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Population scale retrospective analysis reveals distinctive antidepressant and anxiolytic effects of diclofenac, ketoprofen and naproxen in patients with pain.

ABSTRACT: Currently approved monoamine modulating antidepressant and anxiolytic pharmaceutics fail in over one third of patients due to delayed and variable therapeutic effect, adverse reactions preceding the therapeutic action, and adherence issues. Even with adequate adherence to the regimen and tolerability, one third of the patients do not respond to any class of antidepressants. There is a strong correlation between treatment resistant depression and increase in inflammatory cytokines in plasma and cerebrospinal fluid. Furthermore, epidemiological studies suggest that depression and anxiety are commonly comorbid with pain and inflammation. While a link between pain, inflammation and depression has been suggested it remains unclear which anti-inflammatory treatment may be beneficial to patients with depression and anxiety due to pain. Here, we analyzed 430,783 FDA adverse effect reports of patients treated for pain to identify potential antidepressant and anxiolytic effects of various anti-inflammatory medications. Patients treated for depression or patients taking any known antidepressants were excluded. The odds ratio analysis of 139,072 NSAID reports revealed that ketoprofen was associated with decreased reports of depression by a factor of 2.32 (OR 0.43 and 95% Confidence Interval [0.31, 0.59]) and decreased reports of anxiety by a factor of 2.86 (OR 0.35 [0.22, 0.56]), diclofenac with decreased depression reports by a factor of 2.22 (OR 0.45 [0.40, 0.49]) and anxiety by a factor of 2.13 (OR 0.47 [0.41, 0.54]), while naproxen decreased depression reports by a factor of 1.92 (OR 0.52 [0.49, 0.57]) and anxiety by a factor of 1.23 (OR 0.81 [0.75, 0.88]). Other NSAIDs did not exhibit any noticeable antidepressant and/or anxiolytic effect.

SUBMITTER: Makunts T

PROVIDER: S-EPMC5905979 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Ketoprofen and diclofenac are non-steroidal anti-inflammatory drugs (NSAIDs) often used for similar indications, and both are frequently found in surface waters. Diclofenac affects organ histology and gene expression in fish at around 1 M-BM-5g/L. Here, we exposed rainbow trout to ketoprofen (1, 10 and 100 M-BM-5g/L) to investigate if this alternative causes less risk for pharmacological responses in fish. The bioconcentration factor from water to fish blood plasma was <0.05 (4 for diclofenac based on previous studies). Ketoprofen only reached up to 0.6M-bM-^@M-0 of the human therapeutic plasma concentration, thus the probability of target-related effects was estimated to be fairly low. Accordingly, a comprehensive analysis of hepatic gene expression revealed no consistent responses. In some contrast, trout exposed to undiluted, treated sewage effluents bioconcentrated ketoprofen and other NSAIDs much more efficiently, according to a meta-analysis of recent studies. Neither of the setups is however an ideal representation of the field situation. If a controlled exposure system with a single chemical in pure water is a reasonable representation of the environment, then the use of ketoprofen is likely to pose a lower risk for wild fish than diclofenac, but if bioconcentration factors from effluent-exposed fish are applied, the risks may be more similar. Ketoprofen (purity M-bM-^IM-%98%) (Sigma-Aldrich, Steinheim, Germany) was dissolved in water (500 mg/L concentrated solution), stirred vigorously and diluted stepwise to obtain stock concentrations (0.5 mg/L, 5 mg/L and 50 mg/L). Juvenile rainbow trout (Oncorhynchus mykiss) of both sexes (age: approximately six months, weight: 39.4M-BM-16.6g) were obtained from VM-CM-$nneM-CM-%ns fiskodling AB, Sweden, and kept in 500 L holding tanks with sand-filtered, aerated fresh water in a flow-through system for one week prior to the experiment. Eight experimental 48 L glass aquaria, semi-covered in black plastic bags to reduce visual stress from the outside (12:12 h light:dark photocycle), were supplied with filtered, aerated freshwater at a flow rate of 0.25 L/min. At the onset of the experiment 80 trout were randomly divided among the aquaria (ten fish in each). Peristaltic pumps (500 M-BM-5l/min) from each stock solution were used to reach target ketoprofen concentrations of 0 (control), 1 (low), 10 (intermediate) and 100 (high) M-BM-5g/L with two aquaria for each concentration. Water samples were taken from each aquarium at day 1, 7 and 14 and stored at -20M-BM-0C until analysis. To minimize biological variation due to variable food intake, the fish were not fed during the exposure period. It should be stressed that trout readily cope with food deprivation for much longer periods at these temperatures [Kullgren et al., 2010]. To ensure a stable water quality, temperature (12.9M-BM-10.1M-BM-0C), pH (7.4M-BM-10.2) and oxygen saturation (88.3%M-BM-11.3) were monitored every third day. The total organic carbon content of the supply water was 2.5 mg/L. At the experiment termination on day 14, the fish were killed by a rapid blow to the head and blood was collected from the caudal vessels by the use of heparinized syringes. The plasma was instantly separated by centrifugation at 10,000 rpm for 2 min and snap frozen in liquid nitrogen. The length and weight of the fish were measured and their sex determined by macroscopical observation of their gonads. Liver samples for gene expression analyses were collected and snap frozen in liquid nitrogen. Both liver and plasma samples were stored at M-bM-^HM-^R70M-BM-0C until analysis. All animal experiments were approved by the local animal committee in Gothenburg (permission number 216-2010). A 15k rainbow trout gene expression microarray was designed for the RT analyzer platform (febit, Heidelberg, Germany) using The Institute for Genomic Research (TIGR) Rainbow Trout Gene Index (RTGI) database version 7.0 (http://compbio.dfci.harvard.edu/tgi/). Details on the probe design strategy, but for eelpout (Zoarces viviparus), and transcript selection strategy are described elsewhere [Cuklev et al., 2011, Kristiansson et al., 2009, Cuklev et al., 2012]. When available, transcripts at GenBank (http://www.ncbi.nlm.nih.gov/nucleotide) were used. Results from similar microarrays, performed by our research group using the same platform, have shown good correlation with qPCR data [Cuklev et al., Kristiansson et al., 2009, Cuklev et al., 2012, Gunnarsson et al., 2009, Lennquist et al., 2011]. The frozen liver tissue was homogenized using Tissuelyser (Qiagen) and total hepatic RNA was isolated using QIAcube and RNeasyM-BM-. Plus Mini Kit (Qiagen). The RNA quantity was determined with spectophotometric measurements (Nanodrop 1000, NanoDrop Technologies) and the quality was assessed by Experion automated electrophoresis using RNA StdSense chip (Bio-Rad, Sundbyberg, Sweden). Biotinylated aRNA was synthesized using MessageAmpM-bM-^DM-" II-Biotin Enhanced Single Round aRNA Amplification Kit (AmbionM-BM-.). The aRNA samples (20 M-BM-5g) were vacuum dried in a vacuum centrifuge, dissolved in 10 M-BM-5l water and fragmented according to the manufacturerM-bM-^@M-^Ys protocol. The following steps described in this subchapter were all performed by febit. Oligonucleotide arrays were synthesized by photo-controlled in situ synthesis using the Geniom One system (febit). Each biochip consists of eight individually accessible micro-channels, each of which is referred to as a microarray in this manuscript. Four individuals (of both sexes) from each control aquarium and each high exposure concentration aquarium were included in the analysis, i.e. eight fish per exposure concentration. In total, two biochips were analyzed corresponding to 16 microarrays. Pre-hybridization and hybridization were performed based on a customized protocol, described in detail by Cuklev et al. [2011]. The samples were randomly allocated on the biochips. Signals were detected using the internal CCD-camera system of the RT analyzer instrument (febit) and quantified using the Geniom Wizard software. Integration times were 266 and 273 ms, determined automatically by the instrument software. All statistical calculations were done in R-2.12.2 (www.r-project.org) [R Development Core Team, 2010]. The quality of pre- and post-normalized arrays was verified with Box and MA plots. The data analysis was performed in the R-package LIMMA [Smyth, 2004]. Data were normalized using the M-bM-^@M-^XquantileM-bM-^@M-^Y method. Moderated t-statistics and adjusted p-values of differential expression were calculated using the empirical Bayes model. As we found no clear differences between the two control aquaria or between the two aquaria with the highest concentration of ketoprofen (100 M-BM-5g/L), all fish from the same treatment were treated as a single group, i.e. we compared one control group to one group of fish exposed to 100 M-BM-5g/L of ketoprofen.

Project description:Floatation-REST (Reduced Environmental Stimulation Therapy) reduces sensory input to the nervous system through the act of floating supine in a pool of water saturated with Epsom salt. The float experience is calibrated so that sensory signals from visual, auditory, olfactory, gustatory, thermal, tactile, vestibular, gravitational and proprioceptive channels are minimized, as is most movement and speech. This open-label study aimed to examine whether Floatation-REST would attenuate symptoms of anxiety, stress, and depression in a clinical sample. Fifty participants were recruited across a spectrum of anxiety and stress-related disorders (posttraumatic stress, generalized anxiety, panic, agoraphobia, and social anxiety), most (n = 46) with comorbid unipolar depression. Measures of self-reported affect were collected immediately before and after a 1-hour float session, with the primary outcome measure being the pre- to post-float change score on the Spielberger State Anxiety Inventory. Irrespective of diagnosis, Floatation-REST substantially reduced state anxiety (estimated Cohen's d > 2). Moreover, participants reported significant reductions in stress, muscle tension, pain, depression and negative affect, accompanied by a significant improvement in mood characterized by increases in serenity, relaxation, happiness and overall well-being (p < .0001 for all variables). In reference to a group of 30 non-anxious participants, the effects were found to be more robust in the anxious sample and approaching non-anxious levels during the post-float period. Further analysis revealed that the most severely anxious participants reported the largest effects. Overall, the procedure was well-tolerated, with no major safety concerns stemming from this single session. The findings from this initial study need to be replicated in larger controlled trials, but suggest that Floatation-REST may be a promising technique for transiently reducing the suffering in those with anxiety and depression. TRIAL REGISTRATION:ClinicalTrials.gov NCT03051074.

Project description:This paper reported the first example on the use of chitosan films, without further modification, to remove and recover, through bio-sorption processes, the emerging pollutant Diclofenac from water. The latter was adopted as a model, among non-steroidal anti-inflammatory drugs, by obtaining a maximum adsorption capacity, qmax, on chitosan of about 10 mg/g, under the applied experimental conditions of work. The literature gap about the use of chitosan films, which was already used for dyes and heavy metals removal, to adsorb emerging pollutants from water was covered, claiming the wide range application of chitosan films to remove a different class of pollutants. Several parameters affecting the Diclofenac adsorption process, such as the pH and ionic strength of solutions containing Diclofenac, the amount of the bio-sorbent and pollutant, and the temperature values, were investigated. The kinetics and the adsorption isotherms, along with the thermodynamic parameters (?G°, ?H°, and ?S°) were also evaluated. The process occurred very efficiently, and Chitosan/Diclofenac amounts dependent, remove about the 90% of the pollutant, in 2 h, from the tested solutions, through electrostatic interaction involving the carboxylic moiety of Diclofenac and Chitosan amino groups. This finding was confirmed by the pH and salt effects on the bio-sorption process, including swelling measurements of Chitosan films and by FTIR-ATR analysis. In detail, the maximum adsorption was observed at pH 5, when pollutant and Chitosan were negatively and positively charged, respectively. By reducing or increasing the pH around this value, a reduced affinity was observed. Accordingly, the presence of salts retarded the Diclofenac removal screening its charges, which hinders the interaction with Chitosan. The sorption was spontaneous (?G° < 0) and endothermic (?H° > 0) following the pseudo-second order kinetic model. The process was Diclofenac and Chitosan amount dependent. In addition, the Freundlich and Temkin isotherms well described the process, which showed the heterogeneous character of the process. Experiments of the complete desorption were also performed by using NaCl solutions 0.25 M (like sea water salt concentration) proposing the reuse of the pollutant and the recycling of the bio-sorbent lowering the associated costs. The versatility of the adsorbent was reported by exploring the possibility to induce the Diclofenac light-induced degradation after the adsorption and by-products adsorption onto chitosan films. To emphasize the chitosan capacity of treating water, the removal of another pollutant such as Ketoprofen and the mixture of Diclofenac and Ketoprofen were investigated. In this way, a green and eco-friendly production-pollution prevention technology for removing emerging pollutants from water was presented, which reduced the overall environmental impact. This illustrated experiments both in static and dynamic conditions for potential industrial applications.

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Population scale retrospective analysis reveals distinctive antidepressant and anxiolytic effects of diclofenac, ketoprofen and naproxen in patients with pain.

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