Fortschr Neurol Psychiatr 2009; 77(10): 585-590
DOI: 10.1055/s-0028-1109758
Kasuistik

© Georg Thieme Verlag KG Stuttgart · New York

Yohimbin, ein Alpha-2-Antagonist: Literaturübersicht zu psychiatrisch relevanten Wirkungen und Nebenwirkungen mit aktuellem Fallbericht

Psychiatric Effects and Side Effects of the Alpha-2-Antagonist Yohimbine: A Review of Literature and Case ReportM. Scherr1 , D. Schwerthoeffer1 , T. Froboese1 , F. Castrop2 , J. Bäuml1
  • 1Klinik und Poliklinik für Psychiatrie und Psychotherapie (Direktor: Univ.-Prof. Dr. H. Förstl), Klinikum rechts der Isar, Technische Universität München
  • 2Neurologische Klinik und Poliklinik (Direktor: Univ.-Prof. Dr. B. Hemmer), Klinikum rechts der Isar, Technische Universität München
Further Information

Publication History

Publication Date:
09 October 2009 (online)

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.

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

    >