Zusammenfassung
Wir beschreiben den Fall einer 21-jährigen Patientin, die 2-malig den Alpha-2-Antagonisten
Yohimbin zur Gewichtsreduktion einnahm. In engem zeitlichem Zusammenhang mit dem Beginn
der Einnahme standen Verhaltensauffälligkeiten, Änderungen in Konsumverhalten und
Suchterleben (Alkohol, Kokain) und Suizidalität. Daten aus präklinischen und klinischen
Studien werden diskutiert, die einen möglichen kausalen Zusammenhang untermauern.
Vorangestellt ist eine Literaturübersicht über psychische Wirkungen und Nebenwirkungen
von Yohimbin.
Abstract
We describe a 21-year old female patient who had taken the alpha-2-antagonist yohimbine
for weight-loss. The patient reported alterations in alcohol- and cocaine-seeking
along with changes in defensive behaviour, including suicidal tendencies. Pre-clinical
and clinical studies are discussed, which support the hypothesis of a causal relationship.
We added an overview of relevant psychiatric effects and side effects of yohimbine.
Schlüsselwörter
Yohimbin - Kokain - Alkohol - Verhalten - Suizidalität
Key words
Yohimbine - cocaine - alcohol - behaviorial alterations - suicidality
Literatur
1
Vogt H J, Brandl P, Kockott G. et al .
Double-blind, placebo-controlled safety and efficacy trial with yohimbine hydrochloride
in the treatment of nonorganic erectile dysfunction.
Int J Impot Res.
1997;
9 (3)
155-161
2
Becker A J, Mayer M, Stief C G.
Therapy for organic erectile Dysfunction.
Urologe A.
2005;
44 (10)
1160-1166
3
Derouet H, Osterhage J, Sittinger H.
Erectile function disorders. Epidemiology, physiology, etiology, diagnosis and therapy.
Nervenarzt.
2004;
75 (6)
595-605, quiz 606 – 607
4
Giampreti A, Lonati D, Locatelli C. et al .
Acute neurotoxicity after yohimbine ingestion by a body builder.
Clin Toxicol.
2009;
Epub ahead of print 30.7.2009
5
Crespi F.
Anxiolytics antagonize yohimbine-induced central noradrenergic activity: a concomitant
in vivo voltammetry-electrophysiology model of anxiety.
J Neurosci Methods.
2009;
180 (1)
97-105
6
Vasa R A, Pine D S, Masten C L. et al .
Effects of yohimbine and hydrocortisone on panic symptoms, autonomic responses, and
attention to threat in healthy adults.
Psychopharmacology.
2009;
204 (3)
445-455
7
Buffalari D M, Grace A A.
Anxiogenic Modulation of Spontaneous and Evoked Neuronal Activity in the Basolateral
Amygdala.
Neuroscience.
2009;
Epub ahead of print 7.7.2009
8
Bremner J D, Innis R B, Ng C K. et al .
Positron emission tomography measurement of cerebral metabolic correlates of yohimbine
administration in combat-related posttraumatic stress disorder.
Arch Gen Psychiatry.
1997;
54
246-254
9
Southwick S M, Morgan 3 rd C A, Charney D S. et al .
Yohimbine use in a natural setting: effects on posttraumatic stress disorder.
Biol Psychiatry.
1999;
46
442-444
10
Morgan 3 rd C A, Grillon C, Southwick S M. et al .
Yohimbine facilitated acoustic startle reflex in combat veterans with post-traumatic
stress disorder.
Psychopharmacology.
1995;
117
466-471
11
Charney D S, Heninger G R, Breier A.
Noradrenergic function in panic anxiety. Effects of yohimbine in healthy subjects
and patients with agoraphobia and panic disorder.
Arch Gen Psychiatry.
1984;
41
751-763
12
Gurguis G N, Vitton B J, Uhde T W.
Behavioral, sympathetic and adrenocortical responses to yohimbine in panic disorder
patients and normal controls.
Psychiatry Res.
1997;
71 (1)
27-39
13
Myers E A, Banihashemi L, Rinaman L.
The anxiogenic drug yohimbine activates central viscerosensory circuits in rats.
J Comp Neurol.
2005;
492 (4)
426-441
14
Blanchard R J, Taukulis H K, Rodgers R J. et al .
Yohimbine potentiates active defensive responses to threatening stimuli in Swiss-Webster
mice.
Pharmacol Biochem Behav.
1993;
44 (3)
673-681
15
Haller J, Kiem D T, Makara G B.
Do alpha-2 adrenoceptors modify coping strategies in rats?.
Psychopharmacology.
1995;
122 (4)
379-385
16
Mann J J.
Neurobiology of suicidal behaviour.
Nat Rev Neurosci.
2003;
4 (10)
819-828
17
Huang Y Y, Cate S P, Battistuzzi C. et al .
An association between a functional polymorphism in the monoamine oxidase a gene promoter,
impulsive traits and early abuse experiences.
Neuropsychopharmacology.
2004;
29 (8)
1498-1505
18
Carballo J J, Akamnonu C P, Oquendo M A.
Neurobiology of suicidal behavior. An integration of biological and clinical findings.
Arch Suicide Res.
2008;
12 (2)
93-110
19
Gos T, Krell D, Bielau H. et al .
Tyrosine hydroxylase immunoreactivity in the locus coeruleus is elevated in violent
suicidal depressive patients.
Eur Arch Psychiatry Clin Neurosci.
2008;
258 (8)
513-520
20
Meana J J, Barturen F, García-Sevilla J A.
Alpha 2-adrenoceptors in the brain of suicide victims: increased receptor density
associated with major depression.
Biol Psychiatry.
1992;
31 (5)
471-490
21
González-Maeso J, Rodríguez-Puertas R, Meana J J. et al .
Neurotransmitter receptor-mediated activation of G-proteins in brains of suicide victims
with mood disorders: selective supersensitivity of alpha(2A)-adrenoceptors.
Mol Psychiatry.
2002;
7 (7)
755-767
22
Arango V, Underwood M D, Pauler D K. et al .
Differential age-related loss of pigmented locus coeruleus neurons in suicides, alcoholics,
and alcoholic suicides.
Alcohol Clin Exp Res.
1996;
20 (7)
1141-1147
23
Ordway G A, Widdowson P S, Smith K S. et al .
Agonist binding to alpha 2-adrenoceptors is elevated in the locus coeruleus from victims
of suicide.
J Neurochem.
1994;
63 (2)
617-624
24
Escribá P V, Ozaita A, García-Sevilla J A.
Increased mRNA expression of alpha2A-adrenoceptors, serotonin receptors and mu-opioid
receptors in the brains of suicide victims.
Neuropsychopharmacology.
2004;
29 (8)
1512-1521
25
Arango V, Ernsberger P, Sved A F. et al .
Quantitative autoradiography of alpha 1- and alpha 2-adrenergic receptors in the cerebral
cortex of controls and suicide victims.
Brain Res.
1993;
630 (1 – 2)
271-282
26
Emanuele E, Minoretti P, Arra M.
Yohimbine may have a therapeutic role in prevention of suicide by regulation of glial
fibrillary acidic protein expression.
Med Hypotheses.
2006;
67 (6)
1472
27
Feltenstein M W, See R E.
Potentiation of cue-induced reinstatement of cocaine-seeking in rats by the anxiogenic
drug yohimbine.
Behav Brain Res.
2006;
174 (1)
1-8
28
Kupferschmidt D A, Tribe E, Erb S.
Effects of repeated yohimbine and extinction and reinstatement of cocaine seeking.
Pharmacol Biochem Behav.
2009;
91
473-480
29
Wee S, Mandyam C D, Lekic D M. et al .
Alpha 1-noradrenergic system role in increased motivation for cocaine intake in rats
with prolonged access.
Eur Neuropsychopharmacol.
2008;
18
303-311
30
Jiménez-Rivera C A, Feliu-Mojer M, Vázquez-Torres R.
Alpha-noradrenergic receptors modulate the development and expression of cocaine sensitization.
Ann N Y Acad Sci.
2006;
1074
390-402
31
Davis A R, Shields A D, Brigman J L. et al .
Yohimbine impairs extinction of cocaine-conditioned place preference in an alpha2-adrenergic
receptor independent process.
Learn Mem.
2008;
15
667-776
32
Richards J K, Simms J A, Bartlett S E.
Conditioned cues and yohimbine induce reinstatement of beer and near-beer seeking
in Long-Evans rats.
Addict Biol.
2009;
14
144-151
33
Richards J K, Simms J A, Steensland P. et al .
Inhibition of orexin-1 /hypocretin-1 receptors inhibits yohimbine-induced reinstatement
of ethanol and sucrose seeking in Long-Evans rats.
Psychopharmacology.
2008;
199
109-117
34
Marinelli P W, Funk D, Juzytsch W. et al .
The CRF1 receptor antagonist antalarmin attenuates yohimbine-induced increases in
operant alcohol self-administration and reinstatement of alcohol seeking in rats.
Psychopharmacology.
2007;
195
345-355
35
Dzung L e A, Funk D, Harding S. et al .
The role of noradrenaline and 5-hydroxytryptamine in yohimbine-induced increases in
alcohol-seeking in rats.
Psychopharmacology.
2009;
204
477-488
36
McDougle C J, Krystal J H, Price L H. et al .
Noradrenergic response to acute ethanol administration in healthy subjects: comparison
with intravenous yohimbine.
Psychopharmacology.
1995;
118
127-135
37
Stine S M, Southwick S M, Petrakis I L. et al .
Yohimbine-induced withdrawal and anxiety symptoms in opioid-dependent patients.
Biol Psychiatry.
2002;
51
642-651
38
Milne B, Sutak M, Cahill C M. et al .
Low doses of alpha 2-adrenoreceptor antagonists augment spinal morphine analgesia
and inhibit development of acute and chronic tolerance.
Br J Pharmacol.
2008;
155
1264-1278
39
Powers M B, Smits J A, Otto M W. et al .
Facilitation of fear extinction in phobic participants with a novel cognitive enhancer:
a randomized placebo controlled trial of yohimbine augmentation.
J Anxiety Disord.
2009;
23
350-356
40
Mueller D, Olivera-Figueroa L A, Pine D S. et al .
The effects of yohimbine and amphetamine on fear expression and extinction in rats.
Psychopharmacology.
2009;
204
599-606
41
Imaki J, Mae Y, Shimizu S. et al .
Therapeutic potential of alpha2 adrenoreceptor antagonism for antipsychotic-induced
extrapyramidal motor disorders.
Neurosci Lett.
2009;
454
143-147
42
Sanacora G, Berman R M, Cappiello A. et al .
Addition of the alpha2-antagonist yohimbine to fluoxetine: effects on rate of antidepressant
response.
Neuropsychopharmacology.
2004;
29
1166-1171
43
Mavanji V, Datta S.
Sleep-wake effects of yohimbine and atropine in rats with a clomipramine-based model
of depression.
Neuroreport.
2002;
13
1603-1606
44
Schank J R, Liles L C, Weinshenker D.
Norepinephrine signaling through beta-adrenergic receptors is critical for expression
of cocaine-induced anxiety.
Biol Psychiatry.
2008;
63
1007-10 012
Martin Scherr
Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar,
Technische Universität München
Ismaningerstraße 22
81675 München
Email: martin_scherr@hotmail.com