Generalized anxiety disorder (GAD) is associated with painful physical symptoms (PPS). These post hoc analyses of previous trial data assessed PPS and their response to duloxetine treatment in GAD patients. Studies 1 and 2 (n = 840) were 9- to 10-week efficacy trials; study 3 (n = 887) was a relapse prevention trial comprising a 26-week open-label treatment phase and a 26-week double-blind, placebo-controlled treatment continuation phase. Mean baseline visual analog scale scores (VAS, 0–100; n = 1727) ranged from 26 to 37 for overall pain, headache, back pain, shoulder pain, interference with daily activities, and time in pain while awake. In studies 1 and 2, improvement on all VAS scores was greater in duloxetine-treated than in placebo-treated patients (p ≤ 0.01). In study 3, pain symptoms worsened in responders switched to placebo compared with those maintained on duloxetine (p ≤ 0.02). In conclusion, duloxetine was efficacious in the short- and long-term treatment of PPS, which are common in GAD patients.

The objective was to examine duloxetine 60–120mg/day treatment for relapse prevention in adults with generalized anxiety disorder (GAD). Adult patients (N=887; mean age=43.3 years; 61.0% female) with DSM-IV-TR-defined GAD diagnosis were treated with duloxetine for 26 weeks. Patients who completed open-label phase and were treatment responders (≥50% reduction in Hamilton Anxiety Rating Scale total score to ≤11 and “much”/“very much improved” ratings for the last 2 visits of open-label phase) were randomly assigned to receive duloxetine or placebo for a 26-week double-blind continuation phase. Relapse was defined as ≥2-point increase in illness severity ratings or by discontinuation due to lack of efficacy. During the double-blind phase, placebo-treated patients (N=201) relapsed more frequently (41.8%) than duloxetine-treated patients (13.7%, N=204, P≤0.001) and worsened on each outcome measure (P≤0.001, all comparisons). Duloxetine 60–120 mg/day treatment was efficacious and reduced risk of relapse in patients with GAD.

The 5-HTT gene (SLC6A4) is regulated by a common polymorphism in the promoter region (5-HTTLPR), which has functional consequences. Two major alleles have been observed and shown to have differential transcriptional activity with the long (L) allele having greater gene expression than the short (S) allele. 5-HTTLPR appears to modulate depression, anxiety and personality traits such as neuroticism. Additionally, a significant influence of 5-HTTLPR genotype on amygdala reactivity in response to fearful stimuli has been reported. Moreover, 5-HTTLPR seems to impact on the role of stressful life events (SLEs) in the development of depression. An elevated risk of depression and suicidal behaviors has been found in carriers of at least one low expressing S allele who had experienced SLEs, suggesting a gene x environment interaction. However, a recent meta-analysis showed that several findings failed to replicate this finding. Since genetic polymorphisms of the dopaminergic and serotonergic neurotransmission interact at the molecular, analyses with another polymorphism of the dopaminergic system, the dopamine D4 receptor (DRD4) was included to consider these likely gene-gene interactions (epistasis). The aim of this series of studies was to investigate the role 5-HTTLPR and SLEs on the endocrine stress response in different age samples. While newborns have been examined by a heel prick, stress responses were provoked in children (8-12 yrs) and younger adults (19-31 yrs) and older adults (54-68 yrs.) with the Trier Social Stress Test (TSST). The Life History Calendar (LHC) and Life Events Questionnaire (LEQ) were used to acquire data on SLEs. While in newborns the S/S genotype showed a significantly higher acute endocrine stress response than L/L or S/L genotypes, no significant difference between genotype groups was found in children. In the younger adult sample, the genotype impacted on cortisol stress responsiveness was reversed. Adults carrying the more active L allele of the 5-HTTLPR polymorphism showed a significantly larger cortisol response to the TSST than individuals carrying at least one of the lower expressing S allele. In older adults, no significant difference between genotype groups was found. However, results point in the same direction with showing highest cortisol response in individuals with L/L genotype. These data suggest that the association between 5-HTTLPR and endocrine stress reactivity seems to alter across lifespan, more specific the effects of genotype turns around. In addition, a significant interaction effect of 5-HTTLPR and SLEs has been found in the sample of younger adults, i.e. that early SLE as well as a severe number SLEs across the entire lifespan seem to modulate the interaction between HPA axis activity and 5-HTTLPR genotype. Additionally, a DRD4 by 5-HTTLPR interaction emerged which point to independent and joint effects of these polymorphisms on stress responsivity with regard to the concept of genegene interaction.

No description available.

Objectives: To investigate the effects of serotonin and melatonin (MLT) on the regulation of malignant growth and the activity of serotonin receptors (5HTR1a/-1b) in prostate cancer (PCa) cell lines. Materials and Methods: In four PCa cell lines (LNCaP, 22RV1, PC3, DU145) and two reference cell lines 5HTR1a and -1b, relative mRNA expression levels were assessed. Different serotonin and MLT receptor agonists and antagonists were used in stimulation and inhibition experiments. Results: mRNA expression of 5HTR1b was higher than that of 5HTR1a in all PCa cell lines. Serotonin showed a significant growth stimulatory effect in all PCa lines. The 5HTR1a and -1b agonists/antagonists did not significantly affect viability. MLT inhibited viability only in PC3 cells. Similarly, the 5HTR1a antagonist induced apoptotic changes in PC3 cells only at 10–4M, while the 5HTR1b antagonist induced necrosis at 10–4M in all cell lines. Cell cycle alterations were seen in PC3 and DU145 cells under the influence of the 5HTR1a antagonist. Conclusions: Serotonin receptor antagonists and agonists as well as MLT influence viability and apoptosis of PCa cell lines at supraphysiologic concentrations. In contrast to other reports, our results do not support a regulatory role of serotonin or MLT receptor activation or inhibition in PCa growth. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 5 uppsatser.

Anorexia Nervosa (AN) and Bulimia Nervosa (BN) are diseases with considerable individual variation. Genetic background plays an important role in disease susceptibility and severity. To evaluate the relationship between certain genetic loci and diseases subtypes we genotyped and analysed evolution of selected clinical parameters. We investigated a group of 75 pacients with AN (1. study), 127 DSM-4 and ICD-10 diagnosed patients with AN and BN (2. study), and contributed to sample of 2907 AN patients in large GWAS study. Results from the 1st study support association of polymorphism -1438G/A in serotonine receptor 5-HT2A with AN and compare the results from other studies with metaanalyses. In next, polymorphism responsible for the serotonine neurotransmission (serotonine transporter 5-HTT, polymorphisms LPR and VNTR) the study shows different association trend of LPR with AN in Czech population compared to other studies. 5-HTT VNTR polymorphism had no observed association. The second study investigated the role of hemeoxygenase 1 (plays a pivotal role in metabolic stress protecting cells) in eating disorders, in interaction with enviromental stress. We investigated the usefulness of an aggregate measure of the risks of AN and BN that is based on genetic susceptibility loci and the added effect of...

A epilepsia é a condição crônica mais prevalente dentre as doenças neurológicas graves, associada com taxas significativas de morbidade e mortalidade. Pacientes com epilepsia farmacorresistente possuem uma taxa de mortalidade 2 a 3 vezes maior que indivíduos sem epilepsia. A epilepsia do lobo temporal (ELT) é a principal causa de epilepsia farmacorresistente nos adultos e também o protótipo da epilepsia cirurgicamente tratável, portanto, com maior acessibilidade para estudo de possíveis mecanismos epileptogênicos. Esclerose hipocampal (EH) é o achado neuropatológico mais comum em pacientes com ELT. Evidências, baseadas em experimentos animais e estudos em humanos, sugerem que as vias serotoninérgicas desempenham um importante papel na epileptogênese. Pacientes com ELT, causadas pela EH, apresentam maior prevalência de transtornos do humor e psicose contribuindo para uma pior qualidade de vida, com consequente impacto negativo nas respostas terapêuticas farmacológicas e cirúrgicas. Além disso, alguns estudos sugerem a existência de um mecanismo patogênico operante comum entre estas condições. Portanto, esta é um importante variável para análise. O objetivo desse estudo foi correlacionar as variáveis clínicas da epilepsia e a presença de transtornos psiquiátricos coexistentes com a concentração de serotonina (5-HT), a densidade dos receptores serotoninérgicos e a densidade do transportador serotoninérgico (5-HTT) no hipocampo dos pacientes com ELT-EH, que foram submetidos à cirurgia devido à presença de epilepsia farmacorresistente. Foram avaliadas amostras de 44 hipocampos de pacientes cirurgicamente tratados para ELT-EH. A concentração de 5-HT foi avaliada por cromatografia líquida de alta eficiência (HPLC) com detecção por fluorescência. 5-HTT e os receptores serotoninérgicos 5-HT1A, 5-HT2A, 5-HT6 e 5-HT7 foram avaliados por Western Blot. Níveis mais baixos de concentração de 5-HT estiveram associados com a presença de crises TCG (Wilcoxon-Mann-Whitney; p = 0.019). A densidade aumentada do receptor 5-HT1A esteve associada com maior duração da epilepsia (coeficiente de correlação de Spearman: p = 0.040) e a densidade diminuída do receptor 5-HT6 esteve associado com presença de EME (Wilcoxon-Mann-Whitney: p = 0.0027). A densidade dos receptores 5-HT2A e 5-HT7 e do 5-HTT não estiveram associadas com variáveis clínicas da epilepsia. A concentração de 5-HT, a densidade dos receptores e a densidade de 5-HTT não estiveram associadas à presença dos transtornos psiquiátricos neste grupo de pacientes. Nossos achados sugerem que as vias serotoninérgicas estão associadas com mecanismos de epileptogênese. Não foi evidenciado associações entre as vias serotoninérgicas e a presença de comorbidades psiquiátricas neste grupo de pacientes com ELT-EH / Epilepsy is the most prevalent neurological condition and it is associated with significative morbidities and mortalities rates. Patients with refractory epilepsy have a 2- to 3-fold higher mortality rate than people without epilepsy. Temporal lobe epilepsy (TLE) is the most common form of adult drug-resistant epilepsy. It is also the prototype of a surgically treatable epilepsy and because of that it is the most accessible for studies focused in epileptogenesis. Hippocampal sclerosis (HS) is the most common neuropathological finding in patients with TLE. Evidences from experimental, clinical and image studies suggest that the serotonergic system play an important role in epileptogenesis. Patients with TLE-HS have a higher prevalence of mood disorder and psychosis contributing for a worse quality of life with and consequent negative impact in pharmacological and surgical responses. Furthermore, studies suggest a common pathogenic mechanism operant in both conditions. Therefore, this is an important analytical variable. The objective of this study was to correlate clinical variables of epilepsy and the presence of psychiatric disease with serotonin (5-HT) concentration, serotonergic receptor density and serotonergic transporter (5-HTT) density in the hippocampus of TLE-HS patients submitted for surgery due to refractory epilepsy. It was analyzed 44 hippocampal tissue samples from surgical treated TLE-HS patients. 5-HT concentration was assessed by high pressure liquid chromatography (HPLC) with fluorescence detection. 5-HTT and serotonergic receptors 5-HT1A, 5-HT2A, 5-HT6 and 5- HT7 were assessed by Western Blotting. Lower levels of 5-HT concentration were associated with the presence of generalized tonic-clonic seizures (Wilcoxon-Mann-Whitney; p = 0.019). A higher 5-HT1A receptor density was associated with longer epilepsy duration (Spearman correlation coefficient: p = 0.040). Lower 5-HT6 receptor density was associated with the presence of status epilepticus (Wilcoxon-Mann-Whitney: p = 0.0027). 5-HT2A receptor, 5- HT7 receptor and 5-HTT densities were not associated with clinical variables of epilepsy. 5-HT concentration, serotonergic receptors and transporter densities were not associated with the presence of psychiatric disease in this group of patients. Our findings suggest that the serotonergic pathways are associated with epileptogenesis mechanisms. It was not evidenced any association between serotonergic pathways and psychiatric comorbidities in this group of TLE-HS patients

Obsessive-compulsive disorder (OCD), with a prevalence of 1-2 %, frequently leads a chronic course. Persons with OCD are often reluctant to seek help and, if they do, their OCD is often missed. This is unfortunate, since active treatment may substantially improve social function and quality of life. Serotonin reuptake inhibitors (SRIs) have welldocumented efficacy in OCD, but delayed response may be problematic. Methods to predict response have been lacking. Because SRIs are effective, pathophysiological research on OCD has focussed on serotonin. However, no clear aberrations of serotonin have been found, thus other mechanisms ought to be involved. Our aims were to facilitate clinical detection and assessment of OCD, to search for biochemical correlates of response and side-effects in SRI treatment of OCD and to identify any possible involvement of oxytocin in the pathophysiology of OCD. In study I, we tested in 402 psychiatric out-patients the psychometric properties of a concise rating scale, “Brief Obsessive Compulsive Scale” (BOCS). BOCS was shown to be easy to use and have excellent discriminant validity in relation to other common psychiatric diagnoses. Studies II-V were based on 36 OCD patients from a randomised controlled trial of paroxetine, clomipramine or placebo. In study II, contrary to expectation, we found that the change (decrease) of serotonin in whole blood was most pronounced in non-responders to SRI. This is likely to reflect inflammatory influence on platelet turnover rather than serotonergic processes within the central nervous system. In studies IV-V, we found relations between changes of oxytocin in plasma and the anti-obsessive response, and between oxytocin and the SRI related delay of orgasm, respectively. In both cases, the relation to central oxytocinergic mechanisms is unclear. In males, delayed orgasm predicted anti-obsessive response.

Selective serotonin re-uptake inhibitors (SSRIs) are a class of anxiolytic and anti-depressant drugs. SSRIs act on the evolutionarily ancient serotonergic system which is virtually identical throughout the vertebrate phylum. Serotonin is involved in a wide range of processes ranging from neuronal and craniofacial embryonic development to regulation of behaviour. However, SSRIs are also emerging pollutants, mainly entering the environment via sewage treatment plants. Since the serotonergic system is virtually identical in humans and other animals, exposed animals will be affected in similar ways as humans and suspicions are rising that ecologically important behaviours may be affected in subtle ways. Using the three-spined stickleback (Gasterosteus aculeatus) and zebrafish (Danio rerio) as model organisms, this thesis focuses on the behavioural effects of SSRIs in fish. The SSRI used throughout this thesis is citalopram, which has been found in fish in coastal areas of the Baltic Sea and other parts of the world. Effects on behaviour were investigated using several different tests measuring stress response, feeding behaviour, aggression and locomotor activity. Anxiolytic effects of 0.1 μg/l, 1.5 μg/l 15 μg/l were investigated as well as effects of 0.15 μg/l and 1.5 μg/l on feeding behaviour. Because serotonin is involved in the development of the nervous system, the effects of developmental exposure to 1.5 μg/l was studied after 100 days of remediation. Finally, because SSRIs rarely occur alone in natural waters, the effects on zebrafish of citalopram in a cocktail scenario, with the anxiogenic compound 17α-ethinyl estradiol (EE2 ) was also investigated. Citalopram was found to have anxiolytic effects on the three-spined stickleback at 0.1 μg/l, 1.5 μg/l and 15 μg/l. Citalopram also suppressed feeding behaviour within a week of exposure and at concentrations as low as 0.15 μg/l. Developmental exposure to 1.5 μg/l for 30 days was found to increase aggression and feeding behaviour and to reduce locomotor activity. The changes were persistent and remained in adult fish. In the cocktail scenario, citalopram in single-substance exposure had anxiolytic effects on one parameter in the novel tank test at 0.1 μg/l. Citalopram enhanced the anxiogenic effects of EE2 in the novel tank test, but in the scototaxis test citalopram appeared to counteract the effects of EE2. It is concluded that citalopram has the potential to affect behaviour in fish at concentrations that have been found in close proximity of sewage treatment plants. / Det serotonerga systemet är i stort sett identiskt hos människor och övriga vertebrater. Serotonin är inblandat i ett stort antal kroppsliga funktioner, bland annat stressreaktioner, reglering av födobeteende och aggression. Vidare är serotonin med och reglerar nervsystemets tillväxt under embryonalutvecklingen. Selektiva serotoninåterupptagshämmare (SSRI) är en grupp antidepressiva och lugnande läkemedel vars användning har ökat snabbt på senare år då de är effektiva och har få allvarliga bieffekter. SSRI verkar på det serotonerga systemet, genom att blockera återupptaget av serotonin i den presynaptiska nervänden. SSRI har tilldragit sig en viss uppmärksamhet som potentiella miljöhot då de visats kunna påverka ekologiskt relevanta beteenden hos fisk och andra akvatiska organismer vid relativt låga koncentrationer i miljön samtidigt som de bryts ned dåligt i avloppsreningsverk. Avhandlingen fokuserar på ekologiskt relevanta beteendeeffekter av SSRI på fisk, med storspigg (Gasterosteus aculeatus) och zebrafisk (Danio rerio) som modellorganismer. Citalopram har använts som försökssubstans då det anses vara den SSRI som har minst antal sidoeffekter på till exempel det dopaminerga systemet. Citalopram förekommer i utloppsvatten från reningsverk i alla industrialiserade länder och har även hittats i abborre i Östersjön. Effekter av exponering för SSRI har påvisats med hjälp av olika beteendetest. Skototaxi-test och novel tank diving test mäter stressresponsen genom att kvantifiera preferensen för närhet till botten och mörka omgivningar. Ätbeteende har mätts som antal utfall mot en matbit under en given tidsperiod och aggression har mätts genom att räkna antal bett mot en spegel. Anxiolytiska effekter undersöktes vid koncentrationer på 0,1 µg/l, 15 µg/l och 1,5 µg/l. Effekter på ätbeteende undersöktes vid 0,15 µg/l och 1,5 µg/l. Eftersom serotonin är inblandat i embryonalutvecklingen testades de beteendemässiga effekterna av exponering för 1,5 µg/l under utvecklingen. Då citalopram sällan förekommer ensamt i miljön testades ett cocktailscenario där zebrafisk samtidigt exponerades för citalopram och den anxiogena substansen 17α-etinylestradiol (EE2). Citalopram befanns ha anxiolytisk verkan på storspigg samt undertrycka ätbeteendet. Effekter på ätbeteendet uppstod inom en vecka efter exponering och vid den minsta testade dosen vilken var 0,15 µg/l. Storspigg som exponerats under embryonalutvecklingen var mer aggressiva, hade lägre lokomotoraktivitetoch gjorde fler utfall mot mat då de testades 100 dagar efter att exponeringen avslutats. Samtidigt exponering för citalopram och den anxiogena substansen 17α-etinylestradiol (EE2) gav tvetydiga resultat. Citalopram ensamt hade ingen signifikant påverkan på beteendet i detta försök. I skototaxitestet motverkade citalopram den anxiogena effekten av EE2 medan det förstärkte den anxiogena effekten i novel tank. Sammanfattningsvis har citalopram effekter på ekologiskt relevanta beteenden hos fisk i koncentrationer som förekommer i ytvatten. Det har också permanenta effekter på beteende om exponeringen sker under embryonalutvecklingen. Dessa resultat gör det sannolikt att citalopram och andra SSRI har ekologiska effekter i påverkade vattendrag.