Brain Amine Concentrations after Monoamine Oxidase Inhibitor Administration

The concentrations of 5-hydroxytryptamine (5HT), noradrenaline, and dopamine were estimated post mortem in brain stem, hypothalamus, and caudate nucleus in 33 patients who had been treated with isocarboxazid, clorgyline, or tranylcypromine and 11 controls. Similar and highly significant increases in 5HT and noradrenaline concentration occurred with all three drugs. The distribution was unimodal, but about a quarter of the patients showed only a small increase in brain amines. Tranylcypromine seemed to have a significantly greater effect on dopamine in caudate nucleus and hypothalamus compared with isocarboxazid and clorgyline. In the doses used chlorpromazine did not reduce the amine concentrations. Four patients with Parkinson''s syndrome had low concentrations of dopamine in caudate nucleus in spite of monoamine oxidase inhibitor administration.     

Tranylcypromine Cephalgia

Tranylcypromine, a useful antidepressant agent, has been linked with a clinical syndrome of undetermined incidence characterized by exceedingly severe and prolonged headache. Associated phenomena may include paroxysmal hypertension, pallor, chest pain and collapse. This violent reaction does not seem to be related to age, sex, duration of treatment, or pre-existing cardiovascular disease; nor is it possible to predict in whom it will occur. The clinical picture may sometimes be quite similar to that produced by subarachnoid hemorrhage or by pheochromocytoma. The mechanism of action is not known, although it is possible that the syndrome may be due to an amphetamine-like effect; i.e., that tranylcypromine influences the adrenergic component of the reticular activating system. The occurrence of severe headache in the course of tranylcypromine therapy is an indication for immediate withdrawal of the drug. Tranylcypromine cephalgia should be considered as part of the differential diagnosis of sudden, violent and prostrating headache.     

Neuroendocrine and behavioral effects of dietary tryptophan restriction in healthy subjects

The neuroendocrine and behavioral effects of gradual dietary tryptophan (TRP) depletion, utilizing two magnitudes of a 10-day TRP-restriction diet (700 mg/day and 200 mg/day), were studied in 22 healthy subjects. The prolactin response to a 7 gm L-TRP infusion was measured prior to and on day 10 of the diet. Both diets significantly reduced fasting total plasma TRP by 15 to 20%, but only the 200 mg/day TRP diet led to an enhancement of the prolactin response to intravenous L-TRP. Female subjects demonstrated a more robust increase in plasma prolactin following L-TRP infusion pre-diet and exhibited a larger decrease in plasma TRP following dietary TRP restriction compared to males. There were no significant behavioral effects of either diet. Gradual dietary TRP depletion leads to an enhancement of the prolactin response to L-TRP infusion, suggestive of postsynaptic serotonin receptor supersensitivity.     

Heart Rate Variability,Flow, Mood and Mental Stress During Yoga Practices in Yoga Practitioners,Non-yoga Practitioners and People with Metabolic Syndrome

Heart Rate Variability (HRV) and respiratory sinus arrhythmia are directly associated with autonomic flexibility, self-regulation and well-being, and inversely associated with physiological stress, psychological stress and pathology. Yoga enhances autonomic activity, mitigates stress and benefits stress-related clinical conditions, yet the relationship between autonomic activity and psychophysiological responses during yoga practices and stressful stimuli has not been widely explored. This experimental study explored the relationship between HRV, mood states and flow experiences in regular yoga practitioners (YP), non-yoga practitioners (NY) and people with metabolic syndrome (MetS), during Mental Arithmetic Stress Test (MAST) and various yoga practices. The study found that the MAST placed a cardio-autonomic burden in all participants with the YP group showing the greatest reactivity and the most rapid recovery, while the MetS group had significantly blunted recovery. The YP group also reported a heightened experience of flow and positive mood states compared to NY and MetS groups as well as having a higher vagal tone during all resting conditions. These results suggest yoga practitioners have a greater homeostatic capacity and autonomic, metabolic and physiological resilience. Further studies are now needed to determine if regular yoga practice may improve autonomic flexibility in non-yoga practitioners and metabolic syndrome patients. Clinical Trial No ‘ACTRN 2614001075673’     

Effects of daily walking on subjective symptoms, mood and autonomic nervous function

It is well known that moderate exercise is beneficial to health. However, the effects of exercise on subjective symptoms in relation to mood and autonomic nervous function have not yet been fully examined. The purpose of this study was to investigate the effects of daily walking on subjective symptoms as well as on mood and autonomic nervous function in people who take no medication but have some general physical complaints. We assessed their symptoms by the Cornell Medical Index (CMI), and mood states by a profile of mood states (POMS) and a frontal alpha laterality ratio. Autonomic nervous function was evaluated by a supine rest basal level, reactivity to orthostatic challenge (physiological stimulus) and to a self-programmed videogame (psychophysiological stimulus) of heart rate (HR), heart rate variability (HRV), baroreflex sensitivity and blood pressure (BP). Repeated measures analysis of variance showed no significant group (control and walking group) x time (pre- and post- walking period) interaction of CMI scores. In contrast, the A-H sub-scale (anger and hostility) of POMS and basal HR significantly decreased after a 4-week walking period in a walking group compared to a control group. Negative mood score of POMS reduced, and basal high-frequency component of HRV and reactivity to orthostatic challenge of baroreflex sensitivity increased marginally significantly compared to the control group. Multiple regression analysis revealed a significant contribution of A-H to the physical score of CMI, which showed a marginally significant reduction after the experimental period in the walking group. These results suggest that daily walking can improve mood states and shift autonomic balance to parasympathetic predominance, and may consequently contribute to the reduction of subjective symptoms.     

Vasopressor challenges during chronic MAOI or TCA treatment in anesthetized dogs

Ten male mongrel dogs were treated in Phase I with tranylcypromine, 6 mg/kg IM b.i.d., for 21 days. Dogs were anesthetized at weekly intervals before, during, and up to four weeks after drug treatment with a combination of amylbarbital, 25 mg/kg, 1% enflurane in 70:30 N₂0:0₂) and fentanyl, 500 mcg. Bolus IV injections of norepinephrine, 0.1–0.6 mcg/kg, and ephedrine, 0.03–0.12 mg/kg were given while continuously recording arterial blood pressure, lead II of the ECG, heart rate, and rectal temperature. Awakening times were noted. In Phase II, the dogs were given imipramine, 25 mg/kg IM b.i.d., for 21 days. During Phase III, 14 days of tranylcypromine, 7 days of tranylcypromine plus imipramine, and 7 days of imipramine were administered. Anesthetic techniques were repeated in phases II and III. The fourth phase consisted of tranylcypromine injections, 6 mg IM b.i.d., and anesthesia with amylbarbital 25 mg/kg, 2.5% enflurane in 70:30 N₂0:0₂. Vasopressor challenges were repeated during each phase of the study. Following induction of anesthesia and prior to fentanyl challenge, baseline blood pressures and heart rates did not differ from control in Phase I, II, and III of this study. Responses to norepinephrine during all of the tranylcypromine phases were not significantly different from control but ephedrine responses were prolonged, peaking by the second week of treatment. During Phase II, dysrhythmias occurred following norepinephrine and ephedrine with one lethality following norepinephrine, 0.2 mcg/kg. Responses to norepinephrine and awakening times were significantly greater during Phase II compared to Phase I. In Phase III, during the first week of combined therapy the responses to norepinephrine were significantly greater than any other week of this phase. During Phase IV, resting blood pressure and the ephedrine responses were significantly increased during tranylcypromine when the anesthesia regimen did not include fentanyl. These results suggest that during initial treatment with tranylcypromine or imipramine, cardiovascular responses to vasopressor challenges were predicted by the pharmacology of the antidepressant. During tranylcypromine phases, we did not observe exaggerated cardiovascular effects during anesthesia and vasopressor challenges as had been previously reported.

The use of monoamine oxidase inhibitors (MAOIs), alone or in combination with tricyclic antidepressants (TCAs), has been increasing over the last few years because they appear to be more effective than TCAs alone in treating resistant affective disorders. (1,2) However, reluctance to use MAOIs has persisted because of reports of interactions with various foods and drugs. (3–6) In recent years, cell membrane receptor studies have shown that chronic treatment (greater than 14 to 21 days) with either MAOIs of TCAs results in physiological adaptations that partially reduce the interactions between drugs and their receptors. (7,8) Attenuation of arrhythmogenicity has been described in dogs after six weeks of TCA treatment. (9) Clinically, patients on chronic MAOI therapy have undergone elective surgery, including open-heart surgery, without adverse responses. (10,11) The cardiovascular response to analgesics, anesthetics, and vasopressors during the initial phase (less than 14 to 21 days) of treatment with MAOIs compared to TCAs has yet to be addressed. Therefore, the purpose of this study was to examine the cardiovascular responses of analgesic, anesthetic, and vasopressor agents before, during, and after the first three weeks of MAOI and TCA administration in dogs.     

Brain Serotonin,Carbohydrate-Craving,Obesity and Depression

Serotonin-releasing brain neurons are unique in that the amount of neurotransmitter they release is normally controlled by food intake: Carbohydrate consumption-acting via insulin secretion and the “plasma tryptophan ratio” - increases serotonin release; protein intake lacks this effect. This ability of neurons to couple neuronal signaling properties to food consumption is a link in the feedback mechanism that normally keeps carbohydrate and protein intakes more or less constant. However, serotonin release is also involved in such functions as sleep onset, pain sensitivity, blood pressure regulation, and control of the mood. Hence many patients learn to overeat carbohydrates (particularly snack foods, like potato chips or pastries, which are rich in carbohydrates and fats) to make themselves feel better. This tendency to use certain foods as though they were drugs is a frequent cause of weight gain, an d can also be seen in patients who become fat when exposed to stress, or in women with premenstrual syndrome, or in patients with “winter depression,” or in people who are attempting to give up smoking. (Nicotine, like dietary carbohydrates, increases brain serotonin secretion; nicotine withdraw al has the opposite effect.) It also occurs in patients with normal-weight bulimia. Dexfenfluramine constitutes a highly effective treatment for such patients. In addition to producing its general satiety-promoting effect, it specifically reduces their overconsumption of carbohydrate-rich (or carbohydrate-and fat-rich)foods.     

d-Amphetamine raises serum prolactin in man: evaluations after chronic placebo, lithium and pimozide treatment.

One of the major biochemical effects of d-amphetamine is the release and uptake inhibition of dopamine (DA). We measured the effect of d-amphetamine upon prolactin release which is inhibited by DA and stimulated by serotonin. d-Amphetamine (20 mg i.v.) significantly raised the serum prolactin levels of drug-free schizophrenic patients over preinfusion levels and levels following a paired placebo lactose infusion. Amphetamine infusions were repeated after both chronic DA blockade with pimozide and after chronic lithium treatment that has been reported to attenuate amphetamine effects. These chronic pretreatments did not prevent significant increases in prolactin following d-amphetamine infusions. Pimozide raised preinfusion prolactin levels but lithium had no effect. Further studies are needed to clarify the d-amphetamine-induced rise in prolactin.     

The effect of desmopressin on nocturnal polyuria,overnight weight loss,and morning postural hypotension in patients with autonomic failure.

Day and night urine volume, morning and evening body weight, and supine and sitting blood pressure were measured in five patients with chronic autonomic failure who were not receiving treatment with drugs. All had nocturnal polyuria, overnight weight loss, and a pronounced postural fall in blood pressure, with lowest levels in the morning. Desmopressin (2-4 micrograms given intramuscularly at 8 pm) reduced nocturnal polyuria, diminished overnight weight loss, raised supine blood pressure, and reduced the postural fall, especially in the morning, when patients were often at their worst. Desmopressin may be a useful alternative to, or may supplement, other forms of treatment in some patients with autonomic failure.     

Growth hormone,insulin, and prolactin secretion in anorexia nervosa and obesity during bromocriptine treatment.

We studied secretion of growth hormone (GH), insulin, and prolactin in eight women with anorexia nervosa and nine women with refractory obesity before and during treatment with bromocriptine, 10 mg/day. In the anorexic patients the raised plasma GH concentrations occurring during an oral glucose tolerance test fell significantly while on bromocriptine treatment, but there was no change in plasma insulin or blood glucose concentrations. In the obese patients, however, plasma GH concentrations remained low during the oral glucose tolerance test, and were not modified by bromocriptine. Blood glucose and plasma insulin concentrations were also unchanged. Plasma GH and plasma 11-hydroxycorticosteroid responses to insulin-induced hypoglycaemia were unaffected. Serum prolactin concentrations which were raised in five anorexic patients and marginally raised in two obese subjects, fell significantly in both groups during treatment. We observed no consistent weight changes in either groups.     

Pineal function during ethanol intoxication, dependence, and withdrawal

Pineal melatonin and serotonin content were determined during one to four days of continuous intoxication, and during the alcohol withdrawal syndrome. The nocturnal rise in pineal melatonin was blunted in continuously intoxicated animals, however this was found to be unrelated to duration of treatment. The initial dependent-intoxicated phase of the alcohol withdrawal syndrome produced a reduction of nocturnal pineal melatonin content with a concomitant elevation in pineal serotonin. The overt withdrawal phase of the alcohol withdrawal syndrome had no effect on pineal melatonin or serotonin content. This data suggests that ethanol may perturb pineal melatonin synthesis either directly, or indirectly by altered receptor function. Contrary to our expectations the pineal may not be a useful model to probe the physiology of increased noradrenergic neurotransmission produced by ethanol withdrawal.     

Reversible, amine--selective effects of acute and chronic brofaromine treatment in the rat.

The effects of brofaromine, clorgyline (reversible and irreversible type A MAO inhibitors, respectively) and tranylcypromine (non-selective MAO inhibitor) on rat striatal levels of phenylethylamine, tryptamine, m-tyramine and p-tyramine were determined. Brofaromine and clorgyline increased m- and p-tyramine levels, but not phenylethylamine levels. Brofaromine given at a dose of 100 mg/kg did increase tryptamine levels. Tranylcypromine increased the levels of all four amines greatly. The effects of chronic treatment with brofaromine on amine levels were not different from those following acute treatment. By contrast, chronic treatment with clorgyline caused greater increases in striatal m- and p-tyramine levels than did acute clorgyline. These data show that changes in the rat striatal levels of m-tyramine and p-tyramine may be used as in vivo indicators of the selectivity and reversiblity of inhibition of type A MAO, while tryptamine levels reflect non-selective inhibition of both types of MAO.     

Antihypertensive effects of fluoxetine and L-5-hydroxytryptophan in rats.

The combination of fluoxetine (10 mg/kg) and L-5-hydroxytryptophan (5-HTP) (10 mg/kg) significantly lowered blood pressure in spontaneously hypertensive rats and in rats made hypertensive by treatment with deoxycorticosterone (DOCA) and saline. Fluoxetine alone also had a significant effect on blood pressure in DOCA hypertensive rats, but not as great an effect as the combination. Since fluoxetine is an inhibitor of serotonin reuptake and 5-HTP is the serotonin precursor, the antihypertensive effect of this drug combination strengthens previous evidence that serotonin neurons have a role in the central regulation of blood pressure.     

The influence of phenelzine and tranylcypromine on the release of prostaglandins from the rat mesenteric vascular bed

We investigated the effects of phenelzine and tranylcypromine on the release of prostacyclin, thromboxane A2, prostaglandin E2, and prostaglandin E1 from the isolated perfused rat mesenteric vascular bed. Perfusion of the preparation with phenelzine in concentrations of 15, 45, and 135 microM for 150 min led to attenuated release of all four prostaglandins measured. Inhibition generally occurred with the lowest dose used and was most prominent with the highest concentration. Tranylcypromine also decreased prostaglandin formation. However, low doses were not effective in the suppression of prostacyclin release. Both drugs had an inhibitory effect on production of prostaglandin E1, which is a metabolite of dihomo-gamma-linolenic acid, the precursor of arachidonic acid, but this was only shown to be significant with phenelzine. In this work we demonstrate that phenelzine and tranylcypromine have an inhibitory effect on the production of 2-series prostaglandins derived from arachidonic acid, and possibly a similar effect on prostaglandins of the 1-series derived from dihomo-gamma-linolenic acid.     

Prolactin enhances production of interferon-gamma,interleukin-12, and interleukin-10, but not of tumor necrosis factor-alpha,in a stimulus-specific manner

Prolactin, an anterior pituitary hormone, has been shown to have a role in immunomodulation. Some reports have shown the importance of prolactin in activating lymphocytes and macrophages, while in hyperprolactinemia patients, prolactin was found to decrease lymphocyte activation and natural killer function. In the present work, at physiological (15ng/ml) and stress-induced levels (30ng/ml) of prolactin, interferon-gamma (IFN-gamma) and interleukin (IL)-12 p70 levels, but not of IL-10 and tumor necrosis factor-alpha (TNF-alpha), increased significantly (p<0.05-0.006) in phytohemeagglutinin (PHA)+lipopolysaccharide (LPS)-stimulated whole blood. However, no such effect was observed at high concentrations of prolactin (100-300ng/ml). In addition, 15ng/ml of prolactin reversed hydrocortisone suppressive effect on IFN-gamma, IL-12 p70, and IL-10 production in PHA+LPS-stimulated whole blood. On the other hand, in LPS-stimulated whole blood, prolactin enhanced significantly (p=0.027) the production levels of IL-10, but not of IFN-gamma, IL-12 p70, and TNF-alpha, in non-concentration-dependent manner. These results suggest that prolactin modulates cytokine response during antigenic response, and this modulation is stimulus specific.     

A comparison of plasma prolactin levels in young female Long-Evans and Holtzman rats as measured by Nb2 lymphoma bioassay and radioimmunoassay

This study was conducted to determine the plasma levels of prolactin in prepubertal and young, postpubertal, proestrus rats of mammary tumor-susceptible (Sprague-Dawley) and tumor-resistant (Long-Evans) strains using a sensitive bioassay-Nb2 lymphoma cell replication. Prepubertal Long-Evans rats had significantly higher levels of prolactin than did Holtzman Sprague-Dawley rats of the same age. Likewise, Long-Evans rats secreted significantly more prolactin into the blood on the afternoon and evening of proestrus than did Holtzman rats. Finally, ovariectomized Long-Evans rats released more prolactin into the blood at 1 day, but not at 8 or 15 days, of treatment with diethylstilbestrol. Prolactin levels determined by conventional radioimmunoassay and by bioassay were similar except on the afternoon of proestrus, when, in both strains of rats, the bioassay to radioimmunoassay ratio increased significantly above 1.0 during the late evening. In addition, the ratio was significantly less than 1.0 in the early and late afternoon in the Holtzman rats, but not Long-Evans rats. These data indicate that a strain of rats that is resistant to experimentally induced mammary cancer has higher prolactin levels in the blood than does a strain that is susceptible to mammary cancer at a time when mammary gland growth is rapid. Furthermore, there are times during the proestrus prolactin surge when the bioassay yielded higher and lower values of prolactin than radioimmunoassay of the same samples, suggesting functional heterogeneity of prolactin that may impact on mammary gland or other target tissue function.     

Differential effect of the 5-HTT gene-linked polymorphic region on emotional eating during stress exposure following tryptophan challenge

Stress and negative moods, which are thought to be partly mediated by reduced brain serotonin function, often increase emotional eating in dieting women (restrainers). Because the short (S) allele polymorphism in the serotonin transporter gene (5-HTTLPR) is associated with serotonin dysfunction, S allele compared to long (L) allele 5-HTTLPR genotypes may be more susceptible to stress-induced emotional eating. Consequently, serotonin challenge via tryptophan (TRP)-rich protein hydrolysate (TPH) may alleviate stress-induced emotional eating particularly in S/S allele carriers. We tested whether acute stress affects emotional eating in women with high or low dietary restraints depending on their 5-HTTLPR genotype and TPH intake. Nineteen female subjects who were homozygous for the short-allele 5-HTTLPR genotype (S'/S'=S/L(G), L(G)/L(G): restrainers vs. nonrestrainers) and 23 female subjects who were homozygous for the long-allele 5-HTTLPR genotype (L'/L'=L(A)/L(A): restrainers vs. nonrestrainers) were tested in a double-blind, placebo-controlled crossover study of stress-induced emotional eating following intake of TPH or a placebo. TPH intake significantly increased the plasma TRP/large neutral amino acid ratio (P<.0001) in the L'/L' group (70%) compared to the S'/S' group (30%). TPH reduced food intake in both groups, but in the L'/L' group, it also reduced stress-induced negative mood (P=.037) and the desire for sweet, high-fat foods (P=.011) regardless of dietary restraint. Conclusions: Since TPH caused a greater increase in the plasma TRP/large neutral amino acid ratio in the L'/L' group compared to S'/S' group, the exclusive beneficial effects of L'/L' genotype may be due to enhanced brain 5-HT function.     

Brain serotonin turnover and plasma prolactin and growth hormone concentrations during changes in osmotic balance in the domestic fowl

Summary Young cockerels injected 24 h earlier with 0.9% saline,para-chorophenylalanine (pCPA, brain serotonin depletor) or alpha-methylpara-tyrosine (AMPT, brain catecholamine depletor) were deprived of access to water for 24 h. Plasma prolactin concentrations were markedly elevated by water deprivation and returned to normal on rehydration. pCPA, but not AMPT, significantly reduced the increase in prolactin. Concentrations of growth hormone were not affected by water deprivation. Brain serotonin concentrations were reduced by treatment with pCPA. Groups of cockerels were maintained under normal conditions or without access to drinking water for 12 h or 24h. Some were injected with the monoamine oxidase inhibitor pargyline, which increased the prolactin and decreased the growth hormone concentration in the plasma of the hydrated birds. The inhibitory effect of pargyline on growth hormone was augmented following water deprivation. Serotonin levels were not significantly affected by water deprivation but turnover (defined as accumulation of serotonin after pargyline treatment) was increased in the hypothalamus but not in remaining tissue. Injecting 30% saline solution intravenously markedly increased plasma prolactin whilst growth hormone concentrations were decreased. Serotonin turnover was increased in the hypothalamus but not in other brain regions. The results show that secretion of prolactin and growth hormone by the pituitary gland during osmotic imbalance in the fowl may be mediated by changes in hypothalamic scrotonin turnover.     

Monoamine oxidase inhibitory properties of milacemide in rats

Milacemide is a glycine prodrug with reported antiepileptic antimyoclonic properties. In this study, milacemide increased "wet dog shakes" in rats pretreated with 5-Hydroxytryptophan (5-HTP) and carbidopa. Moreover, it worsened the serotonin behavior syndrome precipitated by 5-HTP and the monoamine oxidase inhibitor tranylcypromine. The serotonin syndrome was also elicited by the combination of milacemide and 5-HTP without tranylcypromine. In vitro, milacemide inhibited both monoamine oxidase A and B from the frontal cortex of rats, to a greater extent for MAO B. This drug is currently under investigation in humans as an antiepileptic agent and precautions for the consequences of monoamine oxidase inhibition should be considered when the drug is used in high doses.     

Serotonin and norepinephrine

Rats which had been primed with the serotonin depletor,p-chlorophenylalanine, and sacrificed months later were found to have the same resting levels of brain serotonin and norepinephrine as unprimed controls. However, when treated with the monoamine oxidase inhibitor, tranylcypromine, the former showed a significantly lower accumulation of these biogenic amines than their tranylcyprominetreated unprimed counterparts. These findings indicate that brain serotonin, which had been lowered at the outset byp-chlorophenylalanine, had returned to normal levels but that the priming procedure might have resulted in a long-term decrease in the turnover rates of serotonin as well as norepinephrine. Primed animals may prove suitable as models of disturbed biogenic amine metabolism with possible relevance to schizophrenia and other brain dysfunctions.