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Guilloux JP, Nguyen TML, Gardier AM. [Ketamine: a neuropsychotropic drug with an innovative mechanism of action]. Biol Aujourdhui 2023; 217:133-144. [PMID: 38018940 DOI: 10.1051/jbio/2023026] [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] [Received: 04/22/2023] [Indexed: 11/30/2023]
Abstract
Ketamine, a non-competitive antagonist of the N-methyl-D-aspartate-glutamate receptor (R-NMDA), has a rapid (from 24 h post-dose) and prolonged (up to one week) antidepressant effect in treatment resistant depression and in rodent models of anxiety/depression. Arguments regarding its cellular and molecular mechanisms underlying its antidepressant activity mainly come from animal studies. However, debates still persist on the structural remodeling of frontocortical/hippocampal neurons and the role of excitatory/inhibitory neurotransmitters involved in its behavioral effect. Neurochemical and behavioral changes are maintained 24 h after administration of ketamine, well beyond its plasma elimination half-life. The glutamatergic pyramidal cells of the medial prefrontal cortex are primarily implicated in the therapeutic effects of ketamine. Advances in knowledge of the consequences of R-NMDA blockade allowed to specify the underlying mechanisms involving the activation of AMPA glutamate receptors, which triggers a cascade of intracellular events dependent on the mechanistic target of rapamycin, brain-derived neurotrophic factor, and synaptic protein synthesis facilitating synaptic plasticity (number of dendritic spines, synaptogenesis). This review focuses on abnormalities of neurotransmitter systems involved in major depressive disorders, their potential impact on neural circuitry and beneficial effects of ketamine. Recent preclinical data pave the way for future studies to better clarify the mechanism of action of fast-acting antidepressant drugs for the development of novel, more effective therapies.
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Affiliation(s)
- Jean-Philippe Guilloux
- Laboratoire de Neuropharmacologie, Université Paris-Saclay, Faculté de Pharmacie, Inserm CESP/UMR 1018, Équipe MOODS, F-91400 Orsay, France
| | - Thi Mai Loan Nguyen
- Laboratoire de Neuropharmacologie, Université Paris-Saclay, Faculté de Pharmacie, Inserm CESP/UMR 1018, Équipe MOODS, F-91400 Orsay, France
| | - Alain M Gardier
- Laboratoire de Neuropharmacologie, Université Paris-Saclay, Faculté de Pharmacie, Inserm CESP/UMR 1018, Équipe MOODS, F-91400 Orsay, France
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Bottemanne H, Arnould A, Najar A, Delaigue F, Serresse L, Joly L, Mouchabac S. [Combination of ketamine and esketamine with Exposure and Response Prevention (ERP) therapy for Obsessive-Compulsive Disorder]. L'ENCEPHALE 2023; 49:304-311. [PMID: 37095049 DOI: 10.1016/j.encep.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/24/2022] [Accepted: 08/04/2022] [Indexed: 04/26/2023]
Abstract
Obsessive-Compulsive Disorder (OCD), characterized by the combination of obsession and compulsion, is a clinical and therapeutic challenge. Many patients with OCD do not respond to first-line treatments such as serotonin selective reuptake inhibitors (SSRIs) and exposure and response prevention psychotherapy (ERP). For these resistant patients, some preliminary studies have shown that ketamine, a non-selective glutamatergic NMDA receptors antagonist, could improve the obsessive symptoms. A number of these studies have also suggested that the combination of ketamine with ERP psychotherapy may jointly potentiate the effectiveness of ketamine and ERP. In this paper, we present the existing data on the combined use of ketamine with ERP psychotherapy for OCD. We suggest that modulation of NMDA receptor activity and glutamatergic signaling by ketamine may promote the therapeutic mechanisms involved in ERP such as fear extinction and brain plasticity mechanisms. Finally, we propose a ketamine-augmented ERP psychotherapy (KAP-ERP) protocol in OCD, and we present the limitations associated with its application in clinical practice.
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Affiliation(s)
- Hugo Bottemanne
- Paris Brain Institute - Institut du Cerveau (ICM), UMR 7225/UMRS 1127, Sorbonne University/CNRS/Inserm, Paris, France; Sorbonne University, Department of Philosophy, SND Research Unit, UMR 8011, CNRS, Paris, France; Department of Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
| | - Alice Arnould
- Department of Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Amaury Najar
- Department of Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Fanny Delaigue
- Department of Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Laure Serresse
- Sorbonne University, Unité Mobile d'Accompagnement et de Soins Palliatifs, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Lucie Joly
- Paris Brain Institute - Institut du Cerveau (ICM), UMR 7225/UMRS 1127, Sorbonne University/CNRS/Inserm, Paris, France; Department of Psychiatry, Saint Antoine Hospital, Sorbonne University, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Stéphane Mouchabac
- Paris Brain Institute - Institut du Cerveau (ICM), UMR 7225/UMRS 1127, Sorbonne University/CNRS/Inserm, Paris, France; Department of Psychiatry, Saint Antoine Hospital, Sorbonne University, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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Bottemanne H, Barberousse A, Fossati P. [Multidimensional and computational theory of mood]. Encephale 2022; 48:682-699. [PMID: 35987716 DOI: 10.1016/j.encep.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 12/22/2022]
Abstract
What is mood? Despite its crucial place in psychiatric nosography and cognitive science, it is still difficult to delimit its conceptual ground. The distinction between emotion and mood is ambiguous: mood is often presented as an affective state that is more prolonged and less intense than emotion, or as an affective polarity distinguishing high and low mood swinging around a baseline. However, these definitions do not match the clinical reality of mood disorders such as unipolar depression and bipolar disorder, and do not allow us to understand the effect of mood on behaviour, perception and cognition. In this paper, we propose a multidimensional and computational theory of mood inspired by contemporary hypotheses in theoretical neuroscience and philosophy of emotion. After suggesting an operational distinction between emotion and mood, we show how a succession of emotions can cumulatively generate congruent mood over time, making mood an emerging state from emotion. We then present how mood determines mental and behavioral states when interacting with the environment, constituting a dispositional state of emotion, perception, belief, and action. Using this theoretical framework, we propose a computational representation of the emerging and dispositional dimensions of mood by formalizing mood as a layer of third-order Bayesian beliefs encoding the precision of emotion, and regulated by prediction errors associated with interoceptive predictions. Finally, we show how this theoretical framework sheds light on the processes involved in mood disorders, the emergence of mood congruent beliefs, or the mechanisms of antidepressant treatments in clinical psychiatry.
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Affiliation(s)
- Hugo Bottemanne
- Paris Brain Institute - Institut du Cerveau (ICM), Sorbonne University/CNRS/Inserm, Paris, France; Department of philosophy, Sciences Normes Démocratie research unit, Sorbonne university/CNRS, Paris, France; Department of psychiatry, DMU Neuroscience, Pitié-Salpêtrière hospital, Sorbonne university/Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France.
| | - Anouk Barberousse
- Department of philosophy, Sciences Normes Démocratie research unit, Sorbonne university/CNRS, Paris, France
| | - Philippe Fossati
- Paris Brain Institute - Institut du Cerveau (ICM), Sorbonne University/CNRS/Inserm, Paris, France; Department of psychiatry, DMU Neuroscience, Pitié-Salpêtrière hospital, Sorbonne university/Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
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4
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L’esprit predictif : introduction à la théorie du cerveau bayésien. Encephale 2022; 48:436-444. [DOI: 10.1016/j.encep.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 01/13/2023]
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Bottemanne H, Frileux S, Guesdon A, Fossati P. [Belief updating and mood congruence in depressive disorder]. Encephale 2021; 48:188-195. [PMID: 34916079 DOI: 10.1016/j.encep.2021.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/27/2021] [Accepted: 06/12/2021] [Indexed: 12/28/2022]
Abstract
Depressive disorder is characterized by a polymorphic symptomatology associating emotional, cognitive and behavioral disturbances. One of the most specific symptoms is negative beliefs, called congruent to mood. Despite the importance of these beliefs in the development, the maintenance, and the recurrence of depressive episodes, little is known about the processes underlying the generation of depressive beliefs. In this paper, we detail the link between belief updating mechanisms and the genesis of depressive beliefs. We show how depression alters information processing, generating cognitive immunization when processing positive information, affective updating bias related to the valence of belief and prediction error, and difficultie to disengage from negative information. We suggest that disruption of belief-updating mechanisms forms the basis of belief-mood congruence in depression.
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Affiliation(s)
- H Bottemanne
- Paris Brain Institute - Institut du Cerveau (ICM), UMR 7225/UMRS 1127, CNRS / INSERM, Sorbonne university, Paris, France; Sorbonne University, Department of Philosophy, SND Research Unit, UMR 8011, CNRS, Paris, France; Department of psychiatry, Pitié-Salpêtrière hospital, DMU Neuroscience, Sorbonne university, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France.
| | - S Frileux
- Paris Brain Institute - Institut du Cerveau (ICM), UMR 7225/UMRS 1127, CNRS / INSERM, Sorbonne university, Paris, France; Department of psychiatry, Pitié-Salpêtrière hospital, DMU Neuroscience, Sorbonne university, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - A Guesdon
- Paris Brain Institute - Institut du Cerveau (ICM), UMR 7225/UMRS 1127, CNRS / INSERM, Sorbonne university, Paris, France; Department of psychiatry, Pitié-Salpêtrière hospital, DMU Neuroscience, Sorbonne university, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - P Fossati
- Paris Brain Institute - Institut du Cerveau (ICM), UMR 7225/UMRS 1127, CNRS / INSERM, Sorbonne university, Paris, France; Department of psychiatry, Pitié-Salpêtrière hospital, DMU Neuroscience, Sorbonne university, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
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[Ketamine Augmented Psychotherapy (KAP) in mood disorder: User guide]. Encephale 2021; 48:304-312. [PMID: 34876279 DOI: 10.1016/j.encep.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/30/2021] [Accepted: 08/20/2021] [Indexed: 01/02/2023]
Abstract
Ketamine, a non-competitive NMDA receptor antagonist, is used as a fast-acting antidepressant therapy in depressive disorders. This treatment provokes dissociative effects associating derealization and depersonalization, and a synaptogenic signaling cascade promoting brain plasticity. Despite several preliminary studies suggesting the usefulness of its combination with psychotherapy, administration of ketamine isn't generally combined with per- and post-infusion psychotherapy protocols in its clinical antidepressant use. However, the phenomenology of psychodysleptic experiences and the synaptogenic effect could potentiate cognitive and behavioral therapies (CBT). In this article, we purpose a practical protocol to Ketamine Augmented Psychotherapy (KAP) synthesizing contemporary data from the literature and our clinical experience. We detail proposals for clinical practice, and propose four important steps for the use of a psychodysleptic molecule for antidepressant purposes: preparation, administration, integration, and prolongation. Finally, we discuss the limits and prospects of this combination in the management of mood disorders.
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