ABSTRACT
ObjectiveTo determine the influence of buspirone on sexual function and plasma prolactin in rehabilitative female major depressive patients.MethodsThe female major depressive patients,who had a total HAMD-17 less than 7,were living with a sexual partner and receiving SSRI antidepressant monotherapy for at least six months were recruited.Sexual dysfunction (SD) was assessed using the Arizona Sexual Experience Scale (ASEX).The patients with SD were treated with buspirone 15 ～ 30 mg by 4 weeks.Sexua function and blood samples were compared among the control,non-SD patients,and the SD patients before or after treating with buspirone.The clinical risk factor of SD was also investigated with correlation analysis.ResultsThe general incidence of SD in rehabilitative female major depressive patients was 33.3％.The improvement rate of SD was 60％ after the treatment of buspirone.The ASEX score and it 5 items were significantly decreased in the depressive patients after the treatment of buspirone (P ＜ 0.01 ).Prolactin in subjects treated with buspirone ( ( 20.38 ± 11.91 )ng/ml) was significantly higher than control ( ( 14.2 ± 12.15 ) ng/ml),but not higher than the period prior to treatment with buspirone ( ( 18.15 ±9.84) ng/ml).The ASEX score was significantly correlated the dose of fluoxetine( r=0.504,P=0.002) and paroxetine ( r=0.377,P=0.013).There was no significantly correlation between ASEX score and prolactin in the control,non-SD patients,and the patients before or after treating with buspirone.ConclusionBuspirone can release sexual dysfunction induced by SSRI antideptressant in the depressive patients.
ABSTRACT
BACKGROUND: It has been reported tbat there are rich expressions of serotonin transporter (5-HTT) in the cortical and limbic regions related to emotion and behavior in cerebrum. Regulation of the intensity and persistence of serotonergic nerve response can change the serotonergic neurotransmission, meanwhile, 5-HTT is also an important target for selective serotonin reuptake inhibitors (SSRIs).OBJECTIVE: To observe whether there is a correlation of 5-HTT gene polymorphism with plasma level of 5-HT and the clinical response of SSRIs in the population of Nanjing area.DESIGN: A case-control observation.SETTING: Department of Psychiatry, Brain Hospital of Nanjing Medical University.PARTICIPANTS: Totally 132 inpatients with depression in the Department of Psychiatry, Brain Hospital of Nanjing Medical University and 100 volunteer healthy blood donors were taken as the observational subjects between January 2001 and December 2003.METHODS: The genotype was analyzed with polymerase chain reaction (PCR) polymorphism analysis in the patients with depression and healthy subjects; plasma level of 5-HT was analyzed with high performance liquid chromatography-electrical chemistry detector (HPLC-ECD); and the clinical response to the antidepressants were assessed with Hamilton depression rating scale (HAMD).MAIN OUTCOME MEASURES: The analytical results of 5-HTT genotype frequency and allele frequency in both groups, and the relationship between 5-HTT genotype and plasma level of 5-HT before and after SSRIs treatment were observed.RESULTS: Blood samples were collected from all the 132 patients with depression and 100 normal healthy subjects, and they all finished the scale test and entered the analysis of results. ① There were no significant differences between the depression group and normal control group in the 5-HTT gene genotype frequencies (LL: 24.2%, LS: 44.7%, SS31.1%; LL:29.0%, LS: 47.0%, SS: 24.0%, x2=1.405 8, P ＞ 0.05) and allelefrequencies (L:46.59%, S: 53.41%; L: 52.5%, S: 47.5%, x2=0.696 2, P ＞ 0.05). ② The total score of HAMD had significant differences before treatment among the depressive patients of different genotypes (F=6.48, P=0.002 1). After 4-week treatment of SSRIs antidepressants, the total score of HAMD was significantly decreased, and there was significant difference in the decrease of score (F=3.38, P= 0.037). ③ The plasma level of 5-HT had significant differences before treatment among the depressive patients of different genotypes (F=5.38,P= 0.005 7). After 4-week treatment of SSRIs antidepressants, the plasma level of 5-HT was increased, and the increased level was significantly different among different genotypes (F=23.55, P ＜ 0.01).CONCLUSION: The 5-HTT polymorphism may be not associated with the attack of depression, but with the severity of depression and the clinical responses of SSRIs in the population of Nanjing area, and the genotype in this area may become a reference index for the realization of individualized treatment in patients with depression.
ABSTRACT
BACKGROUND: Monoamine hypothesis has been demonstrated by researches. However, the correlation between the metabolite of plasma monoamine neurotransmitter and anti-depression treatment in patients with depression has less been reported.OBJECTIVE: To study the effect of different drugs on metabolite of plaama monoamine neurotransmitter, and the correlation between the metabolite of plasma monoamine neurotransmitter and anti-depression treatment in patients with depression.DESIGN: Case controlled study.SETTING: Neurological Department and Brain Institute of Nanjing Medical University.PARTICIPANTS: Forty patients with depression hospitalized in Nanjing Brain Hospital (depression group) were diagnosed with the second revised edition of China classification of mental diseases(CCMD-2) and the tenth edition of International classification of diseases. And the total score of Hanmilton rating scale for depression(HAMD) was more than 17. Healthy voluntary blood donators in the control group were from Nanjing Municipal Central Blood Station( n = 20).INTERVENTIONS: Antidepressant was used in the depression for 4 weeks: fluoxetine 20 mg per day; 5-serotonin selective reuptake inhibitor (SSRI) paroxetine 20 mg per day; venlafaxime 50- 100 mg per day;5-serotonin and morepinephrine selective reuptake inhibitor(SNRI) fluvoxamine 50-100 mg per day. High performance liquid chromatograpy(HPLC)was used to measure the level of metabolite of plasma monoamine neurotransmitter in patients with depression before and 42 week after treatment, and the HAMD was used to evaluate clinical effect of the patients.MAIN OUTCOME MEASURES: The levels of metabolites of plasma monoamine neurotransmitters in patients with depression: 5-hydroxyindoleace tic acid(5-HIAA), 3-methoxy-4-hydroxyphenylglycol(MHPG) and homovani llic acid(HVA) were measured before and 4th week after treatment.RESULTS: The levels of 5-HIAA, MHPG and HVA of the metabolites of plasma monoamine neurotransmitters in patients with depression before treatment [ (20.3±14.6), (124.8±103.6), (54.7±32.1) μg/L] were all lower than those in the normal control group[ (39.5±28.4), (334.5 ±107.3), (88.5±37.2) μg/L], with statistically significant differences (P＜0.05). After SSRI treatment, the 5-HIAA content[ (37.1±21.9)μg/L]was significantly increased as compared with that before treatment, whose difference indicated significant meaning ( P＜0.05), but the differences in MHPG and HVA had no significant meaning as compared with those before treatment(P＞0.05) . After SNRI treatment, 5-HIAA and MHPG contents [(35.4±25.2 ), (291.2±120.4) μg/L] both were significantly increased, which indicated significant difference as compared with those before treatment( P＜0.05); but HVA level had no significant changes.CONCLUSION:'The peripheral neurotransmitter metabolites in plasma can reflect their states in brain. The change of neurotransmitter metabolite in plasma can be regarded as an important reference index for the evaluation of depression.