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Complex Role of the Serotonin Receptors in Depression: Implications for Treatment

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Understanding Depression

Abstract

Evidence from pharmacological, neuroimaging, postmortem, and genetic studies underlines the various roles of 5-HT receptor subtypes in the pathogenesis of major depressive disorder. Recent investigations further supported the notion of their interaction with the antidepressant medication and advanced the knowledge on underlying mechanisms of their action. The heterogeneous properties of individual 5-HT receptors offer a chance for development of new generation of antidepressants, which may be more beneficial and effective than traditional selective serotonin reuptake inhibitors (SSRIs). Antagonists of 5-HT2A, 5-HT2C, 5-HT3, 5-HT6, and 5-HT7 receptors, as well as agonists of 5-HT1A, 5-HT1B, 5-HT2C, 5-HT4, and 5-HT6 receptors, were observed to produce antidepressant-like responses. Paradoxical antidepressant-like effects of both agonists and antagonists of 5-HT receptors are likely connected to the diverse neurochemical mechanisms they instantiate. Augmented behavioral effects of SSRIs and other antidepressants used in combined treatment with 5-HT receptor agonists or antagonists have also been reported. The involvement of 5-HT receptors in depression is complex. Identifying the role of 5-HT receptors in response to antidepressants is an essential step in recognizing their mechanisms of action and, thereby, potentially producing more effective antidepressants with fewer side effects in patients with major depressive disorder.

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References

  • aan het Rot M, Mathew SJ, Charney DS. Neurobiological mechanisms in major depressive disorder. Can Med Assoc J. 2009;180:305–13.

    Article  Google Scholar 

  • Abbas AI, Hedlund PB, Huang X-P, Tran TB, Meltzer HY, Roth BL. Amisulpride is a potent 5-HT7 antagonist: relevance for antidepressant actions in vivo. Psychopharmacology. 2009;205:119–28.

    Article  CAS  Google Scholar 

  • Albert PR, Lemonde S. 5-HT1A receptors, gene repression, and depression: guilt by association. Neuroscientist. 2004;10:575–93.

    Article  CAS  Google Scholar 

  • Anthony JP, Sexton TJ, Neumaier JF. Antidepressant-induced regulation of 5-HT1b mRNA in rat dorsal raphe nucleus reverses rapidly after drug discontinuation. J Neurosci Res. 2000;61:82–7.

    Article  CAS  Google Scholar 

  • Baganz NL, Blakely RD. A dialogue between the immune system and brain, spoken in the language of serotonin. ACS Chem Neurosci. 2012;4:48–63.

    Article  Google Scholar 

  • Barnes NM, Neumaier JF. Neuronal 5-HT receptors and SERT. Tocris Biosci Sci Rev Ser. 2011;34:1–16.

    Google Scholar 

  • Bétry C, Etiévant A, Oosterhof C, Ebert B, Sanchez C, Haddjeri N. Role of 5-HT3 receptors in the antidepressant response. Pharmaceuticals. 2011;4:603–29.

    Article  Google Scholar 

  • Bétry C, Overstreet D, Haddjeri N, Pehrson AL, Bundgaard C, Sanchez C, Mørk A. A 5-HT 3 receptor antagonist potentiates the behavioral, neurochemical and electrophysiological actions of an SSRI antidepressant. Pharmacol Biochem Behav. 2015;131:136–42.

    Article  Google Scholar 

  • Bhagwagar Z, Hinz R, Taylor M, Fancy S, Cowen P, Grasby P. Increased 5-HT 2A receptor binding in euthymic, medication-free patients recovered from depression: a positron emission study with [11 C] MDL 100,907. Am J Psychiatry. 2006;163:1580–7.

    Article  Google Scholar 

  • Blier P, Bergeron R, de Montigny C. Selective activation of postsynaptic 5-HT1A receptors induces rapid antidepressant response. Neuropsychopharmacology. 1997;16:333–8.

    Article  CAS  Google Scholar 

  • Blier P, de Montigny C, Chaput Y. Modifications of the serotonin system by antidepressant treatments: implications for the therapeutic response in major depression. J Clin Psychopharmacol. 1987;7:24S.

    Article  CAS  Google Scholar 

  • Blier P, Ward NM. Is there a role for 5-HT 1A agonists in the treatment of depression? Biol Psychiatry. 2003;53:193–203.

    Article  CAS  Google Scholar 

  • Boldrini M, Underwood MD, Mann JJ, Arango V. Serotonin-1A autoreceptor binding in the dorsal raphe nucleus of depressed suicides. J Psychiatr Res. 2008;42:433–42.

    Article  Google Scholar 

  • Bonaventure P, Dugovic C, Kramer M, De Boer P, Singh J, Wilson S, Bertelsen K, Di J, Shelton J, Aluisio L. Translational evaluation of JNJ-18038683, a 5-hydroxytryptamine type 7 receptor antagonist, on rapid eye movement sleep and in major depressive disorder. J Pharmacol Exp Ther. 2012;342:429–40.

    Article  CAS  Google Scholar 

  • Bonaventure P, Kelly L, Aluisio L, Shelton J, Lord B, Galici R, Miller K, Atack J, Lovenberg TW, Dugovic C. Selective blockade of 5-hydroxytryptamine (5-HT) 7 receptors enhances 5-HT transmission, antidepressant-like behavior, and rapid eye movement sleep suppression induced by citalopram in rodents. J Pharmacol Exp Ther. 2007;321:690–8.

    Article  CAS  Google Scholar 

  • Bristow LJ, O’connor D, Watts R, Duxon MS, Hutson PH. Evidence for accelerated desensitisation of 5-HT 2C receptors following combined treatment with fluoxetine and the 5-HT 1A receptor antagonist, WAY 100,635, in the rat. Neuropharmacology. 2000;39:1222–36.

    Article  CAS  Google Scholar 

  • Carr GV, Lucki I. The role of serotonin receptor subtypes in treating depression: a review of animal studies. Psychopharmacology. 2011;213:265–87.

    Article  CAS  Google Scholar 

  • Cardinali DP, Vidal MF, Vigo DE. Agomelatine: its role in the management of major depressive disorder. Clin Med Insights Psychiatry. 2012;4:1.

    Article  Google Scholar 

  • Chenu F, David DJ, Leroux-Nicollet I, Le Maitre E, Gardier AM, Bourin M. Serotonin1B heteroreceptor activation induces an antidepressant-like effect in mice with an alteration of the serotonergic system. J Psychiatry Neurosci. 2008;33:541–50.

    PubMed  PubMed Central  Google Scholar 

  • Clemett DA, Punhani T, Duxon MS, Blackburn TP, Fone KCF. Immunohistochemical localisation of the 5-HT 2C receptor protein in the rat CNS. Neuropharmacology. 2000;39:123–32.

    Article  CAS  Google Scholar 

  • Cremers TIFH, de Boer P, Liao Y, Bosker FJ, den Boer JA, Westerink BHC, Wikström HV. Augmentation with a 5-HT 1A, but not a 5-HT 1B receptor antagonist critically depends on the dose of citalopram. Eur J Pharmacol. 2000;397:63–74.

    Article  CAS  Google Scholar 

  • Gatt JM, Nemeroff CB, Schofield PR, Paul RH, Clark CR, Gordon E, Williams LM. Early life stress combined with serotonin 3A receptor and brain-derived neurotrophic factor valine 66 to methionine genotypes impacts emotional brain and arousal correlates of risk for depression. Biol Psychiatry. 2010;68:818–24.

    Article  CAS  Google Scholar 

  • Gatt JM, Williams LM, Schofield PR, Dobson-Stone C, Paul RH, Grieve SM, Clark CR, Gordon E, Nemeroff CB. Impact of the HTR3A gene with early life trauma on emotional brain networks and depressed mood. Depress Anxiety. 2010;27:752–9.

    Article  CAS  Google Scholar 

  • Guiard BP, Di Giovanni G. Central serotonin-2A (5-HT2A) receptor dysfunction in depression and epilepsy: the missing link? Front Pharmacol. 2015;6:46.

    Article  Google Scholar 

  • Hannon J, Hoyer D. Molecular biology of 5-HT receptors. Behav Brain Res. 2008;195:198–213.

    Article  CAS  Google Scholar 

  • Hedlund PB, Huitron-Resendiz S, Henriksen SJ, Sutcliffe JG. 5-HT 7 receptor inhibition and inactivation induce antidepressant like behavior and sleep pattern. Biol Psychiatry. 2005;58:831–7.

    Article  CAS  Google Scholar 

  • Hirvonen J, Karlsson H, Kajander J, Lepola A, Markkula J, Rasi-Hakala H, Någren K, Salminen JK, Hietala J. Decreased brain serotonin 5-HT1A receptor availability in medication-naive patients with major depressive disorder: an in-vivo imaging study using PET and [carbonyl-11C] WAY-100635. Int J Neuropsychopharmacol. 2008;11:465–76.

    Article  CAS  Google Scholar 

  • Hrdina PD, Demeter E, Vu TB, Sótónyi P, Palkovits M. 5-HT uptake sites and 5-HT 2 receptors in brain of antidepressant-free suicide victims/depressives: increase in 5-HT 2 sites in cortex and amygdala. Brain Res. 1993;614:37–44.

    Article  CAS  Google Scholar 

  • Hoyer D, Hannon JP, Martin GR. Molecular, pharmacological and functional diversity of 5-HT receptors. Pharmacol Biochem Behav. 2002;71:533–54.

    Article  CAS  Google Scholar 

  • Jans LA, Riedel WJ, Markus CR, Blokland A. Serotonergic vulnerability and depression: assumptions, experimental evidence and implications. Mol Psychiatry. 2007;12:522–43.

    Article  Google Scholar 

  • Jensen NH, Cremers TI, Sotty F. Therapeutic potential of 5-HT2C receptor ligands. Sci World J. 2010;10:1870–85.

    Article  CAS  Google Scholar 

  • Khan A, Sambunaris A, Edwards J, Ruth A, Robinson DS. Vilazodone in the treatment of major depressive disorder: efficacy across symptoms and severity of depression. Int Clin Psychopharmacol. 2014;29:86–92.

    Article  Google Scholar 

  • Lee S, Lee K, Lee H, Ham B, Ryu S, Lee M. Association between the 5-HT6 receptor C267T polymorphism and response to antidepressant treatment in major depressive disorder. Psychiatry Clin Neurosci. 2005;59:140–5.

    Article  CAS  Google Scholar 

  • Lemonde S, Du L, Bakish D, Hrdina P, Albert PR. Association of the C (− 1019) G 5-HT1A functional promoter polymorphism with antidepressant response. Int J Neuropsychopharmacol. 2004;7:501–6.

    Article  CAS  Google Scholar 

  • Lemonde S, Turecki G, Bakish D, Du L, Hrdina PD, Bown CD, Sequeira A, Kushwaha N, Morris SJ, Basak A. Impaired repression at a 5-hydroxytryptamine 1A receptor gene polymorphism associated with major depression and suicide. J Neurosci. 2003;23:8788–99.

    Article  CAS  Google Scholar 

  • Leysen JE. 5-HT2 receptors. Curr Drug Targets CNS Neurol Disord. 2004;3:11–26.

    Article  CAS  Google Scholar 

  • Lucae S, Ising M, Horstmann S, Baune BT, Arolt V, Müller-Myhsok B, Holsboer F, Domschke K. HTR2A gene variation is involved in antidepressant treatment response. Eur Neuropsychopharmacol. 2010;20:65–8.

    Article  CAS  Google Scholar 

  • Lucas G, Du J, Romeas T, Mnie-Filali O, Haddjeri N, Piñeyro G, Debonnel G. Selective serotonin reuptake inhibitors potentiate the rapid antidepressant-like effects of serotonin 4 receptor agonists in the rat. PLoS One. 2010;5:e9253.

    Article  Google Scholar 

  • Lucas G, Rymar VV, Du J, Mnie-Filali O, Bisgaard C, Manta S, Lambas-Senas L, Wiborg O, Haddjeri N, Piñeyro G. Serotonin 4 (5-HT 4) receptor agonists are putative antidepressants with a rapid onset of action. Neuron. 2007;55:712–25.

    Article  CAS  Google Scholar 

  • Mann JJ. Role of the serotonergic system in the pathogenesis of major depression and suicidal behavior. Neuropsychopharmacology. 1999;21:99S–105S.

    Article  CAS  Google Scholar 

  • Marek GJ, Carpenter LL, McDougle CJ, Price LH. Synergistic action of 5-HT2A antagonists and selective serotonin reuptake inhibitors in neuropsychiatric disorders. Neuropsychopharmacology. 2003;28:402–12.

    Article  CAS  Google Scholar 

  • Martin CBP, Hamon M, Lanfumey L, Mongeau R. Controversies on the role of 5-HT 2C receptors in the mechanisms of action of antidepressant drugs. Neurosci Biobehav Rev. 2014;42:208–23.

    Article  CAS  Google Scholar 

  • Martinez D, Broft A, Laruelle M. Pindolol augmentation of antidepressant treatment: recent contributions from brain imaging studies. Biol Psychiatry. 2000;48:844–53.

    Article  CAS  Google Scholar 

  • Meneses A. Stimulation of 5-HT 1A, 5-HT 1B, 5-HT 2A/2C, 5-HT 3 and 5-HT 4 receptors or 5-HT uptake inhibition: short-and long-term memory. Behav Brain Res. 2007;184:81–90.

    Article  CAS  Google Scholar 

  • Mengod G, Vilaró MT, Cortés R, López-Giménez JF, Raurich A, Palacios JM. Chemical neuroanatomy of 5-HT receptor subtypes in the mammalian brain. In: The serotonin receptors. Berlin: Springer; 2006. p. 319–64.

    Chapter  Google Scholar 

  • Millan MJ, Marin P, Bockaert J, la Cour CM. Signaling at G-protein-coupled serotonin receptors: recent advances and future research directions. Trends Pharmacol Sci. 2008;29:454–64.

    Article  CAS  Google Scholar 

  • Miquel M, Emerit MB, Nosjean A, Simon A, Rumajogee P, Brisorgueil M, Doucet E, Hamon M, Verge D. Differential subcellular localization of the 5-HT3-As receptor subunit in the rat central nervous system. Eur J Neurosci. 2002;15:449–57.

    Article  Google Scholar 

  • Mullins UL, Gianutsos G, Eison AS. Effects of antidepressants on 5-HT7 receptor regulation in the rat hypothalamus. Neuropsychopharmacology. 1999;21:352–67.

    Article  CAS  Google Scholar 

  • Murrough JW, Henry S, Hu J, Gallezot J-D, Planeta-Wilson B, Neumaier JF, Neumeister A. Reduced ventral striatal/ventral pallidal serotonin1B receptor binding potential in major depressive disorder. Psychopharmacology. 2011;213:547–53.

    Article  CAS  Google Scholar 

  • Nakagawa Y, Ishima T, Takashima T. The 5-HT 3 receptor agonist attenuates the action of antidepressants in the forced swim test in rats. Brain Res. 1998;786:189–93.

    Article  CAS  Google Scholar 

  • Nelson JC, Papakostas GI. Atypical antipsychotic augmentation in major depressive disorder: a meta-analysis of placebo-controlled randomized trials. Am J Psychiatry. 2009;166:980–91.

    Article  Google Scholar 

  • Ohtsuki T, Ishiguro H, Detera-Wadleigh SD, Toyota T, Shimizu H, Yamada K, Yoshitsugu K, Hattori E, Yoshikawa T, Arinami T. Association between serotonin 4 receptor gene polymorphisms and bipolar disorder in Japanese case-control samples and the NIMH genetics initiative bipolar pedigrees. Mol Psychiatry. 2002;7:954–61.

    Article  CAS  Google Scholar 

  • Parsey RV, Ogden RT, Tin A, Sullivan GM, Blumenfeld A, Oquendo MA, Mann JJ. Altered serotonin 1A binding potential in major depression using [11 C] WAY 100635: a second patient cohort. NeuroImage. 2008;41:T44.

    Article  Google Scholar 

  • Pauwels PJ. 5-HT receptors and their ligands. Neuropharmacology. 2003;1083:38–50.

    Google Scholar 

  • Peroutka SJ, Snyder SH. Long-term antidepressant treatment decreases spiroperidol-labeled serotonin receptor binding. Science. 1980;210:88–90.

    Article  CAS  Google Scholar 

  • Petit A-C, Quesseveur G, Gressier F, Colle R, David DJ, Gardier AM, Ferreri F, Lépine J-P, Falissard B, Verstuyft C. Converging translational evidence for the involvement of the serotonin 2A receptor gene in major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2014;54:76–82.

    Article  CAS  Google Scholar 

  • Pompeiano M, Palacios JM, Mengod G. Distribution of the serotonin 5-HT 2 receptor family mRNAs: comparison between 5-HT 2A and 5-HT 2C receptors. Mol Brain Res. 1994;23:163–78.

    Article  CAS  Google Scholar 

  • Pytliak M, Vargová V, Mechírová V, Felsöci M. Serotonin receptors-from molecular biology to clinical applications. Physiol Res. 2011;60:15.

    CAS  PubMed  Google Scholar 

  • Rajkumar R, Mahesh R. Review: the auspicious role of the 5-HT3 receptor in depression: a probable neuronal target? J Psychopharmacol. 2010;24:455–69.

    Article  CAS  Google Scholar 

  • Ramamoorthy R, Radhakrishnan M, Borah M. Antidepressant-like effects of serotonin type-3 antagonist, ondansetron: an investigation in behaviour-based rodent models. Behav Pharmacol. 2008;19:29–40.

    Article  CAS  Google Scholar 

  • Redrobe JP, Bourin M. Partial role of 5-HT 2 and 5-HT 3 receptors in the activity of antidepressants in the mouse forced swimming test. Eur J Pharmacol. 1997;325:129–35.

    Article  CAS  Google Scholar 

  • Rosel P, Arranz B, Urretavizcaya M, Oros M, San L, Navarro MA. Altered 5-HT2A and 5-HT4 postsynaptic receptors and their intracellular signalling systems IP3 and cAMP in brains from depressed violent suicide victims. Neuropsychobiology. 2004;49:189–95.

    Article  CAS  Google Scholar 

  • Rosenzweig-Lipson S, Sabb A, Stack G, Mitchell P, Lucki I, Malberg JE, Grauer S, Brennan J, Cryan JF, Rizzo SJS. Antidepressant-like effects of the novel, selective, 5-HT2C receptor agonist WAY-163909 in rodents. Psychopharmacology. 2007;192:159–70.

    Article  CAS  Google Scholar 

  • Samuels BA, Mendez-David I, Faye C, David SA, Pierz KA, Gardier AM, Hen R, David DJ. Serotonin 1A and serotonin 4 receptors essential mediators of the neurogenic and behavioral actions of antidepressants. Neuroscience. 2016;22(1):26–45.

    Article  Google Scholar 

  • Sánchez C, Hyttel J. Comparison of the effects of antidepressants and their metabolites on reuptake of biogenic amines and on receptor binding. Cell Mol Neurobiol. 1999;19:467–89.

    Article  Google Scholar 

  • Sarkisyan G, Roberts AJ, Hedlund PB. The 5-HT 7 receptor as a mediator and modulator of antidepressant-like behavior. Behav Brain Res. 2010;209:99–108.

    Article  CAS  Google Scholar 

  • Savitz J, Lucki I, Drevets WC. 5-HT1A receptor function in major depressive disorder. Prog Neurobiol. 2009;88(1):17–31.

    Article  CAS  Google Scholar 

  • Serretti A, Artioli P, Lorenzi C, Pirovano A, Tubazio V, Zanardi R. The C (− 1019) G polymorphism of the 5-HT1A gene promoter and antidepressant response in mood disorders: preliminary findings. Int J Neuropsychopharmacol. 2004;7:453–60.

    Article  CAS  Google Scholar 

  • Shelton RC, Sanders-Bush E, Manier DH, Lewis DA. Elevated 5-HT 2A receptors in postmortem prefrontal cortex in major depression is associated with reduced activity of protein kinase A. Neuroscience. 2009;158:1406–15.

    Article  CAS  Google Scholar 

  • Stahl SM. Selecting an antidepressant by using mechanism of action to enhance efficacy and avoid side effects. J Clin Psychiatry. 1998;59:23–9.

    CAS  PubMed  Google Scholar 

  • Stockmeier CA. Involvement of serotonin in depression: evidence from postmortem and imaging studies of serotonin receptors and the serotonin transporter. J Psychiatr Res. 2003;37:357–73.

    Article  Google Scholar 

  • Strome EM, Clark CM, Zis AP, Doudet DJ. Electroconvulsive shock decreases binding to 5-HT 2 receptors in nonhuman primates: an in vivo positron emission tomography study with [18 F] setoperone. Biol Psychiatry. 2005;57:1004–10.

    Article  CAS  Google Scholar 

  • Svenningsson P, Tzavara ET, Qi H, Carruthers R, Witkin JM, Nomikos GG, Greengard P. Biochemical and behavioral evidence for antidepressant-like effects of 5-HT6 receptor stimulation. J Neurosci. 2007;27:4201–9.

    Article  CAS  Google Scholar 

  • Tamburella A, Micale V, Navarria A, Drago F. Antidepressant properties of the 5-HT 4 receptor partial agonist, SL65. 0155: behavioral and neurochemical studies in rats. Prog Neuropsychopharmacol Biol Psychiatry. 2009;33:1205–10.

    Article  CAS  Google Scholar 

  • Tatarczyñska E, Klodzinska A, Chojnacka-Wójcik E. Effects of combined administration of 5-HT~ 1~ A and/or 5-HT~ 1~ B receptor antagonists and paroxetine or fluoxetine in the forced swimming test in rats. Pol J Pharmacol. 2002;54:615–24.

    PubMed  Google Scholar 

  • Tiger M, Rück C, Forsberg A, Varrone A, Lindefors N, Halldin C, Farde L, Lundberg J. Reduced 5-HT 1B receptor binding in the dorsal brain stem after cognitive behavioural therapy of major depressive disorder. Psychiatry Res Neuroimaging. 2014;223:164–70.

    Article  Google Scholar 

  • Wesołowska A. Potential role of the 5-HT 6 receptor in depression and anxiety: an overview of preclinical data. Pharmacol Rep. 2010;62:564–77.

    Article  Google Scholar 

  • Wesołowska A, Nikiforuk A. The selective 5-HT 6 receptor antagonist SB-399885 enhances anti-immobility action of antidepressants in rats. Eur J Pharmacol. 2008;582:88–93.

    Article  Google Scholar 

  • Wesołowska A, Nikiforuk A, Stachowicz K, Tatarczyńska E. Effect of the selective 5-HT 7 receptor antagonist SB 269970 in animal models of anxiety and depression. Neuropharmacology. 2006;51:578–86.

    Article  Google Scholar 

  • Yau JLW, Noble J, Seckl JR. Acute restraint stress increases 5-HT7 receptor mRNA expression in the rat hippocampus. Neurosci Lett. 2001;309:141–4.

    Article  CAS  Google Scholar 

  • Yu YW-Y, Tsai S-J, Lin C-H, Hsu C-P, Yang K-H, Hong C-J. Serotonin-6 receptor variant (C267T) and clinical response to clozapine. Neuroreport. 1999;10:1231–3.

    Article  CAS  Google Scholar 

  • Yu YW-Y, Tsai S-J, Liou Y-J, Hong C-J, Chen T-J. Association study of two serotonin 1A receptor gene polymorphisms and fluoxetine treatment response in Chinese major depressive disorders. Eur Neuropsychopharmacol. 2006;16:498–503.

    Article  CAS  Google Scholar 

  • Yung-yu H, Oquendo MA, Friedman JMH, Greenhill LL, Brodsky B, Malone KM, Khait V, Mann JJ. Substance abuse disorder and major depression are associated with the human 5-HT1B receptor gene (HTR1B) G861C polymorphism. Neuropsychopharmacology. 2003;28:163.

    Article  Google Scholar 

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Amidfar, M., Colic, L., Walter, M., Kim, YK. (2018). Complex Role of the Serotonin Receptors in Depression: Implications for Treatment. In: Kim, YK. (eds) Understanding Depression . Springer, Singapore. https://doi.org/10.1007/978-981-10-6580-4_6

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