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SSRIs 停药后 5-HT 神经元的反弹激活。

Rebound activation of 5-HT neurons following SSRI discontinuation.

机构信息

Dept. of Pharmacology, University of Oxford, Oxford, UK.

Dept. of Experimental Psychology, University of Oxford, Oxford, UK.

出版信息

Neuropsychopharmacology. 2024 Sep;49(10):1580-1589. doi: 10.1038/s41386-024-01857-8. Epub 2024 Apr 12.

Abstract

Cessation of therapy with a selective serotonin (5-HT) reuptake inhibitor (SSRI) is often associated with an early onset and disabling discontinuation syndrome, the mechanism of which is surprisingly little investigated. Here we determined the effect on 5-HT neurochemistry of discontinuation from the SSRI paroxetine. Paroxetine was administered repeatedly to mice (once daily, 12 days versus saline controls) and then either continued or discontinued for up to 5 days. Whereas brain tissue levels of 5-HT and/or its metabolite 5-HIAA tended to decrease during continuous paroxetine, levels increased above controls after discontinuation, notably in hippocampus. In microdialysis experiments continuous paroxetine elevated hippocampal extracellular 5-HT and this effect fell to saline control levels on discontinuation. However, depolarisation (high potassium)-evoked 5-HT release was reduced by continuous paroxetine but increased above controls post-discontinuation. Extracellular hippocampal 5-HIAA also decreased during continuous paroxetine and increased above controls post-discontinuation. Next, immunohistochemistry experiments found that paroxetine discontinuation increased c-Fos expression in midbrain 5-HT (TPH2 positive) neurons, adding further evidence for a hyperexcitable 5-HT system. The latter effect was recapitulated by 5-HT receptor antagonist administration although gene expression analysis could not confirm altered expression of 5-HT autoreceptors following paroxetine discontinuation. Finally, in behavioural experiments paroxetine discontinuation increased anxiety-like behaviour, which partially correlated in time with the measures of increased 5-HT function. In summary, this study reports evidence that, across a range of experiments, SSRI discontinuation triggers a rebound activation of 5-HT neurons. This effect is reminiscent of neural changes associated with various psychotropic drug withdrawal states, suggesting a common unifying mechanism.

摘要

停止使用选择性 5-羟色胺(5-HT)再摄取抑制剂(SSRIs)常常与早期发作和致残性停药综合征有关,而其机制却鲜为人知。在这里,我们确定了 SSRIs 帕罗西汀停药对 5-HT 神经化学的影响。帕罗西汀反复给予小鼠(每天一次,连续 12 天与盐水对照),然后继续或停药长达 5 天。虽然在持续帕罗西汀期间脑组织中 5-HT 和/或其代谢物 5-HIAA 的水平趋于下降,但停药后水平升高,特别是在海马体中。在微透析实验中,连续帕罗西汀可升高海马体细胞外 5-HT,停药后其作用降至盐水对照组水平。然而,持续帕罗西汀可降低(高钾)诱发的 5-HT 释放,但停药后可升高至对照组以上。细胞外海马体 5-HIAA 也在持续帕罗西汀时下降,停药后升高至对照组以上。接下来,免疫组织化学实验发现,帕罗西汀停药增加了中脑 5-HT(TPH2 阳性)神经元中的 c-Fos 表达,为 5-HT 系统过度兴奋提供了进一步证据。5-HT 受体拮抗剂的给药重现了后一种效应,尽管基因表达分析不能证实帕罗西汀停药后 5-HT 自身受体表达的改变。最后,在行为实验中,帕罗西汀停药增加了焦虑样行为,其部分与增加 5-HT 功能的测量结果在时间上相关。总之,这项研究报告了证据表明,在一系列实验中,SSRIs 停药会引发 5-HT 神经元的反弹激活。这种效应让人联想到与各种精神药物戒断状态相关的神经变化,提示存在一种共同的统一机制。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c64c/11319583/8ee9af44292b/41386_2024_1857_Fig1_HTML.jpg

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