Chong Guang Ng

Markus Kosel

Norio Yasui-Furukori

Frontiers in Psychiatry

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TYPE EditorialPUBLISHED 18 April 2023DOI 10.3389/fpsyt.2023.1185678OPEN ACCESSEDITED AND REVIEWED BYRoberto Ciccocioppo,University of Camerino, Italy*CORRESPONDENCEMarkus Koselmarkus.kosel@hcuge.chSPECIALTY SECTIONThis article was submitted toPsychopharmacology,a section of the journalFrontiers in PsychiatryRECEIVED 13 March 2023ACCEPTED 28 March 2023PUBLISHED 18 April 2023CITATIONKosel M, Ng CG and Yasui-Furukori N (2023)Editorial: Assessing the consequences ofantidepressant treatments.Front. Psychiatry 14:1185678.doi: 10.3389/fpsyt.2023.1185678COPYRIGHT© 2023 Kosel, Ng and Yasui-Furukori. This is anopen-access article distributed under the termsof the Creative Commons Attribution License(CC BY). The use, distribution or reproductionin other forums is permitted, provided theoriginal author(s) and the copyright owner(s)are credited and that the original publication inthis journal is cited, in accordance withaccepted academic practice. No use,distribution or reproduction is permitted whichdoes not comply with these terms.Editorial: Assessing theconsequences of antidepressanttreatmentsMarkus Kosel1*, Chong Guang Ng2 and Norio Yasui-Furukori31Department of Adult Psychiatry, Hôpitaux Universitaires de Genève (HUG), Genève, Switzerland,2Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur,Malaysia, 3Dokkyo Medical University, Mibu, Tochigi, JapanKEYWORDSmajor depressive disorder, drug therapy, psychedelic agents, lithium, menstrual bleeding,citalopram, emotion regulationEditorial on the Research TopicAssessing the consequences of antidepressant treatmentsThe pharmacological treatment of major depressive disorder during the last decadeshas essentially been based on antidepressants modulating monoaminergic neurotransmittersystems (serotonin, noradrenaline, and dopamine) by reuptake inhibition and the blockadeof monoamine oxidases. Therapeutic and side effects of such medications have beenwidely assessed. However, since ketamine, a dissociative anesthetic targeting primarily theglutamatergic neurotransmitter system, has been increasingly investigated as a potentialantidepressant following the pioneering work of Berman and later Zarate and their co-workers, the interest in unconventional approaches to treat depression has been revived(1–3). Indeed, the approval of intranasal esketamine to treat resistant depression, but alsothe widespread use of intravenous ketamine in the same indication and also acute suicidalityis certainly one of the major developments in this field during the last years (4).The first article in the Research Topic “Assessing the consequences of antidepressanttreatments” by Raison et al. addresses the effects of the naturalistic psychedelic use ondepression, anxiety, and wellbeing in a cross-sectional online survey in 2,500 adultsconducted in the United States of America. To our knowledge, this is one of the largeststudies of its kind. On average, study participants indicated 39 lifetime uses of psychedelicswhereas the preferred substances were psylocibin (52%), LSD (30%), Ayahuasca, DMT,and ketamine. Based on the data collected including the use of several clinical scales,the authors conclude that psychedelic use is associated with significant improvements indepressive and anxious symptoms. Thirteen percent of participants recorded at least oneharm linked to psychedelic use, such as substance misuse and impulsive behavior (criminal,auto-, or heteroagressive). These results strengthen the idea that the careful prescription ofpsychedelics could be beneficial to patients with depression. However, specific modalities oftheir use as potential antidepressant treatments or facilitators in psychotherapeutic settingsand how to minimize adverse effects and the emergence of addictive behaviors needsto be carefully evaluated. Indeed, according to a recently published treatment guideline,only preliminary results with a low level of evidence are available assessing the efficacy ofserotonergic psychedelics in major depression (3, 5).Frontiers in Psychiatry 01 frontiersin.orgKosel et al. 10.3389/fpsyt.2023.1185678Sklivanioti Greenfield et al. assessed the effect of a single dose of10mg of escitalopram, a widely used selective serotonin reuptakeinhibiting antidepressant drug, on affective tonus, intensity ofemotion and emotion regulation. Forty-six adults were recruitedfrom a non-clinical population in Sweden. The InternationalAffective Picture System was used to induce emotions (fearand disgust). A baseline assessment of all participants includedan emotional reappraisal task. Behavioral data, electrodermalactivity (EDA), and functional near-infrared spectroscopy (fNIRS)recordings were collected. Results were compared between groups5 h after the administration of either placebo or 10mg ofescitalopram. The authors conclude that escitalopram reducesemotion intensity for both fear and disgust compared to placebo.However, the effect of cognitive regulation was more importantthan the effect of escitalopram. EDA and fNIRS results suggestdifferential mechanisms of emotion regulation of cognitive andpharmacological approaches. This study sheds light on the complexregulation of emotions using a selective serotonin reuptakeinhibitor as a probe and links insights into neurophysiologicalprocesses to potential clinical approaches (6).In the third article of the Research Topic, Zhuo et al. assessedthe association of mainly a large number of antidepressants andmood stabilizers with the risk of increased menstrual bleeding,based on data retrospectively collected during a 24 months periodby the physicians of participating adults in China. This is avery important study addressing an often-overlooked side effectof many antidepressant medications: impairment of hemostasis,especially during menstruation. Almost 2,000 participants, themajority with major depressive disorders were included. Heavymenstrual bleeding occurred in 33% of participants. It was moststrongly associated with the prescription of venlafaxine, duloxetine,and mirtazapine and even higher when combined with valproate.As the authors state, these results, based on retrospective data needto be confirmed by a prospective study, including a control group.The final article by Fujikawa et al. is a case report about a specialtreatment setting: administration of lithium using a nasal tubein a patient with bipolar disorder. Standard lithium medicationwas crushed, suspended and administered through the nasal tube.However, this procedure resulted in a critically lowered bloodlithium concentration.In this Research Topic, four articles address very different butimportant aspects of the pharmacological treatment of depression:new substance-based approaches (psychedelics), modulation ofemotions by a serotonergic medication, an often-overlookedunwanted effect of antidepressants and mood stabilizers (increasedmenstrual bleeding) and practical aspects of mood stabilizingtreatment when per osmedication is not possible. Much needs to bedone in order to address the overall efficacy of antidepressant andmood stabilizing treatment and to better address specific individualneeds while minimizing side effects. The articles presented inthis Research Topic reflect some aspects of the current state andchallenges in the field.Author contributionsAll authors listed have made a substantial, direct, andintellectual contribution to the work and approved itfor publication.Conflict of interestThe authors declare that the research was conducted in theabsence of any commercial or financial relationships that could beconstrued as a potential conflict of interest.Publisher’s noteAll claims expressed in this article are solely those of theauthors and do not necessarily represent those of their affiliatedorganizations, or those of the publisher, the editors and thereviewers. Any product that may be evaluated in this article, orclaim that may be made by its manufacturer, is not guaranteed orendorsed by the publisher.References1. Berman RM, Cappiello A, Anand A, Oren DA, Heninger GR,Charney DS, et al. Antidepressant effects of ketamine in depressedpatients. Biol Psychiatry. (2000) 47:351–4. doi: 10.1016/S0006-3223(99)00230-92. Zarate CA Jr, Singh JB, Carlson PJ, Brutsche NE, Ameli R, LuckenbaughDA, et al. A randomized trial of an N-methyl-D-aspartate antagonistin treatment-resistant major depression. Arch Gen Psychiatry. (2006)63:856–64. doi: 10.1001/archpsyc.63.8.8563. Marwaha S, Palmer E, Suppes T, Cons E, Young AH, Upthegrove R.Novel and emerging treatments for major depression. Lancet. (2023) 401:141–53. doi: 10.1016/S0140-6736(22)02080-34. Jollant F, Colle R, Nguyen TML, Corruble E, Gardier AM,Walter M, et al. Ketamine and esketamine in suicidal thoughts andbehaviors: A systematic review. Ther Adv Psychopharmacol. (2023)13:20451253231151327. doi: 10.1177/204512532311513275. Rosenblat JD, Husain MI, Lee Y, McIntyre RS, Mansur RB, Castle D, et al. TheCanadian Network for Mood and Anxiety Treatments (CANMAT) task force report:Serotonergic psychedelic treatments for major depressive disorder. Can J Psychiatry.(2023) 68:5–21. doi: 10.1177/070674372211113716. Jiang Y, Zou D, Li Y, Gu S, Dong J, Ma X, et al. Monoamine neurotransmitterscontrol basic emotions and affect major depressive disorders. Pharmaceuticals. (2022)15:101203. doi: 10.3390/ph15101203Frontiers in Psychiatry 02 frontiersin.org

Editorial: Assessing the consequences of antidepressant treatments

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Editorial: Assessing the consequences of antidepressant treatments

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