title: Pharmacologically-mediated reactivation and reconsolidation blockade of the psychostimulant-abuse circuit: a novel treatment strategy.
abstract: Psychostimulant abuse continues to present legal, socioeconomic and medical challenges as a primary psychiatric disorder, and represents a significant comorbid factor in major psychiatric and medical illnesses. To date, monotherapeutic drug treatments have not proven effective in promoting long-term abstinence in psychostimulant abusers. In contrast to clinical trials utilizing monotherapies, combinations of dopamine (DA) agonists and selective 5-HT(3), 5HT(2A/2C), or NK(1) antagonists have shown robust efficacy in reversing behavioral and neurobiological alterations in animal models of psychostimulant abuse. One important temporal requirement for these treatments is that the 5-HT or NK(1) receptor antagonist be given at a critical time window after DA agonist administration. This requirement may reflect a necessary dosing regimen towards normalizing underlying dysfunctional neural circuits and "addiction memory" states. Indeed, chronic psychostimulant abuse can be conceptualized as a consolidated form of dysfunctional memory maintained by repeated drug- or cue-induced reactivation of neural circuit and subsequent reconsolidation. According to this concept, the DA agonist given first may reactivate this memory circuit, thereby rendering it transiently labile. The subsequent antagonist is hypothesized to disrupt reconsolidation necessary for restabilization, thus leading progressively to a therapeutically-mediated abolishment of dysfunctional synaptic plasticity. We propose that long-term abstinence in psychostimulant abusers may be achieved not only by targeting putative mechanistic pathways, but also by optimizing drug treatment regimens designed to disrupt the neural processes underlying the addicted state.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States. tong.lee@duke.edu
authors.forename: Tong H
authors.initials: TH
authors.lastname: Lee
authors.forename: Steven T
authors.initials: ST
authors.lastname: Szabo
authors.forename: J Corey
authors.initials: JC
authors.lastname: Fowler
authors.forename: Paolo
authors.initials: P
authors.lastname: Mannelli
authors.forename: O Barry
authors.initials: OB
authors.lastname: Mangum
authors.forename: Wayne F
authors.initials: WF
authors.lastname: Beyer
authors.forename: Ashwin
authors.initials: A
authors.lastname: Patkar
authors.forename: William C
authors.initials: WC
authors.lastname: Wetsel
mesh_terms: D000818:Animals; D001521:Behavior Therapy / Q000379:methods; D059333:Central Nervous System Sensitization; D000697:Central Nervous System Stimulants / Q000494:pharmacology*; D006801:Humans; D017294:Ondansetron / Q000627:therapeutic use; D051381:Rats; D012646:Self Administration; D012702:Serotonin Antagonists / Q000627:therapeutic use; D019966:Substance-Related Disorders / Q000188:drug therapy* / Q000523:psychology
chemical_list: D000697:Central Nervous System Stimulants; D012702:Serotonin Antagonists; D017294:Ondansetron