Drug Repurposing Approaches for Depression: Rationale and its Clinical Experience

Abstract

Background: Drug discovery is a very time-consuming, tedious, and expensive process lasting for about two or more decades. This complexity of the process of drug discovery and the sluggish pace at which new drugs are being discovered draw the attention of scientists to redefine the whole process with the help of drug repurposing. The usage of old drug moieties in any other disorder with all new mechanisms is defined as repurposing. Repurposing of drugs knocks out the pre-clinical phase and related studies to give that molecule a redefined purpose. Data from these studies may be used in discovering newer molecules to save human effort, time, and expenses as well.

Purpose: The complex etiology of depression and resistance to its treatment drive novel discoveries via therapeutic repurposing and pharmacological repositioning to treat this complex disorder. In addition to the reduction of neurotransmitters such as epinephrine and serotonin, additional processes like inflammation, inadequate blood flow, and neurotoxicants are also being examined as possibly implicated mechanisms.

Methods: Data was extensively collected, thoroughly reviewed and analysed from research published in the respective field.

Results: Taking into consideration the aforementioned pathways has led to the development of repurposed drugs that can be used to treat treatment-resistant depression (TRD). Conclusions: The incorporation of artificial intelligence in drug repurposing may also enhance the chances of its success rate as it deals with data digitalization which is the main core mechanism used in drug repurposing.

  • Page Number : 27-38
  • Published Date : 2023-04-10
  • Keywords
    Drug discovery, Repurposing, Artificial Intelligence, Depression, Mortality
  • DOI Number
    10.15415/jprtm.2023.111003
  • Authors
    Mimansa Kandhwal, Amarjot Kaur Grewal, Varinder Singh, Heena Khan and Thakur Gurjeet Singh

References

  • Abbruzzese, C., Matteoni, S., Persico, M., Villani, V.,&Paggi, M. G. (2020). Repurposing chlorpromazine in the treatment of glioblastoma multiforme: analysis of literature and forthcoming steps.
  • Journal of Experimental & Clinical Cancer Research, 39, 1-3.https://doi.org/10.1186/s13046-020-1534-z Baker, N. C., Ekins, S., Williams, A. J.,& Tropsha, A. (2018). A bibliometric review of drug repurposing.Drug Discovery Today, 23(3), 661-672.https://doi.org/10.1016/j.drudis.2018.01.018
  • Balasegaram, M., Ritmeijer, K., Lima, M. A., Burza, S., Ortiz Genovese, G., Milani, B., ... & Chappuis, F. (2012). Liposomal amphotericin B as a treatment for human leishmaniasis. Expert opinion on emerging drugs, 17(4), 493-510.https://doi.org/10.1517/14728214.2012.748036
  • Barden, N. (2004). Implication of the hypothalamic–pituitary–adrenal axis in the physiopathology of depression. Journal of Psychiatry and Neuroscience, 29(3), 185-193.
  • Bayramgürler, D., Karson, A., Özer, C., & Utkan, T. (2013). Effects of long-term etanercept treatment on anxiety-and depression-like neurobehaviors in rats. Physiology & Behavior, 119, 145-148.https://doi.org/10.1016/j.physbeh.2013.06.010
  • Brent, D., Emslie, G., Clarke, G., Wagner, K. D., Asarnow, J. R., Keller, M., ... & Zelazny, J. (2008). Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial. Jama, 299(8), 901-913.https://doi.org/10.1001/jama.299.8.901
  • Brunoni, A. R., Lopes, M. &F regni, F. (2008). A systematic review and meta-analysis of clinical studies on major depression and BDNF levels: implications for the role of neuroplasticity in depression. The International Journal of Neuropsychopharmacology, 11(8), 1169-1180.https://doi.org/10.1017/S1461145708009309
  • Bryan, J. (2011). How minoxidil was transformed from an antihypertensive to hair-loss drug. Pharmaceutical Journal, 287(7663), 137.https://doi.org/10.1211/PJ.2021.1.69888
  • Cain, R.A., (2007). Navigating the sequenced treatment alternatives to relieve depression (STAR∗ D) study: practical outcomes and implications for depression treatment in primary care. Primary care: Clinics in Office Practice, 34(3):505-519. https://doi.org/10.1016/j.pop.2007.05.006
  • Cha, Y., Erez, T., Reynolds, I. J., Kumar, D., Ross, J., Koytiger,G., … & Laifenfeld, D. (2018). Drug repurposing from the perspective of pharmaceutical companies.British Journal of Pharmacology,175(2), 168-180.https://doi.org/10.1111/bph.13798
  • Coppen, A., Shaw, D., Herzberg, B. &Maggs, R. (1967). Tryptophan in the treatment of depression. The Lancet, 290(7527), 1178-1180.https://doi.org/10.1016/S0140-6736(67)91894-6
  • Cowen, P. J., Parry-Billings, M. &Newsholme, E. A. (1989). Decreased plasma tryptophan levels in major depression. Journal of Affective Disorders, 16(1), 27-31.https://doi.org/10.1016/0165-0327(89)90051-7
  • Cuijpers, P., Reynolds III, C. F., Donker, T., Li, J., Andersson, G., & Beekman, A. (2012). Personalized treatment of adult depression: medication, psychotherapy, or both? A systematic review. Depression and Anxiety, 29(10), 855-864.https://doi.org/10.1002/da.21985
  • Czumaj, A., Zabielska, J., Pakiet, A., Mika, A., Rostkowska, O., Makarewicz, W., ... &Stelmanska, E. (2019). In vivo effectiveness of orlistat in the suppression of human colorectal cancer cell proliferation. Anticancer Research, 39(7), 3815-3822.https://doi.org/10.21873/anticanres.13531
  • Delgado, P. L. (2000). Depression: the case for a monoamine deficiency. Journal of Clinical Psychiatry, 61(6), 7-11.
  • Dell'Osso, L., Carmassi, C., Mucci, F. &Marazziti, D. (2016). Depression, serotonin and tryptophan. Current Pharmaceutical Design, 22(8), 949-954.https://doi.org/10.2174/1381612822666151214104826
  • Dowrick, C. (2009). Beyond depression: a new approach to understanding and management. Oxford University Press, USA.
  • E Martin, A., A Schober, D., Nikolayev, A., V Tolstikov, V., H Anderson, W., E Higgs, R., ... & M Witkin, J. (2017). Further evaluation of mechanisms associated with the antidepressantlike signature of scopolamine in mice. CNS & Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS & Neurological Disorders), 16(4), 492-500.
  • Ebada, M. E. (2017). Drug repurposing may generate novel approaches to treating depression. Journal of Pharmacy and Pharmacology, 69(11), 1428-1436.https://doi.org/10.1111/jphp.12815
  • Fabbri, C., Kasper, S., Zohar, J., Souery, D., Montgomery, S., Albani, D., ... &Serretti, A. (2021). Drug repositioning for treatment-resistant depression: hypotheses from a pharmacogenomic study. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 104, 110050.https://doi.org/10.1016/j.pnpbp.2020.110050
  • Freitas, A. E., Neis, V. B., & Rodrigues, A. L. S. (2016). Agmatine, a potential novel therapeutic strategy for depression. European Neuropsychopharmacology, 26(12), 1885-1899.https://doi.org/10.1016/j.euroneuro.2016.10.013
  • Gahr, M. (2014). Agomelatine in the treatment of major depressive disorder: an assessment of benefits and risks. Current Neuropharmacology,12(5), 387-398.https://doi.org/10.2174/1570159X12999140619122914
  • Garnock-Jones, K. P., & Keating, G. M. (2009). Atomoxetine: a review of its use in attention-deficit hyperactivity disorder in children and adolescents. Pediatric Drugs, 11, 203-226.https://doi.org/10.2165/00148581-200911030-00005
  • Goldberg, J. S., Bell Jr, C. E. & Pollard, D. A. (2014). Revisiting the monoamine hypothesis of depression: a new perspective. Perspectives in Medicinal Chemistry, 6, PMC-S11375.https://doi.org/10.4137/PMC.S11375
  • Goldstein, I., Burnett, A. L., Rosen, R. C., Park, P. W., &Stecher, V. J. (2019). The serendipitous story of sildenafil: an unexpected oral therapy for erectile dysfunction. Sexual Medicine Reviews, 7(1), 115-128.https://doi.org/10.1016/j.sxmr.2018.06.005 Gurpur, P. B., Liu, J., Burkin, D. J., & Kaufman, S. J. (2009). Valproic acid activates the PI3K/Akt/mTOR pathway in muscle and ameliorates pathology in a mouse model of Duchenne muscular dystrophy. The American Journal of Pathology, 174(3), 999-1008.
  • Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23(1), 56.https://doi.org/10.1136/jnnp.23.1.56
  • Henriksen, K., Christiansen, C., & Karsdal, M. A. (2011). Serological biochemical markers of surrogate efficacy and safety as a novel approach to drug repositioning. Drug Discovery Today, 16(21-22), 967-975.https://doi.org/10.1016/j.drudis.2011.06.010
  • Herbert, J. (2013). Cortisol and depression: three questions for psychiatry. Psychological Medicine, 43(3), 449-469.https://doi.org/10.1017/S0033291712000955
  • Hillhouse, T. M. & Porter, J. H. (2015). A brief history of the development of antidepressant drugs: from monoamines to glutamate. Experimental and Clinical Psychopharmacology, 23(1), 1.https://doi.org/10.1037/a0038550
  • Holsboer, F. (2001). Stress, hypercortisolism and corticosteroid receptors in depression: implicatons for therapy.Journal of Affective Disorder, 62(1-2), 77-91.https://doi.org/10.1016/S0165-0327(00)00352-9
  • Hong, C. T., Chan, L., Hu, C. J., Lin, C. M., Hsu, C. Y., & Lin, M. C. (2017). Tamoxifen and the risk of Parkinson's disease in female patients with breast cancer in asian people: a nationwide population-based study. Journal of Breast Cancer, 20(4), 356-360. https://doi.org/10.4048/jbc.2017.20.4.356
  • Howland, R. H. (2013).Mifepristone as a therapeutic agent in psychiatry. Journal of Psychological Nursing and Mental Health Services, 51(6), 11-14. https://doi.org/10.3928/02793695-20130513-01
  • Hughes, J. P., Rees, S., Kalindjian, S. B., & Philpott, K. L. (2011). Principles of early drug discovery. British Journal of Pharmacology, 162(6), 1239-1249.https://doi.org/10.1111/j.1476-5381.2010.01127.x
  • Hurlen, M., Abdelnoor, M., Smith, P., Erikssen, J., &Arnesen, H. (2002). Warfarin, aspirin, or both after myocardial infarction. New England Journal of Medicine, 347(13), 969-974.https://doi.org/10.1056/NEJMoa020496
  • Husain, M. I., Chaudhry, I. B., Khoso, A. B., Husain, M. O., Hodsoll, J., Ansari, M. A., ... & Young, A. H. (2020). Minocycline and celecoxib as adjunctive treatments for bipolar depression: a multicentre, factorial design randomised controlled trial. The Lancet Psychiatry, 7(6), 515-527.https://doi.org/10.1016/S2215-0366(20)30138-3
  • Institute of Health Metrics and Evaluation, 2023. Global Health Data Exchange (GHDx).
  • Keller, M., Montgomery, S., Ball, W., Morrison, M., Snavely,D., Liu, G., … &Reines, S. (2006). Lack of efficacy of the substance p (neurokinin1 receptor) antagonist aprepitant in the treatment of major depressive disorder.Biological Psychiatry, 59(3), 216-223.https://doi.org/10.1016/j.biopsych.2005.07.013
  • Kerr, J. L., Timpe, E. M., & Petkewicz, K. A. (2010). Bromocriptine mesylate for glycemic management in type 2 diabetes mellitus. Annals of pharmacotherapy, 44(11), 1777-1785.https://doi.org/10.1345/aph.1P271 Khan, H., Bangar, A., Grewal, A. K., Bansal, P. & Singh, T. G. (2022). Caspase-mediated regulation of the distinct signaling pathways and mechanisms in neuronal survival. International Immunopharmacology, 110, 108951. https://doi.org/10.1016/j.intimp.2022.108951 Kinlein, S.A., Wilson, C.D.,& Karatsoreos, I.N. (2015). Dysregulated hypothalamic–pituitary–adrenal axis function contributes to altered endocrine and neurobehavioral responses to acute stress.Frontiers in psychiatry, 6, 31.https://doi.org/10.3389/fpsyt.2015.00031
  • Ko, Y. (2020). Computational drug repositioning: current progress and challenges. Applied Sciences, 10(15), 5076. https://doi.org/10.3390/app10155076
  • Kraus, C., Wasserman, D., Henter, I. D., Acevedo-Diaz, E., Kadriu, B., & Zarate Jr, C. A. (2019). The influence of ketamine on drug discovery in depression. Drug Discovery Today, 24(10), 2033-2043.https://doi.org/10.1016/j.drudis.2019.07.007
  • Kupfer, D.J. (2005).The increasing medical burden in bipolar disorder. Jama, 293(20), 2528-2530.10.1001/jama.293.20.2528
  • Law, G. L., Tisoncik-Go, J., Korth, M. J. &Katze, M. G. (2013). Drug repurposing: a better approach for infectious disease drug discovery?. Current Opinion in Immunology, 25(5), 588-592.https://doi.org/10.1016/j.coi.2013.08.004
  • Li, J., Yang, R., Xia, K., Wang, T., Nie, B., Gao, K., ... & Wang, W. (2018). Effects of stress on behavior and resting-state fMRI in rats and evaluation of Telmisartan therapy in a stress-induced depression model. BMC Psychiatry, 18(1), 1-13.https://doi.org/10.1186/s12888-018-1880-y
  • Little A. (2009). Treatment-resistant depression. American family physician, 80(2),167-172.
  • Mann, J. J. (2005). The medical management of depression. New England Journal of Medicine, 353(17), 1819-1834.https://doi.org/10.1056/NEJMra050730
  • Martinowich, K., Manji, H. & Lu, B. (2007). New insights into BDNF function in depression and anxiety. Nature Neuroscience, 10(9), 1089-1093.https://doi.org/10.1038/nn1971
  • McGirr, A., Vöhringer, P. A., Ghaemi, S. N., Lam, R. W., & Yatham, L. N. (2016). Safety and efficacy of adjunctive second-generation antidepressant therapy with a mood stabiliser or an atypical antipsychotic in acute bipolar depression: a systematic review and meta-analysis of randomised placebo-controlled trials. The Lancet Psychiatry, 3(12), 1138-1146.https://doi.org/10.1016/S2215-0366(16)30264-4
  • Meyer, J. H., Ginovart, N., Boovariwala, A., Sagrati, S., Hussey, D., Garcia, A., …& Houle, S. (2006). Elevated monoamine oxidase a levels in the brain: an explanation for the monoamine imbalance of major depression. Archives of General Psychiatry, 63(11), 1209-1216.https://doi.org/10.1001/archpsyc.63.11.1209
  • Motaghinejad, M., Farokhi, N., Motevalian, M., & Safari, S. (2020). Molecular, histological and behavioral evidences for neuroprotective effects of minocycline against nicotine-induced neurodegeneration and cognition impairment: Possible role of CREB-BDNF signaling pathway. Behavioural Brain Research, 386, 112597. https://doi.org/10.2174/1871527316666170309142646
  • Moussaieff, A., Gross, M., Nesher, E., Tikhonov, T., Yadid, G., & Pinhasov, A. (2012). Incensole acetate reduces depressive-like behavior and modulates hippocampal BDNF and CRF expression of submissive animals. Journal of psychopharmacology, 26(12), 1584-1593.https://doi.org/10.1177/0269881112458729
  • Neumeister, A. (2003). Tryptophan depletion, serotonin, and depression: where do we stand?. Psychopharmacology bulletin, 37(4), 99-115.
  • Nosengo, N. (2016). New tricks for old drugs. Nature, 534(7607), 314-316.https://doi.org/10.1038/534314a
  • Nygaard, H. B., van Dyck, C. H., & Strittmatter, S. M. (2014). Fyn kinase inhibition as a novel therapy for Alzheimer’s disease. Alzheimer's research & therapy, 6, 1-8.https://doi.org/10.1186/alzrt238
  • Osterloh, I. H. (2004). The discovery and development of Viagra®(sildenafil citrate). In Sildenafil (pp. 1-13). Basel: Birkhäuser Basel.https://doi.org/10.1007/978-3-0348-7945-3_1
  • Otte, C., Gold, S. M., Penninx, B. W., Pariante, C. M., Etkin, A., Fava, M., ... &Schatzberg, A. F. (2016). Major depressive disorder. Nature Reviews Disease Primers, 2(1), 1-20. https://doi.org/10.1038/nrdp.2016.65
  • Palomares, T., Cordero, M., Bruzos-Cidon, C., Torrecilla, M., Ugedo, L., & Alonso-Varona, A. (2018). The neuroprotective effect of conditioned medium from human adipose-derived mesenchymal stem cells is impaired by N-acetyl cysteine supplementation. Molecular Neurobiology, 55, 13-25.https://doi.org/10.1007/s12035-017-0714-0
  • Palumbo, A., Facon, T., Sonneveld, P., Blade, J., Offidani, M., Gay, F.,… &Harousseau, J. L. (2008). Thalidomide for treatment of multiple myeloma: 10 years later. Blood, The Journal of the American Society of Hematology,111(8), 3968-3977.https://doi.org/10.1182/blood-2007-10-117457
  • Pariante, C. M. (2017). Why are depressed patients inflamed? A reflection on 20 years of research on depression, glucocorticoid resistance and inflammation. European Neuropsychopharmacology, 27(6), 554-559. https://doi.org/10.1016/j.euroneuro.2017.04.001
  • Plotsky, P. M., Owens, M. J., &Nemeroff, C. B. (1998). Psychoneuroendocrinology of depression: hypothalamic-pituitary-adrenal axis. Psychiatric Clinics of North America, 21(2), 293-307.https://doi.org/10.1016/s0193-953x(05)70006-x
  • Potter, D. E., & Choudhury, M. (2014). Ketamine: repurposing and redefining a multifaceted drug. Drug Discovery Today, 19(12), 1848-1854.https://doi.org/10.1016/j.drudis.2014.08.017
  • Prabhakar, N. K., Khan, H., Grewal, A. K. & Singh, T.G. (2022). Intervention of neuroinflammation in the traumatic brain injury trajectory: In vivo and clinical approaches. International Immunopharmacology, 108, 108902.https://doi.org/10.1016/j.intimp.2022.108902
  • Pushpakom, S., Iorio, F., Eyers, P. A., Escott, K. J., Hopper, S., Wells, A., … & Pirmohamed, M. (2019).Drug repurposing: progress, challenges and recommendations. Nature Reviews Drug Discovery,18(1), 41-58.https://doi.org/10.1038/nrd.2018.168
  • Pytka, K., Młyniec, K., Podkowa, K., Podkowa, A., Jakubczyk, M., Żmudzka, E., … &Filipek, B. (2017). The role of melatonin, neurokinin, neurotrophic tyrosine kinase and glucocorticoid receptors in antidepressant-like effect. Pharmacological Reports, 69(3), 546-554. https://doi.org/10.1016/j.pharep.2017.01.026 Randolph, M., &Tosti, A. (2021). Oral minoxidil treatment for hair loss: A review of efficacy and safety. Journal of the American Academy of Dermatology, 84(3), 737-746.https://doi.org/10.1016/j.jaad.2020.06.1009
  • Rascol, O., Fabbri, M., &Poewe, W. (2021). Amantadine in the treatment of Parkinson's disease and other movement disorders. The Lancet Neurology, 20(12), 1048-1056.https://doi.org/10.1016/S1474-4422(21)00249-0
  • Rihal, V., Kaur, A., Singh, T. G. & Abdel-Daim, M. M. (2022). Therapeutic and mechanistic intervention of vitamin D in neuropsychiatric disorders. Psychiatry Research, 114782.https://doi.org/10.1016/j.psychres.2022.114782
  • Rodriguez, J.M., Monsalves-Alvarez,M., Henriquez, S., Llanos, M.N.,&Troncoso, R. (2016). Glucocorticoid resistance in chronic diseases. Steroids, 115,182-192. https://doi.org/10.1016/j.steroids.2016.09.010
  • Rothstein, J. D., Patel, S., Regan, M. R., Haenggeli, C., Huang, Y. H., Bergles, D. E., ... & Fisher, P. B. (2005). β-Lactam antibiotics offer neuroprotection by increasing glutamate transporter expression. Nature, 433(7021), 73-77.https://doi.org/10.1038/nature03180
  • Schildkraut, J.J. (1965).The catecholamine hypothesis of affective disorders: a review of supporting evidence.American Journal of Psychiatry, 122(5), 509-522.https://doi.org/10.1176/ajp.122.5.509 Souery, D., Papakostas, G. I., & Trivedi, M. H. (2006). Treatment-resistant depression. Journal of Clinical Psychiatry, 67, 16.
  • Taylor, C., Fricker, A.D., Devi, L.A.,& Gomes, I. (2005). Mechanisms of action of antidepressants: from neurotransmitter systems to signaling pathways.Cellular Signaling, 17(5), 549-557.https://doi.org/10.1016/j.cellsig.2004.12.007
  • Teo, S. K., Resztak, K. E., Scheffler, M. A., Kook, K. A., Zeldis, J. B., Stirling, D. I., & Thomas, S. D. (2002). Thalidomide in the treatment of leprosy. Microbes and Infection, 4(11), 1193-1202.https://doi.org/10.1016/s1286-4579(02)01645-3
  • Tripathy, S., Dassarma, B., Roy, S., Chabalala, H.,&Matsabisa, M. G. (2020). A review on possible modes of action of chloroquine/hydroxychloroquine: repurposing against SAR-CoV-2 (COVID-19) pandemic. International Journal of Antimicrobial Agents, 56(2), 106028.https://doi.org/10.1016/j.ijantimicag.2020.106028
  • Tsao, C. W., Lin, Y. S., Chen, C. C., Bai, C. H. & Wu, S. R. (2006). Cytokines and serotonin transporter in patients with major depression. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 30(5), 899-905.https://doi.org/10.1016/j.pnpbp.2006.01.029
  • Weilburg, J. B. (2004). An overview of SSRI and SNRI therapies for depression. Managed Care (Langhorne, Pa.), 13(6 Suppl Depression), 25-33.
  • Wilkes, S. (2008). The use of bupropion SR in cigarette smoking cessation. International Journal of Chronic Obstructive Pulmonary Disease, 3(1), 45-53. https://doi.org/10.2147/copd.s1121
  • Yang, T., Nie, Z., Shu, H., Kuang, Y., Chen, X., Cheng, J., … & Liu, H. (2020). The role of BDNF on neural plasticity in depression. Frontiers in Cellular Neuroscience, 14, 82.https://doi.org/10.3389/fncel.2020.00082
  • You, H., Lu, W., Zhao, S., Hu, Z., & Zhang, J. (2013). The relationship between statins and depression: a review of the literature. Expert Opinion on Pharmacotherapy, 14(11), 1467-1476.https://doi.org/10.1517/14656566.2013.803067
  • Zhang, Q. Q., Li, W. S., Liu, Z., Zhang, H. L., Ba, Y. G., & Zhang, R. X. (2020). Metformin therapy and cognitive dysfunction in patients with type 2 diabetes: a meta-analysis and systematic review. Medicine, 99(10).https://doi.org/10.1097/MD.0000000000019378
  • Zhao, K., & So, H. C. (2018). Drug repositioning for schizophrenia and depression/anxiety disorders: a machine learning approach leveraging expression data. IEEE journal of Biomedical and Health Informatics, 23(3), 1304-1315.https://doi.org/10.1109/JBHI.2018.2856535
  • Zheng, W., Sun, W. &Simeonov, A. (2018). Drug repurposing screens and synergistic drug‐combinations for infectious diseases. British Journal of Pharmacology, 175(2), 181-191.https://doi.org/10.1111/bph.13895