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Alterations in acylcarnitines, amines, and lipids inform about the mechanism of action of citalopram/escitalopram in major depression.

Authors:
Siamak MahmoudianDehkordi Ahmed T Ahmed Sudeepa Bhattacharyya Xianlin Han Rebecca A Baillie Matthias Arnold Michelle K Skime Lisa St John-Williams M Arthur Moseley J Will Thompson Gregory Louie Patricio Riva-Posse W Edward Craighead William McDonald Ranga Krishnan A John Rush Mark A Frye Boadie W Dunlop Richard M Weinshilboum Rima Kaddurah-Daouk

Transl Psychiatry 2021 Mar 2;11(1):153. Epub 2021 Mar 2.

Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, Durham, NC, USA.

Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for major depressive disorder (MDD), yet their mechanisms of action are not fully understood and their therapeutic benefit varies among individuals. We used a targeted metabolomics approach utilizing a panel of 180 metabolites to gain insights into mechanisms of action and response to citalopram/escitalopram. Plasma samples from 136 participants with MDD enrolled into the Mayo Pharmacogenomics Research Network Antidepressant Medication Pharmacogenomic Study (PGRN-AMPS) were profiled at baseline and after 8 weeks of treatment. After treatment, we saw increased levels of short-chain acylcarnitines and decreased levels of medium-chain and long-chain acylcarnitines, suggesting an SSRI effect on β-oxidation and mitochondrial function. Amines-including arginine, proline, and methionine sulfoxide-were upregulated while serotonin and sarcosine were downregulated, suggesting an SSRI effect on urea cycle, one-carbon metabolism, and serotonin uptake. Eighteen lipids within the phosphatidylcholine (PC aa and ae) classes were upregulated. Changes in several lipid and amine levels correlated with changes in 17-item Hamilton Rating Scale for Depression scores (HRSD). Differences in metabolic profiles at baseline and post-treatment were noted between participants who remitted (HRSD≤ 7) and those who gained no meaningful benefits (<30% reduction in HRSD). Remitters exhibited (a) higher baseline levels of C3, C5, alpha-aminoadipic acid, sarcosine, and serotonin; and (b) higher week-8 levels of PC aa C34:1, PC aa C34:2, PC aa C36:2, and PC aa C36:4. These findings suggest that mitochondrial energetics-including acylcarnitine metabolism, transport, and its link to β-oxidation-and lipid membrane remodeling may play roles in SSRI treatment response.

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http://dx.doi.org/10.1038/s41398-020-01097-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925685PMC
March 2021

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