ABSTRACT The symptom of “diminished interest or pleasure” in rewarding stimuli is an affective symptom of nicotine and amphetamine withdrawal, and a core symptom of depression. An

operational measure of this symptom is elevation of brain reward thresholds during drug withdrawal. We report here that acute co-administration of fluoxetine, a selective serotonin reuptake

inhibitor, and p-MPPI, a serotonin-1A receptor antagonist, alleviated the diminished interest in brain stimulation reward observed during withdrawal from nicotine or amphetamine in rats

(i.e., increased reward). By contrast, the same drug combination treatment did not reduce the somatic signs of nicotine withdrawal indicating symptom-specific neurobiological abnormalities.

decreased serotonergic function may mediate the reward decrements characterizing nicotine and amphetamine withdrawal, and that these symptoms may be homologous to a core symptom of

non-drug–induced depressions. SIMILAR CONTENT BEING VIEWED BY OTHERS DOPAMINE D1-LIKE RECEPTOR BLOCKADE AND STIMULATION DECREASES OPERANT RESPONDING FOR NICOTINE AND FOOD IN MALE AND FEMALE

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chronic nicotine or amphetamine administration precipitates withdrawal syndromes characterized by affective symptoms, including “diminished interest or pleasure” in rewarding stimuli (i.e.,

anhedonia) (American Psychiatric Association 1994; Covey et al. 1998; Glassman 1993; Hughes 1992). Interestingly, the symptom of “diminished interest or pleasure” is not only a symptom of

drug withdrawal, but also a core symptom of depression and a negative symptom of schizophrenia (American Psychiatric Association 1994; Markou et al. 1998). Brain reward threshold elevation

is an operational measure of this symptom because it reflects diminished sensitivity to rewarding electrical stimuli. In rats, withdrawal from drugs of abuse belonging to diverse

pharmacological classes, such as nicotine (Epping-Jordan et al. 1998; Watkins et al. 2000b), amphetamine (Kokkinidis and Zacharko 1980a, 1980b; Kokkinidis et al. 1980, 1986; Leith and

Barrett 1976, 1980; Lin et al. 1999, 2000; Paterson et al. 2000; Wise and Munn 1995), cocaine (Baldo et al. 1999; Kokkinidis and McCarter 1990; Markou and Koob 1991, 1992a; Markou et al.

1992) morphine (Schulteis et al. 1994) and ethanol (Schulteis et al. 1995) elevated brain stimulation reward thresholds. In addition to the affective aspects of drug withdrawal reflected in

threshold elevations, nicotine, opiate, or ethanol withdrawal also lead to alterations in a set of behaviors termed somatic signs. In the case of nicotine, these somatic signs are primarily

gasps, writhes, eye blinks, and ptosis (Epping-Jordan et al. 1998; Hildebrand et al. 1997, 1999; Malin et al. 1992). It is unlikely that these somatic signs in the rat reflect the affective

component of drug withdrawal. Nevertheless, the study of both threshold elevations and somatic signs permits the investigation of the effects of manipulations on the various aspects of

withdrawal. Based on evidence demonstrating the efficacy of serotonergic antidepressant treatments, reduced cerebrospinal fluid levels of serotonin metabolites, endocrine measures reflecting

reduced serotonergic neurotransmission and the exacerbation of depressive symptomatology seen after serotonin (5-HT) depletion in depressed individuals, it is hypothesized that reduced

serotonergic neurotransmission underlies at least some aspects or some subtypes of non–drug-induced depressions (for reviews, see Caldecott-Hazard et al. 1991; Caldecott-Hazard and Schneider

1992; Heninger et al. 1996; Markou et al. 1998; Meltzer and Lowy 1988; Willner 1985). The purpose of the present study was to test the hypothesis that reduced serotonergic neurotransmission

mediates some of the affective aspects, not only of non-drug-induced depressions, but also of drug-induced depressions. Thus, the present study tested the hypothesis that enhancement of

serotonergic neurotransmission through acute administration of the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Wong et al. 1995) in combination with a relatively selective

5-HT1A receptor antagonist would alleviate the symptom of “diminished interest or pleasure” observed in rats during nicotine or amphetamine withdrawal. Such an experimental outcome would

suggest that the affective aspects of drug withdrawal may be homologous to the core symptom of depression of “diminished interest or pleasure” in rewarding stimuli. It was also hypothesized

that this serotonergic drug treatment would not reverse the somatic signs of nicotine withdrawal that most likely do not reflect affective aspects of withdrawal. The combination treatment of

a SSRI together with the relatively selective 5-HT1A receptor antagonist p-MPPI [4-(2′-methoxy-phenyl)-1-[2′-(n-(2″-pyridinyl)-p-iodobenzamido]-ethyl-piperazine] (Allen et al. 1997; Kung et

al. 1994a, 1994b, 1995) was selected based on the following considerations. First, the threshold elevations associated with nicotine (Epping-Jordan et al. 1998) and amphetamine (Lin et al.

1999, 2000; Paterson et al. 2000) withdrawal, and the increases in somatic signs seen during nicotine withdrawal (Epping-Jordan et al. 1998) are relatively short lasting phenomena (3–5 days)

that do not allow the detection of the effects of pharmacological treatments that may require chronic administration for producing their effect. _In vivo_ microdialysis work demonstrated

that the administration of a SSRI together with a 5-HT1A receptor antagonist acutely and rapidly elevates forebrain serotonin dialysate levels beyond levels seen after acute treatment with

the SSRI alone (Auerbach and Hjorth 1995; Bel and Artigas 1993; Bengtsson and Milano 1996; Hjorth 1993, 1996; Invernizzi et al. 1994; Knobelman et al. 2000; Kreiss and Lucki 1994, 1995; for

reviews, see Artigas et al. 1996; Blier and de Montigny 1994). Thus, such a drug combination may have rapid therapeutic effects that may be detectable during the short-lasting drug

withdrawal. Second, the combination of a SSRI with pindolol [antagonist at 5-HT1A, 5-HT1B, and β-adrenergic receptors (Assie and Koek 1996; Bourin et al. 1998; Gobert and Millan 1999; Hoyer

and Schoeffter 1991; Newman-Tancredi et al. 1998); also reported to act as a partial agonist at 5-HT1A and α-adrenergic receptors (Clifford et al. 1998; Fornal et al. 1999a, 1999b, 1999c;

Gobert and Millan 1999; Pauwels and Palmier 1994a, 1994b)] accelerates the onset of antidepressant action of SSRIs in humans (Bordet et al. 1998; Zanardi et al. 1997, 1998), or augments the

antidepressant response to SSRIs in terms of both magnitude and duration of the response (Maes et al. 1999; Perez et al. 1997; Tome and Isaac 1998; for review, see McAskill et al. 1998;

however, see Berman et al. 1997, 1999; Tome et al. 1997a, 1997b). In the present study, instead of pindolol, which has multiple receptor actions, the relatively selective 5-HT1A receptor

antagonist p-MPPI was used. The use of p-MPPI allowed the investigation of the role of serotonergic neurotransmission and antagonism at 5-HT1A receptors in drug withdrawal, without

complicating data interpretation with neuroadaptive effects that may occur with chronic SSRI treatment. In summary, acute treatment with a SSRI together with a 5-HT1A receptor antagonist

allowed us to rapidly elevate extracellular serotonin levels and delineate the potential role of serotonin neurotransmission in the affective and somatic aspects of drug withdrawal. MATERIAL

AND METHODS SUBJECTS Male Wistar rats (Charles River, Hollister, CA) (300–320 g at the start of the experiment) were housed in pairs in a temperature and humidity controlled environment

with a 12 hr light/dark cycle (lights on at 6:00 A.M.). Food and water were available ad libitum in the home cages. All subjects were treated in accordance with the National Institutes of

Health “Guide for the Care and Use of Laboratory Animals,” and the animal facilities and experimental protocols were in accordance with the Association for the Assessment and Accreditation

of Laboratory Animal Care. All testing was conducted during the light phase of the light/dark cycle. INTRACRANIAL SELF-STIMULATION The intracranial self-stimulation task used is a modified

version (Markou and Koob 1992b, 1993) of a discrete-trial current-threshold procedure originally developed by Kornetsky and co-workers (Kornetsky and Esposito 1979). The apparatus, surgery,

procedure, and parameters for the lateral hypothalamic intracranial self-stimulation task have been described in detail previously (Harrison et al. 1999; Kornetsky and Esposito 1979; Markou

and Koob 1992b, 1993). _APPARATUS_ The experimental apparatus consisted of 16 Plexiglas chambers (30.5 × 30 × 17 cm) (Med Associates Inc.) encased in sound-attenuating boxes (San Diego

Instruments, San Diego, CA). Each operant chamber consisted of a stainless steel grid floor and a metal wheel manipulandum located on one wall, which required a 0.2 N force to rotate it a

quarter turn. Gold-contact swivel commutators and bipolar leads connected the animals to the stimulation circuit (Plastics One, Roanoke, VA). Brain stimulation was administered by constant

current stimulators (Stimtek 1200, San Diego Instruments, San Diego, CA). The stimulation parameters, data collection and all programming functions were controlled by a microcomputer.

_SURGERY_ The rats were prepared with 11 mm stainless steel bipolar electrodes (Plastics One; diameter = 0.25 mm) in the posterior lateral hypothalamus (AP −0.5 mm from bregma; L ± 1.7 mm;

DV −8.3 mm from dura, with the incisor bar set at 5 mm above the inter-aural line; Pellegrino et al. 1979) under halothane anesthesia (1–1.5% halothane/oxygen mixture) and allowed to recover

for at least seven days. INTRACRANIAL SELF-STIMULATION PROCEDURE The subjects were initially trained to turn the wheel manipulandum on a fixed ratio 1 schedule of reinforcement during which

each quarter turn of a wheel manipulandum resulted in the delivery of a contingent electrical reinforcer. The electrical reinforcer had a train duration of 500 msec and consisted of 0.1

msec rectangular cathodal pulses that were delivered with 100 Hz frequency. The current intensity was adjusted for each animal and typically ranged from 100-250 μA. After successful

familiarization with this procedure (two sessions of 100 reinforcers in less than 20 min), the rats were gradually trained on the discrete-trial current threshold procedure. In this

procedure, at the start of each trial, rats received a non-contingent electrical stimulus. During the following 7.5 sec, the limited hold, if the subjects responded by turning the wheel

manipulandum a quarter turn (positive response), they received a second contingent stimulus identical to the previous non-contingent stimulus. During a 2 sec period immediately after a

positive response, further responses had no reinforcement or task consequences. If no response occurred during the 7.5 sec limited hold period, a negative response was recorded. The

intertrial interval (ITI), which followed the limited hold period, had an average duration of 10 sec (ranging from 7.5–12.5 sec). Responses that occurred during the ITI resulted in a further

12.5 sec delay of the onset of the next trial. During training, the duration of the ITI and delay periods imposed by inappropriate ITI responding were gradually increased until the standard

task parameters were reached. Stimulation intensities were varied according to the classical psychophysical method of limits. Thus, the subjects received four alternating series of

ascending and descending current intensities starting with a descending series. Within each series the stimulus intensity was altered by 5 μA steps between each set of trials (three trials

per set). The initial stimulus intensity was set at 40 μA above the baseline current threshold for each animal. A series was terminated after either 15 stimulus increments (or decrements)

had occurred, or after the determination of the threshold for the series (see below). Each test session typically lasted 30 min and provided two dependent variables. After training in the

above brain stimulation procedure, rats were tested until stable baseline thresholds and latencies were achieved (±10% over a 5-day period), which typically occurred after two to three weeks

of daily baseline testing. _REWARD THRESHOLDS_ The current threshold for each descending series was defined as the stimulus intensity between the successful completion of a set of trials

(positive responses during two or more of the three trials) and the stimulus intensity for the first set of trials, of two consecutive sets, during which the animal failed to respond

positively on two or more of the three trials. During the ascending series, the threshold was defined as the stimulus intensity between the unsuccessful completion of a set of trials

(negative responses during two or more of the three trials) and the stimulus intensity for the first set of trials, of two consecutive sets, during which the animal responded positively on

two or more of the trials. Thus, during each test session, four thresholds were determined and the mean of these values was taken as the threshold for each subject. _RESPONSE LATENCY_ The

latency between the onset of the non-contingent stimulus at the start of each trial and a positive response was recorded as the response latency. The response latency for each test session

was defined as the mean response latency of all trials during which a positive response occurred. DRUGS d-Amphetamine sulphate (obtained from the National Institute on Drug Abuse, Bethesda,

MD) and fluoxetine hydrochloride (Research Biochemicals Inc., Natick, MA) were dissolved in saline and administered intraperitoneally in a volume of 1 ml/kg.

4-(2′-Methoxy-phenyl)-1-[2′-(n-(2″-pyridinyl)-p-iodobenzamido]-ethyl-piperazine hydrochloride (p-MPPI) (Research Biochemicals Inc.) was dissolved in sterile water and sonicated for 10–20

min, and then brought to a pH of approximately 5.2 with 0.1 M NaOH. p-MPPI hydrochloride was administered subcutaneously in a volume of 4 ml/kg. Nicotine hydrogen tartrate (Sigma, St. Louis,

MO) was dissolved in saline and administered through subcutaneous osmotic minipumps. Mecamylamine HCl (Sigma) was dissolved in saline and administered subcutaneously in a volume of 1 ml/kg.

NICOTINE ADMINISTRATION AND WITHDRAWAL When stable self-stimulation performance had been achieved, osmotic minipumps [model 2ML1 (7 day) Alza Corporation, Palo Alto, CA] filled with either

saline (4 groups of _n_ = 8) or nicotine hydrogen tartrate dissolved in saline (4 groups of _n_ = 8), were implanted subcutaneously under halothane/oxygen anesthesia. The surgical wounds

were closed with 9 mm stainless steel autoclips (Becton Dickinson Primary Care Diagnostics, Sparks, MD). The concentration of nicotine was adjusted to compensate for differences in body

weight at the time of implantation, resulting in a dose of 9 mg/kg/day nicotine tartrate (or 3.16 mg/kg/day base) for 7 days. During these 7 days, intracranial self-stimulation reward

thresholds, response latencies and the body weight of the subjects were recorded daily. The minipumps were removed on the seventh day after pump implantation. Intracranial self-stimulation

reward thresholds, response latencies, the number of somatic signs of withdrawal and body weight were measured at regular intervals thereafter. Subjects were tested in the intracranial

self-stimulation (ICSS) procedure at 6, 12, 18, 24, 36, 48, 72, 96, 120, and 144 hr after pump removal. Body weight was measured immediately before each ICSS session. The somatic signs of

nicotine withdrawal have been described in detail previously (Epping-Jordan et al. 1998; Hildebrand et al. 1997, 1999; Malin et al. 1992; Watkins et al. 2000b). Briefly, the number of

abstinence signs, including gasps, writhes, eye blinks, chewing, teeth chattering, cheek tremor, ptosis, “wet dog” shakes, piloerection, genital grooming, and escapes were recorded during a

10 min period. Somatic signs were assessed immediately after the self-stimulation sessions at 6.5, 12.5, 18.5, 24.5, 36.5, 48.5, 72.5, 96.5, 120.5, and 144.5 hr after pump removal. Acute

administration of vehicle, p-MPPI hydrochloride (3 mg/kg), fluoxetine hydrochloride (5 mg/kg), or p-MPPI hydrochloride (3 mg/kg) + fluoxetine hydrochloride (5 mg/kg), occurred prior to the

18-hr test session. This testing time point was selected based on the time course of threshold elevations and somatic signs observed during nicotine withdrawal previously (Epping-Jordan et

al. 1998). p-MPPI hydrochloride was administered 135 min prior to test, and fluoxetine hydrochloride was administered 120 min prior to test. _MECAMYLAMINE CHALLENGE_ On the seventh day

post-pump removal, all subjects were subcutaneously injected with mecamylamine (3.0 mg/kg) 15 min before intracranial self-stimulation testing, which was immediately followed by assessment

of somatic signs of withdrawal. The purpose of this mecamylamine challenge was to test whether prior nicotine exposure and withdrawal would lead to potential tolerance or augmentation to the

withdrawal effects. The dose of mecamylamine used was selected based on data showing that this dose reliably precipitated nicotine withdrawal symptomatology in rats that were chronically

treated with nicotine (Watkins et al. 2000b). AMPHETAMINE ADMINISTRATION AND WITHDRAWAL The amphetamine administration regimen was a modification of that used originally by Leith and Barrett

(1976), and identical to that used by Lin et al. (1999). Briefly, d-amphetamine sulphate (6 groups of _n_ = 8) was administered intraperitoneally three times a day (6:00 A.M., 12:00 A.M.,

6:00 P.M.) for four days in a rising dose regime starting at 1 mg/kg and stabilizing at 5 mg/kg (i.e., 1, 2, 3, 4, 5, 5, 5, 5, 5, 5, 5, 5 mg/kg; total dose = 50 mg/kg). Another set of rats

(6 groups of _n_ = 8) was injected at the same time-points with saline. Intracranial self-stimulation reward thresholds and response latencies were determined at 12, 36, 42, 60, 84, 108,

132, and 156 hr after the last amphetamine or saline injection. Acute administration of vehicle, p-MPPI hydrochloride (3 mg/kg), fluoxetine hydrochloride (2.5 or 5 mg/kg), or p-MPPI

hydrochloride (3 mg/kg) + fluoxetine hydrochloride (2.5 or 5 mg/kg) was administered prior to the 36-hr test session. This testing time point was selected based on the time course of

threshold elevations observed during amphetamine withdrawal previously (Lin et al. 1999). p-MPPI hydrochloride was administered 135 minutes prior to test, and fluoxetine hydrochloride was

administered 120 minutes prior to test. DATA ANALYSES _CHRONIC NICOTINE_ Body weight data recorded during the nicotine phase were expressed as a percentage of the weight immediately after

minipump implantation, to take into account the weight of the mini-pump. Body weight, intracranial self-stimulation reward threshold and response latency data were analyzed using two-way

analyses of variance (ANOVAs) with time after minipump implantation as the within-subject factor and chronic drug treatment (nicotine or saline) as the between-subject factor. _NICOTINE AND

AMPHETAMINE WITHDRAWAL_ All reward threshold and response latency data were expressed as a percentage of the mean baseline value assessed during the five days immediately prior to the

implantation of the minipumps or the first amphetamine injection. Body weight data recorded during the nicotine withdrawal phase were expressed as a percentage of the body weight immediately

after minipump removal. Data were analyzed using three-way mixed factors analyses of variance. The within-subjects factor was time after nicotine, amphetamine or saline treatment, and the

two between-subjects factors were chronic drug treatment [drug (nicotine or amphetamine) versus saline] and acute drug treatment administered during withdrawal. Statistically significant

interactions were followed by post-hoc Newman-Keuls tests. The level of significance was set at _p_ < .05. _MECAMYLAMINE CHALLENGE_ Reward threshold, response latency and somatic signs

data were compared to the data collected the previous day (time-point 144 hr in withdrawal, when performance had returned to baseline levels for all subjects). The data were analyzed using

three-way mixed factors analyses of variance. The within-subjects factor was dose of mecamylamine (0 or 3.0 mg/kg), and the two between-subjects factors were chronic drug treatment (nicotine

or saline) and acute drug treatment administered during withdrawal. Statistically significant interactions were followed by post-hoc Newman-Keuls tests. The level of significance was set at

_p_ < .05. RESULTS CHRONIC NICOTINE There were no statistically significant differences between the mean baseline thresholds or response latencies of subjects assigned to the saline

“withdrawal” group (_n_ = 32) [mean thresholds ± SEM: 155.55 ± 10.06 μA; mean latencies ± SEM: 3.34 ± 0.06 sec], and subjects assigned to the nicotine group (_n_ = 32) [mean thresholds ±

SEM: 160.36 ± 8.04 μA; mean latencies ± SEM: 3.36 ± 0.04 sec] (_p_ > .1). Based on the animals’ performance during the 6- and 12-hr tests (time-points before the acute drug administration

during withdrawal) subjects were assigned to treatment groups so that original withdrawal effects on threshold elevations were equal across groups. _REWARD THRESHOLDS_ Reward thresholds of

nicotine-exposed animals were significantly lower than those of saline-exposed animals [F(1,62) = 5.983, _p_ < .05] during pump-exposure. Post-hoc analysis of a significant days X drug

interaction revealed that the thresholds of nicotine-exposed animals were lower than those of saline-exposed control animals for the first two days after minipump implantation [F(5,310) =

6.166, _p_ < .01] (see Figure 1a ). _RESPONSE LATENCIES_ Response latencies of nicotine-exposed rats also were shorter than those of saline-exposed control rats during pump-exposure

[F(1,62) = 7.917, _p_ < .05]. A trend for a statistically significant days × drug interaction [F(5,310) = 2.134, _p_ = .0612] indicated that the difference in response latencies between

nicotine and saline controls was greatest during the first two days of treatment (see Figure 1b). _BODY WEIGHT_ The percent body weights of the nicotine-exposed rats were lower than those of

the saline control rats during the nicotine phase [F(1,62) = 21.551, _p_ < .01]. The percent body weight of both nicotine-exposed and control rats increased during the seven days of pump

pressure [F(6,372) = 77.247, _p_ < .01]. However, a significant days × drug interaction [F(6,372) = 5.36, _p_ < .01] revealed that the body weight of the saline control rats increased

steadily over time, whereas the nicotine-exposed rats did not gain weight during the first five days of nicotine-exposure. Consequently, the percent body weights of the saline-exposed rats

were consistently greater than those of the nicotine-exposed rats during the seven day pump exposure (_p_ < .05) (see Table 1). NICOTINE WITHDRAWAL _REWARD THRESHOLDS_ Withdrawal from

chronic nicotine administration reliably increased reward thresholds compared to saline-treated rats [F(1,56) = 57.87, _p_ < .0001] (see Figure 2). Analysis of the significant time ×

chronic treatment × acute treatment interaction [F(27,504) = 2.55, _p_ < .0001] revealed the following. Nicotine-exposed rats treated with vehicle during withdrawal had elevated

thresholds at withdrawal hr 6, 12, 18, 24 and 36, and returned to baseline levels at 48 hr post-pump removal compared to saline-exposed rats treated with vehicle. Administration of p-MPPI (3

mg/kg) or fluoxetine (5 mg/kg) administered alone had no significant effect on thresholds of either saline- or nicotine-exposed subjects (Figure 2a, b, d, e). By contrast, nicotine-exposed

rats treated with p-MPPI + fluoxetine had significantly lower thresholds than the nicotine-exposed vehicle-treated subjects at 24, 36 and 48 hr post-nicotine (Figure 2f); that is, thresholds

returned to baseline levels 8 hours after the acute combination drug treatment, and 24 hr before nicotine-exposed vehicle-treated subjects’ thresholds returned to baseline levels.

Saline-exposed subjects treated with vehicle during withdrawal exhibited stable thresholds over the duration of the experiment (Figure 2a). Administration of p-MPPI or fluoxetine alone had

no significant effect on reward thresholds of saline-exposed rats (Figure 2a, b). By contrast, in saline-exposed rats, the co-administration of p-MPPI + fluoxetine elevated thresholds

compared to the previously stable performance of this group at the time-point immediately after this acute drug administration (Figure 2c), an effect that was seen repeatedly (see below).

Thresholds returned to baseline levels by the following test session that was 8 hours after the acute drug treatment. _RESPONSE LATENCIES_ Although there were no statistically significant

interactions [F = 0.94–1.48, _p_ > .1], there was a main effect of chronic drug treatment [F(1,56) = 7.64, _p_ < .01], and a main effect of time [F(9,504) = 7.05, _p_ <.0001] on

response latencies. These main effects indicate longer response latencies in nicotine-exposed rats, and in both groups at 24 hr post-pump removal (see Figure 3). _SOMATIC SIGNS_

Nicotine-exposed animals exhibited an increased number of somatic signs of withdrawal for 72 hr after pump removal compared to saline-exposed rats, reflected in a significant chronic drug

treatment × time interaction [F(9,504) = 14.78, _p_ < .0001] (Figure 4). None of the acute drug treatments administered during withdrawal had a significant effect on the number of somatic

signs in either saline- or nicotine-exposed subjects (_p_ > .1). _BODY WEIGHT_ During nicotine withdrawal, animals that received the p-MPPI + fluoxetine combination treatment had

significantly lower percent body weights than the animals in other treatment groups [F(3,56) = 2.951, _p_ < .05]. A significant hours × pump interaction [F(9,504) = 6.63, _p_ < .01]

revealed that only the nicotine withdrawing animals significantly increased body weight only between 96–120 hr and 120–144 hr post-pump removal. The percent body weight of the

nicotine-exposed rats was therefore greater than that of saline-exposed animals at time points 120 and 144 hr post-pump removal (see Table 2). MECAMYLAMINE CHALLENGE Mecamylamine had no

significant effect on reward thresholds [F(1,56) = 2.974, n.s.]; (0 mg/kg mean ± SEM = 102.287 ± 9.132; 3.0 mg/kg mean ± SEM = 104.288 ± 9.352). Response latencies of all subjects were

increased by the administration of mecamylamine [F(1,56) = 5.598, _p_ < .05], (0 mg/kg mean ± SEM = 100.109 ± 0.954; 3.0 mg/kg mean ± SEM = 102.973 ± 1.229). Mecamylamine also increased

the number of somatic signs displayed by all subjects [F(1,56) = 308.443, _p_ < .01], (0 mg/kg mean ± SEM = 2.453 ± 1.967; 3.0 mg/kg mean ± SEM = 13.172 ± 4.914), thus not showing

differential sensitivity of nicotine- and saline-exposed rats to this dose of mecamylamine. AMPHETAMINE WITHDRAWAL There were no statistically significant differences between the mean

baseline thresholds or response latencies of subjects assigned to the saline “withdrawal” group (_n_ = 48) [mean thresholds ± SEM: 158.86 ± 8.67 μA; mean latencies ± SEM: 3.36 ± 0.044 sec],

and subjects assigned to the amphetamine withdrawal group (_n_ = 48) [mean thresholds ± SEM: 146.03 ± 4.26 μA; mean latencies ± SEM: 3.30 ± 0.04 sec] (_p_ > .1). Based on the animals’

performance during the 12-hr test (time-point before the acute drug administration during withdrawal), subjects were assigned to treatment groups so that original withdrawal effects on

threshold elevations were equal across groups. _THRESHOLDS_ Amphetamine-exposed subjects exhibited elevated brain reward thresholds relative to saline-treated rats after the final

amphetamine injection [F(1,84) = 106.76, _p_ < .0001) (Figure 5). Analysis of the significant time × chronic treatment × acute treatment interaction [F(35,588) = 2.56, _p_ < .0001]

revealed the following. Amphetamine-exposed animals treated with vehicle prior to the 36-hr time-point had elevated thresholds at withdrawal hours 12, 36, 44, 60, and 84, and returned to

baseline levels at 108 hr after the last amphetamine injection compared to saline-exposed rats treated with vehicle. p-MPPI (3 mg/kg) or fluoxetine (2.5 mg/kg) administered alone had no

significant effect on the thresholds of either saline- or amphetamine-exposed subjects (Figure 5a, b, d, e). Nevertheless, the higher fluoxetine dose (5 mg/kg) reduced the duration of the

amphetamine withdrawal-induced elevations of thresholds by 24 hr (Figure 5e). Most importantly, administration of p-MPPI and either of the two doses of fluoxetine prior to the 36-hr time

point reduced the duration of the threshold elevations in amphetamine-exposed rats (Figure 5f). More specifically, amphetamine-exposed rats treated with p-MPPI + 2.5 mg/kg fluoxetine had

significantly lower thresholds than amphetamine-exposed vehicle-treated subjects at 60 and 84 hours post-amphetamine (24 hr after the acute treatment), while p-MPPI + 5 mg/kg fluoxetine

returned thresholds to baseline levels at the 42-hr time-point (8 hr after the acute treatment) (Figure 5f). That is, 2.5 mg/kg fluoxetine in combination with p-MPPI returned thresholds to

baseline levels 48 hours earlier than vehicle treatment, while 5 mg/kg fluoxetine in combination with p-MPPI returned thresholds to baseline levels 72 hours earlier than vehicle treatment

(Figure 5f). As expected, saline-exposed subjects treated with vehicle exhibited stable thresholds over the duration of the experiment (Figure 5a). Administration of p-MPPI or either of the

two doses of fluoxetine alone had no significant effect on reward thresholds of saline-exposed rats (Figure 5a, b). As seen in the nicotine withdrawal experiment, in saline-treated rats, the

co-administration of p-MPPI + the higher dose of fluoxetine (5 mg/kg) elevated thresholds compared to the previously stable thresholds of this group and the saline-exposed vehicle-treated

group's thresholds immediately after the acute drug administration (Figure 5c). Thresholds returned to baseline levels by the following test session that was 8 hours after the acute

drug treatment. Other experiments in unperturbed non-withdrawing control rats confirmed that 10 mg/kg p-MPPI combined with 5 mg/kg fluoxetine also significantly elevated thresholds (data not

shown), providing the third demonstration of decrease in reward after this drug combination when subjects are not in drug withdrawal. _RESPONSE LATENCIES_ There was a main effect of acute

drug treatment during withdrawal [F(5,84) = 2.88, _p_ < .05], a main effect of time [F(7,588) = 5.87, _p_ < .0001], and a significant time X acute drug treatment interaction [F(35,588)

= 1.96, _p_ < .001]. These effects reflect longer response latencies in both saline and amphetamine-exposed rats immediately after the co-administration of p-MPPI and either of the two

fluoxetine doses (36 hr time-point). Further, the effects of p-MPPI + the higher dose of fluoxetine (5 mg/kg) on response latencies were still observed at the 42 hour time-point of

withdrawal which was 8 hr after the administration of the combination drug treatment (see Figure 6). DISCUSSION During chronic nicotine or saline administration, animals treated with

nicotine had lower brain reward thresholds than saline controls. The small threshold elevation of saline-exposed rats on the first day of exposure to the minipumps may be due to residual

discomfort from the minipump surgery that occurred the previous day. Similar small and transient threshold elevations after minipump surgery have been observed previously (Paterson et al.

2000). This effect was not observed in nicotine-exposed rats, possibly reflecting a mild analgesic effect of nicotine. Analgesic effects of nicotine that show rapid tolerance have been shown

previously with bolus injections of nicotine (1–3 mg/kg, free base) or with continuous nicotine exposure through tobacco smoke or minipumps containing almost double the nicotine dose (6

mg/kg/day free base = approximately 17 mg/kg/day salt) used in the present study (Marubio et al. 1999; Mousa et al. 1988; Yang et al. 1992). On the second day of minipump exposure,

nicotine-exposed animals still had lower thresholds than saline controls, indicating a small reward-enhancing effect of continuous slow subcutaneous infusion of nicotine. This result is

consistent with increases in brain stimulation reward seen after acute bolus nicotine administration (Bauco and Wise 1994; Clarke and Kumar 1984; Huston-Lyons and Kornetsky 1992).

Nevertheless, in the present study, this small reward-enhancing effect of nicotine was no longer evident on the third day of minipump exposure possibly reflecting tolerance to the

reward-enhancing effects of slowly infused nicotine. This rapid tachyphylaxis is consistent with experimental and anecdotal reports in humans indicating that the first cigarette of the day

is the most pleasurable, in part because of acute tolerance that develops to the subjective effects of nicotine over the day as the smoker consumes additional cigarettes (for review, see

Russell 1989). The effects of continuous nicotine infusion on response latencies followed a similar pattern of results to that of thresholds. Nicotine-exposed rats were faster in responding

than saline-exposed rats, and there was a trend for this effect to be larger during the first two days of exposure to nicotine. Finally, consistent with previous reports, chronic nicotine

administration suppressed body weight gain compared to the weight gain of saline-exposed animals (Carroll et al. 1989; Grunberg et al. 1986; Levin et al. 1987). After removal of the

minipump, animals previously exposed to nicotine gained weight on the last two days of measurement (120 and 144 hr post-pump removal) in comparison to both their own baseline body weight and

that of saline-exposed animals. Previous studies indicated similar, but more dramatic, effects of nicotine withdrawal on body weight after longer nicotine exposure than that used in the

present study (Levin et al. 1987; Winders and Grunberg 1989). None of the acute serotonergic drug treatments affected this pattern of weight gain in either saline- or nicotine-exposed rats.

In replication of previous findings (Epping-Jordan et al. 1998; Kokkinidis and Zacharko 1980a, 1980b; Kokkinidis et al. 1986; Leith and Barrett 1976, 1980; Lin et al. 1999, 2000; Paterson et

al. 2000; Watkins et al. 2000b; Wise and Munn 1995), both nicotine and amphetamine withdrawal resulted in decreased reward reflected in elevated brain reward thresholds relative to

saline-treated rats’ and to their own pre-drug baseline thresholds. As anticipated (Epping-Jordan et al. 1998; Hildebrand et al. 1997, 1999; Malin et al. 1992; Watkins et al. 2000b),

nicotine withdrawal also led to significant increases in somatic signs. Most importantly, the results indicated that the co-administration of fluoxetine, a selective serotonin reuptake

inhibitor, and p-MPPI, a 5-HT1A receptor antagonist, alleviated the diminished interest in rewarding stimuli observed during withdrawal from nicotine or amphetamine in rats. Further, the

reversal of the threshold elevations associated with amphetamine withdrawal was dose-related because the co-administration of the 5-HT1A antagonist with the highest fluoxetine dose returned

thresholds to baseline levels 24 hr earlier than the co-administration of p-MPPI with the lowest fluoxetine dose. Neither p-MPPI nor the low dose of fluoxetine alone had an effect on

nicotine or amphetamine withdrawal-induced threshold elevations; while the highest dose of fluoxetine when administered alone reduced the duration of the amphetamine, but not nicotine,

withdrawal-induced elevations of thresholds by 24 hr. This rapid restoration of the sensitivity to electrical stimulation (i.e., relative increase in reward) may be attributable to increased

serotonin function in forebrain structures, such as the frontal cortex, the hippocampus and the striatum (e.g., Bel and Artigas 1993; Dreshfield et al. 1996, 1997; Invernizzi et al. 1994;

Gobert and Millan 1999; Rutter et al. 1994). The present data are consistent with the hypothesis that the rapid onset of clinical antidepressant action of SSRIs when combined with pindolol

(Bordet et al. 1998; Tome et al. 1997a, 1997b; Zanardi et al. 1997, 1998; however, see Berman et al. 1997, 1999) is partly attributable to pindolol's 5-HT1A antagonist properties.

Nevertheless, other receptors, such as the 5-HT1B and α-adrenergic receptors, for which pindolol has antagonist and/or partial agonist properties, and other neuromechanisms may also

contribute to pindolol's augmentation of SSRI antidepressant effects. By contrast, in saline-treated rats, this combination treatment resulted in a small, but statistically significant

elevation of reward thresholds (i.e., decrease in reward) compared to the previously stable performance of these groups, an effect that was seen repeatedly (see below). Considering the

relatively short-lasting elevation of reward thresholds seen in saline-treated subjects after the administration of the drug combination, which is typical of acute drug treatments, the

permanent reversal of the reward threshold elevations of nicotine- and amphetamine-withdrawing subjects after a single treatment is note-worthy and somewhat surprising. It is possible that

an acute drug treatment was sufficient to permanently reverse the threshold elevations for the following reasons. The combination of fluoxetine's long half-life (up to 7 hr with

detection of fluoxetine levels up to 30 hr after systemic administration of doses similar to the ones used here; Caccia et al. 1990) and the relatively short-lasting threshold elevation seen

especially during nicotine withdrawal may have allowed the gradually declining enhancement of serotonergic neurotransmission to coincide with the gradual return of reward thresholds to

baseline levels. Further, the doses administered in the present study are much higher than those that would be tolerated by humans on the first administration (although such comparisons are

hard to make) rendering it more likely that the drug treatment would have an acute effect. Further, it has been argued that antidepressants may produce immediate improvement of _some_

symptoms in humans, but this acute effect may be hard to detect statistically because the improvement may be initially small and seen only in some, but not all, symptoms (Detke et al. 1997;

Frazer 1994). Another interesting possibility is that once reversal of a deficit occurs in a relatively “healthy” animal in which the deficit was transiently induced by a manipulation, a

“healthy” system may not readily regress to the previous imbalance. Considering that chronic drug treatment is required in most cases before a therapeutic antidepressant effect is observed

in humans, the demonstration of the reversal of a reward deficit with a single acute drug treatment in the present study may be considered a limitation of the proposed animal model. It could

be argued that under such conditions the mechanisms leading to the reversal of the behavioral deficit are not the same as the ones leading to the clinical therapeutic effect (Detke et al.

1997). Even though such arguments have merit, there are counter-arguments and reasons why the study of the acute effects of drugs, when guided by good working hypotheses, still could promote

our understanding of drug withdrawal, depressive symptomatology, and mode of action of antidepressant compounds. The present study was designed to test the hypothesis that activation of a

specific neurobiological mechanism (i.e., enhanced serotonergic neurotransmission) would reverse a reward deficit. The findings offer one of the few experimental demonstrations that the

enhanced serotonin neurotransmission induced by such drug treatments leads to observable behavioral changes with relevance to depressive symptomatology. For example, the _acute_

administration of the 5-HT1A partial receptor agonist buspirone enhanced the antidepressant-like actions of a low _acute_ dose of a SSRI that had no effect on the forced swim stress when

administered on its own (Redrobe and Bourin 1998). By contrast, the addition of a 5-HT1A receptor antagonist to the chronic treatment with a SSRI did _not_ accelerate the onset of

antidepressant-like action seen after chronic treatment with the SSRI alone neither in the olfactory bulbectomized rat model of depression (Cryan et al. 1998, 1999) nor in the forced swim

test (Moser and Sanger 1999). Finally, the study of the _acute_ effects of drugs in the forced swim test, a postulated animal model of depression (e.g., for review, see Lucki 1997), and in

deficits of the prepulse inhibition of startle, a postulated animal model of gating deficits seen in several psychiatric disorders (e.g., for review, see Swerdlow and Geyer 1998), has led to

a plethora of neurobiological findings with relevance to both healthy and psychopathological states. The ability of the two above-mentioned behavioral paradigms to predict the therapeutic

efficacy of antidepressant and antipsychotic compounds, respectively, demonstrates the predictive validity of these models, which is a starting point in the development of any model (Geyer

and Markou 1995). Similarly, the reversal of the affective, but not the somatic, aspects of drug withdrawal with a drug treatment that enhances serotonergic neurotransmission indicates some

predictive and discriminant validity of the present paradigm as an animal model of the symptom of “diminished interest or pleasure”. Ample evidence indicates that brain stimulation reward

thresholds are a valid and reliable measure of reward that is minimally affected by performance manipulations (Markou and Koob 1992b, 1993). Further, extensive previous work with the

identical brain stimulation reward procedure used in the present study demonstrated that reward thresholds do _not_ co-vary with response latencies (e.g., Harrison et al. 1999; Lin et al.

1999, 2000; Macey et al. 2000; Markou and Koob 1991, 1992b; Paterson et al. 2000). Similarly, the present results also demonstrated a lack of co-variation of threshold elevations with

increased response latencies (see Results section and Figure 3 and 6). Thus, threshold elevations seen during drug withdrawal cannot be attributed to effects of the various manipulations on

performance. The absence of an effect of doses of fluoxetine up to 5 mg/kg on reward thresholds in control subjects in the present and previous studies in our laboratory (Lin et al. 1999)

appears to be in contrast to another report demonstrating elevations in thresholds after 2.5–20 mg/kg fluoxetine using the same intracranial self-stimulation procedure (Lee and Kornetsky

1998). The reasons for this discrepancy are not clear, although there are some methodological differences between the two studies. In the present study, electrodes were placed in the medial

forebrain bundle at the level of the posterior lateral hypothalamus, whereas the majority of placements in the Lee and Kornetsky (1998) study were in the ventral tegmental area. Moreover, in

the present study, fluoxetine was administered 2 hr, while in the Lee and Kornetsky study 1 hr prior to test. Finally, administration of 10 mg/kg fluoxetine 2 hr before the test did result

in threshold elevations in our laboratory (Harrison and Markou, unpublished observations). Thus, the differences in results appear to be quantitative (i.e., dose) rather than qualitative.

Taken together, these findings suggest that higher acute doses of fluoxetine than those used in the present study may counteract threshold elevations associated with drug withdrawal. The

present data suggest that reduced serotonergic neurotransmission may be one of the neurobiological abnormalities underlying the symptom of “diminished interest or pleasure” seen in both

amphetamine and nicotine withdrawal in humans (American Psychiatric Association 1994; Covey et al. 1998; Glassman 1993; Hughes 1992; Markou et al. 1998). This hypothesis is consistent with

the observation that withdrawal from other drugs of abuse, such as cocaine (Parsons et al. 1995) or ethanol (Weiss et al. 1996), also is characterized by decreased serotonergic

neurotransmission as reflected in decreased _in vivo_ dialysate serotonin levels. Further, considering the strong evidence implicating reduced serotonergic neurotransmission as one of the

neurochemical abnormalities associated with depression (for reviews, see Caldecott-Hazard et al. 1991; Caldecott-Hazard and Schneider 1992; Heninger et al. 1996; Markou et al. 1998; Meltzer

and Lowy 1988; Willner 1985), it can be hypothesized that there is homology between the symptom of “diminished interest or pleasure” seen in individuals withdrawing from drugs of abuse and

the same symptom seen in depressed patients. Decreased dopaminergic neurotransmission is another neurobiological abnormality common to withdrawal from a variety of drugs of abuse, including

nicotine (Hildebrand et al. 1999; Parsons et al. 1995; Weiss et al. 1996). Based on the above hypothesis of homology between symptoms seen across psychiatric diagnostic categories, it can be

postulated that reward deficits associated with withdrawal from drugs of abuse may be an animal model of the symptom of “diminished interest or pleasure” with construct, convergent, and

predictive validities (Geyer and Markou 1995). In addition to reward threshold elevations, amphetamine withdrawal also is characterized by decreased breaking-points under a progressive ratio

schedule for a sucrose solution reinforcer, and decrements in anticipatory and motivational measures for sexual reinforcement in rats (Barr and Phillips 1999; Barr et al. 1999). Taken

together, these results provide converging evidence that drug withdrawal is characterized by decreased motivation and “diminished interest or pleasure” for a variety of rewarding stimuli and

situations, a condition resembling a core feature of non-drug-induced depressions (i.e., construct validity) (American Psychiatric Association 1994). Although termination of nicotine

administration induced the anticipated somatic signs of withdrawal, none of the drug treatments altered the number of somatic signs observed during nicotine withdrawal. This dissociation of

the effects of the drug combination treatment on the affective (i.e., reward threshold elevations) versus the somatic signs of withdrawal is evidence for symptom-specific neurobiological

abnormalities, and demonstrates the discriminant validity of this animal model (Geyer and Markou 1995). If, as suggested, the affective symptoms of withdrawal are critical to the development

of drug dependence and in causing relapse during the early stages of abstinence (Koob et al. 1993; Markou et al. 1998), then reversal of such symptoms with serotonergic antidepressant

treatments may reduce the probability of relapse. Indeed, there is evidence that antidepressant treatment results in improvement of mood and reduction of drug use in depressed cocaine,

opiate and nicotine abusers (for reviews, see Hughes et al. 2000; Kosten et al. 1998; Markou et al. 1998; Nunes et al. 1998; Watkins et al. 2000a). The administration of fluoxetine together

with a 5-HT1A receptor antagonist also had dissociable effects on the reward function of withdrawing and non-withdrawing rats. The restoration of the sensitivity of the brain reward system

to the electrical stimuli (i.e., relative increase in reward) after the drug treatment in withdrawing rats contrasts with the small decrease in brain stimulation reward induced by the same

drug treatment in saline-treated rats. This result is consistent with previous studies of “normal” unperturbed rats in which increasing serotonergic neurotransmission reduced response rates

for brain stimulation reward reflecting a decrease in reward (McClelland et al. 1989; Olds 1994). These data from “normal” subjects may seem incompatible with the hypothesis that

antidepressants elevate mood and alleviate reward deficits in depressed individuals through enhancement of serotonergic neurotransmission. This apparent disparity may be explained by the

present results suggesting that the effects of antidepressant treatments on brain reward function may be dependent on the “hedonic” state of the subjects at the time of treatment (Ahmed and

Koob 1998; Koob and Le Moal 1997). The present observation also may explain why previous attempts to show antidepressant-induced alterations in “mood” in unperturbed rats have provided

largely negative results (Fibiger and Phillips 1981; Hall et al. 1990; Lin et al. 1999; Moreau et al. 1992; Markou et al. 1992). In the present study and in confirmation of previous work

(Lin et al. 1999), administration of low fluoxetine doses alone did not elevate thresholds, paralleling the lack of effect of antidepressants on mood in healthy individuals. Thus, the

development of animal models of depression, and potentially of other psychiatric disorders, should be based primarily on modeling and studying deficits that are pathognomic of the disorder;

because the predictive validity of models that study healthy “normal” animals may be limited and could lead to erroneous conclusions. In summary, the present results indicated that acute

administration of a drug combination that enhances serotonergic neurotransmission alleviated the diminished interest in brain stimulation reward observed during withdrawal from nicotine or

amphetamine in rats. By contrast, the same drug combination treatment did not reduce the somatic signs of nicotine withdrawal indicating symptom-specific neurobiological abnormalities. Taken

together with extensive previous observations about depression, the present findings suggest that the affective aspects of both drug- and non-drug-induced depressions may be mediated, at

least partly, by reduced serotonergic neurotransmission. Thus, there may be homology between the affective symptoms of drug withdrawal and the core symptom of “diminished interest or

pleasure” characterizing non-drug-induced depressions. Surprisingly, the same serotonergic drug combination treatment had opposite effects in control rats where reductions in reward were

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references ACKNOWLEDGEMENTS This work was supported by a Novartis Research Grant, a Tobacco-Related Disease Research Program Grant from the State of California (7RT-0004), and a National

Institute on Drug Abuse grant (DA 11946) to A.M. We thank Drs. Mark A. Geyer, George F. Koob, Daniel Hoyer and Neil Paterson for their helpful comments and suggestions, and Mike Arends for

computer and library searches, and editorial assistance. This is publication 12431-NP from The Scripps Research Institute. AUTHOR INFORMATION Author notes * Amanda A Harrison Ph.D Present

address: School of Psychology, University of Leeds, Leeds, England, UK AUTHORS AND AFFILIATIONS * Department of Neuropharmacology, Scripps Research Institute, La Jolla, CA, USA Amanda A

Harrison Ph.D & Yves T B Liem Pharm.D * Department of Psychopharmacology, Faculty of Pharmacy, Utrecht University, Sorbonnelaan 16, 3508 TB Utrecht, 3508 TB Utrecht, The Netherlands Yves

T B Liem Pharm.D & Athina Markou Ph.D Authors * Amanda A Harrison Ph.D View author publications You can also search for this author inPubMed Google Scholar * Yves T B Liem Pharm.D View

author publications You can also search for this author inPubMed Google Scholar * Athina Markou Ph.D View author publications You can also search for this author inPubMed Google Scholar

CORRESPONDING AUTHOR Correspondence to Athina Markou Ph.D. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Harrison, A., Liem, Y. & Markou, A.

Fluoxetine Combined with a Serotonin-1A Receptor Antagonist Reversed Reward Deficits Observed during Nicotine and Amphetamine Withdrawal in Rats. _Neuropsychopharmacol_ 25, 55–71 (2001).

https://doi.org/10.1016/S0893-133X(00)00237-2 Download citation * Received: 23 June 2000 * Revised: 25 October 2000 * Accepted: 26 October 2000 * Issue Date: 01 July 2001 * DOI:

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currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative KEYWORDS * Drug withdrawal * Depression * Serotonin * Nicotine *

Amphetamine * Intracranial self-stimulation * Reward * Motivation * Fluoxetine * 5-HT1A antagonist * Somatic signs * Body weight