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Jiang Y, Dong Y, Hu H. The N-methyl-d-aspartate receptor hypothesis of ketamine's antidepressant action: evidence and controversies. Philos Trans R Soc Lond B Biol Sci 2024; 379:20230225. [PMID: 38853549 DOI: 10.1098/rstb.2023.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/02/2024] [Indexed: 06/11/2024] Open
Abstract
Substantial clinical evidence has unravelled the superior antidepressant efficacy of ketamine: in comparison to traditional antidepressants targeting the monoamine systems, ketamine, as an N-methyl-d-aspartate receptor (NMDAR) antagonist, acts much faster and more potently. Surrounding the antidepressant mechanisms of ketamine, there is ample evidence supporting an NMDAR-antagonism-based hypothesis. However, alternative arguments also exist, mostly derived from the controversial clinical results of other NMDAR inhibitors. In this article, we first summarize the historical development of the NMDAR-centred hypothesis of rapid antidepressants. We then classify different NMDAR inhibitors based on their mechanisms of inhibition and evaluate preclinical as well as clinical evidence of their antidepressant effects. Finally, we critically analyse controversies and arguments surrounding ketamine's NMDAR-dependent and NMDAR-independent antidepressant action. A better understanding of ketamine's molecular targets and antidepressant mechanisms should shed light on the future development of better treatment for depression. This article is part of a discussion meeting issue 'Long-term potentiation: 50 years on'.
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Affiliation(s)
- Yihao Jiang
- Department of Affiliated Mental Health Center & Hangzhou Seventh People's Hospital and School of Brain Science and Brain Medicine, Zhejiang University School of Medicine , Hangzhou 310058, People's Republic of China
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University , Hangzhou 311100, People's Republic of China
| | - Yiyan Dong
- Department of Affiliated Mental Health Center & Hangzhou Seventh People's Hospital and School of Brain Science and Brain Medicine, Zhejiang University School of Medicine , Hangzhou 310058, People's Republic of China
| | - Hailan Hu
- Department of Affiliated Mental Health Center & Hangzhou Seventh People's Hospital and School of Brain Science and Brain Medicine, Zhejiang University School of Medicine , Hangzhou 310058, People's Republic of China
- Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University , Hangzhou 311100, People's Republic of China
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Maji S, Mohapatra D, Jena M, Srinivasan A, Maiti R. Repurposing of dextromethorphan as an adjunct therapy in patients with major depressive disorder: a randomised, group sequential adaptive design, controlled clinical trial protocol. BMJ Open 2024; 14:e080500. [PMID: 38688675 PMCID: PMC11086520 DOI: 10.1136/bmjopen-2023-080500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/18/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Therapeutic latency, lack of efficacy and adverse drug reactions are the major concerns in current antidepressant therapies. To overcome these treatment hurdles, add-on therapy to conventional antidepressant medications may lead to better therapeutic outcomes. The present randomised controlled trial has been planned to evaluate the efficacy and safety of add-on dextromethorphan to selective serotonin reuptake inhibitors (SSRIs) in major depressive disorder (MDD). METHODS AND ANALYSIS A randomised, double-blind, add-on, placebo-controlled, group sequential design clinical trial will be conducted on patients with MDD who will be randomly assigned to the control and the test group in a 1:1 ratio. Patients in the test group will get dextromethorphan 30 mg once daily, whereas patients in the control group will receive a placebo once daily as an add-on to ongoing SSRI treatment for 8 weeks. All patients will be evaluated for the primary outcome (change in the Montgomery-Åsberg Depression Rating Scale score) and secondary outcomes (treatment response rate, remission rate, Clinical Global Impression, serum brain-derived neurotrophic factor, serum dextromethorphan and treatment-emergent adverse events) over the period of 8 weeks. Intention-to-treat analysis will be done for all parameters using suitable statistical tools. ETHICS AND DISSEMINATION This study was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences, Bhubaneswar, India, and the study conformed to the provisions of the Declaration of Helsinki and ICMR's ethical guidelines for biomedical research on human subjects (2017). Written informed consent will be obtained from the participants before recruitment. The results of this study will be published in peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05181527.
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Affiliation(s)
- Shampa Maji
- Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Debadatta Mohapatra
- Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Monalisa Jena
- Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Anand Srinivasan
- Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Rituparna Maiti
- Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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White TL, Gonsalves MA, Harris AD, Walsh EG, Joyce HE. Brain Glutamate Dynamics Predict Positive Agency in Healthy Women: Insights from Combined Application of Pharmacological Challenge, Comprehensive Affective Assessment, and Magnetic Resonance Spectroscopy. ACS Chem Neurosci 2024; 15:491-502. [PMID: 38237555 DOI: 10.1021/acschemneuro.3c00521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024] Open
Abstract
Contributions of brain glutamate (Glu) to conscious emotion are not well understood. Here, we evaluate the relationship of experimentally induced change in neocortical Glu (ΔGlu) and subjective states in well individuals, using combined application of pharmacological challenge, magnetic resonance spectroscopy (MRS), and comprehensive affective assessment. Drug challenge with d-amphetamine (AMP) (20 mg oral), methamphetamine (MA) (Desoxyn, 20 mg oral), and placebo (PBO) was conducted on three separate test days in a within-subjects double blind design. Proton MRS quantified neurometabolites in the right dorsal anterior cingulate cortex 140-150 min post-drug and PBO. Subjective states were assessed at half hour intervals over 5.5 h on each session, yielding 3792 responses per participant (91,008 responses overall, N = 24 participants), with self-reports reduced by principal components analysis (PCA). PCA produced a primary factor score of AMP- and MA-induced positive agency (ΔPA). MRS indicated drug-induced ΔGlu related positively to ΔPA (ΔGluMA r = +0.44, p < 0.05, N = 21), with large effects in females (ΔGluMA r = +0.52, p < 0.05; ΔGluAMP r = +0.61, p < 0.05, N = 11). Subjective states related to ΔGlu included rise in subjective stimulation, vigor, friendliness, elation, positive mood, positive affect (r's = +0.51 to +0.74, p < 0.05), and alleviation of anxiety in females (r = -0.61, p < 0.05, N = 11). These self-reports correlated with ΔGlu to the extent they loaded on ΔPA (r = 0.95 AMP, p = 5 × 10-10; r = 0.63 MA, p = 0.0015, N = 11), indicating the coherence of ΔGlu effects on emotional states. Timing data indicated Glu shaped positive emotion both concurrently and prospectively, with no relationship with pre-MRS emotion (ΔGluAMP r = +0.59 to +0.65, p's < 0.05; ΔGluMA r = +0.53, p < 0.05, N = 11). Together these findings indicate substantive, mechanistic contributions of neocortical Glu to positive agentic states in healthy individuals, which are most readily observed in women. The findings illustrate the promise of combined application of pharmacological challenge, comprehensive affective assessment, and MRS neuroimaging techniques in basic and clinical studies.
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Affiliation(s)
- Tara L White
- Carney Institute for Brain Science, Brown University, Providence, Rhode Island 02912. United States
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island 02912. United States
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island 02912. United States
- Center for Human Rights and Humanitarian Studies, Watson Institute, Brown University, Providence, Rhode Island 02912. United States
- University of Cambridge, Clare Hall, Cambridge CB3 9AL England. U.K
| | - Meghan A Gonsalves
- Neuroscience Graduate Program, Brown University, Providence, Rhode Island 02912. United States
| | - Ashley D Harris
- Department of Radiology, CAIR Program, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Edward G Walsh
- Carney Institute for Brain Science, Brown University, Providence, Rhode Island 02912. United States
| | - Hannah E Joyce
- Undergraduate Program in Cognitive Neuroscience, Brown University, Providence, Rhode Island 02912. United States
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Vecera CM, C. Courtes A, Jones G, Soares JC, Machado-Vieira R. Pharmacotherapies Targeting GABA-Glutamate Neurotransmission for Treatment-Resistant Depression. Pharmaceuticals (Basel) 2023; 16:1572. [PMID: 38004437 PMCID: PMC10675154 DOI: 10.3390/ph16111572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/22/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Treatment-resistant depression (TRD) is a term used to describe a particular type of major depressive disorder (MDD). There is no consensus about what defines TRD, with various studies describing between 1 and 4 failures of antidepressant therapies, with or without electroconvulsive therapy (ECT). That is why TRD is such a growing concern among clinicians and researchers, and it explains the necessity for investigating novel therapeutic targets beyond conventional monoamine pathways. An imbalance between two primary central nervous system (CNS) neurotransmitters, L-glutamate and γ-aminobutyric acid (GABA), has emerged as having a key role in the pathophysiology of TRD. In this review, we provide an evaluation and comprehensive review of investigational antidepressants targeting these two systems, accessing their levels of available evidence, mechanisms of action, and safety profiles. N-methyl-D-aspartate (NMDA) receptor antagonism has shown the most promise amongst the glutamatergic targets, with ketamine and esketamine (Spravato) robustly generating responses across trials. Two specific NMDA-glycine site modulators, D-cycloserine (DCS) and apimostinel, have also generated promising initial safety and efficacy profiles, warranting further investigation. Combination dextromethorphan-bupropion (AXS-05/Auvelity) displays a unique mechanism of action and demonstrated positive results in particular applicability in subpopulations with cognitive dysfunction. Currently, the most promising GABA modulators appear to be synthetic neurosteroid analogs with positive GABAA receptor modulation (such as brexanolone). Overall, advances in the last decade provide exciting perspectives for those who do not improve with conventional therapies. Of the compounds reviewed here, three are approved by the Food and Drug Administration (FDA): esketamine (Spravato) for TRD, Auvelity (dextromethorphan-bupropion) for major depressive disorder (MDD), and brexanolone (Zulresso) for post-partum depression (PPD). Notably, some concerns have arisen with esketamine and brexanolone, which will be detailed in this study.
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Affiliation(s)
- Courtney M. Vecera
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX 77054, USA
| | - Alan C. Courtes
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX 77054, USA
| | - Gregory Jones
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX 77054, USA
| | - Jair C. Soares
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX 77054, USA
| | - Rodrigo Machado-Vieira
- John S. Dunn Behavioral Sciences Center at UTHealth Houston, 5615 H.Mark Crosswell Jr St, Houston, TX 77021, USA
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Papp M, Gruca P, Lason M, Litwa E, Newman-Tancredi A, Depoortère R. The 5-HT 1A receptor biased agonists, NLX-204 and NLX-101, display ketamine-like RAAD and anti-TRD activities in rat CMS models. Psychopharmacology (Berl) 2023; 240:2419-2433. [PMID: 37310446 PMCID: PMC10593613 DOI: 10.1007/s00213-023-06389-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/16/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES NLX-101 and NLX-204 are highly selective serotonin 5-HT1A 'biased' agonists, displaying potent and efficacious antidepressant-like activity upon acute administration in models such as the forced swim test. METHODS we compared the effects of repeated administration of NLX-101, NLX-204 and ketamine in the chronic mild stress (CMS) model of depression, considered to have high translational potential, on sucrose consumption (anhedonia measure), novel object recognition (NOR; working memory measure) and elevated plus maze (EPM; anxiety measure) in male Wistar and Wistar-Kyoto rats (the latter being resistant to classical antidepressants). RESULTS in Wistar rats, NLX-204 and NLX-101 (0.08-0.16 mg/kg i.p.), like ketamine (10 mg/kg i.p.) dose-dependently reversed CMS-induced sucrose intake deficit from treatment Day 1, with nearly full reversal observed at the higher dose at Days 8 and 15. These effects persisted for 3 weeks following treatment cessation. In the NOR test, both doses of NLX-101/NLX-204, and ketamine, rescued the deficit in discrimination index caused by CMS on Days 3 and 17; all three compounds increased time spent in open arms (EPM) but only NLX-204 achieved statistical significance on Days 2 and 16. In Wistar-Kyoto rats, all 3 compounds were also active in the sucrose test and, to a lesser extent, in the NOR and EPM. In non-stressed rats (both strains), the three compounds produced no significant effects in all tests. CONCLUSIONS these observations further strengthen the hypothesis that biased agonism at 5-HT1A receptors constitutes a promising strategy to achieve rapid-acting/sustained antidepressant effects combined with activity against TRD, in addition to providing beneficial effects against memory deficit and anxiety in depressed patients.
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Affiliation(s)
- Mariusz Papp
- Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland
| | - Piotr Gruca
- Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland
| | - Magdalena Lason
- Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland
| | - Ewa Litwa
- Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland
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Chen MH, Lin WC, Li CT, Wu HJ, Bai YM, Tsai SJ, Su TP, Tu PC. Effects of low-dose ketamine infusion on vascular endothelial growth factor and matrix metalloproteinase-9 among patients with treatment-resistant depression and suicidal ideation. J Psychiatr Res 2023; 165:91-95. [PMID: 37487293 DOI: 10.1016/j.jpsychires.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/24/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Evidence indicates that vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) influence the pathophysiology of depression. However, whether low-dose ketamine regulates VEGF and MMP-9 levels and whether changes in VEGF and MMP-9 levels are associated with the antidepressant and antisuicidal effects of ketamine remained unclear. METHODS Forty-eight patients with treatment-resistant depression and strong suicidal ideation (TRD-SI) were randomly assigned to a single infusion of 0.5-mg/kg ketamine or 0.045-mg/kg midazolam. The Montgomery-Åsberg Depression Rating Scale (MADRS) and Columbia-Suicide Severity Rating Scale-Ideation Severity Subscale (CSSRS-ISS) were used at baseline and subsequently at several postinfusion timepoints. VEGF and MMP-9 serum levels were analyzed at baseline and on day 3 postinfusion. RESULTS After adjustment for baseline levels, no significant differences in VEGF (p = .912) and MMP-9 (p = .758) levels were identified on day 3 postinfusion between the study groups. Baseline VEGF levels but not MMP-9 levels were negatively associated with MADRS and CSSRS-ISS scores following infusion. DISCUSSION A single infusion of low-dose ketamine did not alter the VEGF and MMP-9 levels of the patients with TRD-SI. Higher baseline VEGF levels were associated with greater antidepressant and antisuicidal effects of single low-dose ketamine infusion.
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Affiliation(s)
- Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Wei-Chen Lin
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hui-Ju Wu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Pei-Chi Tu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
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Striebel J, Ruppen W, Schneider T. Simultaneous application of lidocaine and ketamine during ambulatory infusion therapy: a retrospective analysis. Pain Manag 2023; 13:539-553. [PMID: 37850330 DOI: 10.2217/pmt-2023-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Background: Infusions with lidocaine or ketamine have been separately established in the treatment of chronic pain. This study aims to retrospectively evaluate the effect of combined infusions of lidocaine and ketamine. Materials & methods: Patient records were screened for receipt of combined ambulatory infusions of lidocaine and ketamine from 2012 through 2021. A scoring system was designed to assess pain response retrospectively. Results: A total of 319 patients were included. Median pain reduction in days was 10.00 (interquartile range: 13.25). Side effects were limited to the acute phase of infusions. A total of 41.4% of patients who received concomitant pain medication reported a dose reduction. Conclusion: Our data support combined infusions as a safe therapy option, with good short-, medium- and long-term reductions in pain and great heterogeneity in treatment response. Clinical trial registration: ClinicalTrials.gov (NCT05103319).
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Affiliation(s)
- Julia Striebel
- Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine & Pain Therapy, University Hospital Basel, Basel, 4031, Switzerland
| | - Wilhelm Ruppen
- Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine & Pain Therapy, University Hospital Basel, Basel, 4031, Switzerland
| | - Tobias Schneider
- Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine & Pain Therapy, University Hospital Basel, Basel, 4031, Switzerland
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White TL, Gonsalves MA, Harris AD, Walsh EG, Joyce HE. Brain Glutamate Dynamics Predict Positive Agency in Healthy Women. RESEARCH SQUARE 2023:rs.3.rs-3021527. [PMID: 37398402 PMCID: PMC10312947 DOI: 10.21203/rs.3.rs-3021527/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Contributions of brain glutamate to conscious emotion are not well understood. Here we evaluate the relationship of experimentally-induced change in neocortical glutamate (ΔGlu) and subjective states in well individuals. Drug challenge with d-amphetamine (AMP; 20 mg oral), methamphetamine (MA; Desoxyn®, 20 mg oral), and placebo (PBO) was conducted on three separate test days in a within-subjects double blind design. Proton magnetic resonance spectroscopy (MRS) quantified neurometabolites in the right dorsal anterior cingulate cortex (dACC) 140-150 m post-drug and PBO. Subjective states were assessed at half hour intervals over 5.5-hours on each session, yielding 3,792 responses per participant (91,008 responses overall, N=24 participants). Self-reports were reduced by principal components analysis to a single factor score of AMP- and MA-induced Positive Agency (ΔPA) in each participant. We found drug-induced ΔGlu related positively with ΔPA (ΔGluMA r=+.44, p<.05, N=21), with large effects in females (ΔGluMA r=+.52, p<.05; ΔGluAMP r=+.61, p<.05, N=11). States related to ΔGlu in females included rise in subjective stimulation, vigor, friendliness, elation, positive mood, positive affect (r's=+.51 to +.74, p<.05), and alleviation of anxiety (r=-.61, p<.05, N=11). Self-reports correlated with DGlu to the extent they loaded on ΔPA (r=.95 AMP, p=5×10-10; r=.63 MA, p=.0015, N=11), indicating coherence of ΔGlu effects. Timing data indicated Glu shaped emotion both concurrently and prospectively, with no relationship to pre-MRS emotion (ΔGluAMP r=+.59 to +.65, p's<.05; ΔGluMA r=+.53, p<.05, N=11). Together these findings indicate substantive, mechanistic contributions of neocortical Glu to positive agentic states in healthy individuals, most readily observed in women.
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Soleymani T, Chen TY, Gonzalez-Kozlova E, Dogra N. The human neurosecretome: extracellular vesicles and particles (EVPs) of the brain for intercellular communication, therapy, and liquid-biopsy applications. Front Mol Biosci 2023; 10:1156821. [PMID: 37266331 PMCID: PMC10229797 DOI: 10.3389/fmolb.2023.1156821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/25/2023] [Indexed: 06/03/2023] Open
Abstract
Emerging evidence suggests that brain derived extracellular vesicles (EVs) and particles (EPs) can cross blood-brain barrier and mediate communication among neurons, astrocytes, microglial, and other cells of the central nervous system (CNS). Yet, a complete understanding of the molecular landscape and function of circulating EVs & EPs (EVPs) remain a major gap in knowledge. This is mainly due to the lack of technologies to isolate and separate all EVPs of heterogeneous dimensions and low buoyant density. In this review, we aim to provide a comprehensive understanding of the neurosecretome, including the extracellular vesicles that carry the molecular signature of the brain in both its microenvironment and the systemic circulation. We discuss the biogenesis of EVPs, their function, cell-to-cell communication, past and emerging isolation technologies, therapeutics, and liquid-biopsy applications. It is important to highlight that the landscape of EVPs is in a constant state of evolution; hence, we not only discuss the past literature and current landscape of the EVPs, but we also speculate as to how novel EVPs may contribute to the etiology of addiction, depression, psychiatric, neurodegenerative diseases, and aid in the real time monitoring of the "living brain". Overall, the neurosecretome is a concept we introduce here to embody the compendium of circulating particles of the brain for their function and disease pathogenesis. Finally, for the purpose of inclusion of all extracellular particles, we have used the term EVPs as defined by the International Society of Extracellular Vesicles (ISEV).
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Affiliation(s)
- Taliah Soleymani
- Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Tzu-Yi Chen
- Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Edgar Gonzalez-Kozlova
- Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Navneet Dogra
- Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Icahn Genomics Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Quan J, Yang H, Qin F, He Y, Liu J, Zhao Y, Ma C, Cheng M. Discovery of novel tryptamine derivatives as GluN2B subunit-containing NMDA receptor antagonists via pharmacophore-merging strategy with orally available therapeutic effect of cerebral ischemia. Eur J Med Chem 2023; 253:115318. [PMID: 37037139 DOI: 10.1016/j.ejmech.2023.115318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/16/2023] [Accepted: 03/27/2023] [Indexed: 04/12/2023]
Abstract
A series of tryptamine derivatives has been designed and synthesized as novel GluN2B subunit-containing NMDA receptor (GluN2B-NMDAR) antagonists, which could simultaneously manifest the receptor-ligand interactions of representative GluN2B-NMDAR antagonists ifenprodil (1) and EVT-101 (3). In the present study, the neuroprotective potential of these compounds was explored through chemical synthesis and pharmacological characterization. Compound Z25 with significantly better neuroprotective activity than the positive control drug (percentage of protection: 55.8 ± 0.6% vs. 41.0 ± 2.7%) was considered to be an effective antagonist of the human GluN2B-NMDA receptor. Judging from in vitro pharmacological profiling, Z25 could downregulate NMDA-induced increased intracellular Ca2+ concentration, and Z25 could also upregulate NMDA-induced decreased intracellular p-ERK 1/2 expression, which suggested that Z25 is an antagonist of the GluN2B-NMDA receptor. Furthermore, the in vitro preliminary evaluation of the drug-like properties of compound Z25 showed remarkable plasma stability. Based on in vivo pharmacokinetic and pharmacodynamic studies in C57 mice, compound Z25 exhibited a relatively short half-life and a low F value (3.12 ± 0.01%), while administration of Z25 substantially improved the cognitive performance of mice in a series of tests of cerebral ischemic injury. Overall, these results support the further development of compound Z25 as a potential lead compound to treat the cerebral ischemic injury by antagonizing GluN2B-NMDA receptor.
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Affiliation(s)
- Jishun Quan
- Key Laboratory of Structure-Based Drug Design & Discovery of Ministry of Education, School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, 110016, People's Republic of China
| | - Huali Yang
- Key Laboratory of Structure-Based Drug Design & Discovery of Ministry of Education, School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, 110016, People's Republic of China
| | - Fengyun Qin
- Key Laboratory of Structure-Based Drug Design & Discovery of Ministry of Education, School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, 110016, People's Republic of China
| | - Yeli He
- Key Laboratory of Structure-Based Drug Design & Discovery of Ministry of Education, School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, 110016, People's Republic of China
| | - Jiao Liu
- Key Laboratory of Structure-Based Drug Design & Discovery of Ministry of Education, School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, 110016, People's Republic of China
| | - Ying Zhao
- Key Laboratory of Structure-Based Drug Design & Discovery of Ministry of Education, School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, 110016, People's Republic of China
| | - Chao Ma
- Key Laboratory of Structure-Based Drug Design & Discovery of Ministry of Education, School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, 110016, People's Republic of China.
| | - Maosheng Cheng
- Key Laboratory of Structure-Based Drug Design & Discovery of Ministry of Education, School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, 110016, People's Republic of China.
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Lineham A, Avila-Quintero VJ, Bloch MH, Dwyer J. The Relationship Between Acute Dissociative Effects Induced by Ketamine and Treatment Response in Adolescent Patients with Treatment-Resistant Depression. J Child Adolesc Psychopharmacol 2023; 33:20-26. [PMID: 36799961 DOI: 10.1089/cap.2022.0086] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Objective: Ketamine has proven effective as a rapid-acting antidepressant agent. Several adult studies have investigated the association between ketamine's acute dissociative effects and depression response, but no studies have examined the association in adolescents with treatment-resistant depression (TRD). Methods: We conducted a secondary data analysis of 16 adolescent participants who participated in a randomized, single-dose, midazolam-controlled crossover trial of ketamine in adolescents with depression. We examined the association between the acute dissociative symptoms (measured at 60 minutes following start of infusion using the Clinician-Administered Dissociative States Scale [CADSS], and its three subscales: depersonalization, derealization, amnesia) and response and depression symptom improvement at 1'day (using the Montgomery-Åsberg Depression Rating Scale). Results: Within the ketamine group, there were no significant associations between dissociation symptoms or CADSS subscale scores and magnitude of depression symptom improvement or likelihood of ketamine response. When receiving midazolam, there was no significant association between overall dissociation symptoms and magnitude or likelihood of response of depressive symptoms. Higher levels of symptoms on the 'depersonalization' CADSS subscale when receiving midazolam were associated with less improvement in depression symptoms at 1 day following infusion. Conclusions: In contrast to some adult literature, the current data do not show a relationship between acute dissociative effects and antidepressant response to ketamine in pediatric patients with TRD. Interpretation may be limited by the small sample size, reducing the power to detect small or medium associations. Future research should utilize larger samples to more definitively measure the magnitude of association between acute dissociative symptoms and later antidepressant response to ketamine and to assess the relationship to trial design (e.g., crossover vs. parallel trial, comparison condition utilized and number of infusions) within both adult and pediatric populations. ClinicalTrials.gov identifier: NCT02579928.
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Affiliation(s)
- Alice Lineham
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Michael H Bloch
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry and Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Dwyer
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
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12
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Chen MH, Tu PC, Su TP. Next generation antidepressants with novel mechanisms for treatment resistant depression. PROGRESS IN BRAIN RESEARCH 2023. [DOI: 10.1016/bs.pbr.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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13
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Asch RH, Hillmer AT, Baldassarri SR, Esterlis I. The metabotropic glutamate receptor 5 as a biomarker for psychiatric disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 168:265-310. [PMID: 36868631 DOI: 10.1016/bs.irn.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The role of glutamate system in the etiology and pathophysiology of psychiatric disorders has gained considerable attention in the past two decades, including dysregulation of the metabotropic glutamatergic receptor subtype 5 (mGlu5). Thus, mGlu5 may represent a promising therapeutic target for psychiatric conditions, particularly stress-related disorders. Here, we describe mGlu5 findings in mood disorders, anxiety, and trauma disorders, as well as substance use (specifically nicotine, cannabis, and alcohol use). We highlight insights gained from positron emission tomography (PET) studies, where possible, and discuss findings from treatment trials, when available, to explore the role of mGlu5 in these psychiatric disorders. Through the research evidence reviewed in this chapter, we make the argument that, not only is dysregulation of mGlu5 evident in numerous psychiatric disorders, potentially functioning as a disease "biomarker," the normalization of glutamate neurotransmission via changes in mGlu5 expression and/or modulation of mGlu5 signaling may be a needed component in treating some psychiatric disorders or symptoms. Finally, we hope to demonstrate the utility of PET as an important tool for investigating mGlu5 in disease mechanisms and treatment response.
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Affiliation(s)
- Ruth H Asch
- Department of Psychiatry, Yale University, New Haven, CT, United States.
| | - Ansel T Hillmer
- Department of Psychiatry, Yale University, New Haven, CT, United States; Department of Radiology and Biomedical Imaging, New Haven, CT, United States
| | - Stephen R Baldassarri
- Yale Program in Addiction Medicine, Yale University, New Haven, CT, United States; Department of Internal Medicine, Yale University, New Haven, CT, United States
| | - Irina Esterlis
- Department of Psychiatry, Yale University, New Haven, CT, United States; Department of Psychology, Yale University, New Haven, CT, United States; Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States
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14
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At-home, sublingual ketamine telehealth is a safe and effective treatment for moderate to severe anxiety and depression: Findings from a large, prospective, open-label effectiveness trial. J Affect Disord 2022; 314:59-67. [PMID: 35809678 DOI: 10.1016/j.jad.2022.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND At-home Ketamine-assisted therapy (KAT) with psychosocial support and remote monitoring through telehealth platforms addresses access barriers, including the COVID-19 pandemic. Large-scale evaluation of this approach is needed for questions regarding safety and effectiveness for depression and anxiety. METHODS In this prospective study, a large outpatient sample received KAT over four weeks through a telehealth provider. Symptoms were assessed using the Patient Health Questionnaire (PHQ-9) for depression, and the Generalized Anxiety Disorder scale (GAD-7) for anxiety. Demographics, adverse events, and patient-reported dissociation were also analyzed. Symptom trajectories were identified using Growth Mixture Modeling, along with outcome predictors. RESULTS A sample of 1247 completed treatment with sufficient data, 62.8 % reported a 50 % or greater improvement on the PHQ-9, d = 1.61, and 62.9 % on the GAD-7, d = 1.56. Remission rates were 32.6 % for PHQ-9 and 31.3 % for GAD-7, with 0.9 % deteriorating on the PHQ-9, and 0.6 % on the GAD-7. Four patients left treatment early due to side effects or clinician disqualification, and two more due to adverse events. Three patient subpopulations emerged, characterized by Improvement (79.3 %), Chronic (11.4 %), and Delayed Improvement (9.3 %) for PHQ-9 and GAD-7. Endorsing side effects at Session 2 was associated with delayed symptom improvement, and Chronic patients were more likely than the other two groups to report dissociation at Session 4. CONCLUSION At-home KAT response and remission rates indicated rapid and significant antidepressant and anxiolytic effects. Rates were consistent with laboratory- and clinic-administered ketamine treatment. Patient screening and remote monitoring maintained low levels of adverse events. Future research should assess durability of effects.
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15
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Beanes G, Caliman-Fontes AT, Souza-Marques B, Silva HDS, Leal GC, Carneiro BA, Guerreiro-Costa LNF, Figueiredo AV, Figueiredo CAV, Lacerda ALT, Costa RDS, Quarantini LC. Effects of GRIN2B, GRIA1, and BDNF Polymorphisms on the Therapeutic Action of Ketamine and Esketamine in Treatment-Resistant Depression Patients: Secondary Analysis From a Randomized Clinical Trial. Clin Neuropharmacol 2022; 45:151-156. [PMID: 36093918 DOI: 10.1097/wnf.0000000000000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effect of genetic variants in glutamate ionotropic receptor N-methyl-d-aspartate type subunit 2B (GRIN2B), glutamate ionotropic receptor α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid type subunit 1 (GRIA1), and brain-derived neurotrophic factor (BDNF) genes on therapeutic response, remission, and total Montgomery-Åsberg Depression Rating Scale scores after treatment with ketamine or esketamine in treatment-resistant depression (TRD) patients. METHODS Participants (N = 60) are from a double-blind, randomized, noninferiority clinical trial comparing single-dose intravenous ketamine (0.5 mg/kg) to esketamine (0.25 mg/kg) for TRD. Montgomery-Åsberg Depression Rating Scale was applied at baseline, 24 hours, 72 hours, and 7 days postinfusion to assess depressive symptoms. Blood samples were collected to evaluate single nucleotide polymorphisms rs1805502 (GRIN2B), rs1994862 (GRIA1), and rs6265 (BDNF). RESULTS There was no association between rs1805502, rs1994862, or rs6265 polymorphisms and antidepressant response (P = 0.909, P = 0.776, and P = 0.482, respectively), remission P = 0.790, P = 0.086, and P = 0.669), or Montgomery-Åsberg Depression Rating Scale scores at each time point (P = 0.907, P = 0.552, and P = 0.778). CONCLUSIONS We found no association between the studied single nucleotide polymorphisms (rs6265, rs1805502, and rs1994862) and ketamine's therapeutic action in TRD patients. Further studies with larger samples are needed to clarify the utility of these genes of interest as predictors for antidepressant treatment.
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Affiliation(s)
| | - Ana Teresa Caliman-Fontes
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos
| | | | - Hátilla Dos Santos Silva
- Laboratório de Imunofarmacologia e Biologia Molecular, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador
| | | | | | | | - Alexandre V Figueiredo
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos
| | - Camila Alexandrina V Figueiredo
- Laboratório de Imunofarmacologia e Biologia Molecular, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador
| | | | - Ryan Dos S Costa
- Laboratório de Imunofarmacologia e Biologia Molecular, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador
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16
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Vazquez G, Gutierrez G, Rosenblat J, Schaffer A, Swainson J, Karthikeyan G, Ravindran N, Lam RW, Do A, Giacobbe P, Hawken E, Milev R. Association of intranasal esketamine, a novel 'standard of care' treatment and outcomes in the management of patients with treatment-resistant depression: protocol of a prospective cohort observational study of naturalistic clinical practice. BMJ Open 2022; 12:e060967. [PMID: 36581972 PMCID: PMC9438206 DOI: 10.1136/bmjopen-2022-060967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Esketamine is the S-enantiomer of racemic ketamine and has been approved by the Food and Drug Administration for the management of treatment resistant depression, demonstrating effective and long-lasting benefits. The objective of this observational study is to elucidate the association of intranasal (IN) esketamine with beneficial and negative outcomes in the management of treatment resistant major depressive disorder. METHODS AND ANALYSIS This is a multicentre prospective cohort observational study of naturalistic clinical practice. We expect to recruit 10 patients per research centre (6 centres, total 60 subjects). After approval to receive IN esketamine as part of their standard of care management of moderate to severe treatment resistant depression, patients will be invited to participate in this study. Association of esketamine treatment with outcomes in the management of depression will be assessed by measuring the severity of depression symptoms using the Montgomery-Åsberg Depression Rating Scale (MADRS), and tolerability by systematically tracking common side effects of ketamine treatment, dissociation using the simplified 6-Item Clinician Administered Dissociative Symptom Scale and potential for abuse using the Likeability and Craving Questionnaire (LCQ). Change in depressive symptoms (MADRS total scores) over time will be evaluated by within-subject repeated measures analysis of variance. We will calculate the relative risk associated with the beneficial (reduction in total scores for depression) outcomes, and the side effect and dropout rates (tolerability) of adding IN esketamine to patients' current pharmacological treatments. Covariate analysis will assess the impact of site and demographic variables on treatment outcomes. ETHICS AND DISSEMINATION Approval to perform this study was obtained through the Health Sciences Research Ethics Board at Queen's University. Findings will be shared among collaborators, through departmental meetings, presented on different academic venues and publishing our manuscript.
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Affiliation(s)
- Gustavo Vazquez
- Psychiatry, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Gilmar Gutierrez
- School of Medicine, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
| | | | - Ayal Schaffer
- Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jennifer Swainson
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Raymond W Lam
- Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
| | - André Do
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Giacobbe
- Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Emily Hawken
- Psychiatry, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Roumen Milev
- Psychiatry, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
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17
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Riggs LM, Thompson SM, Gould TD. (2R,6R)-hydroxynorketamine rapidly potentiates optically-evoked Schaffer collateral synaptic activity. Neuropharmacology 2022; 214:109153. [PMID: 35661657 PMCID: PMC9904284 DOI: 10.1016/j.neuropharm.2022.109153] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 12/31/2022]
Abstract
(2R,6R)-hydroxynorketamine (HNK) is a metabolite of ketamine that exerts rapid and sustained antidepressant-like effects in preclinical studies. We hypothesize that the rapid antidepressant actions of (2R,6R)-HNK involve an acute increase in glutamate release at Schaffer collateral synapses. Here, we used an optogenetic approach to assess whether (2R,6R)-HNK promotes glutamate release at CA1-projecting Schaffer collateral terminals in response to select optical excitation of CA3 afferents. The red-shifted channelrhodopsin, ChrimsonR, was expressed in dorsal CA3 neurons of adult male Sprague Dawley rats. Transverse slices were collected four weeks later to determine ChrimsonR expression and to assess the acute synaptic effects of an antidepressant-relevant concentration of (2R,6R)-HNK (10 μM). (2R,6R)-HNK led to a rapid potentiation of CA1 field excitatory postsynaptic potentials evoked by recurrent optical stimulation of ChrimsonR-expressing CA3 afferents. This potentiation is mediated in part by an increase in glutamate release probability, as (2R,6R)-HNK suppressed paired-pulse facilitation at CA3 projections, an effect that correlated with the magnitude of the (2R,6R)-HNK-induced potentiation of CA1 activity. These results demonstrate that (2R,6R)-HNK increases the probability of glutamate release at CA1-projecting Schaffer collateral afferents, which may be involved in the antidepressant-relevant behavioral adaptations conferred by (2R,6R)-HNK in vivo. The current study also establishes proof-of-principle that genetically-encoded light-sensitive proteins can be used to investigate the synaptic plasticity induced by novel antidepressant compounds in neuronal subcircuits.
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Affiliation(s)
- Lace M Riggs
- Program in Neuroscience and Training Program in Integrative Membrane Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Scott M Thompson
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, 21201, USA; Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Todd D Gould
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, 21201, USA; Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA; Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA; Veterans Affairs Maryland Health Care System, Baltimore, MD, 21201, USA.
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18
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Wang Q, Huang H, Li D, Wang Y, Qi N, Ci Y, Xu T. Intensive rTMS for treatment-resistant depression patients with suicidal ideation: An open-label study. Asian J Psychiatr 2022; 74:103189. [PMID: 35728457 DOI: 10.1016/j.ajp.2022.103189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/04/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022]
Abstract
The advantages of intensive repetitive transcranial magnetic stimulation (rTMS) protocol are in the possible acute effect of the stimulation and in the possible reduction in the time required to achieve remission in depression. Here, we investigated the antidepressant effects and antisuicidal effects of a more intensive rTMS protocol for treatment-resistant depression (TRD) patients with suicidal ideation. Thirty-one outpatients were included in this study, including 22 military veterans and 9 non- militaries. The rTMS treatment consisted of 25 sessions, each session lasting 30 min (60 trains of 50 pulsations, 110 % resting motor threshold intensity) for a total of 3000 pulse. The total amount of stimulation (750,000 pulses) applied by our rTMS protocol was equivalent to that of a 5-week standard rTMS protocol. We found a significant effect of time on the 17-item Hamilton Depression Rating Scale (HAMD-17) scores and the Sheehan Disability Scale (SDS) scores. There was no difference in change in the HAMD-17 scores and SDS scores between the military veteran group and the non-military group between baseline and the week 4 assessment time point. The response rate of depression was 64.52 %, and the remission rate of depression was 51.61 % at day 5. 48.39 % and 35.48 % at week 4, respectively. All patients (100 %) met response criteria of suicidal ideation, and the remission rate was 87.09 % at day 5. The response rate was 83.87 % %, and the remission rate was 77.42 % at week 4. The accelerated high-dose rTMS treatment was well tolerated by all patients. Our intensive rTMS protocol is preliminarily safe and feasible. The TRD patients with suicidal ideation could benefit from much shorter exposure to this protocol with more efficacy in comparison with conventional rTMS protocol. In addition, intensive rTMS offers a promising treatment for military veteran populations.
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Affiliation(s)
- Qi Wang
- Department of Psychiatry and Psychology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Hongfei Huang
- Department of Psychiatry and Psychology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Dongdong Li
- Department of Psychiatry and Psychology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Yitong Wang
- Department of Psychiatry and Psychology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Na Qi
- Department of Psychiatry and Psychology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Yihong Ci
- Department of Psychiatry and Psychology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Tianchao Xu
- Department of Psychiatry and Psychology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China.
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19
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Bahji A, Zarate CA, Vazquez GH. Efficacy and safety of racemic ketamine and esketamine for depression: a systematic review and meta-analysis. Expert Opin Drug Saf 2022; 21:853-866. [PMID: 35231204 PMCID: PMC9949988 DOI: 10.1080/14740338.2022.2047928] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Racemic ketamine and esketamine have demonstrated rapid antidepressant effects. We aimed to review the efficacy and safety of racemic and esketamine for depression. RESEARCH DESIGN AND METHODS We conducted a PRISMA-guided review for relevant randomized controlled trials of racemic or esketamine for unipolar or bipolar major depression from database inception through 2021. We conducted random-effects meta-analyses using pooled rate ratios (RRs) and Cohen's standardized mean differences (d) with their 95% confidence intervals (CI). RESULTS We found 36 studies (2903 participants, 57% female, 45.1 +/- 7.0 years). Nine trials used esketamine, while the rest used racemic ketamine. The overall study quality was high. Treatment with any form of ketamine was associated with improved response (RR=2.14; 95% CI, 1.72-2.66; I2=65%), remission (RR=1.64; 95% CI, 1.33-2.02; I2=39%), and depression severity (d=-0.63; 95% CI, -0.80 to -0.45; I2=78%) against placebo. Overall, there was no association between treatment with any form of ketamine and retention in treatment (RR=1.00; 95% CI, 0.99-1.01; I2<1%), dropouts due to adverse events (RR=1.56; 95% CI, 1.00-2.45; I2<1%), or the overall number of adverse events reported per participant (OR=2.14; 95% CI, 0.82-5.60; I2=62%) against placebo. CONCLUSIONS Ketamine and esketamine are effective, safe, and acceptable treatments for individuals living with depression.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;,British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Carlos A. Zarate
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Gustavo H. Vazquez
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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20
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Abstract
N-methyl-d-aspartate receptors (NMDARs) and alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptors (AMPARs) are excitatory neurotransmission receptors of the central nervous system and play vital roles in synaptic plasticity. Although not fully elucidated, visceral hypersensitivity is one of the most well-characterized pathophysiologic abnormalities of functional gastrointestinal diseases and appears to be associated with increased synaptic plasticity. In this study, we review the updated findings on the physiology of NMDARs and AMPARs and their relation to visceral hypersensitivity, which propose directions for future research in this field with evolving importance.
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21
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Chen Y, Shen M, Liu X, Xu J, Wang C. The Regulation of Glutamate Transporter 1 in the Rapid Antidepressant-Like Effect of Ketamine in Mice. Front Behav Neurosci 2022; 16:789524. [PMID: 35309681 PMCID: PMC8926310 DOI: 10.3389/fnbeh.2022.789524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Accumulating evidence suggests that glutamate clearance plays a critical role in the pathophysiology and treatment of depression. Preclinical and clinical studies have demonstrated that ketamine provides an immediate and sustained antidepressant effect. However, the precise mechanism of its action remains to be elucidated. Glutamate transporter 1 (GLT1) participates in glutamate clearance; therefore, we hypothesized that GLT1 may play an important role in the antidepressant effect of ketamine. In this study, we determined that GLT1 inhibition blocks the antidepressant-like properties of ketamine and alters the phosphorylation of the mammalian target of rapamycin (mTOR) in the prefrontal cortex (PFC). Our results show that pretreatment with dihydrokainic acid (DHK), a GLT1 inhibitor, alleviated the antidepressant-like effect of ketamine, and decreased the level of phosphorylated mTOR (pmTOR) in mice (which is normally upregulated by ketamine). In addition, inhibition of α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA) receptor and L-type voltage-dependent calcium channel (L-VDCC) significantly abolished the antidepressant-like effect of ketamine. Moreover, inhibition of L-VDCC significantly blocked the upregulation of GLT1 and BDNF in the PFC of mice. The inhibition of the AMPA receptor only significantly alleviated BDNF. Our results provide insight into the role of GLT1 as the critical presynaptic molecule participating in the pathophysiological mechanism of depression and contributing to the antidepressant-like effect of ketamine. In addition, our study confirms that both AMPA receptor and L-VDCC are crucial factors in the immediate antidepressant-like effect of ketamine.
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Affiliation(s)
- Yaping Chen
- Zhejiang Provincial Key Laboratory of Pathophysiology, Ningbo University School of Medicine, Ningbo, China
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
- College of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Mengxin Shen
- Zhejiang Provincial Key Laboratory of Pathophysiology, Ningbo University School of Medicine, Ningbo, China
| | - Xu Liu
- Department of Pharmacy, General Hospital of Chinese People’s Armed Police Forces, Beijing, China
| | - Jiangping Xu
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
- *Correspondence: Jiangping Xu, , orcid.org/0000-0002-0447-9229
| | - Chuang Wang
- Zhejiang Provincial Key Laboratory of Pathophysiology, Ningbo University School of Medicine, Ningbo, China
- Chuang Wang, , , orcid.org/0000-0002-3816-230X
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22
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Zhu X, Li T, Hu E, Duan L, Zhang C, Wang Y, Tang T, Yang Z, Fan R. Proteomics Study Reveals the Anti-Depressive Mechanisms and the Compatibility Advantage of Chaihu-Shugan-San in a Rat Model of Chronic Unpredictable Mild Stress. Front Pharmacol 2022; 12:791097. [PMID: 35111057 PMCID: PMC8802092 DOI: 10.3389/fphar.2021.791097] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/13/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Chaihu-Shugan-San is a classical prescription to treat depression. According to the traditional Chinese medicine (TCM) principle, the 2 decomposed recipes in Chaihu-Shugan-San exert synergistic effects, including Shu Gan (stagnated Gan-Qi dispersion) and Rou Gan (Gan nourishment to alleviate pain). However, the specific mechanism of Chaihu-Shugan-San on depression and its compatibility rule remain to be explored. Objective: We aimed to explore the anti-depression mechanisms and analyze the advantage of TCM compatibility of Chaihu-Shugan-San. Methods: The chronic unpredictable mild stress (CUMS) rat model was established. Antidepressant effects were evaluated by sucrose preference test (SPT), and forced swimming test (FST). Tandem Mass Tag (TMT)-based quantitative proteomics of the hippocampus was used to obtain differentially expressed proteins (DEPs). Bioinformatics analysis including Gene Ontology (GO), pathway enrichment, and protein-protein interaction (PPI) networks was utilized to study the DEPs connections. At last, the achieved key targets were verified by western blotting. Results: Chaihu-Shugan-San increased weight gain and food intake, as well as exhibited better therapeutic effects including enhanced sucrose preference and extended immobility time when compared with its decomposed recipes. Proteomics showed Chaihu-Shugan-San, Shu Gan, and Rou Gan regulated 110, 12, and 407 DEPs, respectively. Compared with Shu Gan or Rou Gan alone, the expression of 22 proteins was additionally changed by Chaihu-Shugan-San treatment, whereas the expression of 323 proteins whose expression was changed by Shu Gan or Rou Gan alone were not changed by Chaihu-Shugan-San treatment. Bioinformatics analysis demonstrated that Chaihu-Shugan-San affected neurotransmitter’s release and transmission cycle (e.g., γ-aminobutyric acid (GABA), glutamate, serotonin, norepinephrine, dopamine, and acetylcholine). GABA release pathway is also targeted by the 22 DEPs. Unexpectedly, only 2 pathways were enriched by the 323 DEPs: Metabolism and Cellular responses to external stimuli. Lastly, the expression of Gad2, Vamp2, and Pde2a was verified by western blotting. Conclusions: Chaihu-Shugan-San treats depression via multiple targets and pathways, which may include regulations of 110 DEPs and some neurotransmitter’s transmission cycle. Compared with Shu Gan and Rou Gan, the 22 Chaihu-Shugan-San advanced proteins and the affected GABA pathway may be the advantages of Chaihu-Shugan-San compatibility. This research offers data and theory support for the clinical application of Chaihu-Shugan-San.
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Affiliation(s)
- Xiaofei Zhu
- Department of Integrated Traditional Chinese and Western Medicine, Institute of Integrative Medicine, Xiangya Hospital, Central, South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Teng Li
- Department of Integrated Traditional Chinese and Western Medicine, Institute of Integrative Medicine, Xiangya Hospital, Central, South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - En Hu
- Department of Integrated Traditional Chinese and Western Medicine, Institute of Integrative Medicine, Xiangya Hospital, Central, South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lihua Duan
- Department of Integrated Traditional Chinese and Western Medicine, Institute of Integrative Medicine, Xiangya Hospital, Central, South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Chunhu Zhang
- Department of Integrated Traditional Chinese and Western Medicine, Institute of Integrative Medicine, Xiangya Hospital, Central, South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Wang
- Department of Integrated Traditional Chinese and Western Medicine, Institute of Integrative Medicine, Xiangya Hospital, Central, South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Tao Tang
- Department of Integrated Traditional Chinese and Western Medicine, Institute of Integrative Medicine, Xiangya Hospital, Central, South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhaoyu Yang
- Department of Integrated Traditional Chinese and Western Medicine, Institute of Integrative Medicine, Xiangya Hospital, Central, South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Rong Fan
- Department of Integrated Traditional Chinese and Western Medicine, Institute of Integrative Medicine, Xiangya Hospital, Central, South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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23
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Cole EJ, Phillips AL, Bentzley BS, Stimpson KH, Nejad R, Barmak F, Veerapal C, Khan N, Cherian K, Felber E, Brown R, Choi E, King S, Pankow H, Bishop JH, Azeez A, Coetzee J, Rapier R, Odenwald N, Carreon D, Hawkins J, Chang M, Keller J, Raj K, DeBattista C, Jo B, Espil FM, Schatzberg AF, Sudheimer KD, Williams NR. Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial. Am J Psychiatry 2022; 179:132-141. [PMID: 34711062 DOI: 10.1176/appi.ajp.2021.20101429] [Citation(s) in RCA: 210] [Impact Index Per Article: 105.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Depression is the leading cause of disability worldwide, and half of patients with depression have treatment-resistant depression. Intermittent theta-burst stimulation (iTBS) is approved by the U.S. Food and Drug Administration for the treatment of treatment-resistant depression but is limited by suboptimal efficacy and a 6-week duration. The authors addressed these limitations by developing a neuroscience-informed accelerated iTBS protocol, Stanford neuromodulation therapy (SNT; previously referred to as Stanford accelerated intelligent neuromodulation therapy, or SAINT). This protocol was associated with a remission rate of ∼90% after 5 days of open-label treatment. Here, the authors report the results of a sham-controlled double-blind trial of SNT for treatment-resistant depression. METHODS Participants with treatment-resistant depression currently experiencing moderate to severe depressive episodes were randomly assigned to receive active or sham SNT. Resting-state functional MRI was used to individually target the region of the left dorsolateral prefrontal cortex most functionally anticorrelated with the subgenual anterior cingulate cortex. The primary outcome was score on the Montgomery-Åsberg Depression Rating Scale (MADRS) 4 weeks after treatment. RESULTS At the planned interim analysis, 32 participants with treatment-resistant depression had been enrolled, and 29 participants who continued to meet inclusion criteria received either active (N=14) or sham (N=15) SNT. The mean percent reduction from baseline in MADRS score 4 weeks after treatment was 52.5% in the active treatment group and 11.1% in the sham treatment group. CONCLUSIONS SNT, a high-dose iTBS protocol with functional-connectivity-guided targeting, was more effective than sham stimulation for treatment-resistant depression. Further trials are needed to determine SNT's durability and to compare it with other treatments.
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Affiliation(s)
- Eleanor J Cole
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Angela L Phillips
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Brandon S Bentzley
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Katy H Stimpson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Romina Nejad
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Fahim Barmak
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Clive Veerapal
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Naushaba Khan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Kirsten Cherian
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Emily Felber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Randi Brown
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Elizabeth Choi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Sinead King
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Heather Pankow
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - James H Bishop
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Azeezat Azeez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - John Coetzee
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Rachel Rapier
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Nicole Odenwald
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - David Carreon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Jessica Hawkins
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Maureen Chang
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Jennifer Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Kristin Raj
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Charles DeBattista
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Alan F Schatzberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Keith D Sudheimer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
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24
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Kang MJY, Hawken E, Vazquez GH. The Mechanisms Behind Rapid Antidepressant Effects of Ketamine: A Systematic Review With a Focus on Molecular Neuroplasticity. Front Psychiatry 2022; 13:860882. [PMID: 35546951 PMCID: PMC9082546 DOI: 10.3389/fpsyt.2022.860882] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/18/2022] [Indexed: 12/25/2022] Open
Abstract
The mechanism of action underlying ketamine's rapid antidepressant effects in patients with depression, both suffering from major depressive disorder (MDD) and bipolar disorder (BD), including treatment resistant depression (TRD), remains unclear. Of the many speculated routes that ketamine may act through, restoring deficits in neuroplasticity may be the most parsimonious mechanism in both human patients and preclinical models of depression. Here, we conducted a literature search using PubMed for any reports of ketamine inducing neuroplasticity relevant to depression, to identify cellular and molecular events, relevant to neuroplasticity, immediately observed with rapid mood improvements in humans or antidepressant-like effects in animals. After screening reports using our inclusion/exclusion criteria, 139 publications with data from cell cultures, animal models, and patients with BD or MDD were included (registered on PROSPERO, ID: CRD42019123346). We found accumulating evidence to support that ketamine induces an increase in molecules involved in modulating neuroplasticity, and that these changes are paired with rapid antidepressant effects. Molecules or complexes of high interest include glutamate, AMPA receptors (AMPAR), mTOR, BDNF/TrkB, VGF, eEF2K, p70S6K, GSK-3, IGF2, Erk, and microRNAs. In summary, these studies suggest a robust relationship between improvements in mood, and ketamine-induced increases in molecular neuroplasticity, particularly regarding intracellular signaling molecules.
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Affiliation(s)
- Melody J Y Kang
- Center of Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Emily Hawken
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada.,Providence Care Hospital, Kingston, ON, Canada
| | - Gustavo Hector Vazquez
- Center of Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada.,Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada.,Providence Care Hospital, Kingston, ON, Canada
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25
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Fava VAR, Sarin LM, Lucchese AC, Del Sant L, Magalhães E, Delfino RS, Tuena MA, Nakahira C, Jackowski AP, Abdo G, Surjan J, Steiglich M, Barbosa MG, Porto JAD, Lacerda ALT, Cogo-Moreira H. The probability of response after each subcutaneous injection of esketamine in treatment-resistant depression. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2021; 14:212-217. [PMID: 34861929 DOI: 10.1016/j.rpsmen.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The administration of multiple esketamine doses has shown efficacy for unipolar and bipolar treatment-resistant depression (TRD). Nevertheless, the probability of responding or not after each dose in the real-world remains unknown. This study aimed to estimate it throughout four doses of esketamine, administrated via subcutaneous (SC). MATERIAL AND METHODS We conducted a retrospective analysis of a case series of 70 patients with TRD who received treatment from the esketamine assistance program at Federal University of Sao Paulo, between April 2017 and December 2018. The SC injections were administrated weekly at a dose of 0.5-1.0mg/kg, in conjunction with patients' psychotropic drugs. Response was defined as a decrease of at least 50% in the Montgomery-Åsberg Depression Rating Scale between baseline and 24h after dose. We used hidden Markov modeling in order to estimate de probability of response after each esketamine injection. RESULTS The probability of a patient that was a "non-responder" to become a "responder" following a SC injection of esketamine was 17.30% and the probability that this patient remains a "non-responder" was 82.70%. The probability of a patient that was a "responder" to remain as a "responder" was 95%. CONCLUSIONS Patients with TRD who had not responded after the first dose of esketamine, still had a chance of responding after the subsequent dose administrated via SC.
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Affiliation(s)
| | - Luciana Maria Sarin
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; Centro Alfa de Humanização, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Ana Cecília Lucchese
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; Centro Alfa de Humanização, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Lorena Del Sant
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; Centro Alfa de Humanização, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Eduardo Magalhães
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; Centro Alfa de Humanização, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Rodrigo Simonini Delfino
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; PRODAF - Programa de Transtornos Afetivos, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Marco Aurélio Tuena
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Carolina Nakahira
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Andrea Parolin Jackowski
- LiNC - Laboratory of Integrative Neuroscience, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Guilherme Abdo
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Juliana Surjan
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; PRODAF - Programa de Transtornos Afetivos, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Matheus Steiglich
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - José Alberto Del Porto
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; PRODAF - Programa de Transtornos Afetivos, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Acioly Luiz Tavares Lacerda
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; PRODAF - Programa de Transtornos Afetivos, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; LiNC - Laboratory of Integrative Neuroscience, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Hugo Cogo-Moreira
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; School of Public Health, University of Hong Kong, Hong Kong, SAR, China.
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26
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Yavi M, Henter ID, Park LT, Zarate C. Key considerations in the pharmacological management of treatment-resistant depression. Expert Opin Pharmacother 2021; 22:2405-2415. [PMID: 34252320 PMCID: PMC8648908 DOI: 10.1080/14656566.2021.1951225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
Introduction: Treatment-resistant depression (TRD) is a complex, multifactorial, and biologically heterogeneous disorder with debilitating outcomes. Understanding individual reasons why patients do not respond to treatment is necessary for improving clinical recommendations regarding medication regimens, augmentation strategies, and alternative treatments.Areas covered: This manuscript reviews evidence-based treatment strategies for the clinical management of TRD. Current developments in the field and potential future recommendations for personalized treatment of TRD are also discussed.Expert opinion: Treatment guidelines for TRD are limited by the heterogeneous nature of the disorder. Furthermore, current strategies reflect this heterogeneity by emphasizing disease characteristics as well as drug trial response or failure. Developing robust biomarkers that could one day be integrated into clinical practice has the potential to advance specific treatment targets and ultimately improve treatment and remission outcomes.
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Affiliation(s)
- Mani Yavi
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental HealthNational Institutes of Health Bethesda, MD, USA
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27
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Karrouri R, Hammani Z, Benjelloun R, Otheman Y. Major depressive disorder: Validated treatments and future challenges. World J Clin Cases 2021; 9:9350-9367. [PMID: 34877271 PMCID: PMC8610877 DOI: 10.12998/wjcc.v9.i31.9350] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/02/2021] [Accepted: 10/11/2021] [Indexed: 02/06/2023] Open
Abstract
Depression is a prevalent psychiatric disorder that often leads to poor quality of life and impaired functioning. Treatment during the acute phase of a major depressive episode aims to help the patient reach a remission state and eventually return to their baseline level of functioning. Pharmacotherapy, especially selective serotonin reuptake inhibitors antidepressants, remains the most frequent option for treating depression during the acute phase, while other promising pharmacological options are still competing for the attention of practitioners. Depression-focused psychotherapy is the second most common option for helping patients overcome the acute phase, maintain remission, and prevent relapses. Electroconvulsive therapy is the most effective somatic therapy for depression in some specific situations; meanwhile, other methods have limits, and their specific indications are still being studied. Combining medications, psychotherapy, and somatic therapies remains the most effective way to manage resistant forms of depression.
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Affiliation(s)
- Rabie Karrouri
- Department of Psychiatry, Moulay Ismaïl Military Hospital, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez 30070, Morocco
| | - Zakaria Hammani
- Department of Psychiatry, Moulay Ismaïl Military Hospital, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez 30070, Morocco
| | - Roukaya Benjelloun
- Department of Psychiatry, Faculty of Medicine, Mohammed VI University of Health Sciences, Casablanca 20000, Morocco
| | - Yassine Otheman
- Department of Psychiatry, Moulay Ismaïl Military Hospital, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez 30070, Morocco
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Gutierrez G, Rosenblat J, Hawken E, Swainson J, Vazquez G. Intranasal Esketamine versus Intravenous Ketamine: An observational pilot study assessing efficacy and tolerability of two novel 'standard of care' treatments for treatment resistant depression in naturalistic clinical practice. Protocol for an observational pilot study (Preprint). JMIR Res Protoc 2021; 11:e34711. [PMID: 35604752 PMCID: PMC9171596 DOI: 10.2196/34711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 12/01/2022] Open
Abstract
Background Intravenous (IV) ketamine and intranasal (IN) esketamine have been studied as novel alternatives to manage treatment-resistant depression (TRD). The objective of this observational pilot study is to compare the real-world effectiveness and tolerability of IV ketamine and IN esketamine in the management of unipolar TRD. Objective To compare the effectiveness (primary outcome measure) and tolerability (secondary outcome measure) of racemic ketamine and esketamine in the management of TRD in adults and provide an expert qualitative commentary on the application of IV ketamine and IN esketamine in clinical practice (exploratory objective), focusing on the recruitment process, patient retention, effectiveness, and tolerability of the treatments. Methods This is a multicenter prospective observational study of naturalistic clinical practice. We expect to recruit 10 patients per treatment arm—IV ketamine or IN esketamine per center (2 centers, total 40 subjects). Patients experiencing moderate to severe TRD and who are candidates for receiving low-dose IV ketamine treatments or IN esketamine as part of their standard-of-care treatments will be recruited. We will measure the effectiveness of each treatment arm by measuring the severity of depression symptoms using the Montgomery and Åsberg Depression Rating Scale; tolerability, side effects, and the appearance of dissociation symptoms using the simplified 6-item version of the Clinician Administered Dissociative Symptom Scale (CADSS-6); and potential for abuse using a Likeability and Craving Questionnaire. Logistic regression will examine odds ratios, number needed to treat for response and remission, number needed to harm, and likelihood to be helped or harmed of each treatment. Covariate analysis will assess the impact of site and demographic variables on treatment efficacy. Results This observational trial was approved by the Queen’s University Health Science and Affiliated Teaching Hospital’s Research Ethics Board in February 2021. The two research centers involved have started patient recruitment. Our research center (Providence Care Hospital, Kingston, Ontario) has recruited 9 patients so far. We expect to finalize data gathering by August 2022. The manuscript is expected to be published by December 2022. Conclusions We hypothesize that both treatments will have comparable rapid and robust antidepressant effects and similar tolerability profiles in a real-world setting for the management of TRD. International Registered Report Identifier (IRRID) DERR1-10.2196/34711
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Affiliation(s)
- Gilmar Gutierrez
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Joshua Rosenblat
- Canadian Rapid Treatment Center of Excellence, Toronto, ON, Canada
| | - Emily Hawken
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jennifer Swainson
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Gustavo Vazquez
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
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Herzog DP, Perumal N, Manicam C, Treccani G, Nadig J, Rossmanith M, Engelmann J, Jene T, Hasch A, van der Kooij MA, Lieb K, Gassen NC, Grus FH, Müller MB. Longitudinal CSF proteome profiling in mice to uncover the acute and sustained mechanisms of action of rapid acting antidepressant (2R,6R)-hydroxynorketamine (HNK). Neurobiol Stress 2021; 15:100404. [PMID: 34632008 PMCID: PMC8488754 DOI: 10.1016/j.ynstr.2021.100404] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 02/04/2023] Open
Abstract
Delayed onset of antidepressant action is a shortcoming in depression treatment. Ketamine and its metabolite (2R,6R)-hydroxynorketamine (HNK) have emerged as promising rapid-acting antidepressants. However, their mechanism of action remains unknown. In this study, we first described the anxious and depression-prone inbred mouse strain, DBA/2J, as an animal model to assess the antidepressant-like effects of ketamine and HNK in vivo. To decode the molecular mechanisms mediating HNK's rapid antidepressant effects, a longitudinal cerebrospinal fluid (CSF) proteome profiling of its acute and sustained effects was conducted using an unbiased, hypothesis-free mass spectrometry-based proteomics approach. A total of 387 proteins were identified, with a major implication of significantly differentially expressed proteins in the glucocorticoid receptor (GR) signaling pathway, providing evidence for a link between HNK and regulation of the stress hormone system. Mechanistically, we identified HNK to repress GR-mediated transcription and reduce hormonal sensitivity of GR in vitro. In addition, mammalian target of rapamycin (mTOR) and brain-derived neurotrophic factor (BDNF) were predicted to be important upstream regulators of HNK treatment. Our results contribute to precise understanding of the temporal dynamics and molecular targets underlying HNK's rapid antidepressant-like effects, which can be used as a benchmark for improved treatment strategies for depression in future.
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Affiliation(s)
- David P Herzog
- Department of Psychiatry and Psychotherapy and Focus Program Translational Neurosciences, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Natarajan Perumal
- Experimental and Translational Ophthalmology, Department of Ophthalmology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Caroline Manicam
- Experimental and Translational Ophthalmology, Department of Ophthalmology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Giulia Treccani
- Department of Psychiatry and Psychotherapy and Focus Program Translational Neurosciences, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany.,Institute for Microscopic Anatomy and Neurobiology, Johannes Gutenberg University Medical Center, Mainz, Germany.,Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Risskov, Denmark
| | - Jens Nadig
- Department of Psychiatry and Psychotherapy and Focus Program Translational Neurosciences, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Milena Rossmanith
- Experimental and Translational Ophthalmology, Department of Ophthalmology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Jan Engelmann
- Department of Psychiatry and Psychotherapy and Focus Program Translational Neurosciences, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Tanja Jene
- Department of Psychiatry and Psychotherapy and Focus Program Translational Neurosciences, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Annika Hasch
- Department of Psychiatry and Psychotherapy and Focus Program Translational Neurosciences, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Michael A van der Kooij
- Department of Psychiatry and Psychotherapy and Focus Program Translational Neurosciences, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany.,Leibniz Institute for Resilience Research, Mainz, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy and Focus Program Translational Neurosciences, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany.,Leibniz Institute for Resilience Research, Mainz, Germany
| | - Nils C Gassen
- Neurohomeostasis Research Group, Department of Psychiatry and Psychotherapy, University Medical Center Bonn, Bonn, Germany
| | - Franz H Grus
- Experimental and Translational Ophthalmology, Department of Ophthalmology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Marianne B Müller
- Department of Psychiatry and Psychotherapy and Focus Program Translational Neurosciences, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany.,Leibniz Institute for Resilience Research, Mainz, Germany
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30
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Quantitative behavioural phenotyping to investigate anaesthesia induced neurobehavioural impairment. Sci Rep 2021; 11:19398. [PMID: 34588499 PMCID: PMC8481492 DOI: 10.1038/s41598-021-98405-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Anaesthesia exposure to the developing nervous system causes neuroapoptosis and behavioural impairment in vertebrate models. Mechanistic understanding is limited, and target-based approaches are challenging. High-throughput methods may be an important parallel approach to drug-discovery and mechanistic research. The nematode worm Caenorhabditis elegans is an ideal candidate model. A rich subset of its behaviour can be studied, and hundreds of behavioural features can be quantified, then aggregated to yield a 'signature'. Perturbation of this behavioural signature may provide a tool that can be used to quantify the effects of anaesthetic regimes, and act as an outcome marker for drug screening and molecular target research. Larval C. elegans were exposed to: isoflurane, ketamine, morphine, dexmedetomidine, and lithium (and combinations). Behaviour was recorded, and videos analysed with automated algorithms to extract behavioural features. Anaesthetic exposure during early development leads to persisting behavioural variation (in total, 125 features across exposure combinations). Higher concentrations, and combinations of isoflurane with ketamine, lead to persistent change in a greater number of features. Morphine and dexmedetomidine do not appear to lead to behavioural impairment. Lithium rescues the neurotoxic phenotype produced by isoflurane. Findings correlate well with vertebrate research: impairment is dependent on agent, is concentration-specific, is more likely with combination therapies, and can potentially be rescued by lithium. These results suggest that C. elegans may be an appropriate model with which to pursue phenotypic screens for drugs that mitigate the neurobehavioural impairment. Some possibilities are suggested for how high-throughput platforms might be organised in service of this field.
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31
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Teneralli RE, Kern DM, Cepeda MS, Gilbert JP, Drevets WC. Exploring real-world evidence to uncover unknown drug benefits and support the discovery of new treatment targets for depressive and bipolar disorders. J Affect Disord 2021; 290:324-333. [PMID: 34020207 DOI: 10.1016/j.jad.2021.04.096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/19/2021] [Accepted: 04/25/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Major depressive and bipolar disorders are associated with impaired quality of life and high economic burden. Although progress has been made in our understanding of the underlying pathophysiology and the development of novel pharmacological treatments, a large unmet need remains for finding effective treatment options. The purpose of this study was to identify potential new mechanisms of actions or treatment targets that could inform future research and development opportunities for major depressive and bipolar disorders. METHODS A self-controlled cohort study was conducted to examine associations between 1933 medications and incidence of major depressive and bipolar disorders across four US insurance claims databases. Presence of incident depressive or bipolar disorders were captured for each patient prior to or after drug exposure and incident rate ratios were calculated. Medications that demonstrated ≥50% reduction in risk for both depressive and bipolar disorders within two or more databases were evaluated as potential treatment targets. RESULTS Eight medications met our inclusion criteria, which fell into three treatment groups: drugs used in substance use disorders; drugs that affect the cholinergic system; and drugs used for the management of cardiovascular-related conditions. LIMITATIONS This study was not designed to confirm a causal association nor inform current clinical practice. Instead, this research and the methods employed intended to be hypothesis generating and help uncover potential treatment pathways that could warrant further investigation. CONCLUSIONS Several potential drug targets that could aid further research and discovery into novel treatments for depressive and bipolar disorders were identified.
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Affiliation(s)
- Rachel E Teneralli
- Janssen Research & Development, LLC., Epidemiology, Titusville, NJ, USA.
| | - David M Kern
- Janssen Research & Development, LLC., Epidemiology, Titusville, NJ, USA
| | - M Soledad Cepeda
- Janssen Research & Development, LLC., Epidemiology, Titusville, NJ, USA
| | - James P Gilbert
- Janssen Research & Development, LLC., Observational Health and Data Analytics, Raritan, NJ, USA
| | - Wayne C Drevets
- Janssen Research & Development, LLC., Neuroscience, San Diego, CA, USA
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32
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Irwin MN, VandenBerg A. Retracing our steps to understand ketamine in depression: A focused review of hypothesized mechanisms of action. Ment Health Clin 2021; 11:200-210. [PMID: 34026396 PMCID: PMC8120982 DOI: 10.9740/mhc.2021.05.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction MDD represents a significant burden worldwide, and while a number of approved treatments exist, there are high rates of treatment resistance and refractoriness. Ketamine, an N-methyl-d-aspartate receptor (NMDAR) antagonist, is a novel, rapid-acting antidepressant, however the mechanisms underlying the efficacy of ketamine are not well understood and many other mechanisms outside of NMDAR antagonism have been postulated based on preclinical data. This focused review aims to present a summary of the proposed mechanisms of action by which ketamine functions in depressive disorders supported by preclinical data and clinical studies in humans. Methods A literature search was completed using the PubMed and Google Scholar databases. Results were limited to clinical trials and case studies in humans that were published in English. The findings were used to compile this article. Results The antidepressant effects associated with ketamine are mediated via a complex interplay of mechanisms; key steps include NMDAR blockade on γ-aminobutyric acid interneurons, glutamate surge, and subsequent activation and upregulation of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor. Discussion Coadministration of ketamine for MDD with other psychotropic agents, for example benzodiazepines, may attenuate antidepressant effects. Limited evidence exists for these effects and should be evaluated on a case-by-case basis.
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Affiliation(s)
- Madison N Irwin
- Clinical Pharmacist Specialist in Psychology and Neurology, Department of Pharmacy, Michigan Medicine, Ann Arbor, Michigan
| | - Amy VandenBerg
- Clinical Pharmacist Specialist in Psychology and Neurology, Department of Pharmacy, Michigan Medicine, Ann Arbor, Michigan
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33
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Alexander L, Jelen LA, Mehta MA, Young AH. The anterior cingulate cortex as a key locus of ketamine's antidepressant action. Neurosci Biobehav Rev 2021; 127:531-554. [PMID: 33984391 DOI: 10.1016/j.neubiorev.2021.05.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 12/30/2022]
Abstract
The subdivisions of the anterior cingulate cortex (ACC) - including subgenual, perigenual and dorsal zones - are implicated in the etiology, pathogenesis and treatment of major depression. We review an emerging body of evidence which suggests that changes in ACC activity are critically important in mediating the antidepressant effects of ketamine, the prototypical member of an emerging class of rapidly acting antidepressants. Infusions of ketamine induce acute (over minutes) and post-acute (over hours to days) modulations in subgenual and perigenual activity, and importantly, these changes can correlate with antidepressant efficacy. The subgenual and dorsal zones of the ACC have been specifically implicated in ketamine's anti-anhedonic effects. We emphasize the synergistic relationship between neuroimaging studies in humans and brain manipulations in animals to understand the causal relationship between changes in brain activity and therapeutic efficacy. We conclude with circuit-based perspectives on ketamine's action: first, related to ACC function in a central network mediating affective pain, and second, related to its role as the anterior node of the default mode network.
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Affiliation(s)
- Laith Alexander
- Department of Psychological Medicine, School of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; St Thomas' Hospital, London, United Kingdom.
| | - Luke A Jelen
- Department of Psychological Medicine, School of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Mitul A Mehta
- Department of Psychological Medicine, School of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Allan H Young
- Department of Psychological Medicine, School of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
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34
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Bahji A, Zarate CA, Vazquez GH. Ketamine for Bipolar Depression: A Systematic Review. Int J Neuropsychopharmacol 2021; 24:535-541. [PMID: 33929489 PMCID: PMC8299822 DOI: 10.1093/ijnp/pyab023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/12/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ketamine appears to have a therapeutic role in certain mental disorders, most notably unipolar major depressive disorder. However, its efficacy in bipolar depression is less clear. This study aimed to assess the efficacy and tolerability of ketamine for bipolar depression. METHODS We conducted a systematic review of experimental studies using ketamine for the treatment of bipolar depression. We searched PubMed, MEDLINE, Embase, PsycINFO, and the Cochrane Central Register for relevant studies published since each database's inception. We synthesized evidence regarding efficacy (improvement in depression rating scores) and tolerability (adverse events, dissociation, dropouts) across studies. RESULTS We identified 6 studies, with 135 participants (53% female; 44.7 years; standard deviation, 11.7 years). All studies used 0.5 mg/kg of add-on intravenous racemic ketamine, with the number of doses ranging from 1 to 6; all participants continued a mood-stabilizing agent. The overall proportion achieving a response (defined as those having a reduction in their baseline depression severity of at least 50%) was 61% for those receiving ketamine and 5% for those receiving a placebo. The overall response rates varied from 52% to 80% across studies. Ketamine was reasonably well tolerated; however, 2 participants (1 receiving ketamine and 1 receiving placebo) developed manic symptoms. Some participants developed significant dissociative symptoms at the 40-minute mark following ketamine infusion in 2 trials. CONCLUSIONS There is some preliminary evidence supporting use of intravenous racemic ketamine to treat adults with bipolar depression. There is a need for additional studies exploring longer-term outcomes and alterative formulations of ketamine.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; British Columbia Centre for Substance Use, Vancouver, British Columbia, Canada; Research in Addiction Medicine Scholars [RAMS] Program, Boston University Medical Centre, Boston, MA, USA
| | - Carlos A Zarate
- Section Neurobiology and Treatment of Mood Disorders, Division of Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland, USA
| | - Gustavo H Vazquez
- Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada,Correspondence: Gustavo Vazquez, MD, PhD, FRCPC, Professor of Psychiatry, Queen’s University Medical School, 752 King Street West, Kingston, ON K7L 4X3, Canada ()
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35
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Almeida RF, Ferreira TP, David CVC, Abreu E Silva PC, Dos Santos SA, Rodrigues ALS, Elisabetsky E. Guanine-Based Purines as an Innovative Target to Treat Major Depressive Disorder. Front Pharmacol 2021; 12:652130. [PMID: 33927625 PMCID: PMC8076783 DOI: 10.3389/fphar.2021.652130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/01/2021] [Indexed: 01/18/2023] Open
Affiliation(s)
- Roberto F Almeida
- Departamento de Ciências Biológicas, Programa de Pós-Graduação em Ciências Biológicas, Universidade Federal de Ouro Preto (UFOP), Ouro Preto, Brazil.,Departamento de Bioquímica, Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tiago P Ferreira
- Departamento de Ciências Biológicas, Programa de Pós-Graduação em Ciências Biológicas, Universidade Federal de Ouro Preto (UFOP), Ouro Preto, Brazil
| | - Camila V C David
- Departamento de Ciências Biológicas, Programa de Pós-Graduação em Ciências Biológicas, Universidade Federal de Ouro Preto (UFOP), Ouro Preto, Brazil
| | - Paulo C Abreu E Silva
- Departamento de Ciências Biológicas, Programa de Pós-Graduação em Ciências Biológicas, Universidade Federal de Ouro Preto (UFOP), Ouro Preto, Brazil
| | - Sulamita A Dos Santos
- Departamento de Ciências Biológicas, Programa de Pós-Graduação em Ciências Biológicas, Universidade Federal de Ouro Preto (UFOP), Ouro Preto, Brazil
| | - Ana L S Rodrigues
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Elaine Elisabetsky
- Departamento de Bioquímica, Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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36
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Sanches M, Quevedo J, Soares JC. New agents and perspectives in the pharmacological treatment of major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110157. [PMID: 33159975 PMCID: PMC7750246 DOI: 10.1016/j.pnpbp.2020.110157] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/19/2020] [Accepted: 10/27/2020] [Indexed: 12/28/2022]
Abstract
Despite the important advances in the understanding of the pathophysiology of MDD, a large proportion of depressed patients do not respond well to currently available pharmacological agents. The present review focuses on new targets and future directions in the pharmacological treatment of MDD. Novel agents and their efficacy in the treatment of depression are discussed, with a focus on the respectively target pathophysiological pathways and the level of available evidence. Although it is expected that classic antidepressants will remain the cornerstone of MDD treatment, at least for the near future, a large number of novel compounds is currently under investigation as for their efficacy in the treatment of MDD, many of which with promising results.
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Affiliation(s)
- Marsal Sanches
- UT Health Center of Excellence on Mood Disorders, Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
| | - Joao Quevedo
- UT Health Center of Excellence on Mood Disorders, Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA; Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Jair C Soares
- UT Health Center of Excellence on Mood Disorders, Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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37
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Goldstein Ferber S, Weller A, Yadid G, Friedman A. Discovering the Lost Reward: Critical Locations for Endocannabinoid Modulation of the Cortico-Striatal Loop That Are Implicated in Major Depression. Int J Mol Sci 2021; 22:1867. [PMID: 33668515 PMCID: PMC7918043 DOI: 10.3390/ijms22041867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 12/14/2022] Open
Abstract
Depression, the most prevalent psychiatric disorder in the Western world, is characterized by increased negative affect (i.e., depressed mood, cost value increase) and reduced positive affect (i.e., anhedonia, reward value decrease), fatigue, loss of appetite, and reduced psychomotor activity except for cases of agitative depression. Some forms, such as post-partum depression, have a high risk for suicidal attempts. Recent studies in humans and in animal models relate major depression occurrence and reoccurrence to alterations in dopaminergic activity, in addition to other neurotransmitter systems. Imaging studies detected decreased activity in the brain reward circuits in major depression. Therefore, the location of dopamine receptors in these circuits is relevant for understanding major depression. Interestingly, in cortico-striatal-dopaminergic pathways within the reward and cost circuits, the expression of dopamine and its contribution to reward are modulated by endocannabinoid receptors. These receptors are enriched in the striosomal compartment of striatum that selectively projects to dopaminergic neurons of substantia nigra compacta and is vulnerable to stress. This review aims to show the crosstalk between endocannabinoid and dopamine receptors and their vulnerability to stress in the reward circuits, especially in corticostriatal regions. The implications for novel treatments of major depression are discussed.
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Affiliation(s)
- Sari Goldstein Ferber
- Department of Psychology and the Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan 5290002, Israel; (S.G.F.); (A.W.)
| | - Aron Weller
- Department of Psychology and the Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan 5290002, Israel; (S.G.F.); (A.W.)
| | - Gal Yadid
- The Mina and Everard Goodman Faculty of Life Sciences and the Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan 5290002, Israel;
| | - Alexander Friedman
- Department of Biological Sciences, University of Texas at El Paso, El Paso, TX 79968, USA
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Abstract
The therapeutic onset of traditional antidepressants is delayed by several weeks and many depressed patients fail to respond to treatment altogether. In contrast, subanesthetic ketamine can rapidly alleviate symptoms of depression within hours of a single administration, even in patients who are considered treatment-resistant. Ketamine is thought to exert these effects by restoring the integrity of neural circuits that are compromised in depression. This hypothesis stems in part from preclinical observations that ketamine can strengthen synaptic connections by increasing glutamate-mediated neurotransmission and promoting rapid neurotrophic factor release. An improved understanding of how ketamine, and other novel rapid-acting antidepressants, give rise to these processes will help foster future therapeutic innovation. Here, we review the history of antidepressant treatment advances that preceded the ketamine discovery, critically examine mechanistic hypotheses for how ketamine may exert its antidepressant effects, and discuss the impact this knowledge has had on ongoing drug discovery efforts.
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Affiliation(s)
- Lace M Riggs
- Program in Neuroscience and Training Program in Integrative Membrane Biology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA; .,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA;
| | - Todd D Gould
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA; .,Departments of Pharmacology and Anatomy & Neurobiology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.,Baltimore Veterans Affairs Medical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland 21201, USA
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39
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Sales AJ, Maciel IS, Suavinha ACDR, Joca SRL. Modulation of DNA Methylation and Gene Expression in Rodent Cortical Neuroplasticity Pathways Exerts Rapid Antidepressant-Like Effects. Mol Neurobiol 2021; 58:777-794. [PMID: 33025509 DOI: 10.1007/s12035-020-02145-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Stress increases DNA methylation, primarily a suppressive epigenetic mechanism catalyzed by DNA methyltransferases (DNMT), and decreases the expression of genes involved in neuronal plasticity and mood regulation. Despite chronic antidepressant treatment decreases stress-induced DNA methylation, it is not known whether inhibition of DNMT would convey rapid antidepressant-like effects. AIM This work tested such a hypothesis and evaluated whether a behavioral effect induced by DNMT inhibitors (DNMTi) corresponds with changes in DNA methylation and transcript levels in genes consistently associated with the neurobiology of depression and synaptic plasticity (BDNF, TrkB, 5-HT1A, NMDA, and AMPA). METHODS Male Wistar rats received intraperitoneal (i.p.) injection of two pharmacologically different DNMTi (5-AzaD 0.2 and 0.6 mg/kg or RG108 0.6 mg/kg) or vehicle (1 ml/kg), 1 h or 7 days before the learned helplessness test (LH). DNA methylation in target genes and the correspondent transcript levels were measured in the hippocampus (HPC) and prefrontal cortex (PFC) using meDIP-qPCR. In parallel separate groups, the antidepressant-like effect of 5-AzaD and RG108 was investigated in the forced swimming test (FST). The involvement of cortical BDNF-TrkB-mTOR pathways was assessed by intra-ventral medial PFC (vmPFC) injections of rapamycin (mTOR inhibitor), K252a (TrkB receptor antagonist), or vehicle (0.2 μl/side). RESULTS We found that both 5-AzaD and RG108 acutely and 7 days before the test decreased escape failures in the LH. LH stress increased DNA methylation and decreased transcript levels of BDNF IV and TrkB in the PFC, effects that were not significantly attenuated by RG108 treatment. The systemic administration of 5-AzaD (0.2 mg/kg) and RG108 (0.2 mg/kg) induced an antidepressant-like effect in FST, which was, however, attenuated by TrkB and mTOR inhibition into the vmPFC. CONCLUSION These findings suggest that acute inhibition of stress-induced DNA methylation promotes rapid and sustained antidepressant effects associated with increased BDNF-TrkB-mTOR signaling in the PFC.
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Affiliation(s)
- Amanda J Sales
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
- FMRP-USP, Av Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil.
| | - Izaque S Maciel
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Angélica C D R Suavinha
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Sâmia R L Joca
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- FCFRP-USP, Av Café, sn, Monte Alegre, Ribeirão Preto, SP, 14040-903, Brazil.
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De Berardis D, Tomasetti C, Pompili M, Serafini G, Vellante F, Fornaro M, Valchera A, Perna G, Volpe U, Martinotti G, Fraticelli S, Di Giannantonio M, Kim YK, Orsolini L. An Update on Glutamatergic System in Suicidal Depression and on the Role of Esketamine. Curr Top Med Chem 2021; 20:554-584. [PMID: 32003691 DOI: 10.2174/1568026620666200131100316] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 11/15/2019] [Accepted: 12/09/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND A research on mood disorder pathophysiology has hypothesized abnormalities in glutamatergic neurotransmission, by suggesting further investigation on glutamatergic N-methyl-Daspartate (NMDA) receptor modulators in treating Major Depressive Disorder (MDD). Esketamine (ESK), an NMDA receptor antagonist able to modulate glutamatergic neurotransmission has been recently developed as an intranasal formulation for treatment-resistant depression (TRD) and for rapid reduction of depressive symptomatology, including suicidal ideation in MDD patients at imminent risk for suicide. OBJECTIVE The present study aims at investigating recent clinical findings on research on the role of the glutamatergic system and ESK in treating suicidal depression in MDD and TRD. METHODS A systematic review was here carried out on PubMed/Medline, Scopus and the database on U.S. N.I.H. Clinical Trials (https://clinicaltrials.gov) and the European Medical Agency (EMA) (https://clinicaltrialsregister.eu) from inception until October 2019. RESULTS Intravenous infusion of ESK is reported to elicit rapid-acting and sustained antidepressant activity in refractory patients with MDD and TRD. In phase II studies, intranasal ESK demonstrated a rapid onset and a persistent efficacy in patients with TRD as well as in MDD patients at imminent risk for suicide. However, some data discrepancies have emerged in phase III studies. CONCLUSION The U.S. Food and Drug Administration (FDA) granted fast track and Breakthrough Therapy Designation to Janssen Pharmaceuticals®, Inc. for intranasal ESK in 2013 for treatment-resistant depression (TRD) and in 2016 for the treatment of MDD with an imminent risk of suicide. However, further studies should be implemented to investigate the long-term efficacy and safety of intranasal ESK.
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Affiliation(s)
- Domenico De Berardis
- Department of Neuroscience, Imaging and Clinical Science, University of "G. D'Annunzio", Chieti, Italy.,National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4 Teramo, Italy.,Polyedra, Teramo, Italy
| | - Carmine Tomasetti
- Polyedra, Teramo, Italy.,Department of Psychiatry, Federico II University, Naples, Italy.,NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "SS. Annunziata", ASL 4 Giulianova, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federica Vellante
- Department of Neuroscience, Imaging and Clinical Science, University of "G. D'Annunzio", Chieti, Italy
| | - Michele Fornaro
- Polyedra, Teramo, Italy.,Department of Psychiatry, Federico II University, Naples, Italy
| | - Alessandro Valchera
- Polyedra, Teramo, Italy.,Villa S. Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, Italy
| | - Giampaolo Perna
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, Albese con Cassano, Como, Italy.,Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, Miami University, Miami 786, United States
| | - Umberto Volpe
- Department of Clinical Neurosciences/DIMSC, School of Medicine, Section of Psychiatry, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Science, University of "G. D'Annunzio", Chieti, Italy
| | - Silvia Fraticelli
- Department of Neuroscience, Imaging and Clinical Science, University of "G. D'Annunzio", Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging and Clinical Science, University of "G. D'Annunzio", Chieti, Italy
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Laura Orsolini
- Polyedra, Teramo, Italy.,Department of Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Herts, United Kingdom.,Neomesia Mental Health, Villa Jolanda Hospital, Maiolati Spontini, Italy
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Barbosa MG, Sarin LM, Tuena MA, Del Sant LC, Nakahira C, Magalhães EJM, Fava VAR, Delfino RS, Steglich MS, Puertas C, Lucchese AC, Surjan JC, Abdo GL, Cogo-Moreira H, Del Porto JA, Lacerda ALTD, Jackowski AP. Heterogeneous trajectory of depressive symptoms after repeated subcutaneous esketamine injections. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2020.100053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Comparative efficacy of racemic ketamine and esketamine for depression: A systematic review and meta-analysis. J Affect Disord 2021; 278:542-555. [PMID: 33022440 PMCID: PMC7704936 DOI: 10.1016/j.jad.2020.09.071] [Citation(s) in RCA: 172] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Ketamine appears to have a therapeutic role in certain mental disorders, most notably depression. However, the comparative performance of different formulations of ketamine is less clear. OBJECTIVES This study aimed to assess the comparative efficacy and tolerability of racemic and esketamine for the treatment of unipolar and bipolar major depression. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched PubMed, MEDLINE, Embase, PsycINFO, the Cochrane Central Register of Controlled Clinical Trials, and the Cochrane Database of Systematic Reviews for relevant studies published since database inception and December 17, 2019. STUDY ELIGIBILITY CRITERIA We considered randomized controlled trials examining racemic or esketamine for the treatment of unipolar or bipolar major depression. OUTCOMES Primary outcomes were response and remission from depression, change in depression severity, suicidality, retention in treatment, drop-outs, and drop-outs due to adverse events. ANALYSIS Evidence from randomized controlled trials was synthesized as rate ratios (RRs) for treatment response, disorder remission, adverse events, and withdrawals and as standardized mean differences (SMDs) for change in symptoms, via random-effects meta-analyses. FINDINGS 24 trials representing 1877 participants were pooled. Racemic ketamine relative to esketamine demonstrated greater overall response (RR = 3.01 vs. RR = 1.38) and remission rates (RR = 3.70 vs. RR = 1.47), as well as lower dropouts (RR = 0.76 vs. RR = 1.37). CONCLUSIONS Intravenous ketamine appears to be more efficacious than intranasal esketamine for the treatment of depression.
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Fava VAR, Sarin LM, Lucchese AC, Del Sant L, Magalhães E, Delfino RS, Tuena MA, Nakahira C, Jackowski AP, Abdo G, Surjan J, Steiglich M, Barbosa MG, Porto JAD, Lacerda ALT, Cogo-Moreira H. The probability of response after each subcutaneous injection of esketamine in treatment-resistant depression. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020; 14:S1888-9891(20)30117-8. [PMID: 33075541 DOI: 10.1016/j.rpsm.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/12/2020] [Accepted: 10/05/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The administration of multiple esketamine doses has shown efficacy for unipolar and bipolar treatment-resistant depression (TRD). Nevertheless, the probability of responding or not after each dose in the real-world remains unknown. This study aimed to estimate it throughout four doses of esketamine, administrated via subcutaneous (SC). MATERIAL AND METHODS We conducted a retrospective analysis of a case series of 70 patients with TRD who received treatment from the esketamine assistance program at Federal University of Sao Paulo, between April 2017 and December 2018. The SC injections were administrated weekly at a dose of 0.5-1.0mg/kg, in conjunction with patients' psychotropic drugs. Response was defined as a decrease of at least 50% in the Montgomery-Åsberg Depression Rating Scale between baseline and 24h after dose. We used hidden Markov modeling in order to estimate de probability of response after each esketamine injection. RESULTS The probability of a patient that was a "non-responder" to become a "responder" following a SC injection of esketamine was 17.30% and the probability that this patient remains a "non-responder" was 82.70%. The probability of a patient that was a "responder" to remain as a "responder" was 95%. CONCLUSIONS Patients with TRD who had not responded after the first dose of esketamine, still had a chance of responding after the subsequent dose administrated via SC.
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Affiliation(s)
| | - Luciana Maria Sarin
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; Centro Alfa de Humanização, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Ana Cecília Lucchese
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; Centro Alfa de Humanização, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Lorena Del Sant
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; Centro Alfa de Humanização, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Eduardo Magalhães
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; Centro Alfa de Humanização, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Rodrigo Simonini Delfino
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; PRODAF - Programa de Transtornos Afetivos, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Marco Aurélio Tuena
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Carolina Nakahira
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Andrea Parolin Jackowski
- LiNC - Laboratory of Integrative Neuroscience, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Guilherme Abdo
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Juliana Surjan
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; PRODAF - Programa de Transtornos Afetivos, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Matheus Steiglich
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - José Alberto Del Porto
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; PRODAF - Programa de Transtornos Afetivos, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Acioly Luiz Tavares Lacerda
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; PRODAF - Programa de Transtornos Afetivos, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; LiNC - Laboratory of Integrative Neuroscience, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Hugo Cogo-Moreira
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil; School of Public Health, University of Hong Kong, Hong Kong, SAR, China.
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Stamenkovic DM, Selvaraj S, Venkatraman S, Arshad A, Rancic NK, Dragojevic-Simic VM, Miljkovic MN, Cattano D. Anesthesia for patients with psychiatric illnesses: a narrative review with emphasis on preoperative assessment and postoperative recovery and pain. Minerva Anestesiol 2020; 86:1089-1102. [DOI: 10.23736/s0375-9393.20.14259-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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45
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Cole EJ, Stimpson KH, Bentzley BS, Gulser M, Cherian K, Tischler C, Nejad R, Pankow H, Choi E, Aaron H, Espil FM, Pannu J, Xiao X, Duvio D, Solvason HB, Hawkins J, Guerra A, Jo B, Raj KS, Phillips AL, Barmak F, Bishop JH, Coetzee JP, DeBattista C, Keller J, Schatzberg AF, Sudheimer KD, Williams NR. Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression. Am J Psychiatry 2020; 177:716-726. [PMID: 32252538 DOI: 10.1176/appi.ajp.2019.19070720] [Citation(s) in RCA: 290] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE New antidepressant treatments are needed that are effective, rapid acting, safe, and tolerable. Intermittent theta-burst stimulation (iTBS) is a noninvasive brain stimulation treatment that has been approved by the U.S. Food and Drug Administration for treatment-resistant depression. Recent methodological advances suggest that the current iTBS protocol might be improved through 1) treating patients with multiple sessions per day at optimally spaced intervals, 2) applying a higher overall pulse dose of stimulation, and 3) precision targeting of the left dorsolateral prefrontal cortex (DLPFC) to subgenual anterior cingulate cortex (sgACC) circuit. The authors examined the feasibility, tolerability, and preliminary efficacy of Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), an accelerated, high-dose resting-state functional connectivity MRI (fcMRI)-guided iTBS protocol for treatment-resistant depression. METHODS Twenty-two participants with treatment-resistant depression received open-label SAINT. fcMRI was used to individually target the region of the left DLPFC most anticorrelated with sgACC in each participant. Fifty iTBS sessions (1,800 pulses per session, 50-minute intersession interval) were delivered as 10 daily sessions over 5 consecutive days at 90% resting motor threshold (adjusted for cortical depth). Neuropsychological testing was conducted before and after SAINT. RESULTS One participant withdrew, leaving a sample size of 21. Nineteen of 21 participants (90.5%) met remission criteria (defined as a score <11 on the Montgomery-Åsberg Depression Rating Scale). In the intent-to-treat analysis, 19 of 22 participants (86.4%) met remission criteria. Neuropsychological testing demonstrated no negative cognitive side effects. CONCLUSIONS SAINT, an accelerated, high-dose, iTBS protocol with fcMRI-guided targeting, was well tolerated and safe. Double-blinded sham-controlled trials are needed to confirm the remission rate observed in this initial study.
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Affiliation(s)
- Eleanor J Cole
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Katy H Stimpson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Brandon S Bentzley
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Merve Gulser
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Kirsten Cherian
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Claudia Tischler
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Romina Nejad
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Heather Pankow
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Elizabeth Choi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Haley Aaron
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Jaspreet Pannu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Xiaoqian Xiao
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Dalton Duvio
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Hugh B Solvason
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Jessica Hawkins
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Austin Guerra
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Kristin S Raj
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Angela L Phillips
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Fahim Barmak
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - James H Bishop
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - John P Coetzee
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Charles DeBattista
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Jennifer Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Alan F Schatzberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Keith D Sudheimer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
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Fallon IP, Tanner MK, Greenwood BN, Baratta MV. Sex differences in resilience: Experiential factors and their mechanisms. Eur J Neurosci 2020; 52:2530-2547. [PMID: 31800125 PMCID: PMC7269860 DOI: 10.1111/ejn.14639] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/31/2019] [Accepted: 11/26/2019] [Indexed: 12/14/2022]
Abstract
Adverse life events can lead to stable changes in brain structure and function and are considered primary sources of risk for post-traumatic stress disorder, depression and other neuropsychiatric disorders. However, most individuals do not develop these conditions following exposure to traumatic experiences, and research efforts have identified a number of experiential factors associated with an individual's ability to withstand, adapt to and facilitate recovery from adversity. While multiple animal models of stress resilience exist, so that the detailed biological mechanisms can be explored, studies have been disproportionately conducted in male subjects even though the prevalence and presentation of stress-linked disorders differ between sexes. This review focuses on (a) the mechanisms by which experiential factors (behavioral control over a stressor, exercise) reduce the impact of adverse events as studied in males; (b) whether other manipulations (ketamine) that buffer against stress-induced sequelae engage the same circuit features; and (c) whether these processes operate similarly in females. We argue that investigation of experiential factors that produce resistance/resilience rather than vulnerability to adversity will generate a unique set of biological mechanisms that potentially underlie sex differences in mood disorders.
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Affiliation(s)
- Isabella P. Fallon
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80301, USA
| | - Margaret K. Tanner
- Department of Integrative Biology, University of Colorado Denver, Denver, CO, 80217, USA
| | | | - Michael V. Baratta
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80301, USA
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Xu L, Nan J, Lan Y. The Nucleus Accumbens: A Common Target in the Comorbidity of Depression and Addiction. Front Neural Circuits 2020; 14:37. [PMID: 32694984 PMCID: PMC7338554 DOI: 10.3389/fncir.2020.00037] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/22/2020] [Indexed: 12/21/2022] Open
Abstract
The comorbidity of depression and addiction has become a serious public health issue, and the relationship between these two disorders and their potential mechanisms has attracted extensive attention. Numerous studies have suggested that depression and addiction share common mechanisms and anatomical pathways. The nucleus accumbens (NAc) has long been considered a key brain region for regulating many behaviors, especially those related to depression and addiction. In this review article, we focus on the association between addiction and depression, highlighting the potential mediating role of the NAc in this comorbidity via the regulation of changes in the neural circuits and molecular signaling. To clarify the mechanisms underlying this association, we summarize evidence from overlapping reward neurocircuitry, the resemblance of cellular and molecular mechanisms, and common treatments. Understanding the interplay between these disorders should help guide clinical comorbidity prevention and the search for a new target for comorbidity treatment.
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Affiliation(s)
- Le Xu
- Department of Physiology and Pathophysiology, College of Medicine, Yanbian University School of Medicine, Yanji City, China
| | - Jun Nan
- Department of Orthopedics, Affiliated Hospital of Yanbian University, Yanji City, China
| | - Yan Lan
- Department of Physiology and Pathophysiology, College of Medicine, Yanbian University School of Medicine, Yanji City, China
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Rodrı́guez P, Urbanavicius J, Prieto JP, Fabius S, Reyes AL, Havel V, Sames D, Scorza C, Carrera I. A Single Administration of the Atypical Psychedelic Ibogaine or Its Metabolite Noribogaine Induces an Antidepressant-Like Effect in Rats. ACS Chem Neurosci 2020; 11:1661-1672. [PMID: 32330007 DOI: 10.1021/acschemneuro.0c00152] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Anecdotal reports and open-label case studies in humans indicated that the psychedelic alkaloid ibogaine exerts profound antiaddictive effects. Ample preclinical evidence demonstrated the efficacy of ibogaine, and its main metabolite, noribogaine, in substance-use-disorder rodent models. In contrast to addiction research, depression-relevant effects of ibogaine or noribogaine in rodents have not been previously examined. We have recently reported that the acute ibogaine administration induced a long-term increase of brain-derived neurotrophic factor mRNA levels in the rat prefrontal cortex, which led us to hypothesize that ibogaine may elicit antidepressant-like effects in rats. Accordingly, we characterized behavioral effects (dose- and time-dependence) induced by the acute ibogaine and noribogaine administration in rats using the forced swim test (FST, 20 and 40 mg/kg i.p., single injection for each dose). We also examined the correlation between plasma and brain concentrations of ibogaine and noribogaine and the elicited behavioral response. We found that ibogaine and noribogaine induced a dose- and time-dependent antidepressant-like effect without significant changes of animal locomotor activity. Noribogaine's FST effect was short-lived (30 min) and correlated with high brain concentrations (estimated >8 μM of free drug), while the ibogaine's antidepressant-like effect was significant at 3 h. At this time point, both ibogaine and noribogaine were present in rat brain at concentrations that cannot produce the same behavioral outcome on their own (ibogaine ∼0.5 μM, noribogaine ∼2.5 μM). Our data suggests a polypharmacological mechanism underpinning the antidepressant-like effects of ibogaine and noribogaine.
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Affiliation(s)
- Paola Rodrı́guez
- Laboratorio de Sı́ntesis Orgánica, Departamento de Quı́mica Orgánica, Facultad de Quı́mica, Universidad de la República, Montevideo 11200, Uruguay
- Departamento de Neurofarmacologı́a Experimental, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo 11600, Uruguay
| | - Jessika Urbanavicius
- Departamento de Neurofarmacologı́a Experimental, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo 11600, Uruguay
| | - José Pedro Prieto
- Departamento de Neurofarmacologı́a Experimental, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo 11600, Uruguay
| | - Sara Fabius
- Departamento de Neurofarmacologı́a Experimental, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo 11600, Uruguay
| | - Ana Laura Reyes
- Centro Uruguayo de Imagenologı́a Molecular, Montevideo 11600, Uruguay
| | - Vaclav Havel
- Department of Chemistry, Columbia University, New York, New York 10027, United States
| | - Dalibor Sames
- Department of Chemistry, Columbia University, New York, New York 10027, United States
| | - Cecilia Scorza
- Departamento de Neurofarmacologı́a Experimental, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo 11600, Uruguay
| | - Ignacio Carrera
- Laboratorio de Sı́ntesis Orgánica, Departamento de Quı́mica Orgánica, Facultad de Quı́mica, Universidad de la República, Montevideo 11200, Uruguay
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49
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Jiang X, Lin W, Cheng Y, Wang D. mGluR5 Facilitates Long-Term Synaptic Depression in a Stress-Induced Depressive Mouse Model. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:347-355. [PMID: 31526043 PMCID: PMC7265615 DOI: 10.1177/0706743719874162] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Glutamatergic system has been known to play a role in the pathogenesis of major depression disorder by inducing N-methyl-d-aspartate receptor-dependent long-term depression (LTD) or metabotropic glutamate receptors (mGluR)-dependent LTD. Here, we characterized the LTD in a chronic social defeat stress (CSDS)-induced depressive mouse model. METHODS CSDS was used to induce the depressive-like behaviors in C57BL/6 male mice, which were assessed using sucrose preference test and social interaction test. The synaptic strength including LTD and long-term potentiation (LTP) induced by paired-pulse low frequency stimulation (PP-LFS) was measured using whole-cell recording technique. RESULTS CSDS induced depressive-like behaviors and facilitated PP-LFS-induced LTD in hippocampal CA3-CA1 pathway in the susceptible mice. Interestingly, mGluR5 but not N-methyl-d-aspartate receptor mediated the PP-LFS-induced LTD. In addition, mGluR5 agonist dihydroxyphenylglycine promoted PP-LFS-induced LTD specifically in susceptible mice, which was diminished by activating the BDNF/TrkB signaling pathway. CONCLUSIONS Our results suggest that mGluR5-dependent LTD might be responsible for the development of depressive-like behaviors in CSDS-induced depression mice model.
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Affiliation(s)
- Xiangzhi Jiang
- Psychiatric Outpatient, Qingdao Mental Health Center, Qingdao, China
| | - Wei Lin
- Open Mental Department, Qingdao Mental Health Center, Qingdao, China
| | - Yuanyuan Cheng
- Psychosis Department Ⅰ, Qingdao Mental Health Center, Qingdao, China
| | - Dongming Wang
- Old Age Psychosis Department Ⅱ, Qingdao Mental Health Center, Qingdao, China
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Zhuo C, Lin X, Tian H, Liu S, Bian H, Chen C. Adjunct ketamine treatment of depression in treatment-resistant schizophrenia patients is unsatisfactory in pilot and secondary follow-up studies. Brain Behav 2020; 10:e01600. [PMID: 32174025 PMCID: PMC7218248 DOI: 10.1002/brb3.1600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/07/2020] [Accepted: 02/25/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To investigate the effects of adjunct ketamine treatment on chronic treatment-resistant schizophrenia patients with treatment-resistant depressive symptoms (CTRS-TRD patients), including alterations in brain function. METHODS Intravenous ketamine (0.5 mg/kg body weight) was administered to CTRS-TRD patients over a 1-hr period on days 1, 4, 7, 10, 13, 16, 19, 22, and 25 of our initial pilot study. This treatment method was subsequently repeated 58 days after the start of the pilot study for a secondary follow-up study. Calgary Depression Scale for Schizophrenia (CDSS), Positive and Negative Syndrome Scale (PANSS), and regional homogeneity (ReHo) results were used to assess treatment effects and alterations in brain function throughout the entire duration of our studies. RESULTS Between day 7 and day 14 of the first treatment, CDSS scores were reduced by 63.8% and PANSS scores were reduced by 30.04%. In addition, ReHo values increased in the frontal, temporal, and parietal lobes. However, by day 21, depressive symptoms relapsed. During the second treatment period, CDSS and PANSS scores exhibited no significant differences compared to baseline between day 58 and day 86. On day 65, ReHo values were higher in the temporal, frontal, and parietal lobes. However, on day 79, the increase in ReHo values completely disappeared. CONCLUSIONS Depressive symptoms in CTRS-TRD patients were alleviated with adjunct ketamine treatment for only 1 week during the first treatment period. Moreover, after 1 month, the antidepressant effects of ketamine on CTRS-TRD patients completely disappeared. Correspondingly, ReHo alterations induced by ketamine in the CTRS-TRD patients were not maintained for more than 3 weeks. These pilot findings indicate that adjunct ketamine treatment is not satisfactory for CTRS-TRD patients.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Psychiatry, School of Mental Health, Jining Medical University, Jining, China.,Department of Psychiatric-Neuroimaging-Genetics Laboratory (PNG_Lab), Wenzhou Seventh People's Hospital, Wenzhou, China.,PNGC-Lab, Tianjin Mental Health Centre, Tianjin Anding Hospital, Tianjin, China
| | - Xiaodong Lin
- Department of Psychiatric-Neuroimaging-Genetics Laboratory (PNG_Lab), Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Hongjun Tian
- PNGC-Lab, Tianjin Mental Health Centre, Tianjin Anding Hospital, Tianjin, China
| | - Sha Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Tainyuan, China
| | - Haiman Bian
- Department of Radiology, The Fourth Centre Hospital of Tianjin, Tianjin Medical University Affiliated Fourth Centre Hospital, Tianijn, China
| | - Ce Chen
- Department of Psychiatric-Neuroimaging-Genetics Laboratory (PNG_Lab), Wenzhou Seventh People's Hospital, Wenzhou, China
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