Tachyphylaxis in major depressive disorder: A review of the current state of research

Kinrys, Gustavo; Gold, Alexandra K.; Pisano, Vincent D.; Freeman, Marlene P.; Papakostas, George I.; Mischoulon, David; Nierenberg, Andrew A.; Fava, Maurizio

doi:10.1016/j.jad.2018.10.357

Cited by 31 publications

(19 citation statements)

References 63 publications

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“…Additionally, experimental studies of short TCS application in healthy volunteers may not be generalisable to dermatological patients with chronic TCS use. Despite these limitations, we believe it is still rational to entertain the possibility of TSA/TSW, given the non-conclusive nature of existing research and the mechanistic potential of tolerance, withdrawal and rebound reported with other medications such as intranasal vasoconstrictors [69], benzodiazepines [70], histamine-2 receptor blockers [71], antidepressants [72] and oral steroids [73].…”

Section: Discussionmentioning

confidence: 99%

Steroid Phobia: Is There a Basis? A Review of Topical Steroid Safety, Addiction and Withdrawal

2021

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There is a growing concern amongst patients about topical corticosteroid (TCS) side effects, with increasing discussion of topical steroid addiction (TSA) and topical steroid withdrawal (TSW) particularly on social media platforms. However, the acceptance of TSA/TSW as a distinct condition remains controversial within the dermatological community. We conducted a literature search using PubMed, MEDLINE, Cochrane Library, Google Scholar, Embase and Web of Science to identify original articles addressing TSA/TSW. We described the definition and reported clinical features of TSA/TSW including its classification into erythemato-edematous and papulopustular subtype. To assess the validity of TSA/TSW, we summarised and objectively appraised the postulated mechanisms for this condition, including tachyphylaxis, dysregulation of glucocorticoid receptors, rebound vasodilation and impaired skin barrier leading to a cytokine cascade. Understanding the evidence including its limitations and uncertainties highlights areas for future research and helps medical practitioners better counsel and provide care to patients who may be experiencing or who have concerns about TSA/TSW.

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Section: Discussionmentioning

confidence: 99%

Steroid Phobia: Is There a Basis? A Review of Topical Steroid Safety, Addiction and Withdrawal

2021

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“…Third, risk of symptom-return during long-term AD is substantial. Multiple studies report 3-year cumulative risks exceeding 40% [25]. The risk is particularly high among patients with residual symptoms after acute treatment [26].…”

Section: Oppositional Perturbation and Symptom-returnmentioning

confidence: 99%

Can loss of agency and oppositional perturbation associated with antidepressant monotherapy and low-fidelity psychological treatment dilute the benefits of guideline-consistent depression treatment at the population level?

et al. 2020

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Despite major expansions of evidence-based treatments of common mental disorders in recent decades, especially antidepressant medication, the point prevalence of depression has not decreased; instead it probably increased in young adults. We question whether antidepressants (AD)-monotherapy and low-fidelity-to-guideline psychological treatment (PT) might have no effect or even adverse effects in some patients and contexts that dilute the benefits of treatment at the population level, making it harder for population-based studies to detect treatment-driven prevalence reductions. Randomized Clinical Trial (RCT)s have not identified these effects because AD-monotherapy and low-fidelity PT are uncommon in RCTs where treatment protocols are specified and carefully monitored, unlike treatment in real-world settings. Second, RCTs may have missed the bigger picture of ultimate outcomes due to too short follow-ups. We elaborate two mechanisms through which AD-monotherapy and low-fidelity PT could produce adverse effects on long-term illness course. Both mechanisms are speculative and we outline how to test. Major depressive disorder is a common, highly heterogeneous disorder. To reduce its enormous burden [1], Western countries have expanded their mental health expenditures in specialty and primary care settings since the 1980s [2], providing more treatment for more people, primarily with antidepressants (AD) and, to a lesser extent, psychological treatments (PTs) [3,4]. Both Antidepressant (AD)s and PTs are well-established, evidence-based treatments with roughly similar modest short-term efficacy. Surprisingly, the point-prevalence of depression in the general population has not decreased since the wide-scale use of AD [5]; instead, the prevalence has probably increased, particularly in young people [6]. In addition, the prevalence of recurrentchronic and treatment-resistant depression seems to have risen [7]. One obvious explanation for this "treatment-prevalence paradox" is increased first incidence, offsetting a treatment-driven prevalence drop. But population-based incidence studies do not find such an increase [4,8]. What else could explain the paradox? Explaining the Treatment-Prevalence Paradox We question whether AD-monotherapy and low-fidelity-to-guideline PT might have no effect or even adverse effects in some patients and contexts that dilute the benefits of treatment at the population level, making it harder for population-based studies to detect treatment-driven prevalence reductions. The hypothesized mechanisms through which AD-monotherapy and low-fidelity PT could produce adverse effects on long-term illness course include Loss of Agency [9] and Oppositional Perturbation [10] or Tolerance [11,12]. Both mechanisms are speculative and need rigorous testing. RCTs have not identified these effects because AD-monotherapy and low-fidelity PT are uncommon in RCTs where treatment protocols are specified and carefully monitored, unlike treatment in real-world settings. In addition, AD-withdrawal studies may have m...

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“…Not only do antidepressants take weeks to start working, they also tend to induce tolerance in patients. The buildup of tolerance to antidepressants can be gradual, but about 10-20% of patients experience a sudden, rapid loss of effectiveness (tachyphylaxis) during which symptoms reemerge quickly after the initial remission (Fornaro et al 2019;Kinrys et al 2019).…”

Section: Implications For Psychopharmacologymentioning

confidence: 99%

“…This approach is known as combination therapy when the drugs have similar functions but different mechanisms of action (e.g., two or more antidepressants) or augmentation therapy when the main drug (for example, an antidepressant) is supplemented with molecules that target different systems (e.g., antipsychotics, anxiolytics, or hormones such as testosterone). Combination/augmentation therapies for depression and other mood disorders have yielded promising results against treatment resistance and tachyphylaxis, but are still underresearched (Ionescu et al 2015;Kinrys et al 2019). There are also concerns about the cumulative effects of multiple drugs on the risk for other conditions (e.g., kidney disorders; Nestsiarovich et al 2019).…”

Section: Implications For Psychopharmacologymentioning

confidence: 99%

Invisible Designers: Brain Evolution Through the Lens of Parasite Manipulation

Giudice¹

2019

The Quarterly Review of Biology

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keywords behavior, brain evolution, hormones, neurobiology, parasite-host interactions, parasite manipulation abstract The ability of parasites to manipulate host behavior to their advantage has been studied extensively, but the impact of parasite manipulation on the evolution of neural and endocrine mechanisms has remained virtually unexplored. If selection for countermeasures has shaped the evolution of nervous systems, many aspects of neural functioning are likely to remain poorly understood until parasites-the brain's invisible designers-are included in the picture. This article offers the first systematic discussion of brain evolution in light of parasite manipulation. After reviewing the strategies and mechanisms employed by parasites, the paper presents a taxonomy of host countermeasures with four main categories, namely: restrict access to the brain; increase the costs of manipulation; increase the complexity of signals; and increase robustness. For each category, possible examples of countermeasures are explored, and the likely evolutionary responses by parasites are considered. The article then discusses the metabolic, computational, and ecological constraints that limit the evolution of countermeasures. The final sections offer suggestions for future research and consider some implications for basic neuroscience and psychopharmacology. The paper aims to present a novel perspective on brain evolution, chart a provisional way forward, and stimulate research across the relevant disciplines.

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Tachyphylaxis in major depressive disorder: A review of the current state of research

Cited by 31 publications

References 63 publications

Steroid Phobia: Is There a Basis? A Review of Topical Steroid Safety, Addiction and Withdrawal

Steroid Phobia: Is There a Basis? A Review of Topical Steroid Safety, Addiction and Withdrawal

Can loss of agency and oppositional perturbation associated with antidepressant monotherapy and low-fidelity psychological treatment dilute the benefits of guideline-consistent depression treatment at the population level?

Invisible Designers: Brain Evolution Through the Lens of Parasite Manipulation

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