1
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Dart RC. Can mind-altering prescription medicines be safe? Lessons from ketamine and esketamine. Clin Toxicol (Phila) 2024:1-6. [PMID: 39091275 DOI: 10.1080/15563650.2024.2380773] [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: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Recent decades have witnessed an extraordinary global crisis of drug misuse. Although opioid analgesics receive the most attention, numerous other drugs have increased rates of misuse. KETAMINE AND ESKETAMINE Ketamine and esketamine offer a unique natural experiment to explore two medications that are similar pharmacologically but differ in their availability to users and in their regulation by government agencies. MISUSE AND ABUSE OF KETAMINE AND ESKETAMINE Multisystem "mosaic" surveillance of many drugs using real-world data has emerged in recent years. Ketamine and esketamine have been monitored concurrently. Ketamine is much more widely available than esketamine and shows clear signs of increasing misuse and abuse. In contrast, esketamine is difficult to detect in postmarket surveillance even though availability is increasing. DISCUSSION Ketamine and esketamine offer insights regarding the safety of prescription medications with the potential for misuse. Since the pharmacology of ketamine and esketamine are similar, the regulatory apparatus may be the primary difference that limits misuse. Ketamine has few restrictions and can be prescribed or administered by many healthcare providers, and is available as an illicit drug. In contrast, the product labeling for esketamine has rigorous restrictions on its use. Many important issues remain to be addressed. We need a more rigorous evaluation of the natural experiment of ketamine and esketamine. How does this experience relate to the introduction of new psychedelics? CONCLUSIONS Ketamine misuse use and misuse are increasing while esketamine use in increasing, but misuse is not increasing. It is reasonable to reevaluate the regulatory controls on ketamine to reduce its misuse and abuse.
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Affiliation(s)
- Richard C Dart
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, University of Colorado School of Medicine, Denver, CO, USA
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2
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Yang X, Chen D. Comparing the adverse effects of ketamine and esketamine between genders using FAERS data. Front Pharmacol 2024; 15:1329436. [PMID: 39070784 PMCID: PMC11272469 DOI: 10.3389/fphar.2024.1329436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 06/11/2024] [Indexed: 07/30/2024] Open
Abstract
Background Ketamine was developed as an anesthetic. Esketamine is the isolated S-enantiomer of racemic ketamine. They provide new avenues for the treatment of depression, especially treatment-resistant depression. Considering differences in the pharmacokinetics and hormonal status of ketamine in patients of different genders, sex-based differences in esketamine adverse drug events (ADE) may also be observed. This study presents data mining and safety analysis of adverse events of ketamine and esketamine between genders, promoting the individualization of clinical practice. Methods Adverse drug reactions to ketamine and esketamine reported between the first quarter of 2004 and the second quarter of 2023 in the U.S. Food and Drug Administration on Adverse Event Reporting System (FAERS) were extracted. Thereafter, the reporting odds ratio (ROR) with 95% confidence interval (CI) was calculated. Results A total of 2907 female reports and 1634 male reports on esketamine were included in the analysis. ROR mining showed that completed suicide, decreased therapeutic product effects, urinary retention, and hypertension were common in men. Additionally, 552 female and 653 male ketamine reports were recorded. ROR mining revealed that toxicity to various agents, bradycardia, cystitis and agitation, were more likely to occur in men, whereas women were more likely to develop suicidal ideation, increased transaminase levels, sclerosing cholangitis, and sterile pyuria. Conclusion The adverse events of esketamine and ketamine differ across genders, which should be considered in clinical practice to provide individualized treatment.
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Affiliation(s)
| | - Dongdong Chen
- The Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
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3
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Liu R, Liu C, Feng D, Guo T, Wang Y. Pharmacovigilance of esketamine nasal spray: an analysis of the FDA adverse event reporting system database. Front Pharmacol 2024; 15:1414703. [PMID: 38948465 PMCID: PMC11211360 DOI: 10.3389/fphar.2024.1414703] [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: 04/09/2024] [Accepted: 05/20/2024] [Indexed: 07/02/2024] Open
Abstract
Esketamine nasal spray (ESK-NS) is a new drug for treatment-resistant depression, and we aimed to detect and characterize the adverse events (AEs) of ESK-NS using the Food and Drug Administration (FDA) adverse event reporting system (FAERS) database between 2019 Q1 and 2023 Q4. Reporting odds ratio (ROR), proportional reporting ratio (PRR), and multi-item gamma Poisson shrinker (MGPS) were performed to detect risk signals from the FAERS data to identify potential ESK-NS-AEs associations. A total of 14,606 reports on AEs with ESK-NS as the primary suspected drug were analyzed. A total of 518 preferred terms signals and 25 system organ classes mainly concentrated in psychiatric disorders (33.20%), nervous system disorders (16.67%), general disorders and administration site conditions (14.21%), and others were obtained. Notably, dissociation (n = 1,093, ROR 2,257.80, PRR 899.64, EBGM 876.86) exhibited highest occurrence rates and signal intensity. Moreover, uncommon but significantly strong AEs signals, such as hand-eye coordination impaired, feeling guilty, and feelings of worthlessness, were observed. Additionally, dissociative disorder (n = 57, ROR 510.92, PRR 506.70, EBGM 386.60) and sedation (n = 688, ROR 172.68, PRR 155.53, and EBGM 142.05) both presented strong AE signals, and the former is not recorded in the Summary of Product Characteristics (SmPC). In clinical applications, close attention should be paid to the psychiatric disorders and nervous system disorders, especially dissociation. Meanwhile, clinical professionals should be alert for the occurrence of AEs signals not mentioned in the SmPC and take preventive measures to ensure the safety of clinical use.
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Affiliation(s)
| | | | | | | | - Ying Wang
- Tianjin Anding Hospital, Tianjin, China
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4
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Carroll A, Bayes A, Montebello M, Brett J, Arunogiri S, Saunders JB, Loo CK. Drug dependence and prescribing ketamine for treatment-resistant depression in Australia and New Zealand. Aust N Z J Psychiatry 2024:48674241242315. [PMID: 38561896 DOI: 10.1177/00048674241242315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Ketamine is a restricted and regulated medication in Australia and New Zealand, which has implications when considering treatment for patients with treatment-resistant depression and a history of illicit drug use, abuse or dependence. Regulations governing prescription of ketamine for treatment-resistant depression vary between jurisdictions in Australia and New Zealand, though most restrict use in those with drug dependence. There is substantial variation in definitions of drug dependence used in each jurisdiction, and between the legal and clinical definitions, with the latter specified in the current International Classification of Diseases, Eleventh Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This paper reviews the literature assessing the risk of ketamine misuse and dependence in patients with a history of illicit drug use, abuse or dependence and presents recommendations for psychiatrists who prescribe ketamine in such patients with treatment-resistant depression.
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Affiliation(s)
- Alistair Carroll
- Neuromodulation and Interventional Psychiatry, Black Dog Institute, Sydney, NSW, Australia
- Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Adam Bayes
- Neuromodulation and Interventional Psychiatry, Black Dog Institute, Sydney, NSW, Australia
- Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Mark Montebello
- Drug and Alcohol Services, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Specialty of Addiction Medicine, The University of Sydney, Camperdown, NSW, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Jonathan Brett
- Clinical Pharmacology & Toxicology and Addiction Medicine, St Vincent's Hospital, Sydney, NSW, Australia
- NSW Poisons Information Centre, The Children's Hospital at Westmead, NSW, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
- Medicines and Health Intelligence, School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Shalini Arunogiri
- Statewide Addiction and Mental Health Centre, Turning Point, Eastern Health, Melbourne, VIC, Australia
- Monash Addiction Research Centre, Monash University, Melbourne, VIC, Australia
| | - John B Saunders
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD, Australia
| | - Colleen K Loo
- Neuromodulation and Interventional Psychiatry, Black Dog Institute, Sydney, NSW, Australia
- Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Cardiovascular program. The George Institute for Global Health, Sydney, NSW, Australia
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5
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Hilal F, Jeanblanc J, Naassila M. [Interest and mechanisms of action of ketamine in alcohol addiction- A review of clinical and preclinical studies]. Biol Aujourdhui 2023; 217:161-182. [PMID: 38018944 DOI: 10.1051/jbio/2023028] [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: 05/19/2023] [Indexed: 11/30/2023]
Abstract
Alcohol Use Disorder (AUD) is a psychiatric condition characterized by chronic and excessive drinking despite negative consequences on overall health and social or occupational functioning. There are currently limited treatment options available for AUD, and the effects size and the response rates to these treatments are often low to moderate. The World Health Organization has identified the development of medications to treat AUD as one of its 24 priorities. This past decade was marked by a renewed interest in psychedelic use in psychiatry. At the centre of this renaissance, ketamine, an atypical psychedelic already used in the treatment of major depression, is an NMDA receptor antagonist that exists as a racemic compound made of two enantiomers, S-ketamine, and R-ketamine. Each form can be metabolized into different metabolites, some of which having antidepressant properties. In this article, we review both clinical and preclinical studies on ketamine and its metabolites in the treatment of AUD. Preclinical as well as clinical studies have revealed that ketamine is effective in reducing withdrawal symptoms and alcohol craving. Convergent data showed that antidepressant properties of ketamine largely contribute to the decreased likelihood of alcohol relapse, especially in patients undergoing ketamine-assisted psychotherapies. Its effectiveness is believed to be linked with its ability to regulate the glutamatergic pathway, enhance neuroplasticity, rewire brain resting state network functional connectivity and decrease depressive-like states. However, it remains to further investigate (i) why strong differences exist between male and female responses in preclinical studies and (ii) the respective roles of each of the metabolites in the ketamine effects in both genders. Interestingly, current studies are also focusing on ketamine addiction and the comorbidity between alcohol addiction and depression occurring more frequently in females.
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Affiliation(s)
- Fahd Hilal
- Groupe de recherche sur l'alcool et les pharmacodépendances, INSERM U1247, CURS, Amiens, France
| | - Jérôme Jeanblanc
- Groupe de recherche sur l'alcool et les pharmacodépendances, INSERM U1247, CURS, Amiens, France
| | - Mickaël Naassila
- Groupe de recherche sur l'alcool et les pharmacodépendances, INSERM U1247, CURS, Amiens, France
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6
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Vizgan G, Huamán M, Rychik K, Edeson M, Blaivas JG. Ketamine-induced uropathy: A narrative systemic review of surgical outcomes of reconstructive surgery. BJUI COMPASS 2023; 4:377-384. [PMID: 37334018 PMCID: PMC10268589 DOI: 10.1002/bco2.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/12/2023] [Accepted: 03/17/2023] [Indexed: 06/20/2023] Open
Abstract
Aims Refractory ketamine-induced uropathy (KU) (RKU) has devastating effects on the lower urinary tract leading to ureteral obstruction and even renal failure. The only effective treatment for RKU is major surgical reconstruction or urinary diversion. Nevertheless, there is a paucity of awareness about this destructive condition; the aim of this study is to conduct a narrative systemic review of all surgical outcomes of RKU. Methods This is an English language literature review of surgical outcomes in KU patients who underwent reconstructive lower urinary tract surgery or urinary diversion through 5 August 2022. Two independent researchers assessed the relevance of each paper and disputes were settled by a third party. In-vitro, animal studies, letters to the editor and papers that did not evaluate surgical outcomes were excluded. Results Of the 50 763 identified articles, 622 were relevant based on title, 150 based on abstract, but only 23 papers were relevant by content. In all, 875 patients were documented as having KU, of whom 193 (22%) underwent reconstructive surgery. The data were disconcerting, as the apparent rapid progression from the beginning of KU to end-stage bladder was only a 1-year difference of ketamine abuse between those patients who required surgery (4.4 years) and those that did not (3.4 years). Conclusions The data suggest that the time interval from the beginning of ketamine-induced uropathy to the end-stage bladder may be measured in months, confounding decision making. There is a dearth of literature about KU, and more research is needed to better understand this pathology.
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Affiliation(s)
- Gabriel Vizgan
- SUNY DownstateBrooklynNew YorkUSA
- Department of UrologyInstitute for Bladder and Prostate ResearchNew YorkNew YorkUSA
| | - Michael Huamán
- Department of UrologyInstitute for Bladder and Prostate ResearchNew YorkNew YorkUSA
| | - Kevin Rychik
- Duke University Medical CenterDurhamNorth CarolinaUSA
| | - Max Edeson
- Hackensack Meridian School of MedicineNew JerseyUSA
| | - Jerry G. Blaivas
- SUNY DownstateBrooklynNew YorkUSA
- Department of UrologyInstitute for Bladder and Prostate ResearchNew YorkNew YorkUSA
- Department of UrologyMount Sinai Health SystemNew YorkNew YorkUSA
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7
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Wu SY, Hsu CK, Lim LY, Chen YC, Chang HH, Yang SSD. Ketamine Inhalation Alters Behavior and Lower Urinary Tract Function in Mice. Biomedicines 2022; 11:biomedicines11010075. [PMID: 36672583 PMCID: PMC9855675 DOI: 10.3390/biomedicines11010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/26/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
We aimed to evaluate behavioral and lower urinary tract changes in mice using a novel ketamine inhalation model mimicking human ketamine abusers and compare the results to those obtained using a ketamine intraperitoneal injection model. C57BL/6N mice were placed in a transparent acrylic observation cage connected to an ultrasonic nebulizer producing ketamine (KI) or saline (SI) fog. The mice were given KI or SI fog twice a week for three months. In another experiment arm, the mice were given intraperitoneal ketamine injections (KP) or saline injections (SP) twice a week for three months. The presence of urine ketamine (>100 ng/mL) was determined using a quick test kit. Locomotor activity was recorded by video using the open field test. Lower urinary tract function was assessed using urine spots, cystometry and histology. KI and KP mice crossed the center more frequently and traveled farther than SI and SP mice. Only KI mice, however, demonstrated popcorn-like jumping, and frequent center crossing. Detrusor overactivity, reduced cystometric bladder capacity, and denuded mucosa were observed in both KI and KP mice. Ketamine inhalation induces behavioral and lower urinary tract changes in mice that are comparable to intraperitoneal ketamine injections.
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Affiliation(s)
- Shu-Yu Wu
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Chun-Kai Hsu
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Li-Yi Lim
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
- Department of Surgery, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur 56000, Malaysia
| | - Yi-Chyan Chen
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
| | - Hsi-Hsien Chang
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
| | - Stephen Shei-Dei Yang
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Correspondence: ; Tel.: +886-266289779
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8
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Anderson DJ, Zhou J, Cao D, McDonald M, Guenther M, Hasoon J, Viswanath O, Kaye AD, Urits I. Ketamine-Induced Cystitis: A Comprehensive Review of the Urologic Effects of This Psychoactive Drug. Health Psychol Res 2022; 10:38247. [PMID: 36118982 PMCID: PMC9476224 DOI: 10.52965/001c.38247] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Ketamine is a common medical anesthetic and analgesic but is becoming more widely used as a recreational drug. Significant side effects on the urinary tract are associated with frequent recreational ketamine use most notably ketamine-induced cystitis (KIC). Regular ketamine consumption has been shown to increase the risk of cystitis symptoms by 3- to 4-fold, and cessation of ketamine use is usually associated with improvement of symptoms. Common KIC-related problems are urinary pain and discomfort, bladder epithelial barrier damage, reduced bladder storage and increased pressure, ureter stenosis, and kidney failure, all of which significantly impact patients' quality of life. Furthermore, it becomes a vicious cycle when KIC patients attempt to manage their urinary pain with increased ketamine use. The precise pathophysiology of KIC is still unknown but several theories exist, most of which highlight the inflammatory signaling pathways leading to bladder epithelium damage due to presence of ketamine in the urine. Empirical treatment options for KIC are available and consist of ketamine cessation, noninvasive therapies, and surgery, and should be decided upon based on the time course and severity of the disease. Of note, cessation of use is strongly recommended for all KIC patients, and should be supplemented with motivational interviews and psychological and social support. It is crucial for clinicians to be familiar with KIC diagnosis and treatment, and to be prepared to have informed discussions with ketamine-using patients about the potential health consequences of ketamine.
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Affiliation(s)
| | - Jessica Zhou
- School of Medicine, Medical College of Wisconsin
| | - David Cao
- School of Medicine, Medical College of Wisconsin
| | - Matthew McDonald
- School of Medicine, Rocky Vista University College of Osteopathic Medicine
| | | | - Jamal Hasoon
- Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Omar Viswanath
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Valley Anesthesiology and Pain Consultants, Envision Physician Services; Department of Anesthesiology, University of Arizona College of Medicine Phoenix; Department of Anesthesiology, Creighton University School of Medicine
| | - Alan D Kaye
- Department of Anesthesia, Louisiana State University Health
| | - Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Anesthesiology, Louisiana State University Health Shreveport
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9
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Orsolini L, Salvi V, Volpe U. Craving and addictive potential of esketamine as side effects? Expert Opin Drug Saf 2022; 21:803-812. [PMID: 35509224 DOI: 10.1080/14740338.2022.2071422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Esketamine was approved for adults with treatment-resistant depression (TRD) in conjunction with an oral antidepressant, and for treating depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior. However, evidence of great efficacy and safety of esketamine is accompanied by a widespread concern regarding its addictive potential. AREAS COVERED A comprehensive review on the craving and addictive potential of ketamine and esketamine was carried out. In addition, a clinical case of a 34-year-old TRD woman treated with esketamine who experienced drug-seeking behaviors and craving symptomatology was described and critically discussed, with a particular focus on treatment strategies to manage craving in the short- and long term. EXPERT OPINION Esketamine showed great efficacy and safety in treating TRD and MDD with acute suicidal ideation or behavior. Our clinical experience demonstrated the presence of an additive potential, which has been favorably managed with slow esketamine de-titration and combination with bupropion. However, literature so far published is scant and shows contradictory findings. Therefore, it is crucial to promptly detect and manage craving symptomatology in esketamine-treated TRD patients. In our experience, the use of bupropion to counteract craving and addictive symptoms was proven to be effective and safe.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Virginio Salvi
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
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10
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Guo H, Wang B, Yuan S, Wu S, Liu J, He M, Wang J. Neurological Adverse Events Associated With Esketamine: A Disproportionality Analysis for Signal Detection Leveraging the FDA Adverse Event Reporting System. Front Pharmacol 2022; 13:849758. [PMID: 35462924 PMCID: PMC9023790 DOI: 10.3389/fphar.2022.849758] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/21/2022] [Indexed: 12/19/2022] Open
Abstract
Esketamine was approved for the treatment of treatment-resistant depression in 2019. After the approval of esketamine, numerous concerns have been raised regarding its long-term safety and tolerability. A previous systematic pharmacovigilance study on esketamine-related adverse events (AEs) was published in 2020; however, it has not been updated 2 years later. The primary aim of this study was to detect and characterize neurological safety signals of esketamine to partially update the knowledge in this field using the FDA pharmacovigilance database. Reporting odds ratio (ROR) was calculated for esketamine-related neurological AEs from 2019 to 2021 with a signal considered when the lower limit of the 95% confidence interval (CI) of ROR (ROR025) exceeded one. Severe and non-severe cases were compared using an independent samples t-test or chi-squared (χ2) test, and a rating scale was used to prioritize the signals. The database contained 720 cases of esketamine-associated neurological AEs, with 21 signals detected, ranging from a ROR025 of 1.05 (disturbance in attention) to 204.00 (sedation). 16 latest neurological AEs emerged in the second year of marketing approval of esketamine, with eight signals detected. The associations between esketamine and nervous system disorders persisted when stratifying by sex, age, and reporter type, whereas the spectrum of neurological AEs differed in stratification regimens. Esketamine dosage, antidepressant polypharmacy, or co-prescription with benzodiazepines affected AEs severity (t = 2.41, p = 0.017; χ2 = 6.75, p = 0.009; and χ2 = 4.10, p = 0.043; respectively), while age and sex did not (p = 0.053 and p = 0.397, respectively). Three signals were categorized as moderate clinical priority [i.e., sedation, dizziness, and dysgeusia (priority points 7, 5, and 5, respectively)], showing the same early failure type profiles. Notably, seven detected disproportionality signals were not previously detected in clinical trials. Although the majority of results were in line with those obtained in the previous study, there were discrepancies in the spectrum of neurological AEs and the effects of several risk factors on AEs severity among the two studies that should be recognized and managed early in clinical treatments.
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Affiliation(s)
- Haoning Guo
- Division of Psychopharmacology, Department of Pharmacy, The Third Hospital of Mianyang Sichuan Mental Health Center, Mianyang, China
| | - Bin Wang
- Clinical Experimental Center, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-sen University, Jiangmen, China
| | - Shuying Yuan
- Division of Psychopharmacology, Department of Pharmacy, The Third Hospital of Mianyang Sichuan Mental Health Center, Mianyang, China
| | - Silin Wu
- Division of Psychopharmacology, Department of Pharmacy, The Third Hospital of Mianyang Sichuan Mental Health Center, Mianyang, China
| | - Jing Liu
- Department of Pathology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
- *Correspondence: Jing Liu, ; Miaoquan He, ; Jisheng Wang,
| | - Miaoquan He
- Division of Psychopharmacology, Department of Pharmacy, The Third Hospital of Mianyang Sichuan Mental Health Center, Mianyang, China
- *Correspondence: Jing Liu, ; Miaoquan He, ; Jisheng Wang,
| | - Jisheng Wang
- Division of Psychopharmacology, Department of Pharmacy, The Third Hospital of Mianyang Sichuan Mental Health Center, Mianyang, China
- *Correspondence: Jing Liu, ; Miaoquan He, ; Jisheng Wang,
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11
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Lengvenyte A, Strumila R, Olié E, Courtet P. Ketamine and esketamine for crisis management in patients with depression: Why, whom, and how? Eur Neuropsychopharmacol 2022; 57:88-104. [PMID: 35219097 DOI: 10.1016/j.euroneuro.2022.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/13/2022]
Abstract
Currently, only a limited number of interventions can rapidly relieve depressive symptomatology in patients with major depressive disorder or bipolar disorder experiencing extreme distress. Such crises, especially when suicide attempt or ideation is involved, are a major risk factor of suicide. Ketamine, a N-methyl-d-aspartate glutamate receptor antagonist, and its enantiomer esketamine rapidly reduce depressive symptoms in depressed patients with current suicidal ideation. Recently, esketamine has been approved for use in patients with depression at risk of suicide and for psychiatric emergency by major medical agencies in the United States and Europe, whereas ketamine is increasingly used off-label. However, there is currently limited guidance on why, when, and how to use these drugs in patients with depression to treat a crisis. In this review article, we provide a succinct overview of the cellular and molecular mechanisms of action of ketamine and esketamine, and of the functional brain changes following their administration. We also summarize the major clinical studies on ketamine and esketamine efficacy in patients experiencing a crisis (generally, suicidal ideation), and propose a profile of patients who can benefit most from such drugs, on the basis of neurobiological and clinical observations. Finally, we describe the administration mode, the efficacy and tolerability profiles, the side effect management, possible concomitant treatments and the issue of deprescribing.
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Affiliation(s)
- Aiste Lengvenyte
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France; Psychiatric Clinic, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Robertas Strumila
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France; Psychiatric Clinic, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
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12
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Molecular Pathophysiology and Potential Therapeutic Strategies of Ketamine-Related Cystitis. BIOLOGY 2022; 11:biology11040502. [PMID: 35453701 PMCID: PMC9029571 DOI: 10.3390/biology11040502] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 02/06/2023]
Abstract
Ketamine was first synthesized as a clinical medicine for anesthesia in 1970. It has been used as a recreational drug because of its low cost and hallucination effect in the past decade. Part of ketamine abusers may experience ketamine-related cystitis (KC) and suffer from lower urinary tract symptoms, including urinary frequency, urgency, and severe bladder pain. As the disease progression, a contracted bladder, petechial hemorrhage of the bladder mucosa, and ureteral stricture with hydronephrosis may occur. The pathophysiology of KC is still uncertain, although several hypotheses have been raised. Cessation of ketamine abuse is critical for the management of KC to prevent progressive disease, and effective treatment has not been established. Research has provided some theoretical bases for developing in vitro experiments, animal models, and clinical trials. This review summarized evidence of molecular mechanisms of KC and potential treatment strategies for KC. Further basic and clinical studies will help us better understand the mechanism and develop an effective treatment for KC.
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Highland JN, Farmer CA, Zanos P, Lovett J, Zarate CA, Moaddel R, Gould TD. Sex-dependent metabolism of ketamine and ( 2R,6R)-hydroxynorketamine in mice and humans. J Psychopharmacol 2022; 36:170-182. [PMID: 34971525 PMCID: PMC9904319 DOI: 10.1177/02698811211064922] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ketamine is rapidly metabolized to norketamine and hydroxynorketamine (HNK) metabolites. In female mice, when compared to males, higher levels of (2R,6R;2S,6S)-HNK have been observed following ketamine treatment, and higher levels of (2R,6R)-HNK following the direct administration of (2R,6R)-HNK. AIM The objective of this study was to evaluate the impact of sex in humans and mice, and gonadal hormones in mice on the metabolism of ketamine to form norketamine and HNKs and in the metabolism/elimination of (2R,6R)-HNK. METHODS In CD-1 mice, we utilized gonadectomy to evaluate the role of circulating gonadal hormones in mediating sex-dependent differences in ketamine and (2R,6R)-HNK metabolism. In humans (34 with treatment-resistant depression and 23 healthy controls) receiving an antidepressant dose of ketamine (0.5 mg/kg i.v. infusion over 40 min), we evaluated plasma levels of ketamine, norketamine, and HNKs. RESULTS In humans, plasma levels of ketamine and norketamine were higher in males than females, while (2R,6R;2S,6S)-HNK levels were not different. Following ketamine administration to mice (10 mg/kg i.p.), Cmax and total plasma concentrations of ketamine and norketamine were higher, and those of (2R,6R;2S,6S)-HNK were lower, in intact males compared to females. Direct (2R,6R)-HNK administration (10 mg/kg i.p.) resulted in higher levels of (2R,6R)-HNK in female mice. Ovariectomy did not alter ketamine metabolism in female mice, whereas orchidectomy recapitulated female pharmacokinetic differences in male mice, which was reversed with testosterone replacement. CONCLUSION Sex is an important biological variable that influences the metabolism of ketamine and the HNKs, which may contribute to sex differences in therapeutic antidepressant efficacy or side effects.
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Affiliation(s)
- Jaclyn N. Highland
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore MD, USA.,Program in Toxicology, University of Maryland School of Medicine, Baltimore MD, USA
| | - Cristan A. Farmer
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda MD, USA
| | - Panos Zanos
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore MD, USA.,Pharmacology, University of Maryland School of Medicine, Baltimore MD, USA.,Physiology, University of Maryland School of Medicine, Baltimore MD, USA
| | - Jacqueline Lovett
- Biomedical Research Center, National Institute on Aging, Intramural Research Program, National Institutes of Health, Baltimore MD, USA
| | - Carlos A. Zarate
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda MD, USA
| | - Ruin Moaddel
- Biomedical Research Center, National Institute on Aging, Intramural Research Program, National Institutes of Health, Baltimore MD, USA
| | - Todd D. Gould
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore MD, USA.,Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda MD, USA.,Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore MD, USA.,Veterans Affairs Maryland Health Care System, Baltimore MD, USA.,Reprint requests: Todd D. Gould, Rm. 936 MSTF 685 W. Baltimore St., Baltimore, MD, 21201, USA.
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Combination of electroconvulsive stimulation with ketamine or escitalopram protects the brain against inflammation and oxidative stress induced by maternal deprivation and is critical for associated behaviors in male and female rats. Mol Neurobiol 2022; 59:1452-1475. [PMID: 34994953 DOI: 10.1007/s12035-021-02718-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/23/2021] [Indexed: 12/24/2022]
Abstract
This study aimed at evaluating the treatment effects with ketamine, electroconvulsive stimulation (ECS), escitalopram, alone or in combination in adult rats of both sexes, subjected to the animal model of maternal deprivation (MD). All groups were subjected to the forced swimming test (FST), splash and open field tests. The prefrontal cortex (PFC), hippocampus and serum were collected to analyze oxidative stress and inflammatory parameters. MD induced depressive-like behavior in the FST test in males and reduced grooming time in male and female rats. The treatments alone or combined reversed depressive and anhedonic behavior in females. In males, all treatments increased grooming time, except for ECS + escitalopram + ketamine. MD increased lipid peroxidation and protein carbonylation, nitrite/nitrate concentration and myeloperoxidase activity in the PFC and hippocampus of males and females. However, the treatment's response was sex dependent. Catalase activity decreased in the PFC of males and the PFC and hippocampus of females, and most treatments were not able to reverse it. MD increased the inflammation biomarkers levels in the PFC and hippocampus of males and females, and most treatments were able to reverse this increase. In all groups, a reduction in the interleukin-10 levels in the PFC and hippocampus of female and male rats was observed. Our study shows different responses between the sexes in the patterns evaluated and reinforces the use of the gender variable as a biological factor in MDD related to early stress and in the response of the therapeutic strategies used.
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Ponton E, Turecki G, Nagy C. Sex Differences in the Behavioral, Molecular, and Structural Effects of Ketamine Treatment in Depression. Int J Neuropsychopharmacol 2021; 25:75-84. [PMID: 34894233 PMCID: PMC8756094 DOI: 10.1093/ijnp/pyab082] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/08/2021] [Accepted: 11/15/2021] [Indexed: 12/14/2022] Open
Abstract
Major depressive disorder (MDD) is a common psychiatric illness that manifests in sex-influenced ways. Men and women may experience depression differently and also respond to various antidepressant treatments in sex-influenced ways. Ketamine, which is now being used as a rapid-acting antidepressant, is likely the same. To date, the majority of studies investigating treatment outcomes in MDD do not disaggregate the findings in males and females, and this is also true for ketamine. This review aims to highlight that gap by exploring pre-clinical data-at a behavioral, molecular, and structural level-and recent clinical trials. Sex hormones, particularly estrogen and progesterone, influence the response at all levels examined, and sex is therefore a critical factor to examine when looking at ketamine response. Taken together, the data show females are more sensitive to ketamine than males, and it might be possible to monitor the phase of the menstrual cycle to mitigate some risks associated with the use of ketamine for females with MDD. Based on the studies reviewed in this article, we suggest that ketamine should be administered adhering to sex-specific considerations.
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Affiliation(s)
- Ethan Ponton
- Department of Anatomy and Cell Biology, McGill University, Montreal, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Corina Nagy
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- Correspondence: Corina Nagy, PhD, 6875 LaSalle Blvd, Verdun, Québec, Canada H4H 1R3 ()
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Fitzgerald PJ, Kounelis-Wuillaume SK, Gheidi A, Morrow JD, Spencer-Segal JL, Watson BO. Sex- and stress-dependent effects of a single injection of ketamine on open field and forced swim behavior. Stress 2021; 24:857-865. [PMID: 33517825 PMCID: PMC8325703 DOI: 10.1080/10253890.2021.1871600] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ketamine has emerged as a novel treatment for common psychiatric conditions such as Major Depressive Disorder (MDD) and anxiety disorders, many of which can be initiated and exacerbated by psychological stress. Sex differences in the frequency of both anxiety and depressive disorders are well known and could be due to sex differences in neuroendocrine responses to stress. Ketamine is known to modulate the hormonal response to stress, specifically corticosterone. It is not clear if the acute effect of ketamine on corticosterone differs by sex, or what role this could play in subsequent behavior. Here we test whether a single injection of (R,S)-ketamine (30 mg/kg, i.p.), administered either with or without unpredictable chronic stress (UCS), has different sustained effects on open field test (OFT), elevated zero maze (EZM) or forced swim test (FST) behavior in female versus male C57BL/6J mice. In the OFT (24 h post-injection), ketamine increased center square exploration in males but not females. In contrast, in the FST (72 h post-injection), females showed a trend toward a decrease in immobility after ketamine whereas males were not strongly modulated. These behavioral effects of ketamine were stronger in the presence of UCS than in unstressed animals. UCS animals also showed lower corticosterone after injection than unstressed animals, and in the presence of UCS ketamine increased corticosterone; these effects were similar in both sexes. Corticosterone post-injection did not predict subsequent behavior. These findings complement a growing preclinical literature suggesting both stress-dependency and sex differences in OFT and FST behavioral responses to ketamine.LAY SUMMARYIn humans, it is known that major depression and anxiety disorders, which can be caused or made worse by exposure to psychological stress, occur roughly twice as frequently in women than in men, but the underpinnings of these effects are not well characterized. In the current study, we explored how sex interacts with stress and ketamine (a rapidly acting antidepressant) by assessing both open field and forced swim behavior in mice after chronic mild stress. We report the novel finding that male mice exhibit greater exploration of the aversive center square in the open field after ketamine, whereas females trended toward lower immobility (often interpreted as an antidepressant-like effect) in the forced swim test after this drug, and these effects were amplified by prior stress exposure.
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Affiliation(s)
- Paul J. Fitzgerald
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109
| | | | - Ali Gheidi
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109
| | - Jonathan D. Morrow
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109
| | - Joanna L. Spencer-Segal
- Michigan Neuroscience Institute, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109
- For correspondence: ,
| | - Brendon O. Watson
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109
- For correspondence: ,
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Gastaldon C, Raschi E, Kane JM, Barbui C, Schoretsanitis G. Post-Marketing Safety Concerns with Esketamine: A Disproportionality Analysis of Spontaneous Reports Submitted to the FDA Adverse Event Reporting System. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:41-48. [PMID: 32854103 DOI: 10.1159/000510703] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/30/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Esketamine nasal spray received approval for treatment-resistant depression in March 2019. OBJECTIVE Using the FDA Adverse Event Reporting System (FAERS) database (March 2019-March 2020), we analysed esketamine-related adverse events (AEs) to detect and characterize relevant safety signals. METHODS We used the consolidated case/non-case approach to estimate the reporting odds ratio (ROR) and information component (IC) with relevant confidence intervals (95% CI) for esketamine-related AEs with ≥4 counts. Comparisons between serious and non-serious AEs were performed using non-parametric tests. RESULTS The FAERS database contained 962 cases of esketamine-related AEs, with signals detected for several AEs, such as dissociation (ROR = 1,612.64, 95% CI = 1,354.63, 1,919.79; IC = 8.19, 95% CI = 7.96, 8.35), sedation (ROR = 238.46, 95% CI = 202.98, 280.15; IC = 7, 95% CI = 6.75, 7.18), feeling drunk (ROR = 96.17, 95% CI = 61.42, 150.57; IC = 4.84, 95% CI = 4.09, 5.36), suicidal ideation (ROR = 24.03, 95% CI = 18.72, 30.84; IC = 4.31, 95% CI = 3.9, 4.61), and completed suicide (ROR = 5.75, 95% CI = 3.18, 10.41; IC = 2.25, 95% CI = 1.23, 2.94). Signals for suicidal and self-injurious ideation, but not suicide attempt and completed suicide, remained when comparing esketamine to venlafaxine. Females and patients receiving antidepressant polypharmacy, co-medication with mood stabilizers, antipsychotics, benzodiazepines, or somatic medications were more likely to suffer from serious versus non-serious AEs (χ2 = 125.29, p < 0.001, χ2 = 9.08, p = 0.003, χ2 = 8.14, p = 0.004, χ2 = 19.48, p < 0.001, χ2 = 25.62, p < 0.001, and χ2 = 16.79, p < 0.001, respectively). CONCLUSIONS Esketamine may carry a clear potential for serious AEs, which deserves urgent clarification by means of further prospective studies.
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Affiliation(s)
- Chiara Gastaldon
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy, .,The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, New York, USA,
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - John M Kane
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, New York, USA.,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, New York, USA
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Georgios Schoretsanitis
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, New York, USA
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Sultana S, Berger G, Cox A, Kelly MEM, Lehmann C. Rodent models of ketamine-induced cystitis. Neurourol Urodyn 2021; 40:1704-1719. [PMID: 34350618 DOI: 10.1002/nau.24763] [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: 04/30/2021] [Revised: 06/25/2021] [Accepted: 07/19/2021] [Indexed: 02/03/2023]
Abstract
AIMS Long-term or recreational use of ketamine affects the urinary system and can result in ketamine-induced cystitis (KIC). Rodent models of KIC are important to study KIC pathophysiology and are paramount to the future development of therapies for this painful condition. This review aims to provide a summary of rodent models of KIC, focusing on disease induction, experimental methods, and pathological features of the model. METHOD A literature search was performed using the National Center for Biotechnology Information (NCBI) Pubmed database up to March 2021. 20 articles met the inclusion criteria and were finally selected. RESULTS There are considerable variations in the rodent models used for studying KIC in terms of the strain of the animal being used; dose, duration, and route of ketamine administration to induce KIC, and assessment of pathological features. CONCLUSION KIC remains difficult to fully recapitulate in humans. Improved characterization of KIC models and the experimental parameters and meticulous discussion on translational limitations are required to improve the translational value of research using rodent models of KIC.
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Affiliation(s)
- Saki Sultana
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Geraint Berger
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melanie E M Kelly
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Ophthalmology & Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christian Lehmann
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada
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19
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Boyd NL, Navathe PD. An Update to Aircrew Grounding Periods After Ketamine Use. Aerosp Med Hum Perform 2021; 92:670-675. [PMID: 34503619 DOI: 10.3357/amhp.5764.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION: Ketamine is a rapidly acting general anesthetic which is globally used in surgical analgesia, as well as in the management of pain. It is also used as a recreational drug. Because of its widespread use in surgical settings, the use of this drug presents an aeromedical problemin addition, of course, to the underlying condition for which it has been used. The literature around the mechanisms and side effects of ketamine is reasonably mature, and it is possible to make fairly dependable risk management decisions about return to flying based on the information available. Accordingly, following ketamine use it is recommended that aviators be grounded for 48 h following Aviation Medical Examiner review. If review is unavailable, the aviator should be grounded for 1 wk to allow sufficient time to identify the existence of prolonged side effects, such as psychomimetic effects or cognitive changes.Boyd NL, Navathe PD. An update to aircrew grounding periods after ketamine use. Aerosp Med Hum Perform. 2021; 92(8):670-675.
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Pan WH, Wu KCC, Chen CY, Chu YR, Wu SC, Jou S, Lu TP, Tung YC, Hsu J, Chen WJ. First-time offenders for recreational ketamine use under a new penalty system in Taiwan: incidence, recidivism and mortality in national cohorts from 2009 to 2017. Addiction 2021; 116:1770-1781. [PMID: 33197101 DOI: 10.1111/add.15337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/22/2020] [Accepted: 11/06/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS Ketamine has become a new recreational drug of choice among young people in parts of Asia. Using national databases in Taiwan, this study aimed to (1) examine the yearly trend in the ketamine offence rate over time; (2) estimate the 3-year risk of drug-related re-offence and its correlates among the first-time offenders; and (3) estimate the 3-year standardized mortality ratio (SMR) among the first-time offenders. DESIGN, SETTING AND PARTICIPANTS Retrospective cohort studies of offenders for recreational ketamine use in a penalty system initiated in 2009. Offenders for recreational ketamine use were identified from the Administrative Penalty System for Schedule III/IV Substances database from 2009 to 2017, and the re-offence rate and mortality among first-time offenders were assessed via record-linkage within the database as well as with both the criminal drug offence database and the national mortality database. The cohort from 2009 to 2016 (n = 39 178) was used for the recidivism analysis and the cohort from 2009 to 2013 (n = 25 357) was used for the 3-year SMR analysis. MEASUREMENTS Recidivism was estimated using survival analysis of the event as re-arrest for using ketamine, more serious illicit drugs (Schedules I/II), or any illicit drugs (ketamine or Schedules I/II). SMRs were estimated for overall and cause-specific death within 3 years after the first offence for ketamine use. FINDINGS The age-standardized rates for both prevalent (1.38 per 1000) and first-time offenders (0.65 per 1000) peaked in 2013 and then decreased steadily. The 3-year risk of re-offence was 33.85% [95% confidence interval (CI) = 33.23-34.47%) for ketamine use and 39.52% (95% CI = 39.00-40.04%) for any illicit drug use. These first-time offenders had an SMR of 4.9 (95% CI = 4.3-5.4) for overall mortality, 2.1 (95% CI = 1.6-2.7) for natural deaths and 7.6 (95% CI = 6.7-8.6) for unnatural deaths. CONCLUSIONS Recreational ketamine use in Taiwan appears to lead not only to high risk for drug-related re-offence but also to excess mortality.
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Affiliation(s)
- Wen-Hsuan Pan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kevin Chien-Chang Wu
- Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.,Department of Medical Education and Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Ya Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Roo Chu
- Division of Controlled Drugs, Taiwan Food and Drug Administration, Ministry of Health and Welfare, Executive Yuan, Taipei, Taiwan
| | - Shang-Chi Wu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Susyan Jou
- Graduate School of Criminology, National Taipei University, New Taipei, Taiwan
| | - Tzu-Pin Lu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Chi Tung
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.,Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jui Hsu
- Division of Controlled Drugs, Taiwan Food and Drug Administration, Ministry of Health and Welfare, Executive Yuan, Taipei, Taiwan
| | - Wei J Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.,Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.,Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
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Cosci F, Chouinard G. Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:283-306. [PMID: 32259826 DOI: 10.1159/000506868] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/27/2020] [Indexed: 11/19/2022]
Abstract
Studies on psychotropic medications decrease, discontinuation, or switch have uncovered withdrawal syndromes. The present overview aimed at analyzing the literature to illustrate withdrawal after decrease, discontinuation, or switch of psychotropic medications based on the drug class (i.e., benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonists, antidepressants, ketamine, antipsychotics, lithium, mood stabilizers) according to the diagnostic criteria of Chouinard and Chouinard [Psychother Psychosom. 2015;84(2):63-71], which encompass new withdrawal symptoms, rebound symptoms, and persistent post-withdrawal disorders. All these drugs may induce withdrawal syndromes and rebound upon discontinuation, even with slow tapering. However, only selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, and antipsychotics were consistently also associated with persistent post-withdrawal disorders and potential high severity of symptoms, including alterations of clinical course, whereas the distress associated with benzodiazepines discontinuation appears to be short-lived. As a result, the common belief that benzodiazepines should be substituted by medications that cause less dependence such as antidepressants and antipsychotics runs counter the available literature. Ketamine, and probably its derivatives, may be classified as at high risk for dependence and addiction. Because of the lag phase that has taken place between the introduction of a drug into the market and the description of withdrawal symptoms, caution is needed with the use of newer antidepressants and antipsychotics. Within medication classes, alprazolam, lorazepam, triazolam, paroxetine, venlafaxine, fluphenazine, perphenazine, clozapine, and quetiapine are more likely to induce withdrawal. The likelihood of withdrawal manifestations that may be severe and persistent should thus be taken into account in clinical practice and also in children and adolescents.
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Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy, .,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands,
| | - Guy Chouinard
- Clinical Pharmacology and Toxicology Program, McGill University and Mental Health Institute of Montreal Fernand Seguin Research Centre, University of Montreal, Montreal, Québec, Canada
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22
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Abstract
Over the last two decades, the dissociative anaesthetic agent ketamine, an uncompetitive N-Methyl-D-Aspartate (NMDA) receptor antagonist, has emerged as a novel therapy for treatment-resistant depression (TRD), demonstrating rapid and robust antidepressant effects within hours of administration. Ketamine is a racemic mixture composed of equal amounts of (S)-ketamine and (R)-ketamine. Although ketamine currently remains an off-label treatment for TRD, an (S)-ketamine nasal spray has been approved for use in TRD (in conjunction with an oral antidepressant) in the United States and Europe. Despite the promise of ketamine, key challenges including how to maintain response, concerns regarding short and long-term side-effects and the potential for abuse remain. This review provides an overview of the history of ketamine, its use in psychiatry and its basic pharmacology. The clinical evidence for the use of ketamine in depression and potential adverse effects associated with treatment are summarized. A synopsis of some of the putative neurobiological mechanisms underlying ketamine's rapid-acting antidepressant effects is provided before finally outlining future research directions, including the need to identify biomarkers for predicting response and treatment targets that may be used in the development of next-generation rapid-acting antidepressants that may lack ketamine's side-effects or abuse potential.
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Affiliation(s)
- Luke A Jelen
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - James M Stone
- Centre for Affective Disorders, Department of Psychological Medicine, 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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23
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Ng J, Lui LMW, Rosenblat JD, Teopiz KM, Lipsitz O, Cha DS, Xiong J, Nasri F, Lee Y, Kratiuk K, Rodrigues NB, Gill H, Subramaniapillai M, Mansur RB, Ho R, Cao B, McIntyre RS. Ketamine-induced urological toxicity: potential mechanisms and translation for adults with mood disorders receiving ketamine treatment. Psychopharmacology (Berl) 2021; 238:917-926. [PMID: 33484298 DOI: 10.1007/s00213-021-05767-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/14/2021] [Indexed: 12/14/2022]
Abstract
Intravenous (IV) ketamine has been shown to have rapid and robust antidepressant effects in adults with treatment-resistant depression (TRD). Urological toxicity has been observed in chronic ketamine abusers as evidenced by dysuria, urgency, and hematuria. The foregoing observation provides the basis for evaluating whether ketamine-induced urological toxicity (KIUT) is associated with sub-anesthetic doses of ketamine (0.5-1.0 mg/kg) in adults with mood disorders. The overarching objective of this article is to identify potential mechanisms of KIUT which appears to be dose and frequency dependent. Available research indicates that high-frequency ketamine is associated with disruption of the urothelial barrier as well as direct ketamine toxicity (i.e., decreased expression of junction proteins) in KIUT of the bladder. Chronic and high-frequency ketamine use is also associated with bladder inflammation mediated via neurogenic and IgE inflammation. Other non-mutually exclusive causes are nerve hyperplasia, hypersensitivity, cell apoptosis, microvascular damage, and overexpression of carcinogenic genes. Notwithstanding the evidence of KIUT in ketamine abusers, there is no evidence that ketamine and/or esketamine treatment in adults with mood disorders is associated with KIUT. However, all patients receiving ketamine/esketamine for mood disorder treatment should be queried about genitourinary symptoms during acute and, where applicable, maintenance dosing.
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Affiliation(s)
- Jason Ng
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Leanna M W Lui
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Kayla M Teopiz
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Orly Lipsitz
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Danielle S Cha
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.,School of Medicine, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Jiaqi Xiong
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Flora Nasri
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Yena Lee
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Kevin Kratiuk
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Nelson B Rodrigues
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Hartej Gill
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Mehala Subramaniapillai
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Rodrigo B Mansur
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Bing Cao
- School of Psychology and Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, 400715, China.,National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing, 400715, China
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada. .,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada. .,Brain and Cognition Discovery Foundation, Toronto, Canada.
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24
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Alsheikh MY. Post-Acute Withdrawal Syndrome: The Major Cause of Relapse among Psychoactive Substances Addicted Users. ARCHIVES OF PHARMACY PRACTICE 2021. [DOI: 10.51847/ioicfujpnm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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25
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Prakash S, Gupta AK, Meena JP, Seth R. A review of the clinical applications of ketamine in pediatric oncology. Pediatr Blood Cancer 2021; 68:e28785. [PMID: 33128439 DOI: 10.1002/pbc.28785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 12/30/2022]
Abstract
Ketamine is a dissociative anesthetic agent with excellent analgesic properties and a favorable safety profile. The feasibility and efficacy of various routes of administration have been established, including intravenous (IV), intramuscular (IM), oral, intranasal, rectal, and transdermal routes. The advent of newer anesthetic agents has led to a decline in the use of ketamine as an anesthetic, but its utility in short-term sedation and analgesia has expanded. Its value for chronic pain management in children with cancer is being increasingly recognized but requires more evidence. The use of topical ketamine is largely in investigational stages. Medical use of ketamine is, to a great extent, free from significant long-term neurological side effects. The objective of this review is to provide a brief account of the pharmacology of ketamine and primarily focus on the clinical applications of ketamine in pediatric oncology.
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Affiliation(s)
- Satya Prakash
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Kumar Gupta
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jagdish Prasad Meena
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Seth
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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26
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Fattore L, Marti M, Mostallino R, Castelli MP. Sex and Gender Differences in the Effects of Novel Psychoactive Substances. Brain Sci 2020; 10:brainsci10090606. [PMID: 32899299 PMCID: PMC7564810 DOI: 10.3390/brainsci10090606] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 12/12/2022] Open
Abstract
Sex and gender deeply affect the subjective effects and pharmaco-toxicological responses to drugs. Men are more likely than women to use almost all types of illicit drugs and to present to emergency departments for serious or fatal intoxications. However, women are just as likely as men to develop substance use disorders, and may be more susceptible to craving and relapse. Clinical and preclinical studies have shown important differences between males and females after administration of “classic” drugs of abuse (e.g., Δ9-tetrahydrocannabinol (THC), morphine, cocaine). This scenario has become enormously complicated in the last decade with the overbearing appearance of the new psychoactive substances (NPS) that have emerged as alternatives to regulated drugs. To date, more than 900 NPS have been identified, and can be catalogued in different pharmacological categories including synthetic cannabinoids, synthetic stimulants (cathinones and amphetamine-like), hallucinogenic phenethylamines, synthetic opioids (fentanyls and non-fentanyls), new benzodiazepines and dissociative anesthetics (i.e., methoxetamine and phencyclidine-derivatives). This work collects the little knowledge reached so far on the effects of NPS in male and female animal and human subjects, highlighting how much sex and gender differences in the effects of NPS has yet to be studied and understood.
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Affiliation(s)
- Liana Fattore
- Institute of Neuroscience-Cagliari, National Research Council (CNR), Cittadella Universitaria, 09042 Monserrato, Cagliari, Italy
- Correspondence:
| | - Matteo Marti
- Department of Morphology, Surgery and Experimental Medicine, Section of Legal Medicine and LTTA Center, University of Ferrara, 44121 Ferrara, Italy;
- Department of Anti-Drug Policies, Collaborative Center for the Italian National Early Warning System, Presidency of the Council of Ministers, 00187 Rome, Italy
| | - Rafaela Mostallino
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Cittadella Universitaria, 09042 Monserrato, Cagliari, Italy; (R.M.); (M.P.C.)
| | - Maria Paola Castelli
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Cittadella Universitaria, 09042 Monserrato, Cagliari, Italy; (R.M.); (M.P.C.)
- National Institute of Neuroscience (INN), University of Cagliari, 09124 Cagliari, Italy
- Center of Excellence “Neurobiology of Addiction”, University of Cagliari, 09124 Cagliari, Italy
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Brokatzky S, Blessing A, Rudaz M, Hansen A, Dammann G. Kann die Symptombelastung einen regulären oder
irregulären Behandlungsabschluss bei Substanzkonsumstörungen
vorhersagen? SUCHTTHERAPIE 2020. [DOI: 10.1055/a-1197-9866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Zusammenfassung
Ziel der Studie Das Ziel der vorliegenden explorativen Studie war zu
untersuchen, ob die subjektive Symptombelastung vor und während der
Behandlung von PatientInnen mit einer Substanzkonsumstörung einen
Einfluss darauf hat, ob die Behandlung regulär (d. h. in
gegenseitigem Einverständnis zwischen Therapeut und Patient) oder
irregulär (d. h. Therapeut oder Patient bricht ab) beendet
wird.
Methodik In der vorliegenden, retrospektiven Untersuchung wurden 54
PatientInnen einer Drogenentzugs- und Entwöhnungsstation untersucht.
Die Informationen zur Art des Behandlungsabschlusses wurden der
Basisdokumentation und zur Symptombelastung der Brief-Symptom-Checkliste
(BSCL) entnommen.
Ergebnisse Die Ergebnisse der binären logistischen
Regressionsanalysen zeigten, dass eine allgemeine Reduktion der
Symptombelastung während der Behandlung mit einem regulären
statt einem irregulären Behandlungsabschluss einherging. Die
Analysen der Subskalen der BSCL ergaben signifikante Effekte für
eine Abnahme der Ängstlichkeit und des Paranoiden Denkens
während der Therapie zugunsten eines regulären
Behandlungsabschlusses. Des Weiteren sagten hohe Werte der Zwanghaftigkeit
zu Behandlungsbeginn einen regulären Behandlungsabschluss
vorher.
Schlussfolgerung Bei der Behandlung von PatientInnen mit
Substanzkonsumstörungen erscheint es sinnvoll, die allgemeine
subjektive Symptombelastung während der Behandlung zu erfragen, um
Therapieabbrüche zu vermeiden. Insbesondere sollten die
Ängstlichkeit und das Paranoide Denken in den Fokus der Behandlung
rücken, da diese in der vorliegenden Studie einen regulären
Behandlungsabschluss vorhersagten.
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Affiliation(s)
- Stefan Brokatzky
- Psychiatrische Klinik Münsterlingen, Schweiz
- Klinik für Konsiliarpsychiatrie und Psychosomatik,
UniversitätsSpital Zürich, Schweiz
| | | | - Myriam Rudaz
- Psychiatrische Klinik Münsterlingen, Schweiz
- Department of Family and Child Sciences, Florida State University,
Tallahassee, FL, USA
| | | | - Gerhard Dammann
- Psychiatrische Klinik Münsterlingen, Schweiz
- Universitätsklinik für Psychiatrie und Psychotherapie,
Paracelsus Medizinische Privatuniversität Salzburg,
Österreich
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28
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Liang H, Tang WK, Chu WCW, Ernst T, Chen R, Chang L. Striatal and white matter volumes in chronic ketamine users with or without recent regular stimulant use. Drug Alcohol Depend 2020; 213:108063. [PMID: 32498030 PMCID: PMC7686125 DOI: 10.1016/j.drugalcdep.2020.108063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous studies found enlarged striatum and white matter in those with stimulants use disorders. Whether primarily ketamine users (Primarily-K) and ketamine users who co-used stimulants and other substances (K+PolyS) have abnormal brain volumes is unknown. This study aims to evaluate possible brain structural abnormalities, cognitive function and depressive symptoms, between Primarily-K and K+PolyS users. METHODS Striatal and white matter volumes were automatically segmented in 39 Primarily-K users, 41 K+PolyS users and 46 non-drug users (ND). Cognitive performance in 7 neurocognitive domains and depressive symptoms were also evaluated. RESULTS Ketamine users had larger caudates than ND-controls (Right: 1-way-ANCOVA-p=0.035; K+PolyS vs. ND, p=0.030; Linear trend for K+PolyS>Primarily-K>ND, p=0.011; Left: 1-way-ANCOVA-p=0.047, Primarily-K vs. ND p=0.051) and larger total white matter (1-way ANCOVA-p=0.009, Poly+K vs. Primarily-K, p=0.05; Poly+K vs. ND p=0.011; Linear trend for K+PolyS>Primarily-K >ND, p=0.004). Across all ketamine users, they performed poorer on Arithmetic, learning and memory tasks, and were more depressed than Non-users (p<0.001 to p=0.001). Greater lifetime ketamine usage correlated with more depressive symptoms (r=0.27, p=0.008). Larger white matter correlated with better learning across all participants (r=0.21, p=0.019), while larger right caudate correlated with lower depression scores in ketamine users (r=-0.28, p=0.013). CONCLUSION Ketamine users had larger caudates and total white matter than ND-controls. The even larger white matter in K+PolyS users suggests additive effects from co-use of ketamine and stimulants. However, across the ketamine users, since greater volumes were associated with better learning and less depressive symptom, the enlarged caudates and white matter might represent a compensatory response.
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Affiliation(s)
- Huajun Liang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201 USA
| | - Wai Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Winnie CW Chu
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Thomas Ernst
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201 USA,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21201 USA
| | - Rong Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201 USA
| | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine,University of Maryland School of Medicine, Baltimore, MD, 21201, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21201, USA; Department of Neurology University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
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29
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Wang X, Cui J, Zhuo Y, Shen B, Zhang S, Liu W, Shen M, Xiang P. A Retrospective of Prevalence of Drugs of Abuse by Hair Analysis in Shanghai using LC–MS-MS. J Anal Toxicol 2020; 44:482-489. [DOI: 10.1093/jat/bkaa007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/17/2019] [Accepted: 12/25/2019] [Indexed: 12/18/2022] Open
Abstract
Abstract
This study presents a retrospective analysis of the prevalence of drug abuse in Shanghai by hair analysis. Files and toxicology analysis results of a total of 5,610 cases requesting for hair analysis of abused drugs at the Academy of Forensic Science (AFS) in Shanghai over 12 months between August 2018 and July 2019 were reviewed. All cases of drug abuse identified by hair analysis were from the public security organs in Shanghai, China. Hair samples were analyzed for drugs of abuse and related metabolites, mainly including amphetamine (AMP), methamphetamine (MA), 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA), tetrahydrocannabinol (THC), ketamine (K), norketamine (NK), cocaine (COC), benzoylecgonine, morphine, 6-acetylmorphine, flunitrazepam, and 5-methoxy-N,N-diisopropyltryptamine (5-MeO-DIPT), using liquid chromatography–tandem mass spectrometry (LC–MS-MS). Among the 5,610 cases, 1,713 (30.5%) were positive for drugs of abuse, with amphetamine-type stimulants (ATS) (57%), including amphetamines (AMP and MA) (48%), MDMA and MDA (9%), being the most frequently detected drugs, followed by THC (14%), COC (8%), 5-MeO-DIPT (8%), and K (7%). The majority (75%) of positive hair samples were from male subjects. Overall, 77% of abusers were younger than 44 years old. The proportion of female subjects (22.3%) under 24 years was larger than that of male subjects (7.8%). There were 132 cases (7.7%) in which more than one type of drug was detected among 1,713 drug-positive cases. The most common combination was MDMA and K. The present study characterizes the current toxicological profile of drug abuse cases and provides a scientific basis for drug abuse prevention. Moreover, the hair concentration distributions of the commonly abused drugs in positive cases have been reported.
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Affiliation(s)
- Xin Wang
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Jingjing Cui
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
- School of Pharmacy, Yantai University, Yantai, China
| | - Yue Zhuo
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
- Institute of Forensic Science, Guizhou Medical University, Guiyang, China
| | - Baohua Shen
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Sujing Zhang
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Wei Liu
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Min Shen
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Ping Xiang
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
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30
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Huang MC, Chen CH, Chen LY, Chang HM, Chen CK, Lin SK, Xu K. Chronic ketamine abuse is associated with orexin-A reduction and ACTH elevation. Psychopharmacology (Berl) 2020; 237:45-53. [PMID: 31377886 DOI: 10.1007/s00213-019-05342-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 07/25/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Ketamine has emerged as a major substance of abuse worldwide. Evidence suggests a role of orexin system in reward processing, withdrawal, and stress response. It also interacts with the stress mechanisms of hypothalamic-pituitary-adrenal (HPA) axis to regulate drug-taking behavior. The study aimed to explore the relevance of orexin and stress hormones to chronic ketamine abuse. METHODS We enrolled 67 ketamine-dependent (KD) patients and 64 controls. The levels of orexin-A, adrenocorticotropic hormone (ACTH), and cortisol were measured at baseline, 1 week, and 2 weeks after ketamine discontinuation. KD patients were assessed by Beck Depression Inventory, Beck Anxiety Inventory, and Visual Analogue Scale for ketamine craving at baseline. RESULTS Compared with the controls, KD patients had significantly lower orexin-A (0.65 ± 0.12 vs. 0.74 ± 0.10 ng/mL, p < 0.001) and increased ACTH (32.3 ± 16.3 vs. 22.3 ± 11.0 pg/mL, p = 0.008) levels at baseline, whereas cortisol levels were similar between two groups. Levels of the three markers did not correlate with ketamine use variables, craving, depression, or anxiety symptoms. The levels did not alter after 1 or 2 weeks of ketamine discontinuation. Notably, those with higher anxiety had lower orexin-A but increased cortisol levels than did those with lower anxiety. CONCLUSIONS This study showed that KD patients had persistent orexin-A reduction and stress hormone dysregulation in early abstinence. The anxious phenotype of KD might be associated with a lower orexin-A expression. These results point to a promising pathway to investigate the neurochemical mechanisms of ketamine addiction.
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Affiliation(s)
- Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, 309, Song-De Road, Xinyi District, Taipei City, 110, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Xing St., Taipei, 110, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chun-Hsin Chen
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, 111, Sec. 3, Hsing-Long Rd, Taipei, 116, Taiwan
| | - Lian-Yu Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, 309, Song-De Road, Xinyi District, Taipei City, 110, Taiwan.,Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Hu-Ming Chang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, 309, Song-De Road, Xinyi District, Taipei City, 110, Taiwan
| | - Chih-Ken Chen
- Department of Psychiatry & Community Medicine Research Center, Chang Gung Memorial Hospital, 200, Ln 208, Ji-Jing 1st Rd, Keelung, Taiwan. .,Chang Gung University School of Medicine, 5, Fu-Hsing Rd, Gue-Shan District Taoyuan City, 333, Taiwan.
| | - Shih-Ku Lin
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, 309, Song-De Road, Xinyi District, Taipei City, 110, Taiwan. .,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Xing St., Taipei, 110, Taiwan.
| | - Ke Xu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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31
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Hsieh KY, Wang CJ, Huang LL, Chang YS, Tsai CH, Wu YH, Lin YF, Lin WH. Correlates Related to Probable Common Mental Disorders among Ketamine Users: Cognitive and Urinary Impairments. TAIWANESE JOURNAL OF PSYCHIATRY 2020. [DOI: 10.4103/tpsy.tpsy_36_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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32
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Lerner A, Klein M. Dependence, withdrawal and rebound of CNS drugs: an update and regulatory considerations for new drugs development. Brain Commun 2019; 1:fcz025. [PMID: 32954266 PMCID: PMC7425303 DOI: 10.1093/braincomms/fcz025] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 12/11/2022] Open
Abstract
The purpose of this article is to describe dependence and withdrawal phenomena related to CNS drugs discontinuation and to clarify issues related to the evaluation of clinical drug withdrawal and rebound as they relate to safety in new drug development. The article presents current understanding and definitions of drug dependence and withdrawal which are also relevant and important features of addiction, though not the same. Addiction, called substance use disorder in DSM-5, affects an individual’s brain and behaviour, represents uncontrollable drug abuse and inability to stop taking a drug regardless of the harm it causes. Characteristic withdrawal syndromes following abrupt discontinuation of CNS-active drugs from numerous drug classes are described. These include drugs both scheduled and non-scheduled in the Controlled Substances Act, which categorizes drugs in five schedules based on their relative abuse potentials and dependence liabilities and for regulatory purposes. Schedules 1 and 2 contain drugs identified as those with the highest abuse potential and strictest regulations. Less recognized aspects of drug withdrawal, such as rebound and protracted withdrawal syndromes for several drug classes are also addressed. Part I presents relevant definitions and describes clinical withdrawal and dependence phenomena. Part II reviews known withdrawal syndromes for the different drug classes, Part III describes rebound and Part IV describes protracted withdrawal syndromes. To our knowledge, this is the first compilation of withdrawal syndromes for CNS drugs. Part V provides details of evaluation of dependence and withdrawal in the clinical trials for CNS drugs, which includes general design recommendations, and several tools, such as withdrawal questionnaires and multiple scales that are helpful in the systematic evaluation of withdrawal. The limitations of different aspects of this method of dependence and withdrawal evaluation are also discussed.
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Affiliation(s)
- Alicja Lerner
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993-0002, USA
- Correspondence to: Alicja Lerner, MD, PhD, FDA Controlled Substance Staff, Center for Drug Evaluation and Research, Food and Drug Administration 10903 New Hampshire Avenue, Building 51 Silver Spring, MD 20993-0002, USA E-mail:
| | - Michael Klein
- Controlled Substance Scientific Solutions LLC, 4601 North Park Avenue #506, Chevy Chase, MD 20815-4572, USA
- Correspondence may also be addressed to: Michael Klein, PhD Controlled Substance Scientific Solutions LLC 4601 North Park Avenue #506 Chevy Chase, MD 20815-4572 USA E-mail:
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33
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Pathological Consequences of Drug Abuse: Implication of Redox Imbalance. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:4780852. [PMID: 31915508 PMCID: PMC6930710 DOI: 10.1155/2019/4780852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 11/17/2022]
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34
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Jhang J, Wang H, Hsu Y, Birder LA, Kuo H. Upregulation of neurotrophins and transforming growth factor‐β expression in the bladder may lead to nerve hyperplasia and fibrosis in patients with severe ketamine‐associated cystitis. Neurourol Urodyn 2019; 38:2303-2310. [DOI: 10.1002/nau.24139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/20/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Jia‐Fong Jhang
- Department of Urology, Hualien Tzu Chi General HospitalBuddhist Tzu Chi Medical Foundation, and Tzu Chi University Hualien Taiwan
| | - Hsiu‐Jen Wang
- Department of Urology, Hualien Tzu Chi General HospitalBuddhist Tzu Chi Medical Foundation, and Tzu Chi University Hualien Taiwan
| | - Yung‐Hsiang Hsu
- Department of PathologyBuddhist Tzu Chi General Hospital and Tzu Chi University Hualien Taiwan
| | - Lori A. Birder
- Departments of Medicine, Pharmacology, and Chemical BiologyUniversity of Pittsburgh Pittsburgh Pennsylvania
| | - Hann‐Chorng Kuo
- Department of Urology, Hualien Tzu Chi General HospitalBuddhist Tzu Chi Medical Foundation, and Tzu Chi University Hualien Taiwan
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Schoepfer KJ, Strong CE, Saland SK, Wright KN, Kabbaj M. Sex- and dose-dependent abuse liability of repeated subanesthetic ketamine in rats. Physiol Behav 2019; 203:60-69. [PMID: 29055748 PMCID: PMC5906213 DOI: 10.1016/j.physbeh.2017.10.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/13/2017] [Accepted: 10/17/2017] [Indexed: 12/21/2022]
Abstract
RATIONALE Subanesthetic ketamine (KET) elicits rapid, robust, but transient antidepressant effects. KET's antidepressant actions can be augmented and maintained for a longer duration when repeatedly delivered. However, KET is recreationally abused, raising long-term treatment safety concerns. Women are more likely than men to seek treatment for depression, escalate from casual to compulsive drug use, and are more sensitive to antidepressants. Similarly, female rodents are more sensitive than males to KET's rapid antidepressant-like behavioral effects; dose-response thresholds in these assays equal 2.5 and 5.0mg/kg (i.p.), respectively. This suggests the utility of preclinical rodent models in optimizing sex-differential KET therapy protocols and minimizing adverse drug reactions. OBJECTIVES Here, we assessed behavioral and biochemical correlates of abuse liability following six serial KET treatments on alternating days at three subanesthetic, antidepressant-like doses (2.5, 5.0, or 10mg/kg, i.p.) in adult male and female rats. A potential role for ΔFosB-mediated transcription in the nucleus accumbens is outlined in the context of KET-mediated locomotor sensitization. RESULTS Antidepressant-like threshold doses (2.5, 5.0mg/kg KET) failed to evoke a conditioned place preference in all animals, but only males positively responded to a higher dose (10mg/kg). Behavioral sensitization to 5.0 or 10mg/kg KET's locomotor-activating effects was established in both sexes, and females' sensitized response to 5.0mg/kg was greater than males'. KET-induced hyperlocomotion positively correlated with ΔFosB protein expression in the nucleus accumbens. rAAV-ΔJunD inhibition of ΔFosB-mediated transcription in the accumbens failed to block locomotor sensitization to 10mg/kg KET. CONCLUSIONS These data suggest that in rats, six alternating-day treatments with 2.5mg/kg KET do not induce apparent behavioral signatures of abuse liability despite accumulation of ΔFosB protein in the accumbens. Additionally, females are more sensitive than males to KET's locomotor-stimulant properties, both acutely and after repeated treatments. More studies are needed to determine brain regions and neural mechanisms responsible for KET-induced behavioral adaptations and to extrapolate these data to inform sex-dependent strategies for long-term KET therapy protocols for depression.
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Affiliation(s)
- Kristin J Schoepfer
- Program in Neuroscience, Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Caroline E Strong
- Program in Neuroscience, Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Samantha K Saland
- Program in Neuroscience, Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Katherine N Wright
- Program in Neuroscience, Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Mohamed Kabbaj
- Program in Neuroscience, Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA; College of Medicine, Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA.
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de Carvalho Cartágenes S, Fernandes LMP, Carvalheiro TCVS, de Sousa TM, Gomes ARQ, Monteiro MC, de Oliveira Paraense RS, Crespo-López ME, Lima RR, Fontes-Júnior EA, Prediger RD, Maia CSF. "Special K" Drug on Adolescent Rats: Oxidative Damage and Neurobehavioral Impairments. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:5452727. [PMID: 31001375 PMCID: PMC6437740 DOI: 10.1155/2019/5452727] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 12/19/2018] [Accepted: 12/31/2018] [Indexed: 12/24/2022]
Abstract
Ketamine is used in clinical practice as an anesthetic that pharmacologically modulates neurotransmission in postsynaptic receptors, such as NMDA receptors. However, widespread recreational use of ketamine in "party drug" worldwide since the 1990s quickly spread to the Asian orient region. Thus, this study aimed at investigating the behavioral and oxidative effects after immediate withdrawal of intermittent administration of ketamine in adolescent female rats. For this, twenty female Wistar rats were randomly divided into two groups: control and ketamine group (n = 10/group). Animals received ketamine (10 mg/kg/day) or saline intraperitoneally for three consecutive days. Three hours after the last administration, animals were submitted to open field, elevated plus-maze, forced swim tests, and inhibitory avoidance paradigm. Twenty-four hours after behavioral tests, the blood and hippocampus were collected for the biochemical analyses. Superoxide dismutase, catalase, nitrite, and lipid peroxidation (LPO) were measured in the blood samples. Nitrite and LPO were measured in the hippocampus. The present findings demonstrate that the early hours of ketamine withdrawal induced oxidative biochemistry unbalance in the blood samples, with elevated levels of nitrite and LPO. In addition, we showed for the first time that ketamine withdrawal induced depressive- and anxiety-like profile, as well as short-term memory impairment in adolescent rodents. The neurobehavioral deficits were accompanied by the hippocampal nitrite and LPO-elevated levels.
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Affiliation(s)
- Sabrina de Carvalho Cartágenes
- Laboratory of Pharmacology of Inflammation and Behavior, Pharmacy Faculty, Institute of Health Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - Luanna Melo Pereira Fernandes
- Laboratory of Pharmacology of Inflammation and Behavior, Pharmacy Faculty, Institute of Health Sciences, Federal University of Pará, Belém, Pará, Brazil
| | | | - Thais Miranda de Sousa
- Laboratory of Pharmacology of Inflammation and Behavior, Pharmacy Faculty, Institute of Health Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - Antônio Rafael Quadros Gomes
- Laboratory of Microbiology and Immunology of Teaching and Research, Pharmacy Faculty, Institute of Health Science, Federal University of Pará, Belém, Pará, Brazil
| | - Marta Chagas Monteiro
- Laboratory of Microbiology and Immunology of Teaching and Research, Pharmacy Faculty, Institute of Health Science, Federal University of Pará, Belém, Pará, Brazil
| | | | - Maria Elena Crespo-López
- Laboratory of Molecular Pharmacology, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - Rafael Rodrigues Lima
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - Enéas Andrade Fontes-Júnior
- Laboratory of Pharmacology of Inflammation and Behavior, Pharmacy Faculty, Institute of Health Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - Rui Daniel Prediger
- Department of Pharmacology, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Cristiane Socorro Ferraz Maia
- Laboratory of Pharmacology of Inflammation and Behavior, Pharmacy Faculty, Institute of Health Sciences, Federal University of Pará, Belém, Pará, Brazil
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Freeman MP, Papakostas GI, Hoeppner B, Mazzone E, Judge H, Cusin C, Mathew S, Sanacora G, Iosifescu D, DeBattista C, Trivedi MH, Fava M. Sex differences in response to ketamine as a rapidly acting intervention for treatment resistant depression. J Psychiatr Res 2019; 110:166-171. [PMID: 30641350 PMCID: PMC6360121 DOI: 10.1016/j.jpsychires.2019.01.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/03/2019] [Accepted: 01/07/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND While ketamine has been increasingly studied for treatment resistant depression (TRD), the impact of sex differences on treatment outcomes has not been well studied. The objective was to ascertain whether there were differences in response to a single administration of ketamine for TRD between men and women, and between pre- and post-menopausal women. METHODS A randomized, double-blind, placebo-controlled trial (N = 99; N = 50 male; N = 49 female) was conducted to investigate the efficacy of intravenous ketamine versus active placebo as augmentation of antidepressant therapy for TRD. Patients were assigned to one of five arms; one-time administration of ketamine of varying doses (i.e., 0.1, 0.2, 0.5, and 1.0 mg/kg), and one group receiving active placebo (intravenous midazolam). A priori-planned analyses were conducted to compare responses between women and men, as well pre-vs. postmenopausal women. RESULTS Analyses demonstrated no significant differences between women and men in terms of treatment response (F(1,80) = 0.06, p = 0.80). There were no significant differences in the frequency of adverse effects (AEs) reported by those assigned to ketamine treatment groups (p > 0.21 for all AEs reported more than once), although women reported more headaches (12% vs. 6%, p = 0.30) and nausea (10% vs. 6%, p = 0.47). In comparing pre-vs. postmenopausal women, no differences in efficacy were observed (F(1,76) = 0.36, p = 0.55). CONCLUSIONS Results do not support differential efficacy or tolerability of ketamine for the treatment of TRD between women and men, nor based on menopause status among women. However, larger trials with these a priori aims are needed to confirm these results.
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Affiliation(s)
| | | | | | | | | | | | - Sanjay Mathew
- Baylor College of Medicine/Michael E. Debakey VA Medical Center, USA
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Trofimiuk E, Wielgat P, Braszko JJ, Car H. Stress and Ketamine, Bimodal Influence on Cognitive Functions. Behav Brain Res 2018; 360:354-364. [PMID: 30562568 DOI: 10.1016/j.bbr.2018.12.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/04/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
Abstract
The glutamate N-methyl-D-aspartate receptor (NMDAR) non-selective antagonist, ketamine, has been recently repurposed as a rapidly acting antidepressant, catalyzing the vigorous investigation of glutamate-signaling modulators as novel therapeutic agents for depressive disorders. Beneficial effects of this drug in the quick-acting treatment of depression are recognized. The long-term effects of ketamine have not been known, including the cognitive sphere. It is well acknowledged that prolonged exposure to stress induces depression and cognitive impairment. It seemed reasonable to ask how the long-term ketamine administration would affect stressed animals in the aspect of cognitive functions. In the current study we tested whether it is possible for ketamine, used in prolonged-regimen in rats, to alleviate stress-evoked memory deficits? Stressed (restraint 2 h daily for 21 days) and non-stressed rats (6-weeks-old) were treated with ketamine for 21 days and next subjected to a battery of behavioral tests: for the assessment of working and reference spatial memory (Morris water maze (MWM) and Barnes maze (BM)), stereotypy (stereotypy test - ST), locomotor functions (Open field - OF) and anxiety behavior (Elevated plus maze - EPM). Ketamine administration resulted in a significant stereotype behaviour in rats tested in ST. Stressed rats displayed a significant decline in the spatial working and reference memory. The effect of chronic ketamine administration depended on the type of test and differed between control rats and animals simultaneously exposed to chronic stress. However, in the MWM the impact was quite unequivocal, as we observed an improvement in spatial memory in stressed animals and a deterioration in non-stressed animals after ketamine administration. In the BM, the effect of ketamine changed in successive attempts, from favorable in the initial period to negative at the end of the test in the group of stressed animals and without a significant impact on control animals. We found no significant effects of ketamine on locomotor performance and on the level of anxiety. Taken together, these findings demonstrate that ketamine potently abolishes or prevents some kinds of stress-induced memory impairments and cognitive decline in rats, although in some circumstances, it could even increase damage to memory, especially in unstressed animals. It seems that the prolonged use of ketamine in the prevention of stress-induced memory declines can fulfill its role.
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Affiliation(s)
- Emil Trofimiuk
- Department of Clinical Pharmacology, Medical University of Bialystok, Waszyngtona 15A, 15-274 Bialystok, Poland.
| | - Przemysław Wielgat
- Department of Clinical Pharmacology, Medical University of Bialystok, Waszyngtona 15A, 15-274 Bialystok, Poland
| | - Jan J Braszko
- Department of Clinical Pharmacology, Medical University of Bialystok, Waszyngtona 15A, 15-274 Bialystok, Poland
| | - Halina Car
- Department of Clinical Pharmacology, Medical University of Bialystok, Waszyngtona 15A, 15-274 Bialystok, Poland
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Strong C, Kabbaj M. On the safety of repeated ketamine infusions for the treatment of depression: Effects of sex and developmental periods. Neurobiol Stress 2018; 9:166-175. [PMID: 30450382 PMCID: PMC6236511 DOI: 10.1016/j.ynstr.2018.09.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/23/2018] [Accepted: 09/04/2018] [Indexed: 12/16/2022] Open
Abstract
In this review, we will discuss the safety of repeated treatments with ketamine for patients with treatment-resistant depression (TRD), a condition in which patients with major depression do not show any clinical improvements following treatments with at least two antidepressant drugs. We will discuss the effects of these treatments in both sexes at different developmental periods. Numerous small clinical studies have shown that a single, low-dose ketamine infusion can rapidly alleviate depressive symptoms and thoughts of suicidality in patients with TRD, and these effects can last for about one week. Interestingly, the antidepressant effects of ketamine can be prolonged with intermittent, repeated infusion regimens and produce more robust therapeutic effects when compared to a single infusion. The safety of such repeated treatments with ketamine has not been thoroughly investigated. Although more studies are needed, some clinical and preclinical reports indicated that repeated infusions of low doses of ketamine may have addictive properties, and suggested that adolescent and adult female subjects may be more sensitive to ketamine's addictive effects. Additionally, during ketamine infusions, many TRD patients report hallucinations and feelings of dissociation and depersonalization, and therefore the effects of repeated treatments of ketamine on cognition must be further examined. Some clinical reports indicated that, compared to women, men are more sensitive to the psychomimetic effects of ketamine. Preclinical studies extended these findings to both adolescent and adult male rodents and showed that male rodents at both developmental periods are more sensitive to ketamine's cognitive-altering effects. Accordingly, in this review we shall focus our discussion on the potential addictive and cognitive-impairing effects of repeated ketamine infusions in both sexes at two important developmental periods: adolescence and adulthood. Although more work about the safety of ketamine is warranted, we hope this review will bring some answers about the safety of treating TRD with repeated ketamine infusions.
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Affiliation(s)
| | - Mohamed Kabbaj
- Corresponding author. Florida State University, 3300-H, 1115 W. Call St, Tallahassee, FL, 32306, USA.
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Incrocci RM, Paliarin F, Nobre MJ. Prelimbic NMDA receptors stimulation mimics the attenuating effects of clozapine on the auditory electrophysiological rebound induced by ketamine withdrawal. Neurotoxicology 2018; 69:1-10. [PMID: 30170016 DOI: 10.1016/j.neuro.2018.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/24/2018] [Accepted: 08/24/2018] [Indexed: 11/26/2022]
Abstract
Ketamine (KET) is a non-competitive N-Methyl-d-aspartate (NMDA) receptors antagonist that intensifies sensory experiences, prompts hallucinations and delusions, exacerbates previously installed psychosis and disrupts physiological evoked potentials (AEPs). Pharmacologically, KET stimulates glutamate efflux in the medial prefrontal cortex, mainly in the prelimbic (PrL) sub-region. Efferences from this region exert a top-down regulatory control of bottom-up sensory processes either directly or indirectly. In the midbrain, the central nucleus of the inferior colliculus (CIC) plays a fundamental role in the processing of auditory ascending information related to sound localization, sensorimotor gating, and preattentive event-related potentials. Auditory hallucinations elicited during a psychotic outbreak are accompanied by CIC neural activation. Thus, it is possible that NMDA-mediated glutamate neurotransmission in the PrL indirectly modulates CIC neuronal firing. The aim of the present study was to assess the effects of KET on the latency and amplitude of AEPs elicited in the CIC of rats tested during KET effects and following withdrawal from the chronic administration. Changes on emotionally induced by KET treatment were evaluated with the use of the elevated zero maze (EZM). Unlike typical neuroleptics, the atypical antipsychotic clozapine (CLZ) potently blocks the disruption of the sensorimotor gating induced by NMDA antagonists. Therefore, the effects of KET withdrawal on AEPs were challenged with a systemic injection of CLZ. In addition, we further investigated the role of NMDA receptors of the PrL on the AEPs expression recorded in the CIC through intra-PrL infusions of NMDA itself. Our results showed that the processing of sensory information in the CIC is under indirect control of PrL. These data suggest that the long-term KET treatment disrupts the collicular auditory field potentials, possibly through influencing PrL glutamate activity on intrinsic 5-HT mechanisms in the dorsal raphe and CIC.
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Affiliation(s)
- Roberta Monteiro Incrocci
- Departamento de Psicologia, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo (USP), 14040-901, Ribeirão Preto, SP, Brazil; Instituto de Neurociências e Comportamento-INeC, Campus USP, 14040-901, Ribeirão Preto, SP, Brazil
| | - Franciely Paliarin
- Departamento de Psicologia, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo (USP), 14040-901, Ribeirão Preto, SP, Brazil; Instituto de Neurociências e Comportamento-INeC, Campus USP, 14040-901, Ribeirão Preto, SP, Brazil
| | - Manoel Jorge Nobre
- Departamento de Psicologia, Uni-FACEF, 14401-135, Franca, SP, Brazil; Departamento de Psicologia, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo (USP), 14040-901, Ribeirão Preto, SP, Brazil; Instituto de Neurociências e Comportamento-INeC, Campus USP, 14040-901, Ribeirão Preto, SP, Brazil.
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Ou YL, Liu CY, Cha TL, Wu ST, Tsao CW. Complete reversal of the clinical symptoms and image morphology of ketamine cystitis after intravesical hyaluronic acid instillation: A case report. Medicine (Baltimore) 2018; 97:e11500. [PMID: 29995815 PMCID: PMC6076118 DOI: 10.1097/md.0000000000011500] [Citation(s) in RCA: 3] [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: 12/31/2022] Open
Abstract
RATIONALE Ketamine abuse is an emerging issue in many countries, and ketamine cystitis (KC) is a growing disease which more and more urologists may encounter with. There was no gold standard diagnostic criteria of ketamine cystits established yet, but well-accepted with the positive substance abuse history and clinical symptoms. The clinical presentation of ketamine cystitis varies and may mimic those presented in interstitial cystitis (IC), such as voiding frequency, urgency with urge incontinence, dysuria, nocturia, burning sensation during urination, post urination pain, painful hematuria, and small bladder capacity, but there are still differences that KC presented with more urgency, hematuria, pyuria and upper urinary tract involvement such as ureteral stenosis, vesico-ureteric reflux, hydronephrosis and renal function impairment. PATIENT CONCERNS We presented an interesting case with a 36-year-old man who's symptoms mimic acute prostatitis but there was no positive pathogen been cultured. The computed tomography (CT) findings revealed asymmetrical bladder wall thickening, which misleading us to the impression of bladder cancer. After the cystoscopy with bladder biopsy, the pathology revealed severe inflammation without malignancy. After that, we prescribed anticholinergic agent, beta-3 agonist and nonsteroidal anti-inflammatory drug (NSAID) for him, but in vain. DIAGNOSES Erosive cystitis with prominent infiltration by eosinophils, lymphocytes, neutrophils and plasma cells. INTERVENTIONS Then we introduced hyaluronic acid (HA) instillation, once a week for total 10 times. OUTCOMES After the treatment, his urgency, frequency, nocturia improved and his bladder capacity increased from less than 100ml to 350mL per urination. The following magnetic resonance imaging (MRI) and bladder biopsy result revealed complete reversal. LESSONS To our literature review, this is the first case of ketamine cystitis presented with asymmetrical bladder wall thickening, which may be considered as an irreversible change, but turns out complete reversal of the clinical symptoms and image morphology after merely intravesical hyaluronic acid instillation.
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Affiliation(s)
- Ying-Lun Ou
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Chin-Yu Liu
- Department of Nutritional Science, Fu Jen Catholic University, New Taipei City, Taiwan, Republic of China
| | - Tai-Lung Cha
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Sheng-Tang Wu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Chih-Wei Tsao
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
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Rice TR, Shah LD, Trelles P, Lin SK, Christensen DS, Walther A, Sher L. Mental health of the male adolescent and young man: the Copenhagen statement. World J Pediatr 2018; 14:224-232. [PMID: 29679360 DOI: 10.1007/s12519-018-0155-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/20/2018] [Accepted: 03/27/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Male adolescents and young men benefit when their mental health care is specialized to match their unique gendered and developmental needs. Sensitivity to the social circumstances of this population is important; additionally, the emerging ability to tailor care through knowledge gleaned from the intersection of psychiatry, neurology, and endocrinology informs care. DATA SOURCES This article summarized the views of six experts in the area of the adolescent and young adult male mental health. These experts were select members of the World Federation of Societies of Biological Psychiatry's Task Force on Men's Mental Health. They convened to present two symposia on the topic of men's mental health at the 13th World Congress of Biological Psychiatry (WCBP) in Copenhagen, Denmark in 2017. RESULTS In these works, a special focus is paid to addictive disorders, disruptive behavior disorders, aggression, and brain development. Collectively, the authors present an argument for the merits of a male-specific model of mental health care to advance the overall well-being of this population. CONCLUSIONS Men's mental health should be recognized as a social issue as much as a medical issue, with special attention paid to problems such as unemployment, familial disruption, and substance abuse. These problems, and especially those of major societal impact including violence and suicide which are much more frequently the product of male youth and men, should have more male-tailored options for service provision that respond to men's mental health needs.
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Affiliation(s)
- Timothy R Rice
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Lesha D Shah
- New York University School of Medicine, New York, NY, USA
| | - Pilar Trelles
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Shih-Ku Lin
- Taipei City Hospital and Taipei Medical University, Taipei, China
| | - Dinne Skjærlund Christensen
- Department of Public Health, Center for Healthy Aging and Section of Environmental Health, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Walther
- Biological Psychology, TU Dresden, Dresden, Germany
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Leo Sher
- James J. Peters VA Medical Center and Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Wright KN, Kabbaj M. Sex differences in sub-anesthetic ketamine's antidepressant effects and abuse liability. Curr Opin Behav Sci 2018; 23:36-41. [PMID: 30038955 DOI: 10.1016/j.cobeha.2018.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sub-anesthetic ketamine produces rapid antidepressant effects in patients with bipolar and unipolar major depression where conventional monoaminergic-based antidepressant drugs have been ineffective or ridden with side effects. A single ketamine infusion can produce antidepressant effects lasting up to two weeks, and multiple ketamine infusions prolong this effect. Pre-clinical studies are underway to uncover ketamine's mechanisms of action, but there are still many questions unanswered regarding the safety of its long-term use. Abuse liability is one area of concern, as recreational ketamine use is an ongoing issue in many parts of the world. Another understudied area is sex differences in responsivity to ketamine. Women are twice as likely as men to be diagnosed with depression, and they progress through stages of drug addiction more rapidly than their male counterparts. Despite this, preclinical studies in ketamine's antidepressant and addictive-like behaviors in females are limited. These intersecting factors in recent clinical and pre-clinical studies are reviewed to characterize ketamine's therapeutic potential, its limitations, and its potential mechanisms of action.
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Affiliation(s)
- Katherine N Wright
- Florida State University, Department of Biomedical Sciences, Program in Neuroscience, Tallahassee, FL
| | - Mohamed Kabbaj
- Florida State University, Department of Biomedical Sciences, Program in Neuroscience, Tallahassee, FL
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Huang MC, Chen LY, Chang HM, Liang XY, Chen CK, Cheng WJ, Xu K. Decreased Blood Levels of Oxytocin in Ketamine-Dependent Patients During Early Abstinence. Front Psychiatry 2018; 9:633. [PMID: 30534093 PMCID: PMC6275217 DOI: 10.3389/fpsyt.2018.00633] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/07/2018] [Indexed: 01/03/2023] Open
Abstract
Background: Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, is a common drug of abuse worldwide. Existing evidence suggest a disruption of oxytocin system involves in the development of addiction. In this study, we aimed to investigate the role of oxytocin in ketamine addiction by measuring the blood oxytocin levels in ketamine-dependent (KD) patients. Methods: Sixty-five KD patients and 65 controls were enrolled. Fasting plasma levels of oxytocin were determined at baseline and 1 and 2 weeks after ketamine withdrawal. Ketamine use variables, Beck Depression Inventory, Beck Anxiety Inventory (BAI), Visual Analog Scale for craving, and Childhood Trauma Questionnaire-short form were assessed in KD patients. Results: KD patients had significantly lower levels of oxytocin at baseline compared to controls (5.89 ± 2.13 vs. 9.53 ± 4.17 ng/mL, P < 0.001). Oxytocin levels increased after one (6.74 ± 2.63, P < 0.002) and 2 weeks (6.89 ± 2.69, P = 0.01) of withdrawal in KD patient despite the levels were still lower than controls (P = 0.001 and 0.002, respectively). The clinical variables did not correlate with baseline oxytocin levels except BAI scores, which showed a negative correlation with the levels (r = -0.263; P = 0.039). Conclusion: We found a distinctively reduced oxytocin level in KD patients and the level did not normalize after early abstinence. Lower oxytocin might be associated with anxious phenotype of ketamine dependence. These results suggest that oxytocin system dysregulated following chronic ketamine abuse and might provide insight in evaluating the potential therapeutic use of oxytocin for treating ketamine dependence.
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Affiliation(s)
- Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Lian-Yu Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Hu-Ming Chang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Xiao-Yu Liang
- Department of Psychiatry, Yale University School of Medicine, New Heaven, CT, United States
| | - Chih-Ken Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan.,Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Wan-Ju Cheng
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan.,Department of Public Health, China Medical University, Taichung, Taiwan
| | - Ke Xu
- Department of Psychiatry, Yale University School of Medicine, New Heaven, CT, United States
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Li CSR, Zhang S, Hung CC, Chen CM, Duann JR, Lin CP, Lee TSH. Depression in chronic ketamine users: Sex differences and neural bases. Psychiatry Res 2017; 269:1-8. [PMID: 28892733 PMCID: PMC5634929 DOI: 10.1016/j.pscychresns.2017.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/16/2017] [Accepted: 09/01/2017] [Indexed: 01/10/2023]
Abstract
Chronic ketamine use leads to cognitive and affective deficits including depression. Here, we examined sex differences and neural bases of depression in chronic ketamine users. Compared to non-drug using healthy controls (HC), ketamine-using females but not males showed increased depression score as assessed by the Center of Epidemiological Studies Depression Scale (CES-D). We evaluated resting state functional connectivity (rsFC) of the subgenual anterior cingulate cortex (sgACC), a prefrontal structure consistently implicated in the pathogenesis of depression. Compared to HC, ketamine users (KU) did not demonstrate significant changes in sgACC connectivities at a corrected threshold. However, in KU, a linear regression against CES-D score showed less sgACC connectivity to the orbitofrontal cortex (OFC) with increasing depression severity. Examined separately, male and female KU showed higher sgACC connectivity to bilateral superior temporal gyrus and dorsomedial prefrontal cortex (dmPFC), respectively, in correlation with depression. The linear correlation of sgACC-OFC and sgACC-dmPFC connectivity with depression was significantly different in slope between KU and HC. These findings highlighted changes in rsFC of the sgACC as associated with depression and sex differences in these changes in chronic ketamine users.
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Affiliation(s)
- Chiang-Shan R Li
- Department of Psychiatry, Yale University, New Haven, CT, USA; Department of Neuroscience, Yale University, New Haven, CT, USA; Beijing Huilongguan Hospital, Beijing, China.
| | - Sheng Zhang
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Chia-Chun Hung
- Bali Psychiatric Center, Ministry of Health and Welfare, Taiwan
| | - Chun-Ming Chen
- Department of Radiology, China Medical University Hospital, Taichung, Taiwan
| | - Jeng-Ren Duann
- Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan; Institute for Neural Computation, University of California San Diego, La Jolla, CA, USA
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang Ming University, Taipei, Taiwan
| | - Tony Szu-Hsien Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan.
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Liebe T, Li S, Lord A, Colic L, Krause AL, Batra A, Kretzschmar MA, Sweeney-Reed CM, Behnisch G, Schott BH, Walter M. Factors Influencing the Cardiovascular Response to Subanesthetic Ketamine: A Randomized, Placebo-Controlled Trial. Int J Neuropsychopharmacol 2017; 20:909-918. [PMID: 29099972 PMCID: PMC5737852 DOI: 10.1093/ijnp/pyx055] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/28/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The increasing use of ketamine as a potential rapid-onset antidepressant necessitates a better understanding of its effects on blood pressure and heart rate, well-known side effects at higher doses. For the subanesthetic dose used for depression, potential predictors of these cardiovascular effects are important factors influencing clinical decisions. Since ketamine influences the sympathetic nervous system, we investigated the impact of autonomic nervous system-related factors on the cardiovascular response: a genetic polymorphism in the norepinephrine transporter and gender effects. METHODS Blood pressure and heart rate were monitored during and following administration of a subanesthetic dose of ketamine or placebo in 68 healthy participants (mean age 26.04 ±5.562 years) in a double-blind, randomized, controlled, parallel-design trial. The influences of baseline blood pressure/heart rate, gender, and of a polymorphism in the norepinephrine transporter gene (NET SLC6A2, rs28386840 [A-3081T]) on blood pressure and heart rate changes were investigated. To quantify changes in blood pressure and heart rate, we calculated the maximum change from baseline (ΔMAX) and the time until maximum change (TΔMAX). RESULTS Systolic and diastolic blood pressure as well as heart rate increased significantly upon ketamine administration, but without reaching hypertensive levels. During administration, the systolic blood pressure at baseline (TP0Sys) correlated negatively with the time to achieve maximal systolic blood pressure (TΔMAXSys, P<.001). Furthermore, women showed higher maximal diastolic blood pressure change (ΔMAXDia, P<.001) and reached this peak earlier than men (TΔMAXDia, P=.017) at administration. NET rs28386840 [T] carriers reached their maximal systolic blood pressure during ketamine administration significantly earlier than [A] homozygous (TΔMAXSys, P=.030). In a combined regression model, both genetic polymorphism and TP0Sys were significant predictors of TΔMAXSys (P<.0005). CONCLUSIONS Subanesthetic ketamine increased both blood pressure and heart rate without causing hypertensive events. Furthermore, we identified gender and NET rs28386840 genotype as factors that predict increased cardiovascular sequelae of ketamine administration in our young, healthy study population providing a potential basis for establishing monitoring guidelines.
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Affiliation(s)
- Thomas Liebe
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Magdeburg, Germany (Dr Liebe, Ms Colic, and Dr Krause); School of Psychology and Cognitive Science, East China Normal University, Shanghai, China (Dr Li); Department of Immunology, Queensland Institute of Medical Research, Herston, Queensland, Australia (Dr Lord); Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany (Dr Batra); Department of Anesthesiology and Intensive Care Medicine (Dr Kretzschmar) and Neurocybernetics and Rehabilitation (Dr Sweeney-Reed), University Hospital, Magdeburg, Germany; Behavioural Neuroscience, Leibniz Institute for Neurobiology, Magdeburg, Germany (Ms Behnisch and Dr Schott); Translational Psychiatry Tübingen, University Hospital Tübingen, Tübingen, Germany (Drs Liebe and Walter).,Correspondence: Martin Walter, MD, Head, Translational Psychiatry, General Psychiatry and Psychotherapy, Eberhard-Karls-University, Tübingen, Calwer Str. 14, 72076 Tübingen, Germany ()
| | - Shijia Li
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Magdeburg, Germany (Dr Liebe, Ms Colic, and Dr Krause); School of Psychology and Cognitive Science, East China Normal University, Shanghai, China (Dr Li); Department of Immunology, Queensland Institute of Medical Research, Herston, Queensland, Australia (Dr Lord); Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany (Dr Batra); Department of Anesthesiology and Intensive Care Medicine (Dr Kretzschmar) and Neurocybernetics and Rehabilitation (Dr Sweeney-Reed), University Hospital, Magdeburg, Germany; Behavioural Neuroscience, Leibniz Institute for Neurobiology, Magdeburg, Germany (Ms Behnisch and Dr Schott); Translational Psychiatry Tübingen, University Hospital Tübingen, Tübingen, Germany (Drs Liebe and Walter)
| | - Anton Lord
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Magdeburg, Germany (Dr Liebe, Ms Colic, and Dr Krause); School of Psychology and Cognitive Science, East China Normal University, Shanghai, China (Dr Li); Department of Immunology, Queensland Institute of Medical Research, Herston, Queensland, Australia (Dr Lord); Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany (Dr Batra); Department of Anesthesiology and Intensive Care Medicine (Dr Kretzschmar) and Neurocybernetics and Rehabilitation (Dr Sweeney-Reed), University Hospital, Magdeburg, Germany; Behavioural Neuroscience, Leibniz Institute for Neurobiology, Magdeburg, Germany (Ms Behnisch and Dr Schott); Translational Psychiatry Tübingen, University Hospital Tübingen, Tübingen, Germany (Drs Liebe and Walter)
| | - Lejla Colic
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Magdeburg, Germany (Dr Liebe, Ms Colic, and Dr Krause); School of Psychology and Cognitive Science, East China Normal University, Shanghai, China (Dr Li); Department of Immunology, Queensland Institute of Medical Research, Herston, Queensland, Australia (Dr Lord); Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany (Dr Batra); Department of Anesthesiology and Intensive Care Medicine (Dr Kretzschmar) and Neurocybernetics and Rehabilitation (Dr Sweeney-Reed), University Hospital, Magdeburg, Germany; Behavioural Neuroscience, Leibniz Institute for Neurobiology, Magdeburg, Germany (Ms Behnisch and Dr Schott); Translational Psychiatry Tübingen, University Hospital Tübingen, Tübingen, Germany (Drs Liebe and Walter)
| | - Anna Linda Krause
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Magdeburg, Germany (Dr Liebe, Ms Colic, and Dr Krause); School of Psychology and Cognitive Science, East China Normal University, Shanghai, China (Dr Li); Department of Immunology, Queensland Institute of Medical Research, Herston, Queensland, Australia (Dr Lord); Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany (Dr Batra); Department of Anesthesiology and Intensive Care Medicine (Dr Kretzschmar) and Neurocybernetics and Rehabilitation (Dr Sweeney-Reed), University Hospital, Magdeburg, Germany; Behavioural Neuroscience, Leibniz Institute for Neurobiology, Magdeburg, Germany (Ms Behnisch and Dr Schott); Translational Psychiatry Tübingen, University Hospital Tübingen, Tübingen, Germany (Drs Liebe and Walter)
| | - Anil Batra
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Magdeburg, Germany (Dr Liebe, Ms Colic, and Dr Krause); School of Psychology and Cognitive Science, East China Normal University, Shanghai, China (Dr Li); Department of Immunology, Queensland Institute of Medical Research, Herston, Queensland, Australia (Dr Lord); Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany (Dr Batra); Department of Anesthesiology and Intensive Care Medicine (Dr Kretzschmar) and Neurocybernetics and Rehabilitation (Dr Sweeney-Reed), University Hospital, Magdeburg, Germany; Behavioural Neuroscience, Leibniz Institute for Neurobiology, Magdeburg, Germany (Ms Behnisch and Dr Schott); Translational Psychiatry Tübingen, University Hospital Tübingen, Tübingen, Germany (Drs Liebe and Walter)
| | - Moritz A Kretzschmar
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Magdeburg, Germany (Dr Liebe, Ms Colic, and Dr Krause); School of Psychology and Cognitive Science, East China Normal University, Shanghai, China (Dr Li); Department of Immunology, Queensland Institute of Medical Research, Herston, Queensland, Australia (Dr Lord); Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany (Dr Batra); Department of Anesthesiology and Intensive Care Medicine (Dr Kretzschmar) and Neurocybernetics and Rehabilitation (Dr Sweeney-Reed), University Hospital, Magdeburg, Germany; Behavioural Neuroscience, Leibniz Institute for Neurobiology, Magdeburg, Germany (Ms Behnisch and Dr Schott); Translational Psychiatry Tübingen, University Hospital Tübingen, Tübingen, Germany (Drs Liebe and Walter)
| | - Catherine M Sweeney-Reed
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Magdeburg, Germany (Dr Liebe, Ms Colic, and Dr Krause); School of Psychology and Cognitive Science, East China Normal University, Shanghai, China (Dr Li); Department of Immunology, Queensland Institute of Medical Research, Herston, Queensland, Australia (Dr Lord); Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany (Dr Batra); Department of Anesthesiology and Intensive Care Medicine (Dr Kretzschmar) and Neurocybernetics and Rehabilitation (Dr Sweeney-Reed), University Hospital, Magdeburg, Germany; Behavioural Neuroscience, Leibniz Institute for Neurobiology, Magdeburg, Germany (Ms Behnisch and Dr Schott); Translational Psychiatry Tübingen, University Hospital Tübingen, Tübingen, Germany (Drs Liebe and Walter)
| | - Gusalija Behnisch
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Magdeburg, Germany (Dr Liebe, Ms Colic, and Dr Krause); School of Psychology and Cognitive Science, East China Normal University, Shanghai, China (Dr Li); Department of Immunology, Queensland Institute of Medical Research, Herston, Queensland, Australia (Dr Lord); Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany (Dr Batra); Department of Anesthesiology and Intensive Care Medicine (Dr Kretzschmar) and Neurocybernetics and Rehabilitation (Dr Sweeney-Reed), University Hospital, Magdeburg, Germany; Behavioural Neuroscience, Leibniz Institute for Neurobiology, Magdeburg, Germany (Ms Behnisch and Dr Schott); Translational Psychiatry Tübingen, University Hospital Tübingen, Tübingen, Germany (Drs Liebe and Walter)
| | - Björn H Schott
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Magdeburg, Germany (Dr Liebe, Ms Colic, and Dr Krause); School of Psychology and Cognitive Science, East China Normal University, Shanghai, China (Dr Li); Department of Immunology, Queensland Institute of Medical Research, Herston, Queensland, Australia (Dr Lord); Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany (Dr Batra); Department of Anesthesiology and Intensive Care Medicine (Dr Kretzschmar) and Neurocybernetics and Rehabilitation (Dr Sweeney-Reed), University Hospital, Magdeburg, Germany; Behavioural Neuroscience, Leibniz Institute for Neurobiology, Magdeburg, Germany (Ms Behnisch and Dr Schott); Translational Psychiatry Tübingen, University Hospital Tübingen, Tübingen, Germany (Drs Liebe and Walter)
| | - Martin Walter
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Magdeburg, Germany (Dr Liebe, Ms Colic, and Dr Krause); School of Psychology and Cognitive Science, East China Normal University, Shanghai, China (Dr Li); Department of Immunology, Queensland Institute of Medical Research, Herston, Queensland, Australia (Dr Lord); Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany (Dr Batra); Department of Anesthesiology and Intensive Care Medicine (Dr Kretzschmar) and Neurocybernetics and Rehabilitation (Dr Sweeney-Reed), University Hospital, Magdeburg, Germany; Behavioural Neuroscience, Leibniz Institute for Neurobiology, Magdeburg, Germany (Ms Behnisch and Dr Schott); Translational Psychiatry Tübingen, University Hospital Tübingen, Tübingen, Germany (Drs Liebe and Walter)
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Wright KN, Strong CE, Addonizio MN, Brownstein NC, Kabbaj M. Reinforcing properties of an intermittent, low dose of ketamine in rats: effects of sex and cycle. Psychopharmacology (Berl) 2017; 234:393-401. [PMID: 27837330 PMCID: PMC5384643 DOI: 10.1007/s00213-016-4470-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 10/27/2016] [Indexed: 11/30/2022]
Abstract
RATIONALE Repeated intermittent exposure to ketamine has rapid and long-lasting antidepressant effects, but the abuse potential has only been assessed at high doses. Furthermore, while females are more susceptible to depression and more sensitive to ketamine's antidepressant-like effects, the abuse potential for ketamine in females is unknown. OBJECTIVES The objectives of this study are to determine the reinforcing properties of low-dose intermittent ketamine in adult rats of both sexes and determine whether cycling gonadal hormones influence females' response to ketamine. In male rats, we also aimed to determine whether reinstatement to intermittent ketamine is comparable to intermittent cocaine. METHODS Male rats intravenously self-administered cocaine (0.75 mg/kg/infusion) or ketamine (0.1 mg/kg/infusion) once every fourth day, while intact cycling female rats self-administered ketamine only during preidentified stages of their 4-day estrus cycle, when gonadal hormones are either high (proestrus) or low (diestrus). After acquiring self-administration, rats underwent daily extinction training followed by cue-primed and drug-primed reinstatement to assess drug-seeking behavior. RESULTS Diestrus-trained females fail to maintain ketamine self-administration and did not display reinstatement to ketamine-paired cues. Males and proestrus-trained females reinstated to ketamine-paired cues. Ketamine-primed reinstatement was dependent on simultaneous cue presentation. Male rats reinstated to cocaine priming independent of cue presentation. CONCLUSION These findings indicate that females's responsivity to this dose of ketamine depends on stage of cycle, as only proestrus-trained females and males respond to ketamine's reinforcing effects under this treatment paradigm.
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Affiliation(s)
- Katherine N. Wright
- Program in Neuroscience, Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Caroline E. Strong
- Program in Neuroscience, Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Marjorie N. Addonizio
- Program in Neuroscience, Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Naomi C. Brownstein
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA,Department of Statistics, Florida State University, Tallahassee, FL, USA
| | - Mohamed Kabbaj
- Program in Neuroscience, Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA. .,College of Medicine, Department of Biomedical Sciences, Florida State University, 1115 W. Call St., Tallahassee, FL, 32306, USA.
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48
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Hassan Z, Bosch OG, Singh D, Narayanan S, Kasinather BV, Seifritz E, Kornhuber J, Quednow BB, Müller CP. Novel Psychoactive Substances-Recent Progress on Neuropharmacological Mechanisms of Action for Selected Drugs. Front Psychiatry 2017; 8:152. [PMID: 28868040 PMCID: PMC5563308 DOI: 10.3389/fpsyt.2017.00152] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/02/2017] [Indexed: 12/15/2022] Open
Abstract
A feature of human culture is that we can learn to consume chemical compounds, derived from natural plants or synthetic fabrication, for their psychoactive effects. These drugs change the mental state and/or the behavioral performance of an individual and can be instrumentalized for various purposes. After the emergence of a novel psychoactive substance (NPS) and a period of experimental consumption, personal and medical benefits and harm potential of the NPS can be estimated on evidence base. This may lead to a legal classification of the NPS, which may range from limited medical use, controlled availability up to a complete ban of the drug form publically accepted use. With these measures, however, a drug does not disappear, but frequently continues to be used, which eventually allows an even better estimate of the drug's properties. Thus, only in rare cases, there is a final verdict that is no more questioned. Instead, the view on a drug can change from tolerable to harmful but may also involve the new establishment of a desired medical application to a previously harmful drug. Here, we provide a summary review on a number of NPS for which the neuropharmacological evaluation has made important progress in recent years. They include mitragynine ("Kratom"), synthetic cannabinoids (e.g., "Spice"), dimethyltryptamine and novel serotonergic hallucinogens, the cathinones mephedrone and methylone, ketamine and novel dissociative drugs, γ-hydroxybutyrate, γ-butyrolactone, and 1,4-butanediol. This review shows not only emerging harm potentials but also some potential medical applications.
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Affiliation(s)
- Zurina Hassan
- Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia
| | - Oliver G Bosch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia
| | - Suresh Narayanan
- School of Social Sciences, Universiti Sains Malaysia, Minden, Malaysia
| | | | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Boris B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Christian P Müller
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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49
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Ketamine abuse potential and use disorder. Brain Res Bull 2016; 126:68-73. [DOI: 10.1016/j.brainresbull.2016.05.016] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/26/2016] [Accepted: 05/30/2016] [Indexed: 02/07/2023]
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50
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Jhang JF, Birder LA, Chancellor MB, Kuo HC. Patient characteristics for different therapeutic strategies in the management ketamine cystitis. Neurourol Urodyn 2016; 36:687-691. [PMID: 26998599 DOI: 10.1002/nau.22996] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 02/21/2016] [Indexed: 11/09/2022]
Abstract
AIMS Long-term ketamine abuse results in severely inflamed bladder and intractable bladder pain. Currently there is no guideline for clinician to follow how to manage patients with ketamine cystitis (KC). This study analyzed the KC patient characteristics between who received conservative management and augmentation enterocystoplasty (AE). METHODS A total of 53 patients with chronic ketamine abuse and lower urinary tract symptoms were included in this study. All of the patients have been initially treated conservatively but fail. They were admitted for detailed urological examinations. Patients were classified according to their maximal bladder capacity (MBC). The patients with extremely small MBC (<100 ml) with or without upper urinary tract damage and very small MBC with upper urinary tract damage were recommended to receive AE. The patient characteristics and treatment outcome are compared between patients with AE and conservative treatment. RESULTS Among them, 28 patients underwent AE and 25 were managed with conservative treatment. The only significant difference between groups was more patients with urgency urinary incontinence underwent AE. Patients underwent AE had significantly smaller MBC, thicker bladder wall, and higher incidence of vesicoureteral reflux. Patients underwent AE reported a good outcome. Most of patients received conservative treatment had a fair result. CONCLUSIONS KC patients who already developed a contracted bladder with extremely small bladder capacity (<300 ml) with irreversible urinary tract change, partial cystectomy, and AE seems necessary for early restoration of a normal lower urinary tract function. The treatment outcome of AE is better than patients with conservative treatment. Neurourol. Urodynam. 36:687-691, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jia-Fong Jhang
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Lori A Birder
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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