD methods are suitable for the determination of fluoxetine in plasma samples from patients on therapy with the antidepressant for therapeutic drug monitoring. Therefore, these methods were successfully applied for the analysis of plasma samples from elderly patients undergoing therapy with Prozac®. In this work, the method MEPS (microextraction by packed sorbent)/ LC-UV was also developed and validated for the simultaneous analysis of sertraline, paroxetine, citalopram, fluoxetine and mirtazapine in plasma samples for therapeutic drug monitoring. The MEPS process variables were optimized (pH, sample volume, ionic strength, draw-eject cycles volume and desorption conditions) to establish the sorption equilibrium in a short time analysis and to obtain adequate analytical sensitivity for determination of antidepressants within therapeutic range. The developed MEPS/LC-UV method allowed integration of the analytes desorption and sample injection in the chromatographic system (LC-UV) in a single step, using a MEPS extraction microsyringe. The MEPS extraction phase, M1 (C8/SCX) was reused over 50 times with minimum loss of extraction efficiency, proving the robustness of the sorbent material. According to the evaluated analytical validation parameters, the developed MEPS/LC-UV method is suitable for the determination of antidepressants in plasma samples for therapeutic drug monitoring.

A depressão em idosos é uma desordem persistente e recorrente, resultado do stress psicossocial ou efeito de doenças fisiológicas, que podem acarretar a desabilidade do indivíduo, aumento dos sintomas das doenças clínicas, na maior utilização dos serviços de saúde e altas taxas de suicídios.A monitorização terapêutica permite a ndividualização do regime de dosagem, assegurando a eficácia clínica e minimizando os efeitos adversos dos fármacos, prescritos na clínica. Os antidepressivos têm sido monitorados, pois, apresentam intervalos terapêuticos bem estabelecidos, ou seja, a maioria dos pacientes, que apresentam concentrações plasmáticas dentro deste intervalo fixo, tem as desordens psiquiátricas mantidas sob controle e efeitos adversos aceitáveis. Os antidepressivos tricíclicos (ADTs): imipramina, amitriptilina, nortriptilina e desipramina, embora eficazes e ainda muito utilizados, apresentam efeitos adversos, não desejáveis. Os antidepressivos, inibidores seletivos da recaptação de serotonina (SSRIs): citalopram, fluoxetina, paroxetina e sertralina, apresentam eficácia clínica comparável aos clássicos ADTs, mas destituídos dos efeitos adversos associados aos mesmos. Os métodos convencionais, empregados no tratamento de amostras biológicas, para análises de antidepressivos por técnicas cromatográficas, têm sido a extração líquido-líquido e extração em fase sólida. A microextração em fase sólida tem sido empregada em diferentes análises em fluidos biológicos, porém essa técnica apresenta certas limitações como, o número limitado de fases extratoras disponíveis no comércio que sejam adequadas para a análise de compostos não iônicos. A avaliação de novas fases extratoras, mais seletivas, estáveis e de baixo custo tem sido requerida para a análise de fármacos. O interesse no uso de poli(pirrol) (PPY), como fase extratora para SPME, está relacionado às diferentes interações dos fármacos (hidrofóbicas, -, com o grupo funcional polar, troca iônica, ácido-base) aos grupos multifuncionais deste polímero. Sua polimerização pode ser alcançada tanto por oxidação química, quanto por eletrodeposição em meio aquoso ou orgânico. O método eletroquímico apresenta algumas vantagens, tais como: o polímero ou mistura de polimeros podem ser revestidos diretamente em um metal, incorporação de diferentes grupos funcionais, entre outras, a polimerização pode ser eletroquimicamente controlada através da voltametria cíclica. Neste trabalho o poli(pirrol) (PPY) foi eletrodepositado em eletrodo de aço inox e empregado para a microextração em fase sólida dos antidepressivos: paroxetina, fluoxetina, mirtazapina, duloxetina, sertralina e citalopram. As variáveis da eletrodeposição, número de ciclos e contra-íon empregado no processo de eletrodeposição foram otimizadas. Assim como as variáveis SPME: tempo, temperatura, pH e volume de amostra, e tempo e solvente de dessorção; almejando maior sensibilidade para o método SPME-PPY/LC UV proposto. A extração sortiva em barra de agitação (SBSE), técnica recente de preparo de amostras, para a pré-concentração de compostos orgânicos presentes em amostras biológicas, baseia-se na extração estática, através do polímero polidimetilsiloxano (PDMS), no qual ocorre a dissolução (sorção) do analito. Neste trabalho, as técnicas SBSE e cromatografia líquida de alta eficiência com detecção UV (SBSE/LC UV) foram avaliadas para a análise simultânea de antidepressivos em amostras de plasma para fins de monitorização terapêutica. As condições cromatográficas de análise, assim como as variáveis SBSE de extração (tempo, temperatura, força iônica, pH da matriz) e tempo de dessorção, foram otimizadas, visando adequada sensibilidade analítica. A validação analítica foi realizada segundo normas da ANVISA, para ambos os métodos propostos, em diferentes concentrações plasmáticas, as quais contemplam o intervalo terapêutico. Segundo os parâmetros de validação avaliados, os métodos SBSE/LCUV e SPMEPPY/LCUV padronizados poderão ser empregados nas análises dos antidepressivos, para fins de monitorização terapêutica. / Depression in the elderly is a persistent and recurrent disorder resulting from psychosocial stress or physiological effect or disease. This condition can lead to disability, cognitive impairment, enhanced symptoms of medical illnesses, increased use of health care services and, increased of suicide rates. Therapeutic monitoring allows individualization of the dose regimen, ensuring clinical effectiveness and minimizing the adverse effects of drugs, prescribed at the clinic. Antidepressants have been monitored because they present well - established therapeutic intervals; in other words, most of the patients present plasmatic concentrations within this fixed range, so that their psychiatric disorders are kept under control and the adverse effects are acceptable. The tricyclic antidepressants (ADTs) imipramine, amitriptyline, nortryptiline, and desipramine, have adverse effects. The selective serotonin reuptake inhibitors (SSRIs) antidepressants citalopram, fluoxetine, paroxetine, and sertraline, are clinically effectiveness as the classic ADTs, but they do not lead to the adverse effects associated to the latter. The conventional methods employed in the treatment of biological samples for analysis of antidepressants by chromatographic techniques have been the liquid-liquid extraction (LLE) and solid phase extraction (SPE) techniques. Solid-phase microextraction (SPME) has been used in various analyses of biological fluids. However, this technique has limitations such as the small number of comemercially available extracting phases that are appropriate for the analysis of non-ionic compounds. Investigation of new extraction phases that are more selective and stable, as well as inexpensive, has been requested for drug analysis. The interest in the use of poly(pirrole) (PPY) as an extraction phase for SPME is related to the different interactions of the drugs (hydrophobic, - , with the polar functional group, ionic exchange and acid-base) with the multifunctional groups on this polymer. The PPY polymerization can be achieved by chemical oxidation or electropolymerization in aqueous solution or organic solvents. The electrochemical method has advantages such as, the polymer or a mixes of polymers can be directly deposited on a metal wire, different functional groups can be incorporated, polymerization can be electrochemically controlled by cyclic voltammetry. In this work poly(pyrrole) was electropolymerized on stainless steel electrodes and employed for the solid phase microextraction of the antidepressants paroxetine, fluoxetine, mirtazapine, duloxetine, sertraline, and citalopram. The electropolymerization variables, the number of cycles and counterion employed in the process were optimized, as well as the SPME variables, time, temperature, pH, sample volume, and desorption solvent; aiming at a better sensibility for the proposed method SPME-PPY/LC-UV. The stir bar sorptive extraction (SBSE), recently established technique for samples preparation, that targets the pre concentration of organic compounds present in biological samples. It is based on static extraction, through the polymeric polydimethylsiloxane (PDMS), where there is analyte dissolution (sorption). In this work, the SBSE technique and liquid chromatography with UV detector (SBSE/LC-UV) were evaluated for the simultaneous determination of antidepressants in plasma samples for therapeutic monitoring purposes. The cromatographic conditions, the SBSE extraction variables (time, temperature, ionic strength and matrix pH), and the dessorption time were optimized for appropriate analytical sensibility. The analytical validation was accomplished according to the norms of ANVISA for both of the proposed methods, in different plasmatic concentrations, which contemplate the therapeutic interval. According to the evaluated validation parameters, the standardized methods SBSE/LC-UV and SPME-PPY/LC-UV can be used in the analyses of antidepressants for therapeutic drug monitoring purposes.