Depressive disorder is one of the most important diseases influencing human health in the 21st century. Antidepressants can improve some depressive symptoms and signs of depressive disorder in patients. It is thought that neurotransmitters (especially serotonin and/or norepinephrine and/or dopamine) have important roles in antidepression effects, but their pharmacological effects on the intracellular signal transduction pathway remain unclear. The aim of this thesis is to explore the effect of the antidepressants paroxetine (a selective serotonin reuptake inhibitor) and nortriptyline (a tricyclic antidepressant) on the intracellular Ca2+-related signal transduction and apoptosis of human prostate cancer PC3 cells. By using the fura-2 method, in PC3 cell, we found paroxetine (at concentrations between 10-150 £gM) and nortriptyline (at concentrations between 50-500 £gM) increased [Ca2+]i of PC3 cells in a concentration-dependent manner. The Ca2+ signal was reduced partly by removing extracellular Ca2+ indicating that Ca2+ entry and release both contributed to the [Ca2+]i rise. In Ca2+-free medium, pretreatment with the endoplasmic reticulum Ca2+ pump inhibitor nearly abolished paroxetine and nortriptyline-induced Ca2+ release. Conversely, pretreatment with nortriptyline greatly reduced the inhibitor-induced [Ca2+]i rise, suggesting that antidepressants released Ca2+ from the endoplasmic reticulum. Inhibition of phospholipase C with U73122 inhibited paroxetine-induced [Ca2+]i rise by 80%, but did not change nortriptyline-induced [Ca2+]i rise. Paroxetine-induced Ca2+ influx was inhibited by the store-operated Ca2+ channel blockers econazole and SK&F96365, the phospholipase A2 inhibitor aristolochic acid, and protein kinase C modulators. Nortriptyline-induced Ca2+ influx was inhibited by activation of protein kinase C. Nortriptyline at a concentration of 10 £gM increased the viability of the PC3 cells. At 50 £gM, nortriptyline killed 45% of the cells, and induced significant apoptosis, as measured by propidium iodide staining. Collectively, in PC3 cells, paroxetine induced [Ca2+]i rise is caused by phospholipase C-dependent Ca2+ release from the endoplasmic reticulum and Ca2+ influx via store-operated Ca2+ channels in a manner regulated by protein kinase C and phospholipase A2. Nortriptyline increased [Ca2+]i via phospholipase C-independent Ca2+ release from the endoplasmic reticulum and Ca2+ influx from the protein kinase C-sensitive pathway. Nortriptyline also induced apoptosis at a higher level. The results of this thesis may be helpful for understanding the effects of antidepressants on the intracellular signaling of cultured cells, and might illustrate a new possible mechanism concerning antidepressants¡¦ therapeutic effects or clinical side effects.

[pt] A bomba de sódio e potássio Na+,K+-ATPase é uma enzima que oscila entre duas conformações principais E1 e E2 durante o ciclo de transporte dos íons Na+ e K+ através de membranas. O esteróide cardiotônico ouabaína é um inibidor específico que se liga à enzima na conformação E2. A sonda fluorescente antroilouabaína (AO) apresenta incremento de fluorescência ao associar-se ao sítio de ouabaína da Na+,K+-ATPase. Várias drogas tricíclicas, incluindo o antipsicótico clorpromazina (CPZ) e o antidepressivo nortriptilina (NOR), inibem a atividade da Na+,K+-ATPase em concentrações clinicamente relevantes. No presente trabalho estudaram-se os efeitos de NOR e de CPZ sobre a fluorescência de AO associada a Na+,K+-ATPase. A nortriptilina aumentou a fluorescência de AO, tendo sido esse efeito dependente da concentração de droga e da conformação da enzima. Os resultados permitiram a obter a constante de associação NOR- Na+,K+-ATPase e sugeriram que essa associação tende a estabilizar a conformação E2. Já a clorpromazina em concentrações abaixo de 10 µM teve efeito desprezível sobre a fluorescência de AO. Irradiação com luz ultravioleta, no entanto, provocou reações foto-induzidas de CPZ com Na+,K+- ATPase que modificaram a cinética de formação dos produtos de fotodegradação de CPZ, como demonstrado através da fluorescência desses produtos. A foto-associação de CPZ com Na+,K+-ATPase alterou também a estrutura local do sítio de ouabaína, provocando aumento considerável do rendimento quântico e deslocamento do pico de fluorescência de AO. A fototoxicidade associada à CPZ indicou potencial para sua utilização em fotoquimioterapia. / [en] The sodium and potassium pump Na+,K+ -ATPase is an enzyme that oscillates between two major conformations E1 and E2 during the ion transport cycle across membranes. The cardiotonic steroid ouabain specifically inhibits this enzyme by binding to the E2 conformation. The fluorescent label anthroylouabain (AO) presents increased fluorescence when binding to the ouabain site of Na+,K+ - ATPase. Tricyclic drugs such as the antipsychotic chlorpromazine (CPZ) and the antidepressant nortriptyline (NOR) inhibit Na+,K+ -ATPase activity at clinically relevant concentrations. In the present work the effects of NOR and CPZ on the fluorescence properties of AO-bound Na+,K+ -ATPase of electrocyte membranes from E. electricus were studied. Nortriptyline was found to increase the AO fluorescence in a concentration and conformation-dependent manner. The association constant between NOR and Na+,K+ -ATPase was obtained. The results suggested that the binding of NOR shifts the conformation equilibrium of the enzyme towards E2. CPZ, on the other hand, induced negligible fluorescence change up to 10 µM. Ultraviolet irradiation, however, provoked photo-induced reactions of CPZ with Na+,K+ -ATPase, which modified the kinetics of CPZphotodegradation, as demonstrated by the fluorescent products. The photolabeling of Na+,K+ -ATPase with CPZ also modified the local structure of the ouabain site inducing a blue shift and a considerable increase of the AO quantum yield. The results suggest that CPZ binds to Na+,K+ -ATPase and photolabels amino-acid residues near the ouabain binding site. The CPZ-associated phototoxicity pointed to its potential use in photochemotherapy.

Background: Antidepressants are widely used in the treatment of chronic pain. Applied doses are lower than those needed to unfold an antidepressive effect. While efficacy of antidepressants for chronic pain has been reported in large randomized-controlled trials (RCT), there is inconsistent data on adverse effects and tolerability. We aimed at synthesizing data from RCT to explore adverse effect profiles and tolerability of antidepressants for treatment of chronic pain. Methods: Systematic literature research and meta-analyses were performed regarding side effects and safety of different antidepressants in the treatment of chronic pain according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The National Center for Biotechnology Information library and MEDLINE were searched. Randomized placebo-controlled trials were included in quantitative data synthesis. results: Out of 1,975 screened articles, 33 papers published between 1995 and 2015 were included in our review and 23 studies were included in the meta-analyses. A higher risk for adverse effects compared to placebo was observed in all antidepressants included in our analyses, except nortriptyline. The most prevalent adverse effects were dry mouth, dizziness, nausea, headache, and constipation. Amitriptyline, mirtazapine, desipramine, venlafaxine, fluoxetine, and nortriptyline showed the highest placebo effect-adjusted risk of adverse effects. Risk for withdrawal due to adverse effects was highest in desipramine (risk ratio: 4.09, 95%-confidence interval [1.31; 12.82]) followed by milnacipran, venlafaxine, and duloxetine. The most common adverse effects under treatment with antidepressants were dry mouth, dizziness, nausea, headache, and constipation followed by palpitations, sweating, and drowsiness. However, overall tolerability was high. Each antidepressant showed distinct risk profiles of adverse effects. conclusion: Our synthesized data analysis confirmed overall tolerability of low-dose antidepressants for the treatment of chronic pain and revealed drug specific risk profiles. This encompassing characterization of adverse effect profiles might be useful in defining multimodal treatment regimens for chronic pain which also consider patients’ comorbidities and co-medication.

Background: Antidepressants are widely used in the treatment of chronic pain. Applied doses are lower than those needed to unfold an antidepressive effect. While efficacy of antidepressants for chronic pain has been reported in large randomized-controlled trials (RCT), there is inconsistent data on adverse effects and tolerability. We aimed at synthesizing data from RCT to explore adverse effect profiles and tolerability of antidepressants for treatment of chronic pain. Methods: Systematic literature research and meta-analyses were performed regarding side effects and safety of different antidepressants in the treatment of chronic pain according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The National Center for Biotechnology Information library and MEDLINE were searched. Randomized placebo-controlled trials were included in quantitative data synthesis. results: Out of 1,975 screened articles, 33 papers published between 1995 and 2015 were included in our review and 23 studies were included in the meta-analyses. A higher risk for adverse effects compared to placebo was observed in all antidepressants included in our analyses, except nortriptyline. The most prevalent adverse effects were dry mouth, dizziness, nausea, headache, and constipation. Amitriptyline, mirtazapine, desipramine, venlafaxine, fluoxetine, and nortriptyline showed the highest placebo effect-adjusted risk of adverse effects. Risk for withdrawal due to adverse effects was highest in desipramine (risk ratio: 4.09, 95%-confidence interval [1.31; 12.82]) followed by milnacipran, venlafaxine, and duloxetine. The most common adverse effects under treatment with antidepressants were dry mouth, dizziness, nausea, headache, and constipation followed by palpitations, sweating, and drowsiness. However, overall tolerability was high. Each antidepressant showed distinct risk profiles of adverse effects. conclusion: Our synthesized data analysis confirmed overall tolerability of low-dose antidepressants for the treatment of chronic pain and revealed drug specific risk profiles. This encompassing characterization of adverse effect profiles might be useful in defining multimodal treatment regimens for chronic pain which also consider patients’ comorbidities and co-medication.