Current and future pharmacotherapy of severe psychiatric disorders
Authors:
Eva Češková
Authors‘ workplace:
Psychiatrická klinika LF MU a FN Brno
Published in:
Čas. Lék. čes. 2018; 157: 96-100
Category:
Review Article
Overview
Despite of tremendous development in CNS research, current treatment is suboptimal especially in severe mental disorders. In medicine, there are two main methods of improving the healthcare provided: seeking new treatment procedures and perfecting (optimizing) the existing ones. Optimization of treatment includes not only practical tools such as therapeutic drug monitoring, but also implementation of general trends into the clinical practice. New pharmacological options include drugs aimed at other than monoaminergic systems and old drugs used before the psychopharmacological era.
In pharmacoresistant depression promising options include switch to new multimodal/multifunctional antidepressants, augmentation with new atypical antipsychotics (cariprazine and brexpiprazole) and adjunctive treatment with anti-inflammatory and anti-apoptotic agents and nutraceuticals. Ketamine, opioids and psychedelics are in different phases of clinical testing. Recent advances in technology and emerging knowledge about the dysfunctional brain circuits and neuroplasticity have led to the development of different new neuromodulation techniques usually used as add-on therapy.
In schizophrenia the cornerstone of the current treatment is still antipsychotic medications. In addition to aripiprazole two new partial dopamine agonists, brexpiprazole and cariprazine are now available. Especially the group of partial dopamine agonists is in the center of interest. Due to severe consequences of partial adherence, new formulations of long-acting injections of the second-generation antipsychotics with longer interval of application have been developed (3- month paliperidone palmitate). New treatment options not yet available include cannabidiol, glutamate modulators and nicotine receptors agonists.
Keywords:
optimization of treatment, depressive disorder, schizophrenia, treatment multimodal/multifunctional antidepressants, partial dopamine agonists, glutamate modulators, nicotine receptors agonists
Sources
1. Demyttenaere K, Bruffaerts R, Posada-Villa J et al. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004; 291: 2581–2590.
2. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1545–1602.
3. Rief W, Barsky AJ, Bingel U et al. Rethinking psychopharmacotherapy: the role of treatment context and brain plasticity in antidepressant and antipsychotic interventions. Neurosci Biobehav Rev 2016; 60: 51–64.
4. Iwamoto K. Understanding the epigenetic architecture of psychiatric disorders: modifications and beyond. Psychiatry Clin Neurosci 2018; 72: 194.
5. Hiemke C, Bergemann N, Clement HW et al. Consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology: update 2017. Pharmacopsychiatry 2018; 51(1-02): e1.
6. El-Mallakh RS, Roberts RJ, El-Mallakh PL et al. Pharmacogenomics in psychiatric practice. Clin Lab Med 2016; 36: 507–523.
7. Leon AC. Evolution of psychopharmacology trial design and analysis: six decades in the making. J Clin Psychiatry 2011; 72: 331–340.
8. Wegener G, Rujescu D. The current development of CNS drug research. Int J Neuropsychopharmacol 2013; 16: 1687–1693.
9. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006; 3: e 442
10. Češková E. Current pharmacotherapy of depression – focused on multimodal/multifunctional antidepressants. Expert Opin Pharmacother 2016; 17: 1835–1837.
11. Xu Y, Hackett M, Carter G et al. Effect of low-dose and very low-dose ketamine among patients with major depression: a systematic review and meta-analysis. Int J Neuropsychopharmacol 2016; 19, pii: pyv124.
12. Garay RP, Zarate CA jr., Charpeaud T et al. Investigational drugs in recent clinical trials for treatment-resistant depression. Expert Rev Neurother 2017; 17(6): 593–609.
13. Fava M, Memisoglu A, Thase ME al. Opioid modulation with buprenorphine (samidorphan as adjunctive treatment for inadequate response to antidepressants: a randomized double-blind placebo-controlled trial. Am J Psychiatry 2016; 173: 499–508.
14. Rucker JJ, Jelen LA, Flynn S et al. Psychedelics in the treatment of unipolar mood disorders: a systematic review. J Psychopharmacol 2016; 30: 1220–1229.
15. Nichols DE, Johnson MW, Nichols CD. Psychedelics as medicines: an emerging new paradigm. Clin Pharmacol Ther 2017; 101: 209–219.
16. Citrome L. Brexpiprazole for schizophrenia and as adjunct for major depressive disorder: A systematic review of the efficacy and safety profile for the newly approved antipsychotic-what is the number needed to treat, number needed to harm and likelihood to be helped or harmed? Int J Clin Pract 2015; 69: 978–997.
17. Raison CL, Rutherford RE, Woolwine BJ et al. A randomized controlled trial of the tumor necrosis factor antagonist infliximab for treatment-resistant depression: the role of baseline inflammatory biomarkers. JAMA Psychiatry 2013; 70: 31–41.
18. Ellul P, Boyer L, Groc L et al. Interleukin-1beta-targeted treatment strategies in inflammatory depression: toward personalized care. Acta Psych Scand 2016; 134: 469–484.
19. Sarris J, Murphy J, Mischoulon D et al. Adjunctive nutraceuticals for depression: a systematic review and meta-analyses. Am J Psychiatry 2016; 173: 575–587.
20. Bewernick B, Schlaepfer TE. Update on neuromodulation for treatment-resistant depression. F1000Res 2015; 4, pii: F1000 Faculty Rev-1389.
21. Cloutier M, Aigbogun MS, Guerin A et al. The economic burden of schizophrenia in the United States in 2013. J Clin Psychiatry 2016; 77: 764–771.
22. Citrome L. The ABC’s of dopamine receptor partial agonists-aripiprazole, brexpiprazole and cariprazine: the15-min challenge to sort these agents out. Int J Clin Practice 2015; 69: 1211–1220.
23. Kishimoto T, Nitta M, Borenstein M et al. Long-acting injectable versus oral antipsychotics in schizophrenia: a systematic review and meta-analysis of mirror-image studies. J Clin Psychiatr 2013; 74: 957–965.
24. Kishimoto T, Robenzadeh A, Leucht C et al. Long-acting injectable vs oral antipsychotics for relapse prevention in schizophrenia: a meta-analysis of randomized trials. Schizophr Bull 2014; 40: 192–213.
25. Savitz AJ, Xu H, Gopal S et al. Efficacy and safety of paliperidone palmitate 3-month formulation for patients with schizophrenia: a randomized, multicentre, double-blind, noninferiority study. Int J Neuropsychopharmacol 2016; 19: pyw018.
26. Davis RE, Correll CU. ITI-007 in the treatment of schizophrenia: from novel pharmacology to clinical outcomes. Expert Rev Neurother 2016; 16: 601–614.
27. Leweke FM, Mueller JK, Lange B, Rohleder C. Therapeutic potential of cannabinoids in psychosis. Biol Psychiatry 2016; 79: 604–612.
28. Dauvermann MR, Lee G, Dawson N. Glutamatergic regulation of cognition and functional brain connectivity: insights from pharmacological, genetic and translational schizophrenia research. Br J Pharmacol 2017; 174: 3136–3160.
29. Shim SS, Hammonds MD, Kee BS. Potentiation of the NMDA receptor in the treatment of schizophrenia: focused on the glycine site. Eur Arch Psychiatry Clin Neurosci 2008; 258: 16–27.
30. Adams CE, Stevens KE. Evidence for a role of nicotinic acetylcholine receptors in schizophrenia. Front Biosci 2007; 12: 4755–4772.
31. Kalkman HO, Feuerbach D. Modulatory effects of α7 nAChRs on the immune system and its relevance for CNS disorders. Cell Mol Life Sci 2016; 73: 2511–2530.
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