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Third-generation antipsychotic cariprazine as a promising drug for the treatment of depressive disorders

Abstract

Cariprazine is currently approved for the treatment of patients with depressive and mixed episodes of Bipolar I disorder. Several randomized controlled trials have been carried to investigate its efficacy in patients with major depressive disorder. This review summarizes the potential benefits of Cariprazine for the treatment of major symptoms of Bipolar I disorder and major depressive disorder considering its pharmacodynamic properties, efficacy and tolerance. Its preferential affinity for the D3 receptor, with functional selectivity according to the predominant neural environment, contributes to its efficacy in a wide range of psychopathological symptoms (including mood disorder, anhedonia and cognitive impairment), high safety and good tolerance.

Keywords

cariprazine, unipolar depressive disorder, bipolar affective disorder, third-generation antipsychotics, pathogenesis

PDF (Русский)

References

  1. Villanueva R. Neurobiology of major depressive disorder // Neural Plasticity. – 2013. – Vol. 2013. – Art. 873278. – https://doi.org/10.1155/2013/873278
  2. Mergl R. et al. Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition / /Depression and Anxiety. – 2007. – Vol. 24, no. 3. – Pp. 185–195. – https://doi.org/10.1002/da.20192
  3. Sheehan D.V. Establishing the real cost of depression // Managed Care (Langhorne, Pa.). – 2002. – Vol. 11, no. 8, suppl. – Pp. 7–25.
  4. Dean J., Keshavan M. The neurobiology of depression: An integrated view // Asian Journal of Psychiatry. – 2017. – Vol. 27. – Pp. 101–111. – https://doi.org/10.1016/j.ajp.2017.01.025
  5. Мосолов С.Н. Современные биологические гипотезы рекуррентной депрессии (обзор) // Журнал неврологии и психиатрии имени В.В. Корсакова. – 2012. – Т. 112, № 11-2. – С. 29–40.
  6. Алфимов Р.В., Костюкова Е.Г., Мосолов С.Н. Методы преодоления терапевтической резистентности при рекуррентных депрессиях // Биологические методы терапии психических расстройств. Доказательная медицина – клинической практике. – М.: Социальнополитическая мысль, 2012. – С. 438–473.
  7. Perez-Caballero L. et al. Monoaminergic system and depression // Cell and Tissue research. – 2019. – Vol. 377. – Pp. 107–113. – https://doi.org/10.1007/s00441-018-2978-8
  8. Lang U.E., Borgwardt S. Molecular mechanisms of depression: perspectives on new treatment strategies // Cellular Physiology and Biochemistry. – 2013. – Vol. 31, no. 6. – Pp. 761–777. – https://doi.org/10.1159/000350094
  9. Blier P., Blondeau C. Neurobiological bases and clinical aspects of the use of aripiprazole in treatment-resistant major depressive disorder // Journal of Affective Disorders. – 2011. – Vol. 128. – Pp. S3–S10. – https://doi.org/10.1016/S0165-0327(11)70003-9
  10. Horacek J. et al. Mechanism of action of atypical antipsychotic drugs and the neurobiology of schizophrenia // CNS Drugs. – 2006. – Vol. 20. – Pp. 389–409. – https://doi.org/10.2165/00023210-200620050-00004
  11. Carlsson A. Dopamine receptor agonists: intrinsic activity vs. state of receptor // Journal of Neural Transmission. – 1983. – Vol. 57. – Pp. 309–315. – https://doi.org/10.1007/BF01249001
  12. Keltner N.L., Johnson V. Aripiprazole: a third generation of antipsychotics begins? // Perspectives in Psychiatric Care. – 2002. – Vol. 38, no. 4. – Art. 157. – https://doi.org/10.1111/j.1744-6163.2002.tb01566.x
  13. Mailman R.B., Murthy V. Third generation antipsychotic drugs: partial agonism or receptor functional selectivity? // Current Pharmaceutical Design. – 2010. – Vol. 16, no. 5. – Pp. 488–501. – https://doi.org/10.2174/138161210790361461
  14. Rybakowski J. Etiopathogenesis of bipolar affective disorder-the state of the art for 2021 // Psychiatria Polska. – 2021. – Vol. 55, no. 3. – Pp. 481–496. – https://doi.org/10.12740/pp/132961
  15. Ceskova E., Silhan P. Novel treatment options in depression and psychosis // Neuropsychiatric Disease and Treatment. – 2018. – Vol. 14. – Pp. 741–747. – https://doi.org/10.2147/NDT.S157475
  16. Hamon M., Blier P. Monoamine neurocircuitry in depression and strategies for new treatments // Progress in Neuro-Psychopharmacology and Biological Psychiatry. – 2013. – Vol. 45. – Pp. 54–63. – https://doi.org/10.1016/j.pnpbp.2013.04.009
  17. Carlsson A. The contribution of drug research to investigating the nature of endogenous depression // Pharmacopsychiatry. – 1976. – Vol. 9
  18. De Deurwaerdère P., Di Giovanni G. Serotonergic modulation of the activity of mesencephalic dopaminergic systems: therapeutic implications // Progress in Neurobiology. – 2017. – Vol. 151. – Pр. 175–236. – https://doi.org/10.1016/j.pneurobio.2016.03.004
  19. Grinchii D., Dremencov E. Mechanism of action of atypical antipsychotic drugs in mood disorders // International Journal of Molecular Sciences. – 2020. – Vol. 21, no. 24. – Art. 9532. – https://doi.org/10.3390/ijms21249532
  20. Ślifirski G., Król M., Turło J. 5-HT receptors and the development of new antidepressants // International Journal of Molecular Sciences. – 2021. – Vol. 22, no. 16. – Art. 9015. – https://doi.org/10.3390/ijms22169015
  21. Eshel N. et al. Dopamine neurons share common response function for reward prediction error // Nature Neuroscience. – 2016. – Vol. 19, no. 3. – Pp. 479–486.– https://doi.org/10.1038/nn.4239
  22. Wise R.A. Dopamine, learning and motivation // Nature Reviews Neuroscience. – 2004. – Vol. 5, no. 6. – Pp. 483–494. – https://doi.org/10.1038/nrn1406
  23. Wise R.A. Dopamine and reward: the anhedonia hypothesis 30 years on // Neurotoxicity Research. – 2008. – Vol. 14. – Pр. 169-183.– https://doi.org/10.1007/BF03033808
  24. Pandit R. et al. Melanocortin 3 receptor signaling in midbrain dopamine neurons increases the motivation for food reward // Neuropsychopharmacology. – 2016. – Vol. 41, no. 9. – Pp. 2241–2251.– https://doi.org/10.1038/npp.2016.19
  25. Grace A.A. Dysregulation of the dopamine system in the pathophysiology of schizophrenia and depression // Nature Reviews Neuroscience. – 2016. – Vol. 17, no. 8. – Pp. 24– 532. – https://doi.org/10.1038/nrn.2016.57.
  26. Sultan K.T., Brown K.N., Shi S.H. Production and organization of neocortical interneurons // Frontiers in Cellular Neuroscience. – 2013. – Vol. 7. – Art. 221. – https://doi.org/10.3389/fncel.2013.00221
  27. Buzsaki G., Draguhn A. Neuronal oscillations in cortical networks // Science. – 2004. – Vol. 304, no. 5679. – Pp. 1926–1929.– https://doi.org/10.1126/science.1099745
  28. Steullet P. et al. Redox dysregulation, neuroinflammation, and NMDA receptor hypofunction: a “central hub” in schizophrenia pathophysiology? // Schizophrenia Research. – 2016. – Vol. 176, no. 1. – Pp. 41–51. – https://doi.org/10.1016/j.schres.2014.06.021
  29. Taliaz D. et al. Knockdown of brain-derived neurotrophic factor in specific brain sites precipitates behaviors associated with depression and reduces neurogenesis // Molecular Psychiatry. – 2010. – Vol. 15, no. 1. – Pp. 80–92. – https://doi.org/10.1038/mp.2009.67
  30. Krishnan V., Nestler E.J. The molecular neurobiology of depression // Nature. – 2008. – Vol. 455, no. 7215. – Pp. 894–902. – https://doi.org/10.1038/nature07455
  31. Hall J., Thomas K.L., Everitt B.J. Rapid and selective induction of BDNF expression in the hippocampus during contextual learning // Nature Neuroscience. – 2000. – Vol. 3, no. 6. – Pp. 533–535. – https://doi.org/10.1038/75698
  32. Li P., Snyder G.L., Vanover S.E., Vanover K.E. Dopamine targeting drugs for the treatment of schizophrenia: Past, present and future // Current Topics in Medicinal Chemistry. – 2016. – Vol. 16, no. 29. – Pp. 3385–3403. – https://doi.org/10.2174/1568026616666160608084834
  33. Martinowich K., Lu B. Interaction between BDNF and serotonin: role in mood disorders // Neuropsychopharmacology. – 2008. – Vol. 33, no. 1. – Pp. 73–83. – https://doi.org/10.1038/sj.npp.1301571
  34. Szapacs M.E. et al. Exploring the relationship between serotonin and brain-derived neurotrophic factor: analysis of BDNF protein and extraneuronal 5-HT in mice with reduced serotonin transporter or BDNF expression // Journal of Neuroscience Methods. – 2004. – Vol. 140, no. 1–2. – Pp. 81–92. – https://doi.org/10.1016/j.jneumeth.2004.03.026
  35. Santarelli L. et al. Requirement of hippocampal neurogenesis for the behavioral effects of antidepressants // Science. – 2003. – Vol. 301, no. 5634. – Pp. 805–809. – https://doi.org/10.1126/science.1083328
  36. Surget A. et al. Antidepressants recruit new neurons to improve stress response regulation // Molecular Psychiatry. – 2011. – Vol. 16, no. 12. – Pp. 1177–1188. – https://doi.org/10.1038/mp.2011.48
  37. Mateus-Pinheiro A. et al. Sustained remission from depressive-like behavior depends on hippocampal neurogenesis // Translational Psychiatry. – 2013. – Vol. 3, no. 1. – Pp. e210-e210. – https://doi.org/10.1038/tp.2012.141
  38. Chikama K. et al. Chronic atypical antipsychotics, but not haloperidol, increase neurogenesis in the hippocampus of adult mouse // Brain Res. – 2017. – Vol. 1676. – Pp. 77–82. – https://doi.org/10.1016/j.brainres.2017.09.006
  39. Patrício P. et al. Differential and converging molecular mechanisms of antidepressants’ action in the hippocampal dentate gyrus // Neuropsychopharmacology. – 2015. – Vol. 40, no. 2. – Pp. 338–349. – https://doi.org/10.1038/npp.2014.176
  40. Bessa J.M. et al. The mood-improving actions of antidepressants do not depend on neurogenesis but are associated with neuronal remodeling // Molecular Psychiatry. – 2009. – Vol. 14, no. 8. – Pp. 764–773. – https://doi.org/10.1038/mp.2008.119
  41. Mateus-Pinheiro A. et al. Sustained remission from depressive-like behavior depends on hippocampal neurogenesis // Translational Psychiatry. – 2013. – Vol. 3, no. 1. – Pp. e210–e210. – https://doi.org/10.1038/tp.2012.141
  42. Wang H.D., Deutch A.Y. Dopamine depletion of the prefrontal cortex induces dendritic spine loss: reversal by atypical antipsychotic drug treatment // Neuropsychopharmacology. – 2008. – Vol. 33, no. 6. – Pp. 1276–1286. – https://doi.org/10.1038/sj.npp.1301521
  43. Morais M. et al. The modulation of adult neuroplasticity is involved in the mood-improving actions of atypical antipsychotics in an animal model of depression // Translational psychiatry. – 2017. – Vol. 7, no. 6. – Pp. e1146–e1146. – https://doi.org/10.1038/tp.2017.120
  44. Schildkraut J.J. The catecholamine hypothesis of affective disorders: a review of supporting evidence // American Journal of Psychiatry. – 1965. – Vol. 122, no. 5. – Pp. 509–522. – https://doi.org/10.1176/ajp.122.5.509
  45. Bunney W.E. The current status of research in the catecholamine theories of affective disorders // Psychopharmacology Communications. – 1975. – Vol. 1, no. 6. – Pp. 599–609.
  46. Ashok A. et al. The dopamine hypothesis of bipolar affective disorder: the state of the art and implications for treatment // Molecular Psychiatry. – 2017. – Vol. 22. – Pp. 666–679. – https://doi.org/10.1038/mp.2017.16
  47. Yatham L.N. et al. A positron emission tomography study of dopamine transporter density in patients with bipolar disorder with current mania and those with recently remitted mania // JAMA Psychiatry. – 2022. – Vol. 79, no. 12. – Pp. 1217–1224. – https://doi.org/10.1001/jamapsychiatry.2022.3541
  48. Jensen N.H. et al. N-desalkylquetiapine, a potent norepinephrine reuptake inhibitor and partial 5-HT1A agonist, a putative mediator of quetiapine’s antidepressant activity // Neuropsychopharmacology. – 2008. – Vol. 33. – Pp. 2303–2312. – https://doi.org/10.1038/sj.npp.1301646
  49. Tuppurainen H. et al. Extrapyramidal side-effects and dopamine D(2/3) receptor binding in substantia nigra // Nord J Psychiatry. – 2010 – Vol. 64, no. 4. – Pp. 233–238. – https://doi.org/10.3109/08039480903484076
  50. Durgam S. et al. An 8-week randomized, double-blind, placebo-controlled evaluation of the safety and efficacy of cariprazine in patients with bipolar I depression // American Journal of Psychiatry. – 2016. – Vol. 173, no. 3. – Pp. 271–281. – https://doi.org/10.1176/appi.ajp.2015.15020164
  51. Медведев В.Э. Карипразин — современный препарат для лечения шизофрении и биполярного расстройства // Современная терапия психических расстройств. – 2022. – № 3. – С. 51–57. – https://doi.org/10.21265/PSYPH.2022.46.63.006
  52. Durgam S. et al. Efficacy and safety of adjunctive cariprazine in inadequate responders to antidepressants: a randomized, double-blind, placebo-controlled study in adult patients with major depressive disorder // The Journal of Clinical Psychiatry. – 2016. – Vol. 77, no. 3. – Art. 6112. – https://doi.org/10.4088/JCP.15m10070
  53. Kiss B., Horti F., Bobok A. Poster# 16 cariprazine, a D3/D2 dopamine receptor partial agonist antipsychotic, displays greater D3 receptor occupancy in vivo compared with other antipsychotics // Schizophrenia Research. – 2012. – No. 136. – Art. S190.– https://doi.org/10.1016/S0920-9964(12)70588-1
  54. Slifstein M. et al. Cariprazine demonstrates high dopamine D3 and D2 receptor occupancy in patients with schizophrenia: a clinical PET study with [11C]-(+)-PHNO // Neuropsychopharmacology. – 2013. – Vol. 38. – Pp. S520–S521.
  55. Tohen M. Cariprazine as a treatment option for depressive episodes associated with bipolar 1 disorder in adults: an evidence-based review of recent data // Drug Design, Development and Therapy. – 2021. – Vol. 15. – Pp. 2005–2012. – https://doi.org/10.2147/DDDT.S240860
  56. Петрова Н.Н. Расстройства аутистического спектра во взрослом возрасте. Обзор // Психиатрия, Психотерапия и Клиническая Психология. – 2022. – Т.13, № 2. – С. 179- 191. – https://doi.org/10.34883/PI.2022.13.2.003
  57. Yatham L.N. et al. A positron emission tomography study of dopamine transporter density in patients with bipolar disorder with current mania and those with recently remitted mania // JAMA Psychiatry. – 2022. – Vol. 79, no. 12. – Pp. 1217–1224. – https://doi.org/10.1001/jamapsychiatry.2022.3541
  58. Ragguett R.M., McIntyre R.S. Cariprazine for the treatment of bipolar depression: a review // Expert Rev Neurother. – 2019. – Vol. 19, no. 4. – Pp. 317–323. – httpd://doi.org/10.1080/14737175.2019.1580571
  59. McIntyre R.S., Suppes T., Earley W., Patel M., Stahl S.M. Cariprazine efficacy in bipolar I depression with and without concurrent manic symptoms: post hoc analysis of 3 randomized, placebo-controlled studies // CNS spectrums. – 2020. – Vol. 25, no. 4. – Pp. 502– 510. – https://doi.org/10.1017/S1092852919001287
  60. Lam R.W. et al. Combining antidepressants for treatment-resistant depression: a review // Journal of Clinical Psychiatry. – 2002. – Vol. 63, no. 8. – Pp. 685–693. – https://doi.org/10.4088/jcp.v63n0805
  61. Nelson J.C., Papakostas G.I. Atypical antipsychotic augmentation in major depressive disorder: a meta-analysis of placebo-controlled randomized trials // American Journal of Psychiatry. – 2009. – Vol. 166, no. 9. – Pp. 980–991. – https://doi.org/10.1176/appi.ajp.2009.09030312
  62. Wright B.M., Eiland III E.H., Lorenz R. Augmentation with atypical antipsychotics for depression: a review of evidence-based support from the medical literature // Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. – 2013. – Vol. 33, no. 3. – Pp. 344–359. – https://doi.org/10.1002/phar.1204
  63. Earley W.R. et al. Cariprazine augmentation to antidepressant therapy in major depressive disorder: results of a randomized, double-blind, placebo-controlled trial // Psychopharmacology Bulletin. – 2018. – Vol. 48, no. 4. – Pp. 62–80.
  64. Pinto J.V. et al. Cariprazine in the treatment of Bipolar Disorder: A systematic review and meta-analysis // Bipolar Disorders. – 2020. – Vol. 22, no. 4. – Pp. 360–371. – https://doi.org/10.1111/bdi.12850
  65. Vieta E. et al. Long-term safety and tolerability of cariprazine as adjunctive therapy in major depressive disorder // International Clinical Psychopharmacology. – 2019. – Vol. 34, no. 2. – Pp. 76–83. – https://doi.org/10.1097/YIC.0000000000000246
  66. Fava M. et al. Efficacy of adjunctive low-dose cariprazine in major depressive disorder: a randomized, double-blind, placebo-controlled trial // International Clinical Psychopharmacology. – 2018. – Vol. 33, no. 6. – Pp. 312–321. – https://doi.org/10.1097/YIC.0000000000000235
  67. Bahji A. et al. Comparative efficacy and tolerability of pharmacological treatments for the treatment of acute bipolar depression: a systematic review and network meta-analysis // Journal of Affective Disorders. – 2020. – Vol. 269. – Pp. 154–184. – https://doi.org/10.1016/j.jad.2020.03.030
  68. Batinic B. et al. Assessment of cognitive function, social disability and basic life skills in euthymic patients with bipolar disorder // Psychiatr Danub. – 2021. – Vol. 33, no. 3. – Pp. 320–327. – https://doi.org/10.24869/psyd.2021.320
  69. Tabarés-Seisdedos R. et al. Neurocognitive and clinical predictors of functional outcome in patients with schizophrenia and bipolar I disorder at one-year follow-up // J Affect Disord. – 2008 – Vol. 109, no. 3. – Pp. 286–299. – https://doi.org/10.1016/j.jad.2007.12.234
  70. Huang M. et al. The role of dopamine D3 receptor partial agonism in cariprazine-Induced neurotransmitter efflux in rat hippocampus and nucleus accumbens // J Pharmacol Exp Ther. – 2019 – Vol. 371, no. 2. – Pp. 517–525. – https://doi.org/10.1124/jpet.119.259879
  71. Zimnisky R. et al. Cariprazine, a dopamine D(3)-receptor-preferring partial agonist, blocks phencyclidine-induced impairments of working memory, attention set-shifting, and recognition memory in the mouse // Psychopharmacology (Berl). – 2013. – Vol. 22. – Pp. 91– 100. – https://doi.org/10.1007/s00213-012-2896-5
  72. Stahl S. Drugs for psychosis and mood: unique actions at D3, D2, and D1 dopamine receptor subtypes // CNS Spectr. – 2017. – Vol. 22, no. 5. – Pp. 375–384. – https://doi.org/10.1017/S1092852917000608
  73. Calabrese F. et al. The role of dopamine D3 receptors in the mechanism of action of cariprazine // CNS Spectrums. – 2020. – Vol. 25, no. 3. – Pp. 343–351. – https://doi.org/10.1017/S109285291900083X 7
  74. Citrome L. Cariprazine in schizophrenia: clinical efficacy, tolerability, and place in therapy // Adv Ther. – 2013. – Vol. 30, no. 2. – Pp. 114–126. – https://doi.org/10.1007/s12325-013-0006-7
  75. Citrome L. Cariprazine for bipolar depression: What is the number needed to treat, number needed to harm and likelihood to be helped or harmed? // Int J Clin Pract. – 2019. – Vol. 73, no. 10. – Art. 13397. – https://doi.org/10.1111/ijcp.13397
  76. Nakamura T. et al. Clinical pharmacology study of cariprazine (MP-214) in patients with schizophrenia (12-week treatment) // Drug Des Devel Ther. – 2016. – Vol. 10. – Pp. 327–338. – https://doi.org/10.2147/DDDT.S95100
  77. Caccia S. et al. A new generation of antipsychotics: pharmacology and clinical utility of cariprazine in schizophrenia // Therapeutics and Clinical Risk Management. – 2013. – Vol. 9. – Pp. 319–328. – https://doi.org/10.2147/TCRM.S35137
  78. Мосолов С.Н., Алфимов П.В. Роль дофаминовых D3-рецепторов в механизме действия современных антипсихотиков // Современная терапия психических расстройств. – 2014. – № 1. – С. 2-9.
  79. Earley W. et al. Efficacy of cariprazine on negative symptoms in patients with acute schizophrenia: a post hoc analysis of pooled data // Schizophrenia Research. – 2019. – Vol. 204. – Pp. 282–288. – https://doi.org/10.1016/j.schres.2018.08.020
  80. Mohr P., Masopust J., Kopeček M. Dopamine receptor partial agonists: Do they differ in their clinical efficacy? // Frontiers in Psychiatry. – 2022. – Vol. 12. – Art. 2491. – https://doi.org/10.3389/fpsyt.2021.781946
  81. Forte A. et al. Long-term morbidity in bipolar-I, bipolar-II, and unipolar major depressive disorders // J Affect Disord. – 2015 – Vol. 178. – Pp. 71–78. – https://doi.org/10.1016/j.jad.2015.02.011
  82. Rancans E. et al.The effectiveness and safety of cariprazine in schizophrenia patients with negative symptoms and insufficient effectiveness of previous antipsychotic therapy: an observational study // Int Clin Psychopharmacol. – 2021 – Vol. 36, no. 3. – Pp. 154–161. – https://doi.org/10.1097/YIC.0000000000000351

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