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To compare the efficacy and safety of augmenting paroxetine with risperidone, buspirone, valproate, trazodone, or thyroid hormone in patients with treatment-resistant depression (TRD), 225 patients with retrospectively and/or prospectively identified stage II TRD were randomly assigned to receive an 8-week treatment of paroxetine 20 mg/d augmented with risperidone 2 mg/d (n = 45), sodium valproate 600 mg/d (n = 39), buspirone 30 mg/d (n = 46), trazodone 100 mg/d (n = 47), or thyroid hormone 80 mg/d (n = 48). The primary outcome was the remission rate defined as the 17-item Hamilton Rating Scale for Depression score of 7 or less at the end of study. Secondary outcomes included remission rate based on the Self-rating Depression Scale score of 50 or less at the end of study, response rate based on 17-item Hamilton Rating Scale for Depression total score of 50% improvement or greater from baseline, and the change in scores of Clinical Global Impression-Improvement scale, the Short Form 36 Health Survey, and the Life Satisfaction Rating Scale. The remission rates were 26.7% for risperidone, 48.7% for valproate, 32.6% for buspirone, 42.6% for trazodone, and 37.5% for thyroid hormone. There was no statistical significance among treatment arms in remission rates, secondary outcome measures, and adverse events. Risperidone, valproate, buspirone, trazodone, or thyroid hormone augmentation to paroxetine 20 mg/d was effective and well tolerated in Chinese patients with TRD. Large-sample studies are warranted to support or refute these findings.
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Cognitive deficits are often associated with acute depressive episodes and contribute to the functional impairment seen in patients with Major Depressive Disorder (MDD). Many patients sustain residual cognitive deficits after treatment that may be independent of the core MDD disorder. We tracked changes in cognitive deficits relative to antidepressant treatment response using the patient self-rated Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (MGH-CPFQ) during a 6-week, double-blind trial of a combination antidepressant treatment (buspirone 15 mg with melatonin-SR 3 mg) versus buspirone (15 mg) monotherapy versus placebo in MDD patients with acute depressive episodes. The CPFQ includes distinct cognitive and physical functioning dimension subscales. Treatment response was determined using the Inventory of Depressive Symptomatology (IDSc30). Treatment responders improved significantly more on the total CPFQ than non-responders (p < 0.0001) regardless of treatment assignment. The cognitive dimension of the CPFQ score favored the combination treatment over the other two groups (ANCOVA: p = 0.050). Among the treatment non-responders, the effect size for the CPFQ cognitive dimension was 0.603 favoring the combination treatment over the over two groups and 0.113 for the CPFQ physical dimension. These preliminary findings suggest that a combination of buspirone with melatonin may benefit cognitive function distinct from mood symptoms and that some aspects of cognition may be specific targets for treatment within a population of patients with MDD.
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Numerous studies have suggested that the central alpha2-adrenergic receptor system may exert an important role in some types of human anxiety. The anxiolytic-like activity and potential side effect-like activities of the novel and purported alpha2-adrenergic compound TDIQ (5,6,7,8-1,3-dioxolo[4,5-g]isoquinoline) were compared to those of the anxiolytic drugs diazepam and buspirone, and the nonselective alpha2-adrenergic agent clonidine. Anxiolytic-like behavior was assessed in an object (marble)-burying assay, a selective test for the evaluation of known anxiolytics and identification of putative antianxiety compounds, that used mice housed either alone or in groups (5/cage). The rodents' antianxiety-like effect was defined as dose-related increases in the number of marbles that remained uncovered in their bedding material without concomitant disruption of their motor activities. Rotarod and inclined screen procedures were employed as potential indicators of side effects. An additional test monitored the heart rate (HR) and blood pressure (BP) of mice after the intravenous (IV) administration of doses of TDIQ. The reference compounds inhibited marble-burying behavior in a dose-related manner and produced various degrees of impairment in the side effect tests. TDIQ also inhibited object burying and displayed a wide separation between doses that produced anxiolytic-like activity and doses that produced some, if any, disruption of coordinated movement and/or motor activity. Moreover, the IV administration of TDIQ, up to 10 mg/kg, produced negligible effects on the HR and BP of mice. TDIQ could be a lead candidate for a new type of structural compound in the treatment of certain forms of anxiety.
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Most G. sempervirens dilutions did not affect the total distance traveled in the OF (only the 5C had an almost significant stimulatory effect on this parameter), indicating that the medicine caused no sedation effects or unspecific changes in locomotor activity. In the same test, buspirone induced a slight but statistically significant decrease in locomotion. G. sempervirens showed little stimulatory activity on the time spent and distance traveled in the central zone of the OF, but this effect was not statistically significant. In the LD test, G. sempervirens increased the % time spent in the light compartment, an indicator of anxiolytic-like activity, with a statistically significant effect using the 5C, 9C and 30C dilutions. These effects were comparable to those of buspirone. The number of transitions between the compartments of the LD test markedly increased with G. sempervirens 5C, 9C and 30C dilutions.
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The subjects with a good outcome had a higher self-directedness and lower harm avoidance score; this difference was more pronounced in the fluoxetine-treated subjects. At multiple regression analysis, only self-directedness predicted a good outcome.
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The study was conducted on 36 male albino Wistar rats. Animals injected with saline, buspirone (0.2 mg/kg) and propranolol (1 mg/kg) for 2 weeks were exposed to an episode of 2 hours restraint stress. Cumulative food intake and body weight changes were monitored over a period of 24 hours. Exploratory activity in the lit area of light dark box was monitored 24 hours after the termination of restraint period.
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Response rate was 37% for ophthalmologists and 34% for neurologists. The most common causes of acquired nystagmus were estimated to be multiple sclerosis and stroke. 58% of ophthalmologists and 94.5% of neurologists reported seeing patients with nystagmus. The most commonly used medical treatment was gabapentin and baclofen. Other drugs used were clonazepam, carbamazepine, benzhexol, ondansetrone, buspirone, memantine, and botulinum toxin (n=3). Eleven ophthalmologists and 52 neurologists noted symptomatic improvement with medical treatment. Eleven ophthalmologists and 44 neurologists noted improvement in visual acuity (VA). Occurrence of side effects noted with baclofen and gabapentin treatments were similar.
Naloxone has previously been shown to block the effects of benzodiazepines in the Swiss but not in the BALB/c strain. We have also reported that naloxone potentiates subeffective doses of benzodiazepines in Swiss mice. In the present studies we first determined whether naloxone could block anxiolytic-like effects of meprobamate in Swiss and BALB/c mice. Then we evaluated if subeffective doses of meprobamate could be potentiated in Swiss as well as in BALB/c mice. The elevated plus-maze test and the light/dark choice procedure were used. The lowest dose of meprobamate with anxiolytic-like effects was 60 mg/kg in the BALB/c mice. This dose was effective in both the plus-maze and in the light/dark choice procedure. In Swiss mice the same dose was effective in the plus-maze, whereas 120 mg/kg was required in the light/dark choice procedure. When an effective dose of meprobamate was combined with naloxone, 10 mg/kg, no blockade of anxiolytic-like effects was obtained in any strain in any procedure. To the contrary, when a subeffective dose of meprobamate was combined with naloxone, 10 mg/kg, an anxiolytic-like effect was obtained in both strains in both procedures. The present series of experiment shows that the ability of naloxone to block anxiolytic-like drug effects do not apply to meprobamate. However, the naloxone-induced potentiation of subeffective doses previously observed after treatment with benzodiazepines or buspirone was present also after treatment with meprobamate. Moreover, although blockade of anxiolytic-like drug effects with naloxone has not been observed in BALB/c mice, potentiation was as evident in that strain as in the Swiss. This suggests that the mechanisms behind naloxone's blockade of anxiolytic-like effects are independent from those behind its potentiation of such effects.
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Prolactin response to buspirone was evaluated in patients with schizophrenia, with and without tardive dyskinesia (TD). Prolactin response in patients with schizophrenia without TD was significantly decreased, compared to healthy comparison subjects (F = 6.36, df = 5, p < 0.0001). Furthermore, prolactin levels after administration of buspirone were not significantly increased from baseline. In contrast, there was no prolactin response difference between patients with schizophrenia and TD and healthy subjects. This finding suggests that decreased dopamine (D(2)) receptor sensitivity may result in lower risk of developing TD and may lead to a fuller understanding of the variable expression of D(2)-receptor mediated side effects.
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Buspirone, a non-sedating anxiolytic, has yielded contradictory results in smoking cessation pilot studies and trials. We tested buspirone (n = 51) versus placebo (n = 49) in a placebo-controlled, double-blind trial of smoking cessation. Survival analyses were performed with use of strict abstinence criteria for efficacy (carbon monoxide levels < or = 8 ppm; no self-reported slips to smoking). No treatment differences were observed between active and placebo groups. There were also no differences among "anxiety" level groups formed post hoc from high versus low, pre-quit anxiety test scores. A number of withdrawal symptoms increased significantly after subjects quit smoking for both the active drug and placebo groups, but these symptoms were not relieved by treatment. There appears to be little evidence that buspirone is effective in smoking cessation or in the relief of withdrawal associated with cessation in a general sample. Selecting for generalized anxiety or anxiety related to cessation is suggested for future testing.
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During the study 9 patients dropped out (4 from the BSR group and 5 from the AML group). Twelve (54.4%) patients from the BSR group responded to treatment (> 50% reduction in the headache index), compared to 17 (60.7%) from the AML group. In the BSR group, 14 (53.8%) patients reported various mild side effects (nausea most frequently), vs 21 (65.5%) of the AML group (mouth dryness more frequently). Patients treated with AML had better opinion and used less drugs for the acute treatment of headaches than the BSR treated patients.
Dopamine receptors (DR) have been extensively studied, but only in recent years they became object of investigation to elucidate the specific role of different subtypes (D1R, D2R, D3R, D4R, D5R) in neural transmission and circuitry. D1-like receptors (D1R and D5R) and D2-like receptors (D2R, D2R and D4R) differ in signal transduction, binding profile, localization in the central nervous system and physiological effects. D3R is involved in a number of pathological conditions, including schizophrenia, Parkinson's disease, addiction, anxiety, depression and glaucoma. Development of selective D3R ligands has been so far challenging, due to the high sequence identity and homology shared by D2R and D3R. As a consequence, despite a rational design of selective DR ligands has been carried out, none of currently available medicines selectively target a given D2-like receptor subtype. The availability of the D3R ligand [(11)C]-(+)-PHNO for positron emission tomography studies in animal models as well as in humans, allows researchers to estimate the expression of D3R in vivo; displacement of [(11)C]-(+)-PHNO binding by concurrent drug treatments is used to estimate the in vivo occupancy of D3R. Here we provide an overview of studies indicating D3R as a target for pharmacological therapy, and a review of market approved drugs endowed with significant affinity at D3R that are used to treat disorders where D3R plays a relevant role.
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The antidepressant effects of essential oils of Anthemis nobilis (chamomile), Salvia sclarea (clary sage; clary), Rosmarinus officinalis (rosemary), and Lavandula angustifolia (lavender) were assessed using a forced swim test (FST) in rats. Rats were treated with essential oils by intraperitoneal injection or inhalation. Serum levels of corticosterone were assessed by enzyme-linked immunosorbent assay (ELISA).
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Behavioral changes in zebrafish induced by acute administration of buspirone have been interpreted to be the result of reduced anxiety. The purpose of the current study was to determine whether the effects of short-term and mid-term habituation to an open field corroborated the anxiolytic hypothesis. We exposed single zebrafish for 60 min to 5 mgL buspirone and tested them twice, immediately after exposure and again 3.5 h later. Each session lasted 20 min. Distance from bottom of tank, velocity, duration freezing, distance from center and horizontal distribution, and preferred spatial location were analyzed with a 3-D tracking system. In the early session (starting at 10:30), 20 min habituation of control zebrafish only marginally increased distance from bottom, which was still 90% higher in zebrafish treated with buspirone. When extending the habituation to 3.5 h, the picture became more complex. Distance from bottom did not further increase in control zebrafish. More importantly, some signs of increased anxiety were present in the buspirone group, such as increased freezing, reduced velocity, and increased bottom-dwelling. However, analyzing data of individual fish excluded rebound anxiety as unlikely. The delayed effects might be drug side effects, such as motor impairment and/or dizziness. The immediate and the delayed effects of buspirone have the appearance to be unrelated.
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Citalopram is a selective serotonin reuptake inhibitor that is N-demethylated to N-desmethylcitalopram partially by CYP2C19 and partially by CYP3A4 and N-desmethylcitalopram is further N-demethylated by CYP2D6 to the likewise inactive metabolite di-desmethylcitalopram. The two metabolites are not active. The fact that citalopram is metabolised by more than one CYP means that inhibition of its biotransformation by other drugs is less likely. Besides citalopram has a wide margin of safety, so even if there was a considerable change in serum concentration then this would most likely not be of clinical importance. In vitro citalopram does not inhibit CYP or does so only very moderately. A number of studies in healthy subjects and patients have confirmed, that this also holds true in vivo. Thus no change in pharmacokinetics or only very small changes were observed when citalopram was given with CYP1A2 substrates (clozapine and therophylline), CYP2C9 (warfarin), CYP2C19 (imipramine and mephenytoin), CYP2D6 (sparteine, imipramine and amitriptyline) and CYP3A4 (carbamazepine and triazolam). At the pharmacodynamic level there have been a few documented cases of serotonin syndrome with citalopram and moclobemide and buspirone. It is concluded that citalopram is neither the source nor the cause of clinically important drug-drug interactions.
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The strongest recommendations for controlled studies of safety and efficacy in children and adolescents can be given for the following drugs: benzodiazepines for acute anxiety; buspirone (and newer serotonin 1A agonists as they become available) for anxiety and depression; beta-blockers for aggressive dyscontrol; guanfacine for attention-deficit/hyperactivity disorder; and naltrexone for hyperactivity, inattention, and aggression in autistic disorder.
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Systematic review of papers published in English for the last 10 years.
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The azapirone class of anxiolytic drugs is being evaluated for clinical use in the treatment of depression. Buspirone, a serotonin (5-hydroxytryptamine, 5-HT) partial agonist active at the 5-HT1A receptor subtype, was evaluated in the treatment of depression in a series of five placebo-controlled, parallel group studies involving 382 patients with DSM-III major depression and significant associated anxiety symptoms (both Hamilton depression [HAM-D] and Hamilton anxiety [HAM-A] scales greater than or equal to 18). Buspirone therapy was initiated at 15 mg/day with individual dose titration to a maximum of 90 mg/day and resulted in marked improvement in both depressive and anxiety symptoms. Analyses of the composite data base from the five studies show significant (p less than 0.05) improvement in mean HAM-D, HAM-A, and Clinical Global Impression-Global Improvement scale ratings for buspirone-treated compared with placebo-treated patients. Of particular interest was significant improvement in cardinal depression symptoms, e.g., depressed mood, guilt, work and interest, anergia, and diurnal variation of mood. Subset analyses revealed that patients with melancholic-type major depression and patients with more severe symptoms (judged by higher initial HAM-D or HAM-A total scores) responded better to buspirone than did patients who were less ill. The buspirone dose most frequently associated with clinically significant improvement was 40 mg/day. Gepirone, an analogue of buspirone with highly selective binding affinity for the 5-HT1A receptor subtype, also shows promise of antidepressant efficacy in preliminary controlled clinical trials. These data suggest that azapirones, which as partial agonists modulate 5-HT1A receptor function, have clinically important antidepressant properties.
Evidence suggests that generalized anxiety disorder (GAD) has a fairly chronic course marked by significant long-term distress and comorbidity. Research has focused on short-term treatment of GAD, and long-term outcome studies after either short- or long-term treatment have been relatively neglected. The authors discuss the benefits and risks of various drug and nondrug therapies used in the long-term management of generalized anxiety disorder and suggest avenues for future research.
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The involvement of serotonergic receptor subtypes in modulation of rat behavior in a black and white test box was studied. The high efficacy 5-HT(1A) receptor agonist 8-OH-DPAT [8-hydroxy-2-(di-n-propylamino)tetraline] was inactive, and the partial agonist buspirone showed an anxiolytic-like response that was weaker than the response to diazepam. The non-selective 5-HT(1) receptor agonists TFMPP [1-(trifluoromethylphenyl) piperazine] and eltoprazine were inactive. Low doses of the 5-HT(1A) receptor antagonist WAY 100.635 [N-[2-[4-(2-methoxyphenyl)-1-piperazinyl]ethyl]-N-(2-pyridinyl)cyclohexanecarboxamide] induced an anxiolytic-like response; 10-100 times higher doses induced an anxiogenic-like response. The 5-HT(2A/2C) and 5-HT(3) receptor antagonists ritanserin and ondansetron induced anxiolytic-like responses. The 5-HT(2A/2C) receptor agonist DOI [1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane] and the 5-HT(2A) receptor antagonist-MDL 100.151 [(=) chi-(2,3-dimethoxyphenyl)-1-[2-(4-fluorphenyl)ethyl]-4-piperidin-methanol] were inactive. 8-OH-DPAT potentiated the anxiolytic-like effect of ritanserin. It is suggested that 5-HT(1A) and 5-HT(2C) receptors are involved in mediation of exploratory behavior in rats, and that the 5-HT receptor subtype mediated effects may modulate one another.