Neuropsychopharmacology

Antipsychotic dosing regimens, commonly daily or via slow-release compounds, are designed to maintain steady-state plasma concentrations. They are guided by their plasma half-life that is typically in the range of several hours. This schedule contrasts with the slow time course of therapeutic efficacy, which often takes weeks to develop fully. This discrepancy led us to hypothesize that the effects of a single dose of an antipsychotic drug might be detectable well beyond the time window predicted by receptor occupancy. To test this, we administered a single dose of the antipsychotic drug clozapine to mice. We observed long-term behavioral effects and changes to cortical activity patterns up to several days after administration. Specifically, clozapine induced a decorrelation of activity in the dorsal cortex observable up to 9 days post administration. This effect was driven by a genetically and functionally distinct subset of layer 5 intratelencephalic neurons, possibly through a clozapine induced increase in the reliability of long-range inhibitory functional influence that exhibited a similar long-term change. Thus, our findings suggest that longer dosing intervals for antipsychotic drugs warrant clinical exploration.

Nearly one third of women of reproductive age in the United States are prescribed opioids annually; 14% of women fill an opioid prescription during pregnancy, and one in five report misuse. Opioid use during pregnancy has given rise to an increasing population of infants born with gestational opioid exposure. Although substantial clinical work has focused on treating these infants as they experience opioid withdrawal symptoms at the time of birth, notably few studies have examined the effects of gestational opioid exposure on brain development and long-term cognitive function. During typical brain development, endogenous opioids and their receptors are highly expressed by neural progenitor cells, neurons, and glia where they modulate cell proliferation, differentiation, and maturation. Thus, any disruption to the endogenous opioid system during the critical period of brain development may have lasting consequences on brain cell populations and the behaviors they influence. Indeed, opioid-exposed infants have smaller brains than age-matched peers and show significant neurodevelopmental impairment; they also have higher rates of learning disability at school age. To investigate how exposure to exogenous opioids during brain development affects neural maturation in the hippocampus, a brain region critical for learning and memory, our lab has developed a clinically relevant perigestational morphine exposure rat model. The current study reports that perigestational exposure to morphine delays postnatal hippocampal neuronal maturation, alters astrocyte and oligodendrocyte proliferation, and alters expression of brain-derived neurotrophic factor (BDNF), a protein crucial for healthy brain growth. Furthermore, we show that environmental enrichment rescues BDNF deficits, offering evidence for the effectiveness of non-invasive, non-pharmacological intervention for developmental consequences of perigestational opioid exposure.

Cannabis use is an increasingly common therapeutic for a variety of chronic diseases. In addition, people with sleep problems may self-medicate using cannabis products. However, genetic architecture of cannabis use and its shared genetic predispositions with sleep traits has not been systematically examined. We performed a meta-analysis of cannabis use within the All of Us and UK Biobank cohorts, consisting of 152,807 cases and 220,272 controls. Our meta-analysis identified 39 independent loci, including the previously reported CADM2 locus associated with cannabis use and replicating previous work. Additionally our associations include neuronal and sleep-regulating genes such as HTR1A, RAI1, SLC39A8, and NCAM1. Moreover, tissue-specific analyses revealed that the genetic architecture of cannabis use is heavily enriched within the central nervous system and specific brain cell types. In addition, we observed significant positive genetic correlations with clinical insomnia, insomnia-related medication usage, and objectively measured nighttime physical activity, alongside negative correlations with morningness chronotype and daytime activity. Fine-mapping and colocalization analyses identified shared genetic signals between cannabis use and clinical insomnia including a near-perfect colocalization at SLC39A8 and CADM2. Together, these results highlight the shared genetic risk between cannabis use and sleep disorders. Additionally, our findings indicate the importance of investigating the genetic effects of cannabis use as its use becomes more widespread, both recreationally and medicinally.

The 7-nicotinic acetylcholine receptor (7nAChR) has driven extensive research over the past three decades for its pro-cognitive potential. It is the leading druggable target for the cognitive deficits associated with schizophrenia and has motivated major pharmaceutical and clinical efforts to ameliorate similar impairments in other neurological disorders, such as Alzheimers disease (AD). Yet, a systematic evaluation of the role played by 7nAChR in cognition, and its mechanistic underpinnings, is still lacking. Here we report that 7nAChRs on principal and inhibitory forebrain neurons are largely inconsequential to mouse behavior, including in domains that are most sensitive to schizophrenia-related cognitive impairments. By contrast, loss of 7nAChR from astrocytes produces profound behavioral alterations that are cognitive domain-specific, are time-of-day dependent, coincide with reduced levels of the N-methyl D-aspartate receptor (NMDAR) co-agonist D-serine, and are fully restored by D-serine supplementation. Further, an 7nAChR partial agonist previously evaluated in Phase III trials for cognitive enhancement in schizophrenia and AD fails to augment behavior in mice lacking astrocytic 7nAChRs. Together, these findings identify astrocytes and D-serine/NMDAR signaling as a central mechanism through which 7nAChR, a major drug target, promotes cognitive behavior.

Psychedelics show therapeutic potential for treating psychiatric disorders. While studies have emphasized the roles of cortical pyramidal cells, GABAergic neurons also express serotonin receptors and are therefore likely targets of psychedelics. In this study, we determine the effect of psilocybin on the activity dynamics of major GABAergic cell types in the mouse medial frontal cortex. Psilocybin reduces the firing of somatostatin-expressing interneurons, but increases the activity of parvalbumin-expressing interneurons. This cell type-specific response is unlikely to involve vasoactive intestinal peptide-expressing interneurons. Instead, pharmacological blockade and conditional knockout experiments demonstrate that psilocybin acts on the 5-HT1A receptor at SST interneurons, which contributes to the drugs long-term behavioral effects. Collectively, the results reveal that the classic psychedelic psilocybin alters cortical inhibition in a cell type-specific manner.

Metabotropic glutamate 2/3 receptors (mGluR2/3) have been implicated in depression, anxiety, learning, and memory. However, their causal role in reward-related behaviors remains unclear. Here, we examined the effects of intraperitoneal administration of LY341495, a selective mGluR2/3 antagonist, on reward-related behaviors in mice. In a head-fixed temporal conditioning task, mice received a 10% sucrose solution every 10 seconds. After training, mice exhibited anticipatory licking and pupil dilation aligned with expected reward delivery, indicating successful reward prediction. LY341495 dose-dependently reduced licking behavior without disrupting temporal prediction, as normalization analyses revealed reduced gain but preserved timing. LY341495 also induced overall pupil dilation and attenuated reward-proximity pupillary responses. To determine whether reduced licking reflected general motor impairment, we assessed spontaneous locomotion in a freely moving open-field task. LY341495 did not affect locomotor activity or excretion, suggesting intact general motor and autonomic function. To further evaluate orofacial motor function, we measured ultrasonic vocalizations (USVs) during a social interaction task. LY341495 did not significantly alter USVs, indicating preserved mouth-related motor function independent of licking. In contrast, LY341495 dose-dependently reduced food intake in a freely moving feeding task. Moreover, social preference testing revealed that LY341495 reduced social interaction, suggesting impaired processing of non-food rewards. Together, these findings demonstrate that mGluR2/3 signaling regulates reward-seeking behaviors independently of general locomotor or orofacial motor function. These results provide new insights into glutamatergic mechanisms underlying reward processing and may have clinical implications for obesity, eating disorders, and psychiatric conditions involving motivational dysfunction.

Cannabidiol (CBD) has recently gained significant public acceptance as a safe therapeutic, contributing to increased use during pregnancy. However, little is known about how maternal CBD exposure impacts fetal brain development. Here, we established a preclinical CBD perinatal exposure (CBD-PCE) model to examine the impacts of CBD on astrocyte morphology in the medial prefrontal cortex (mPFC), a brain region critical for working memory and affective behaviors. Astrocytes play critical roles in maintaining ionic/metabolic homeostasis, neurotransmission, and neurovascular coupling in the CNS. They exhibit highly ramified processes with endfeet surrounding synapses, forming tripartite synapses. We quantitatively assessed the impact of CBD-PCE on astrocyte morphology and the composition of tripartite synapses in mPFC using high-resolution three-dimensional (3D) imaging. Our morphometric analyses revealed that CBD-PCE reduced astrocyte density and increased the number of major branches and whole-cell volume in the mPFC of male, but not female, progenies. Using high-magnification 3D analysis, we found that mPFC astrocytes after CBD-PCE exhibited increased neuropil infiltration volume and reduced surface-to-volume ratios in males but not in females. Moreover, the levels of aquaporin-4 (AQP4) and Kir4.1 inwardly rectifying potassium channel, two key components in regulating ionic homeostasis, are elevated on the membranes of male CBD-PCE astrocytes. We also analyzed mPFC tripartite synapses and observed significant increases in thalamocortical tripartite synapse density in both sexes, whereas intracortical excitatory synapses were reduced only in females. Collectively, these findings demonstrate that CBD-PCE induces sex-specific changes in astrocyte morphology and in the composition of tripartite synapses in the mPFC of the progenys brains.

Traumatic brain injuries (TBIs) are more than mere lesions and generate a persistent secondary pathology. This, combined with functional reorganization of circuits post-injury, may explain the increased risk for psychiatric disorders in patients with TBI. In the current studies, we demonstrate that frontal TBI changed the Pavlovian behavioral response to reinforcer-predicting cues and reduced the motivational value of cues. TBI also chronically impaired decision-making on a gambling-like task with reinforcer-paired cues. To investigate how these changes occur, we evaluated the nucleus accumbens (NAc) core. At a subacute time point (14 days), we confirmed reduced input to the NAc with optogenetics and evaluated electrophysiological and transcriptional changes. TBI increased neuronal excitability and the single nucleus RNA sequencing profile indicated a substantial stress and inflammatory response, but also high indicators of plasticity, particularly in D1- and D2-positive medium spiny neurons. To evaluate how these subacute changes transitioned to chronic NAc dysfunction, we measured immunohistochemical surrogates of activity post-mortem and recorded calcium activity from the NAc after TBI during Pavlovian conditioning. TBI reduced histological markers of activity and reduced cue-evoked calcium activity. Overall, these data indicate that substantial reorganization of the NAc occurs following frontal brain injury. A primary effect of this is to reduce the salience of environmental cues linked to outcomes. The inability to properly process outcomes could contribute to broader psychiatric symptoms after TBI, including impairments in decision-making, behavioral flexibility, and impulsivity but also presents a potential treatment target.

Major depressive disorder (MDD) is a common psychiatric illness with a high proportion of patients being nonresponsive to therapy. Selective serotonin reuptake inhibitors (SSRI) are widely prescribed for treating depression. Chronic SSRI administration is needed for therapeutic effects, a process implicating in part, increased neurogenesis in the hippocampus. Recent genome wide association studies (GWAS) identified the DrD2 locus, which encodes the dopamine D2 receptor (D2R) as a major risk factor in MDD. Here we demonstrate that behavioural effects associated with chronic administration of the SSRI drug fluoxetine and its accompanying neurogenic effects require D2R. Administration of fluoxetine to congenital D2R-knockout mice, or co-administration of the antidepressant with the antipsychotic D2R antagonist drug haloperidol prevented the neurogenic effects of fluoxetine. Furthermore, while acute behavioural responses to fluoxetine did not require D2R, this receptor was essential for the behavioural effects of chronic fluoxetine. The neurogenic impact of chronic fluoxetine was further associated with beta-arrestin 2-mediated signalling and the hippocampal regulation of the pro-neurogenic factor BDNF. These results support a role of D2R in regulating the therapeutically relevant chronic effects of fluoxetine on mood, BDNF signalling, and associated hippocampal neurogenesis. Furthermore, our findings suggest an unappreciated interaction between genetic risk for MDD and treatment responsiveness as well as a negative interaction between SSRIs and antipsychotic drugs in the regulation of hippocampal neurogenesis.

Opioid and methamphetamine use disorders (OUD and MUD) are characterized by enduring neural adaptations within brain reward circuitry, yet the cell-type-specific post-transcriptional mechanisms underlying these changes remain poorly understood. While microglia are essential for maintaining central nervous system homeostasis and modulating neuroinflammatory responses to drugs of abuse, their alternative splicing (AS) programs have not been defined in the context of addiction. This study characterized the microglial AS landscape in the mouse dorsal striatum during morphine and methamphetamine intravenous self-administration (IVSA), as well as following a 21-day period of abstinence. Analysis of RNA-sequencing data using rMATS and DEXSeq revealed that both drugs significantly dysregulate core splicing machinery, with skipped exons (SE) emerging as the most prevalent splicing event. Notably, morphine exposure induced a robust persistent splicing signature, comprising 736 exonic regions in 221 genes that remained altered through abstinence, whereas methamphetamine-induced changes were primarily reversible. Functional annotation predicted that approximately 27.5% of these events induce frameshifts, potentially impacting critical microglial pathways such as autophagy (Wdr81), chromatin remodeling (Chd4, Kmt2c), and RNA processing (Hnrnpl, Mbnl2, Tia1). These findings identify previously unrecognized post-transcriptional neuroimmune mechanisms and suggest that persistent splicing dysregulation in microglia may contribute to the long-term pathophysiology of OUD. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=104 SRC="FIGDIR/small/716002v1_ufig1.gif" ALT="Figure 1"> View larger version (41K): org.highwire.dtl.DTLVardef@1c30f01org.highwire.dtl.DTLVardef@10e16d7org.highwire.dtl.DTLVardef@1fd80dforg.highwire.dtl.DTLVardef@17c80f_HPS_FORMAT_FIGEXP M_FIG C_FIG

Adolescent binge drinking is a strong predictor of alcohol use disorder and related mental health outcomes in adulthood, which may be due to disruptions in myelination during this dynamic period of brain development. White matter expansion in frontal regions during adolescence is essential for mature decision-making and stress regulation, yet the cellular mechanisms by which alcohol disrupts this process remain poorly understood. We used multi-label immunofluorescence and confocal microscopy to visualize proteins in oligodendrocyte lineage cells and myelin ensheathment of axons in the anterior cingulate cortex (Cg1) and corpus callosum (CC) following four weeks of episodic voluntary binge drinking using the Drinking-in-the-Dark model in adolescent male and female C57BL/6NJ mice beginning on postnatal day 28. Contrary to our initial hypothesis that alcohol targets early-stage oligodendrocyte precursor cells (OPCs), binge drinking selectively depleted mature oligodendrocytes expressing aspartoacylase (ASPA) in the Cg1 and CC of male mice, but not females. This enzyme is essential for lipid biosynthesis and myelin production, and this cell-specific loss was accompanied by significant hypomyelination of axons only in males. These findings identify a later maturational stage of oligodendroglial development as a sex-dependent target of alcohol, advancing our mechanistic understanding of prefrontal myelin deficits in adolescent drinking. Furthermore, ASPA emerges as a potential therapeutic target for alcohol use disorder and demyelinating diseases, with differential vulnerability across sex carrying important implications for adult neurodevelopmental outcomes.

BackgroundIndividual vulnerability to addiction is driven by neuroadaptations within dopaminergic circuits. G protein-coupled receptor kinases (GRKs), specifically GRK2 and GRK3 regulate D2 receptor (D2R) signaling and trafficking, but their role in amphetamine (AMPH)-induced locomotor sensitization remains unclear. This study aimed to determine whether GRK2/3 inhibition alters locomotor sensitization and its associated molecular correlates across striatal regions. MethodsAdult rats (n = 39) were assigned to saline, acute AMPH, or repeated AMPH groups and received intraperitoneal administration of vehicle or the GRK2/3 inhibitor Cmpd101 (1.0 mg/kg intraperitoneally, i.p.). Locomotor activity was assessed under basal and injection conditions to evaluate sensitization. Protein levels of D2R, GRK2, and GRK5 were quantified across striatal regions using Western blot and analyzed with linear mixed models. ResultsRepeated AMPH exposure induced locomotor sensitization in a subset of animals, but Cmpd101 did not significantly modify locomotor activity or sensitization expression. At the molecular level, Cmpd101 had no effect on D2R levels and produced selective, region-dependent changes in GRK2 and GRK5. Notably, GRK2/3 inhibition altered the relationship between protein expression and locomotor sensitization in a region-specific manner, rather than inducing consistent changes in absolute protein levels. ConclusionsGRK2/3 inhibition by Cmpd101 produces region-specific molecular effects and reshapes protein-behavior relationships without significantly altering locomotor sensitization. These findings support a model in which GRKs act as context-dependent modulators of dopaminergic signaling rather than direct drivers of behavioral output.

There is strong evidence that synaptic plasticity is a critical cellular mechanism underlying learning and memory. Although the forms of synaptic plasticity used by different circuits and cell types vary, a widespread presumption is that the male and female brain has evolved to use the same form of plasticity within the same circuits during performance on the same task. Here, we used complimentary approaches to determine how activity in the mouse frontal cortex supports the extinction of associative memories in a context-dependent manner. While in vivo recordings show that both male and female mice have similar cue-relevant activity patterns and ensemble dynamics in excitatory neurons from the infralimbic cortex (IL) during learning, activity in amygdala-projecting IL neurons was indispensable for extinction memories only in male mice. Likewise, male but not female mice showed evidence for the recruitment of IL by structural remodeling and clustering of dendritic spines on these neurons, and extinction memory impairments were evident only in male mice after projection-specific IL deletion of the glutamate receptor subunit GRIN2B. This work provides strong evidence that synaptic plasticity mechanisms employed during learning and critical for memory retrieval differ between males and females, which undercuts the utility of one-size-fits all therapeutic approaches for mental health conditions in which memory is disrupted.

Previous studies have linked opioid use to altered metabolic profiles, but findings have been inconsistent and mechanisms remain unclear. One potential mechanism involves increased adiposity, leading to chronic low-grade inflammation that elevates metabolic risk. Here, we examined metabolic profiles in individuals with opioid use disorder (OUD) and matched non-OUD controls, focusing on the sequential mediating roles of BMI and inflammation. Data from individuals with OUD (n=281) and non-OUD (n=246) were drawn from a natural history screening protocol from the National Institute on Alcohol Abuse and Alcoholism intramural program. Groups were matched on age, sex, race, ethnicity, socioeconomic status, and education via propensity score matching. Metabolic measures included BMI, blood glucose, hemoglobin A1c (HbA1c), and lipid profiles, with lipid imbalance indexed by the atherogenic index of plasma (AIP). Inflammatory markers included C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Individuals with OUD had significantly higher BMI (F1,481=12.9, p<0.001), HbA1c (F1,481=10.5, p=0.001), lower high-density lipoprotein cholesterol (HDL-C; F1,481= 46.2, p< 0.001), higher low-density lipoprotein cholesterol (LDL-C; F1, 481=11.9, p< 0.001), and higher AIP (F1,481=20.7, p< 0.001) compared to non-OUD. Inflammatory markers were also elevated in individuals with OUD, including CRP (F1,481=9.4, p=0.002) and ESR (F1,481=7.4, p= 0.007), and statistically mediated group differences in AIP and HbA1c, respectively. Our results are consistent with prior evidence of metabolic dysfunctions in individuals with OUD and suggest inflammation as a contributing mechanism. Targeting metabolic health and inflammation may offer new avenues for improving long-term health outcomes in OUD.

Antipsychotic drugs are the first-line treatment for psychosis yet their mechanism of action remains poorly understood, largely due to the challenge to faithfully model psychosis preclinically. Here, we focus on the emerging concept that psychosis can be caused by brain autoimmunity and present a novel mouse model of anti-N-methyl-D-aspartate-receptor (anti-NMDAR) encephalitis, a condition that manifests with psychosis and autoanti-bodies against the NMDAR. We devised a new mRNA-based approach to immunize mice against the NMDAR. Immunized mice developed psychosis-like behaviors that were caused by anti-NMDAR autoantibodies leading to phagocytosis of NMDARs by brain microglia. The antipsychotic drug clozapine rescued psychosis-like behaviors and, remarkably, reduced anti-NMDAR autoantibody levels and antibody-mediated phagocytosis of NMDARs. The immunomodulatory effects of clozapine were confirmed in a mouse model of systemic lupus erythematosus. Our results demonstrate that clozapine suppresses autoimmunity driving psychosis-like behaviors, raising the possibility that immunomodulation contributes to antipsychotic drug action. HIGHLIGHTSO_LImRNA immunization against the NMDAR induces psychosis-like behavior in mice C_LIO_LIAnti-NMDAR autoantibodies are sufficient for psychosis-like behavior C_LIO_LIMicroglial phagocytosis of NMDARs mediates psychosis-like behavior induced by anti-NMDAR autoanti-bodies. C_LIO_LIClozapine reduces anti-NMDAR autoantibodies, microglial phagocytosis and psychosis-like behavior, consistent with immunomodulation as a potential mechanism of antipsychotic drug action. C_LI

Recent evidence suggests that psychosis involves glutamatergic dysfunction and altered activity/connectivity within corticolimbic circuitry. While altered relationships between corticolimbic glutamatergic metabolite levels and resting-state functional connectivity (FC) have been described in schizophrenia and first-episode psychosis (FEP), whether these disruptions are also present prior to psychosis onset remains unclear. We measured Glx (glutamate + glutamine) levels in the anterior cingulate cortex (ACC) and hippocampus with magnetic resonance spectroscopy (MRS), and resting-state FC between corticolimbic regions of interest (ACC, hippocampus, amygdala and nucleus accumbens (NAc)) in antipsychotic-naive participants at clinical high-risk for psychosis (CHR-P, n=22), compared to healthy controls (HC, n=23) and FEP participants (n=10). Primary analyses compared corticolimbic Glx-FC interactions between CHR-P and HC groups. FEP individuals were included in secondary Glx comparisons but were excluded from FC analyses due to insufficient sample size after quality control. There was a significant interaction between group and ACC Glx for FC between the NAc and the bilateral amygdala and hippocampus (p-FDR=0.021), which was driven by a significant negative association in the CHR-P group (p-FDR=0.005). Complementary seed-to-whole-brain analyses revealed additional negative associations between ACC Glx and FC with the left middle temporal gyrus, and between hippocampal Glx and FC with the parahippocampal and temporal fusiform cortices in CHR-P individuals, which were absent in HC. FEP showed higher Glx than HC across both regions (p=0.015), but there were no significant Glx differences between CHR-P and HC. These data suggest that increased risk for psychosis is associated with altered relationships between corticolimbic connectivity and glutamatergic function.

Importance: Suicide is a leading cause of death in the United States with risk strongly influenced by Interpersonal trauma, contributing to treatment resistance and clinical complexity. Objective: To assess clinical and genetic factors in individuals who died from suicide, with and without interpersonal trauma exposure. Design: Individuals who died from suicide with and without trauma were compared in a retrospective case-case design. Prevalence of 19 broad clinical categories was assessed between groups. Results directed selection of 42 clinical subcategories, and 40 polygenic scores (PGS) for further assessment. Multivariable logistic regression models, adjusted for critical covariates and multiple tests, were formulated. Models were also stratified by age group (<26yo and >=26yo), sex, and age/sex. Setting: A population-based evaluation of comorbidity and polygenic scoring in two suicide death subgroups. Participants: A total of 8 738 Utah Suicide Mortality Research Study individuals (23.9% female, average age = 42.6 yo) who died from suicide were evaluated, divided into trauma (N = 1 091) and non-trauma exposed (N = 7 647) individuals. A subset of unrelated European genotyped individuals was also assessed in PGS analyses (Trauma N = 491; Non-trauma N = 3 233). Exposures: Trauma is here defined as interpersonal trauma exposure, including abuse, assault, and neglect from International Classification of Disease coding. Main Outcomes and Measures: Prevalence of comorbid clinical sub/categories and PGS enrichment in trauma versus non-trauma exposed suicide deaths. Results: Overall, trauma-exposed individuals died from suicide earlier (mean age of 38.1 yo versus 43.3 yo; P <0.0001) and were disproportionately female (38% versus 21%, OR = 3.3, CI = 2.9-3.8). Prevalence of asphyxiation and overdose methods, prior suicidality, psychiatric diagnoses, and substance use (OR range = 1.3-3.7) were elevated in trauma exposed individuals who died from suicide. Genetic PGS were also elevated in trauma-exposed individuals who died from suicide for depression, bipolar disorder, cannabis use, PTSD, insomnia, and schizophrenia (OR range = 1.1-1.4) with ADHD and opioid use showing uniquely elevated PGS in trauma exposed males (OR range = 1.2-1.4). Conclusions and Relevance: Results demonstrated multiple convergent lines of age- and sex-specific evidence differentiating trauma-exposed from non-trauma exposed suicide death. Such findings suggest unique biological backgrounds and may refine identification and treatment of this high-risk group.

Substance use disorders (SUD) are chronic conditions with devastating effects on brain health, functioning, and survival. In this study, we compared brain morphometry of 2,782 individuals with SUD to 1,951 controls and assessed the topographic overlap of these differences with brain connectivity and receptor architecture. Across SUD, we identified a morphometric signature involving frontal, parietal, temporal and limbic systems that overlapped with cortical hub regions and harbored cortical and subcortical disease epicenters. Findings were highly consistent across six substances and numerous robustness and generalizability analyses. Transdiagnostic comparisons showed high spatial overlap of SUD epicenters with those of schizophrenia and bipolar disorder, suggesting shared network-constrained cortical differences. Finally, multivariate mapping revealed that SUD brain differences aligned with two neurotransmitter axes contrasting cannabinoid-opioid and dopaminergic systems. These findings indicate that addiction-related brain differences are shaped by connectome and neurotransmitter architecture, positioning brain network and neurochemical organization as key principles of SUD-related brain alterations.

Breathing is controlled by a distributed brainstem network that includes multiple catecholaminergic nuclei. The locus coeruleus (LC), the brains primary source of noradrenaline (NA), projects to several respiratory centers, including the Kolliker-Fuse (KF) nucleus in the pons. While LC neurons are predominantly noradrenergic (NAergic), many co-release glutamate, which may contribute to the state-dependent modulation of breathing, particularly during opioid exposure. Here, we examined how opioids affect NAergic and glutamatergic signaling in the LC-KF circuit using optogenetics and whole-cell patch clamp recordings in mouse brain slices. Optogenetic activation of LC terminals evoked glutamatergic excitatory postsynaptic currents (EPSCs) in KF neurons that were presynaptically inhibited by the opioid receptor agonist Met-enkephalin. Additionally, [~]36% of glutamate-responsive KF neurons exhibited postsynaptic opioid inhibition via GIRK currents, while KF neurons receiving excitatory NAergic input showed minimal opioid sensitivity. To assess the behavioral role of glutamate release from all catecholaminergic neurons, we compared breathing in awake VGluT2fl/fl::TH-Cre mice (lacking VGluT2 in tyrosine hydroxylase-positive neurons) to control littermates and TH-Cre hemizygous mice using whole-body plethysmography. The conditional VGluT2 knockout mice exhibited prolonged inspiratory duration, increased tidal volume, and reduced respiratory rate during baseline breathing, with state-dependent differences emerging during hypercapnia. Systemic morphine administration diminished these genotype differences, and machine learning analysis using dynamic time warping confirmed that genotype-specific breathing patterns were distinguishable at baseline, but not after morphine. These findings demonstrate that glutamate co-release from catecholaminergic neurons modulates respiratory patterning in a state-dependent manner and is selectively vulnerable to opioid inhibition.

Importance: Conventional repetitive transcranial magnetic stimulation (rTMS) can be ineffective in individuals who have previously failed brain stimulation, ketamine and/or multiple lines of therapies. Modern accelerated rTMS protocols using image-guided targets have not been systematically investigated in these individuals. The goal of this study was to assess the feasibility and efficacy of personalized, connectivity-guided, accelerated intermittent theta-burst stimulation (iTBS) in patients with treatment-resistant depression (TRD) of varying refractoriness. Objective: To assess whether connectivity-guided, accelerated iTBS produces significant reductions in depression severity, and to what extent this benefit extends to ultra treatment-resistant depression (UTRD). Design: This was an open-label feasibility trial of connectivity-guided, accelerated iTBS in patients with TRD. Two distinct groups of participants were recruited from a neurosurgical-psychiatry clinic with UTRD and an interventional psychiatry clinic with TRD. Patients were stratified into a priori treatment-resistance subgroups. Patients received five days of open-label treatment. Outcome measures were collected immediately prior to and after treatment, as well as at 4- and 12-weeks post-treatment. Setting: This trial (NCT05813093) was conducted between November 2023 and July 2025 at Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada. Participants: Patients with major depressive disorder. A total of 96 participants were screened, with 73 meeting eligibility criteria (UTRD=30, TRD=43). One withdrew due to inability to tolerate the baseline MRI, and the other withdrew voluntarily prior to treatment. Intervention: Participants underwent a neuronavigated accelerated iTBS (600 pulses) protocol using personalized left dorsolateral prefrontal cortex (dlPFC) targets derived from functional magnetic resonance imaging (fMRI), comprising eight daily treatments, repeated over five days. Main Outcomes: Primary outcomes were i) change in Hamilton Depression Rating Scale (HAM-D17) from baseline to the end of the fifth day of treatment, and ii) the difference in change in HAM-D17 between UTRD and TRD subgroups. Results: Connectivity-guided fMRI targeting yielded personalized targets clustered around the anterolateral dlPFC. Accelerated iTBS elicited rapid antidepressant effects ({Delta}HAM-D17 -9.01 [SD 6.06], t = -12.45, p < 0.001) regardless of treatment-resistance group ({Delta}HAM-D17 -9.64 [SD 5.94] vs -8.10 [SD 6.12], t = -1.05, p = 0.299), which were sustained up to 12 weeks after treatment. Overall response and remission rates at the end of treatment were 40.8% and 16.9%. Self-report scales revealed broad symptomatic relief outside of core depressive symptoms. Conclusions & Relevance: This study demonstrated that fMRI connectivity-guided, accelerated iTBS induces sustained antidepressant effects and broader psychiatric benefits in patients across the spectrum of TRD. In a cohort unlikely to respond to most antidepressant therapies, connectivity-guided, accelerated iTBS offers a safe, well-tolerated option that can achieve benefit, or when ineffective, allow patients to expeditiously proceed with subsequent therapies than conventional rTMS. Trial Registration: This clinical trial was registered at clinicaltrials.gov with NCT05813093.