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Garcia-Carachure I, Lira O, Themann A, Rodriguez M, Flores-Ramirez FJ, Lobo MK, Iñiguez SD. Sex-Specific Alterations in Spatial Memory and Hippocampal AKT-mTOR Signaling in Adult Mice Pre-exposed to Ketamine and/or Psychological Stress During Adolescence. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:240-251. [PMID: 38298791 PMCID: PMC10829642 DOI: 10.1016/j.bpsgos.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 02/02/2024] Open
Abstract
Background Ketamine (KET) is administered to manage major depression in adolescent patients. However, the long-term effects of juvenile KET exposure on memory-related tasks have not been thoroughly assessed. We examined whether exposure to KET, psychological stress, or both results in long-lasting alterations in spatial memory in C57BL/6 mice. Furthermore, we evaluated how KET and/or psychological stress history influenced hippocampal protein kinase B-mechanistic target of rapamycin (AKT-mTOR)-related signaling. Methods On postnatal day 35, male and female mice underwent vicarious defeat stress (VDS), a form of psychological stress that reduces sociability in both sexes, with or without KET exposure (20 mg/kg/day, postnatal days 35-44). In adulthood (postnatal day 70), mice were assessed for spatial memory performance on a water maze task or euthanized for hippocampal tissue collection. Results Juvenile pre-exposure to KET or VDS individually increased the latency (seconds) to locate the escape platform in adult male, but not female, mice. However, juvenile history of concomitant KET and VDS prevented memory impairment. Furthermore, individual KET or VDS pre-exposure, unlike their combined history, decreased hippocampal AKT-mTOR signaling in adult male mice. Conversely, KET pre-exposure alone increased AKT-mTOR in the hippocampus of adult female mice. Lastly, rapamycin-induced decreases of mTOR in naïve adult female mice induced spatial memory retrieval deficits, mimicking adult male mice with a history of exposure to VDS or KET. Conclusions Our preclinical model shows how KET treatment for the management of adolescent psychological stress-induced sequelae does not impair spatial memory later in life. However, juvenile recreational KET misuse, like psychological stress history, results in long-term spatial memory deficits and hippocampal AKT-mTOR signaling changes in a sex-specific manner.
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Affiliation(s)
| | - Omar Lira
- Department of Psychology, The University of Texas at El Paso, El Paso, Texas
| | - Anapaula Themann
- Department of Psychology, The University of Texas at El Paso, El Paso, Texas
| | - Minerva Rodriguez
- Department of Psychology, The University of Texas at El Paso, El Paso, Texas
| | | | - Mary Kay Lobo
- Department of Neurobiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sergio D. Iñiguez
- Department of Psychology, The University of Texas at El Paso, El Paso, Texas
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Hack LM, Zhang X, Heifets BD, Suppes T, van Roessel PJ, Yesavage JA, Gray NJ, Hilton R, Bertrand C, Rodriguez CI, Deisseroth K, Knutson B, Williams LM. Ketamine's acute effects on negative brain states are mediated through distinct altered states of consciousness in humans. Nat Commun 2023; 14:6631. [PMID: 37857620 PMCID: PMC10587184 DOI: 10.1038/s41467-023-42141-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 09/27/2023] [Indexed: 10/21/2023] Open
Abstract
Ketamine commonly and rapidly induces dissociative and other altered states of consciousness (ASCs) in humans. However, the neural mechanisms that contribute to these experiences remain unknown. We used functional neuroimaging to engage key regions of the brain's affective circuits during acute ketamine-induced ASCs within a randomized, multi-modal, placebo-controlled design examining placebo, 0.05 mg/kg ketamine, and 0.5 mg/kg ketamine in nonclinical adult participants (NCT03475277). Licensed clinicians monitored infusions for safety. Linear mixed effects models, analysis of variance, t-tests, and mediation models were used for statistical analyses. Our design enabled us to test our pre-specified primary and secondary endpoints, which were met: effects of ketamine across dose conditions on (1) emotional task-evoked brain activity, and (2) sub-components of dissociation and other ASCs. With this design, we also could disentangle which ketamine-induced affective brain states are dependent upon specific aspects of ASCs. Differently valenced ketamine-induced ASCs mediated opposing effects on right anterior insula activity. Participants experiencing relatively higher depersonalization induced by 0.5 mg/kg of ketamine showed relief from negative brain states (reduced task-evoked right anterior insula activity, 0.39 SD). In contrast, participants experiencing dissociative amnesia showed an exacerbation of insula activity (0.32 SD). These results in nonclinical participants may shed light on the mechanisms by which specific dissociative states predict response to ketamine in depressed individuals.
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Affiliation(s)
- Laura M Hack
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra-Pacific Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Xue Zhang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Boris D Heifets
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Peter J van Roessel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra-Pacific Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jerome A Yesavage
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra-Pacific Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Nancy J Gray
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Rachel Hilton
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Claire Bertrand
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Carolyn I Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Karl Deisseroth
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA
| | - Brian Knutson
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
- Sierra-Pacific Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
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Masuda FK, Aery Jones EA, Sun Y, Giocomo LM. Ketamine evoked disruption of entorhinal and hippocampal spatial maps. Nat Commun 2023; 14:6285. [PMID: 37805575 PMCID: PMC10560293 DOI: 10.1038/s41467-023-41750-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/15/2023] [Indexed: 10/09/2023] Open
Abstract
Ketamine, a rapid-acting anesthetic and acute antidepressant, carries undesirable spatial cognition side effects including out-of-body experiences and spatial memory impairments. The neural substrates that underlie these alterations in spatial cognition however, remain incompletely understood. Here, we used electrophysiology and calcium imaging to examine ketamine's impacts on the medial entorhinal cortex and hippocampus, which contain neurons that encode an animal's spatial position, as mice navigated virtual reality and real world environments. Ketamine acutely increased firing rates, degraded cell-pair temporal firing-rate relationships, and altered oscillations, leading to longer-term remapping of spatial representations. In the reciprocally connected hippocampus, the activity of neurons that encode the position of the animal was suppressed after ketamine administration. Together, these findings demonstrate ketamine-induced dysfunction of the MEC-hippocampal circuit at the single cell, local-circuit population, and network levels, connecting previously demonstrated physiological effects of ketamine on spatial cognition to alterations in the spatial navigation circuit.
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Affiliation(s)
- Francis Kei Masuda
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Emily A Aery Jones
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Yanjun Sun
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Lisa M Giocomo
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA, 94305, USA.
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Pilozzi A, Foster S, Mischoulon D, Fava M, Huang X. A Brief Review on the Potential of Psychedelics for Treating Alzheimer's Disease and Related Depression. Int J Mol Sci 2023; 24:12513. [PMID: 37569888 PMCID: PMC10419627 DOI: 10.3390/ijms241512513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
Alzheimer's disease (AD), the most common form of senile dementia, is poised to place an even greater societal and healthcare burden as the population ages. With few treatment options for the symptomatic relief of the disease and its unknown etiopathology, more research into AD is urgently needed. Psychedelic drugs target AD-related psychological pathology and symptoms such as depression. Using microdosing, psychedelic drugs may prove to help combat this devastating disease by eliciting psychiatric benefits via acting through various mechanisms of action such as serotonin and dopamine pathways. Herein, we review the studied benefits of a few psychedelic compounds that may show promise in treating AD and attenuating its related depressive symptoms. We used the listed keywords to search through PubMed for relevant preclinical, clinical research, and review articles. The putative mechanism of action (MOA) for psychedelics is that they act mainly as serotonin receptor agonists and induce potential beneficial effects for treating AD and related depression.
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Affiliation(s)
- Alexander Pilozzi
- Neurochemistry Laboratory, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Simmie Foster
- Neurochemistry Laboratory, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
- Depression Clinical & Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - David Mischoulon
- Depression Clinical & Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Maurizio Fava
- Depression Clinical & Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Xudong Huang
- Neurochemistry Laboratory, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
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Speers LJ, Sissons DJ, Cleland L, Bilkey DK. Hippocampal phase precession is preserved under ketamine, but the range of precession across a theta cycle is reduced. J Psychopharmacol 2023; 37:809-821. [PMID: 37515458 PMCID: PMC10399102 DOI: 10.1177/02698811231187339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
BACKGROUND Hippocampal phase precession, which depends on the precise spike timing of place cells relative to local theta oscillations, has been proposed to underlie sequential memory. N-methyl-D-asparate (NMDA) receptor antagonists such as ketamine disrupt memory and also reproduce several schizophrenia-like symptoms, including spatial memory impairments and disorganized cognition. It is possible that these impairments result from disruptions to phase precession. AIMS/METHODS We used an ABA design to test whether an acute, subanesthetic dose (7.5 mg/kg) of ketamine disrupted phase precession in CA1 of male rats as they navigated around a rectangular track for a food reward. RESULTS/OUTCOMES Ketamine did not affect the ability of CA1 place cells to precess despite changes to place cell firing rates, local field potential properties and locomotor speed. However, ketamine reduced the range of phase precession that occurred across a theta cycle. CONCLUSION Phase precession is largely robust to acute NMDA receptor antagonism by ketamine, but the reduced range of precession could have important implications for learning and memory.
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Affiliation(s)
| | - Daena J Sissons
- Psychology Department, Otago University Dunedin, New Zealand
- Psychology Department, University of Canterbury, Christchurch, New Zealand
| | - Lana Cleland
- Psychology Department, Otago University Dunedin, New Zealand
- Department Psychological Medicine, Otago University, Christchurch, New Zealand
- Department Population Health, Otago University, Christchurch, New Zealand
| | - David K Bilkey
- Psychology Department, Otago University Dunedin, New Zealand
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Schep LJ, Slaughter RJ, Watts M, Mackenzie E, Gee P. The clinical toxicology of ketamine. Clin Toxicol (Phila) 2023:1-14. [PMID: 37267048 DOI: 10.1080/15563650.2023.2212125] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Ketamine is a pharmaceutical drug possessing both analgesic and anaesthetic properties. As an anaesthetic, it induces anaesthesia by producing analgesia with a state of altered consciousness while maintaining airway tone, respiratory drive, and hemodynamic stability. At lower doses, it has psychoactive properties and has gained popularity as a recreational drug. OBJECTIVES To review the epidemiology, mechanisms of toxicity, pharmacokinetics, clinical features, diagnosis and management of ketamine toxicity. METHODS Both OVID MEDLINE (January 1950-April 2023) and Web of Science (1900-April 2023) databases were searched using the term "ketamine" in combination with the keywords "pharmacokinetics", "kinetics", "poisoning", "poison", "toxicity", "ingestion", "adverse effects", "overdose", and "intoxication". Furthermore, bibliographies of identified articles were screened for additional relevant studies. These searches produced 5,268 non-duplicate citations; 185 articles (case reports, case series, pharmacokinetic studies, animal studies pertinent to pharmacology, and reviews) were considered relevant. Those excluded were other animal investigations, therapeutic human clinical investigations, commentaries, editorials, cases with no clinical relevance and post-mortem investigations. EPIDEMIOLOGY Following its introduction into medical practice in the early 1970s, ketamine has become a popular recreational drug. Its use has become associated with the dance culture, electronic and dubstep dance events. MECHANISM OF ACTION Ketamine acts primarily as a non-competitive antagonist on the glutamate N-methyl-D-aspartate receptor, causing the loss of responsiveness that is associated with clinical ketamine dissociative anaesthesia. PHARMACOKINETICS Absorption of ketamine is rapid though the rate of uptake and bioavailability is determined by the route of exposure. Ketamine is metabolized extensively in the liver. Initially, both isomers are metabolized to their major active metabolite, norketamine, by CYP2B6, CYP3A4 and CYP2C9 isoforms. The hydroxylation of the cyclohexan-1-one ring of norketamine to the three positional isomers of hydroxynorketamine occurs by CYP2B6 and CYP2A6. The dehydronorketamine metabolite occurs either by direct dehydrogenation from norketamine via CYP2B6 metabolism or non-enzymatic dehydration of hydroxynorketamine. Norketamine, the dehydronorketamine isomers, and hydroxynorketamine have pharmacological activity. The elimination of ketamine is primarily by the kidneys, though unchanged ketamine accounts for only a small percentage in the urine. The half-life of ketamine in humans is between 1.5 and 5 h. CLINICAL FEATURES Acute adverse effects following recreational use are diverse and can include impaired consciousness, dizziness, irrational behaviour, hallucinations, abdominal pain and vomiting. Chronic use can result in impaired verbal information processing, cystitis and cholangiopathy. DIAGNOSIS The diagnosis of acute ketamine intoxication is typically made on the basis of the patient's history, clinical features, such as vomiting, sialorrhea, or laryngospasm, along with neuropsychiatric features. Chronic effects of ketamine toxicity can result in cholangiopathy and cystitis, which can be confirmed by endoscopic retrograde cholangiopancreatography and cystoscopy, respectively. MANAGEMENT Treatment of acute clinical toxicity is predominantly supportive with empiric management of specific adverse effects. Benzodiazepines are recommended as initial treatment to reduce agitation, excess neuromuscular activity and blood pressure. Management of cystitis is multidisciplinary and multi-tiered, following a stepwise approach of pharmacotherapy and surgery. Management of cholangiopathy may require pain management and, where necessary, biliary stenting to alleviate obstructions. Chronic effects of ketamine toxicity are typically reversible, with management focusing on abstinence. CONCLUSIONS Ketamine is a dissociative drug employed predominantly in emergency medicine; it has also become popular as a recreational drug. Its recreational use can result in acute neuropsychiatric effects, whereas chronic use can result in cystitis and cholangiopathy.
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Affiliation(s)
- Leo J Schep
- Professional Practice Fellow, Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | | | - Martin Watts
- Emergency Department, Southland Hospital, Invercargill, New Zealand
| | - Elliot Mackenzie
- Obstetrics and Gynaecology, Women and Childrens Health. Dunedin Public Hospital, Dunedin, New Zealand
| | - Paul Gee
- National Poisons Centre, University of Otago, Dunedin, New Zealand
- Emergency Department, Christchurch Hospital, Christchurch, New Zealand
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Rogan T, Wilkinson ST. The Role of Psychotherapy in the Management of Treatment-Resistant Depression. Psychiatr Clin North Am 2023; 46:349-358. [PMID: 37149349 DOI: 10.1016/j.psc.2023.02.006] [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: 05/08/2023]
Abstract
This article reviews the role of psychotherapy in management of treatment-resistant depression (TRD). Meta-analyses of randomized trials show that psychotherapy has a positive therapeutic benefit in TRD. There is less evidence that one type of psychotherapy approach is superior to another. However, more trials have examined cognitive-based therapies than other forms of psychotherapy. Also reviewed is the potential combination of psychotherapy modalities and medication/somatic therapies as an approach to TRD. There is significant interest in ways that psychotherapy modalities could be combined with medication/somatic therapies to harness a state of enhanced neural plasticity and improve longer-term outcomes in mood disorders.
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Affiliation(s)
- Taylor Rogan
- The Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA
| | - Samuel T Wilkinson
- The Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA.
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Adzic M, Lukic I, Mitic M, Glavonic E, Dragicevic N, Ivkovic S. Contribution of the opioid system to depression and to the therapeutic effects of classical antidepressants and ketamine. Life Sci 2023:121803. [PMID: 37245840 DOI: 10.1016/j.lfs.2023.121803] [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: 03/31/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
Abstract
Major depressive disorder (MDD) afflicts approximately 5 % of the world population, and about 30-50 % of patients who receive classical antidepressant medications do not achieve complete remission (treatment resistant depressive patients). Emerging evidence suggests that targeting opioid receptors mu (MOP), kappa (KOP), delta (DOP), and the nociceptin/orphanin FQ receptor (NOP) may yield effective therapeutics for stress-related psychiatric disorders. As depression and pain exhibit significant overlap in their clinical manifestations and molecular mechanisms involved, it is not a surprise that opioids, historically used to alleviate pain, emerged as promising and effective therapeutic options in the treatment of depression. The opioid signaling is dysregulated in depression and numerous preclinical studies and clinical trials strongly suggest that opioid modulation can serve as either an adjuvant or even an alternative to classical monoaminergic antidepressants. Importantly, some classical antidepressants require the opioid receptor modulation to exert their antidepressant effects. Finally, ketamine, a well-known anesthetic whose extremely efficient antidepressant effects were recently discovered, was shown to mediate its antidepressant effects via the endogenous opioid system. Thus, although opioid system modulation is a promising therapeutical venue in the treatment of depression further research is warranted to fully understand the benefits and weaknesses of such approach.
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Affiliation(s)
- Miroslav Adzic
- Department of Molecular Biology and Endocrinology, Vinca - Institute for Nuclear Sciences, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia.
| | - Iva Lukic
- Department of Molecular Biology and Endocrinology, Vinca - Institute for Nuclear Sciences, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Milos Mitic
- Department of Molecular Biology and Endocrinology, Vinca - Institute for Nuclear Sciences, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Emilija Glavonic
- Department of Molecular Biology and Endocrinology, Vinca - Institute for Nuclear Sciences, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Nina Dragicevic
- Department of Pharmacy, Singidunum University, Belgrade, Serbia
| | - Sanja Ivkovic
- Department of Molecular Biology and Endocrinology, Vinca - Institute for Nuclear Sciences, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
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Toxicity patterns associated with chronic ketamine exposure. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2023. [DOI: 10.1016/j.toxac.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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10
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Kipkemoi DJ, Ireri AM, Ngugi MP. Cognition Enhancing Potential of Aqueous Leaf Extract of Amaranthus dubius in Mice. J Evid Based Integr Med 2023; 28:2515690X231211661. [PMID: 37960857 PMCID: PMC10644747 DOI: 10.1177/2515690x231211661] [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: 07/25/2022] [Revised: 08/08/2023] [Accepted: 10/15/2023] [Indexed: 11/15/2023] Open
Abstract
Amaranthus dubius is a vegetable consumed for its nutritional content in Kenya. In herbal medicine, A. dubius is utilized to relief fever, anemia and hemorrhage. Additionally, it is utilized to manage cognitive dysfunction and is considered to augment brain function, but there is no empirical evidence to support this claim. The contemporary study investigated cognitive enhancing potential of A. dubius in mice model of Alzheimer's disease (AD)-like dementia induced with ketamine. Cognitively damaged mice were treated with aqueous extract of A. dubius leaf upon which passive avoidance task (PAT) was used to assess the cognitive performance. At the end of passive avoidance test, brains of the mice were dissected to evaluate the possibility of the extract to inhibit hallmarks that propagate AD namely oxidative stress and acetylcholinesterase activity. Additionally, characterization of secondary metabolites was done using liquid chromatograph- mass spectrometry analysis. During PAT test, extract-treated mice showed significantly increased step-through latencies than AD mice, depicting ability of A. dubius to reverse ketamine-induced cognitive decline. Further, the extract remarkably lowered malondialdehyde levels to normal levels and effectively inhibited acetylcholinesterase enzyme. The study showed that A. dubius extract is endowed with phytoconstituents that possess anti-oxidant and anticholinesterase activities. Thus, this study confirmed promising therapeutic effects of 200, 300 and 400 mg/kg bw of A. dubius extract with potential to alleviate cognitive disarray observed in AD.
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Affiliation(s)
- Daisy Jepkosgei Kipkemoi
- Department of Biochemistry, Microbiology and Biotechnology, School of Pure and Applied Sciences, Kenyatta University, Nairobi, Kenya
| | - Anthony Murithi Ireri
- Department of Educational Psychology, School of Education, Kenyatta University, Nairobi, Kenya
| | - Mathew Piero Ngugi
- Department of Biochemistry, Microbiology and Biotechnology, School of Pure and Applied Sciences, Kenyatta University, Nairobi, Kenya
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Brain volume in chronic ketamine users - relationship to sub-threshold psychotic symptoms and relevance to schizophrenia. Psychopharmacology (Berl) 2022; 239:3421-3429. [PMID: 34228135 PMCID: PMC9584979 DOI: 10.1007/s00213-021-05873-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/05/2021] [Indexed: 11/23/2022]
Abstract
RATIONALE Ketamine may model aspects of schizophrenia arising through NMDA receptor activity deficits. Although acute ketamine can induce effects resembling both positive and negative psychotic symptoms, chronic use may be a closer model of idiopathic psychosis. OBJECTIVES We tested the hypotheses that ketamine users had lower brain volumes, as measured using MRI, and greater sub-threshold psychotic symptoms relative to a poly-drug user control group. METHODS Ketamine users (n = 17) and poly-drug using controls (n = 19) were included in the study. All underwent volumetric MRI imaging and measurement of sub-threshold psychotic symptoms using the Comprehensive Assessment of At-Risk Mental State (CAARMS). Freesurfer was used to analyse differences in regional brain volume, cortical surface area and thickness between ketamine users and controls. The relationship between CAARMS ratings and brain volume was also investigated in ketamine users. RESULTS Ketamine users were found to have significantly lower grey matter volumes of the nucleus accumbens, caudate nucleus, cerebellum and total cortex (FDR p < 0.05; Cohen's d = 0.36-0.75). Within the cortex, ketamine users had significantly lower grey matter volumes within the frontal, temporal and parietal cortices (Cohen's d 0.7-1.31; FDR p < 0.05). They also had significantly higher sub-threshold psychotic symptoms (p < 0.05). Frequency of ketamine use showed an inverse correlation with cerebellar volume (p < 0.001), but there was no relationship between regional brain volumes and sub-threshold psychotic symptoms. CONCLUSIONS Chronic ketamine use may cause lower grey matter volumes as well as inducing sub-threshold psychotic symptoms, although these likely arise through distinct mechanisms.
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Zhong J, Wu H, Wu F, He H, Zhang Z, Huang J, Cao P, Fan N. Abnormal fractional Amplitude of Low-Frequency Fluctuation in chronic ketamine users. Psychiatry Res Neuroimaging 2022; 326:111536. [PMID: 36067548 DOI: 10.1016/j.pscychresns.2022.111536] [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] [Received: 12/17/2021] [Revised: 08/05/2022] [Accepted: 08/25/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Ketamine has become a major substance of abuse worldwide. Nevertheless, The long-term effects of ketamine use on intrinsic spontaneous neural activity remain unknown. OBJECTIVES In the present study, rs-fMRI was used to explore whether chronic ketamine use changes the intrinsic spontaneous neural activity, and whether the intrinsic spontaneous neural activity changes in chronic ketamine users(CKUs) are associated with cognitive impairments observed in chronic ketamine users. METHODS 28 CKUs and 30 healthy controls(HC) were enrolled. The fractional amplitude of low-frequency fluctuations (fALFF) was measured to evaluate the intrinsic spontaneous neural activity in multiple brain regions. Cognitive alterations were assessed using MATRICS Consensus Cognitive Battery (MCCB). RESULTS CKUs showed higher fALFF in the right parahippocampal gyrus(PHG), right anterior cingulate cortex(ACC), left cerebellar vermis, left posterior cingulate cortex(PCC), bilateral caudate, and lower fALFF in the right middle occipital gyrus(MOG), left cuneus, right precuneus. The fALFF in the right PHG, left cerebellar vermis, bilateral caudate, right ACC of CKUs presented a negative correlation with the average quantity of ketamine use/day(g) and estimated total ketamine consumption. The fALFF in left PCC had a negative correlation with the average quantity of ketamine use/day(g). Speed of processing on MCCB presented a negative correlation with the fALFF in the right MOG. CONCLUSION Our study found abnormal fALFF in multiple brain areas in CKUs, which indicated the changes of intrinsic spontaneous neural activity in multiple brain areas. The changes of fALFF were associated with the severity of ketamine use and cognitive impairment in CKUs.
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Affiliation(s)
- Jun Zhong
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong Province, 510370, China
| | - Huawang Wu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong Province, 510370, China
| | - Fengchun Wu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong Province, 510370, China
| | - Hongbo He
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong Province, 510370, China
| | - Zhaohua Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong Province, 510370, China
| | - Jiaxin Huang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong Province, 510370, China
| | - Penghui Cao
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong Province, 510370, China
| | - Ni Fan
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong Province, 510370, China.
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13
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Walsh CA, Livne O, Shmulewitz D, Stohl M, Hasin DS. Use of plant-based hallucinogens and dissociative agents: U.S. Time Trends, 2002-2019. Addict Behav Rep 2022; 16:100454. [PMID: 36119808 PMCID: PMC9471967 DOI: 10.1016/j.abrep.2022.100454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/28/2022] [Accepted: 09/03/2022] [Indexed: 11/29/2022] Open
Abstract
Aims Information on time trends in use of different plant-based hallucinogens is lacking. The current study used nationally representative U.S. data to assess overall and age-specific time trends in the prevalence of lifetime and 12-month use of plant-based hallucinogens and dissociative agents. Methods Participants were respondents aged ≥ 12 years (N = 1,006,051) from the National Survey on Drug Use and Health, 2002-2019. Predictors were continuous years. Outcomes included illicit use of peyote, mescaline, psilocybin, ketamine, salvia, and tryptamine. Sociodemographic variables (gender; age; race/ethnicity; educational level; family income) were modeled as covariates. Trends were estimated overall and by age (12-17, 18-25, 26+). Prevalence differences [PDs] were obtained for each category, along with 95 % confidence intervals [CI]. Results Increases in lifetime use were observed for psilocybin (2002-2019 PD=+1.61), tryptamine (2006-2014 PD=+0.55; 2015-2019 PD=+0.44), and ketamine (2006-2014 PD=+0.27; 2015-2019 PD=+0.21). Mescaline use decreased (PD = -0.89). While overall lifetime salvia use increased between 2006 and 2014 (PD=+1.81), prevalence did not change between 2015 and 2019. Twelve-month use of tryptamine and ketamine increased between 2006 and 2014 (PD=+0.14; +0.03, respectively). Twelve-month ketamine use also increased from 2015 to 2019 (PD=+0.03). By age, participants aged 12-17 and 18-25 showed decreases in use of most types of hallucinogens, but those age 26+ generally showed increases. Conclusions While use of plant-based hallucinogens and dissociative agents remains rare, lifetime use of ketamine, tryptamine, and psilocybin is increasing in adults. Considering these increases alongside concerns about unsupervised use of illicit products whose dose and composition is uncertain, clinicians and policymakers should remain mindful of the rising rates of illicit use in the general population.
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Affiliation(s)
- Claire A. Walsh
- New York State Psychiatric Institute, New York, NY, United States
| | - Ofir Livne
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Dvora Shmulewitz
- New York State Psychiatric Institute, New York, NY, United States,Department of Psychiatry, Columbia University Medical Center, New York, NY, United States
| | - Malki Stohl
- New York State Psychiatric Institute, New York, NY, United States
| | - Deborah S. Hasin
- New York State Psychiatric Institute, New York, NY, United States,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States,Department of Psychiatry, Columbia University Medical Center, New York, NY, United States,Corresponding author at: Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, Box 123, New York, NY 10032, United States.
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14
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Li Z, He Z, Li Z, Sun T, Zhang W, Xiang H. Differential synaptic mechanism underlying the neuronal modulation of prefrontal cortex, amygdala, and hippocampus in response to chronic postsurgical pain with or without cognitive deficits in rats. Front Mol Neurosci 2022; 15:961995. [PMID: 36117908 PMCID: PMC9478413 DOI: 10.3389/fnmol.2022.961995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/12/2022] [Indexed: 11/15/2022] Open
Abstract
Chronic Postsurgical Pain (CPSP) is well recognized to impair cognition, particularly memory. Mounting evidence suggests anatomic and mechanistic overlap between pain and cognition on several levels. Interestingly, the drugs currently used for treating chronic pain, including opioids, gabapentin, and NMDAR (N-methyl-D-aspartate receptor) antagonists, are also known to impair cognition. So whether pain-related cognitive deficits have different synaptic mechanisms as those underlying pain remains to be elucidated. In this context, the synaptic transmission in the unsusceptible group (cognitively normal pain rats) was isolated from that in the susceptible group (cognitively compromised pain rats). It was revealed that nearly two-thirds of the CPSP rats suffered cognitive impairment. The whole-cell voltage-clamp recordings revealed that the neuronal excitability and synaptic transmission in the prefrontal cortex and amygdala neurons were enhanced in the unsusceptible group, while these parameters remained the same in the susceptible group. Moreover, the neuronal excitability and synaptic transmission in hippocampus neurons demonstrated the opposite trend. Correspondingly, the levels of synaptic transmission-related proteins demonstrated a tendency similar to that of the excitatory and inhibitory synaptic transmission. Furthermore, morphologically, the synapse ultrastructure varied in the postsynaptic density (PSD) between the CPSP rats with and without cognitive deficits. Together, these observations indicated that basal excitatory and inhibitory synaptic transmission changes were strikingly different between the CPSP rats with and without cognitive deficits.
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15
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Effects of stress on endophenotypes of suicide across species: A role for ketamine in risk mitigation. Neurobiol Stress 2022; 18:100450. [PMID: 35685678 PMCID: PMC9170747 DOI: 10.1016/j.ynstr.2022.100450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/05/2022] [Accepted: 04/15/2022] [Indexed: 12/28/2022] Open
Abstract
Suicide is a leading cause of death and morbidity worldwide, yet few interventions are available to mitigate its risk. Barriers to effective treatments involve a limited understanding of factors that predict the onset of suicidal thoughts and behaviors. In the context of suicide risk, stress is a precipitating factor that is largely overlooked in the literature. Indeed, the pathophysiology of stress and suicide are heavily interconnected, underscoring the need to target the stress system in suicide prevention. In this review, we integrate findings from the preclinical and clinical literature that links stress and suicide. We focus specifically on the effects of stress on underlying biological functions and processes associated with suicide, allowing for the review of research using animal models. Owing to the rapid anti-suicidal effects of (R,S)-ketamine, we discuss its ability to modulate various stress-related endophenotypes of suicide, as well as its potential role in preventing suicide in those with a history of chronic life stress (e.g., early life adversity). We highlight future research directions that could advance our understanding of stress-related effects on suicide risk, advocating a dimensional, endophenotype approach to suicide research. Suicide and chronic stress pathophysiology are interconnected. Chronic stress has profound impacts on several endophenotypes of suicide. Animal and human research points to stress as a precipitating factor in suicide. Ketamine modulates specific biological processes associated with stress and suicide. Suicide research into endophenotypes can help inform risk-mitigation strategies.
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16
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Vines L, Sotelo D, Johnson A, Dennis E, Manza P, Volkow ND, Wang GJ. Ketamine use disorder: preclinical, clinical, and neuroimaging evidence to support proposed mechanisms of actions. INTELLIGENT MEDICINE 2022; 2:61-68. [PMID: 35783539 PMCID: PMC9249268 DOI: 10.1016/j.imed.2022.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Ketamine, a noncompetitive NMDA receptor antagonist, has been exclusively used as an anesthetic in medicine and has led to new insights into the pathophysiology of neuropsychiatric disorders. Clinical studies have shown that low subanesthetic doses of ketamine produce antidepressant effects for individuals with depression. However, its use as a treatment for psychiatric disorders has been limited due to its reinforcing effects and high potential for diversion and misuse. Preclinical studies have focused on understanding the molecular mechanisms underlying ketamine's antidepressant effects, but a precise mechanism had yet to be elucidated. Here we review different hypotheses for ketamine's mechanism of action including the direct inhibition and disinhibition of NMDA receptors, AMPAR activation, and heightened activation of monoaminergic systems. The proposed mechanisms are not mutually exclusive, and their combined influence may exert the observed structural and functional neural impairments. Long term use of ketamine induces brain structural, functional impairments, and neurodevelopmental effects in both rodents and humans. Its misuse has increased rapidly in the past 20 years and is one of the most common addictive drugs used in Asia. The proposed mechanisms of action and supporting neuroimaging data allow for the development of tools to identify 'biotypes' of ketamine use disorder (KUD) using machine learning approaches, which could inform intervention and treatment.
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Affiliation(s)
| | | | | | | | | | | | - Gene-Jack Wang
- Corresponding author: Gene-Jack Wang, Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 10 Center Dr, Rm B2L124, Bethesda, Maryland, United States ()
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17
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Nikayin S, Murphy E, Krystal JH, Wilkinson ST. Long-term safety of ketamine and esketamine in treatment of depression. Expert Opin Drug Saf 2022; 21:777-787. [PMID: 35416105 DOI: 10.1080/14740338.2022.2066651] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Ketamine is an NMDA receptor antagonist that can produce rapid-acting antidepressant effects. Esketamine (Spravato), the S-enantiomer of racemic ketamine, was approved by the FDA for treatment-resistant depression in 2019. Here we review what is known about the long-term safety of both racemic ketamine and esketamine as therapies for psychiatric disorders. AREAS COVERED In this article, we conducted a safety review of ketamine and esketamine. In looking at ketamine and esketamine long-term safety effects, we considered data available from experimental studies and several phase-three clinical trials. EXPERT OPINION Based on available data, the most common side effects of ketamine/esketamine are generally transient, mild, and self-limited. These include dissociation, nausea, headache, elevated heart rate, and blood pressure. Treatment with esketamine may lead to an increased risk of lower urinary tract symptoms, such as dysuria or urgency. However, severe bladder pathology has not been reported among patients receiving doses of esketamine/ketamine in line with prescribing guidelines for depression. There is considerable data that ketamine at high doses can lead to long-term impairments in cognition. However, the esketamine clinical trials found that cognition generally remains stable or improves over time, suggesting that when used appropriately, there is no increased risk of cognitive impairment.
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Affiliation(s)
- Sina Nikayin
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Eva Murphy
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - John H Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
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18
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Sala N, Paoli C, Bonifacino T, Mingardi J, Schiavon E, La Via L, Milanese M, Tornese P, Datusalia AK, Rosa J, Facchinetti R, Frumento G, Carini G, Salerno Scarzella F, Scuderi C, Forti L, Barbon A, Bonanno G, Popoli M, Musazzi L. Acute Ketamine Facilitates Fear Memory Extinction in a Rat Model of PTSD Along With Restoring Glutamatergic Alterations and Dendritic Atrophy in the Prefrontal Cortex. Front Pharmacol 2022; 13:759626. [PMID: 35370690 PMCID: PMC8968915 DOI: 10.3389/fphar.2022.759626] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/25/2022] [Indexed: 12/17/2022] Open
Abstract
Stress represents a major risk factor for psychiatric disorders, including post-traumatic stress disorder (PTSD). Recently, we dissected the destabilizing effects of acute stress on the excitatory glutamate system in the prefrontal cortex (PFC). Here, we assessed the effects of single subanesthetic administration of ketamine (10 mg/kg) on glutamate transmission and dendritic arborization in the PFC of footshock (FS)-stressed rats, along with changes in depressive, anxious, and fear extinction behaviors. We found that ketamine, while inducing a mild increase of glutamate release in the PFC of naïve rats, blocked the acute stress-induced enhancement of glutamate release when administered 24 or 72 h before or 6 h after FS. Accordingly, the treatment with ketamine 6 h after FS also reduced the stress-dependent increase of spontaneous excitatory postsynaptic current (sEPSC) amplitude in prelimbic (PL)-PFC. At the same time, ketamine injection 6 h after FS was found to rescue apical dendritic retraction of pyramidal neurons induced by acute stress in PL-PFC and facilitated contextual fear extinction. These results show rapid effects of ketamine in animals subjected to acute FS, in line with previous studies suggesting a therapeutic action of the drug in PTSD models. Our data are consistent with a mechanism of ketamine involving re-establishment of synaptic homeostasis, through restoration of glutamate release, and structural remodeling of dendrites.
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Affiliation(s)
- Nathalie Sala
- Laboratory of Neuropsychopharmacology and Functional Neurogenomics, Dipartimento di Scienze Farmaceutiche, Università Degli Studi di Milano, Milano, Italy
| | - Caterina Paoli
- Laboratory of Neuropsychopharmacology and Functional Neurogenomics, Dipartimento di Scienze Farmaceutiche, Università Degli Studi di Milano, Milano, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Tiziana Bonifacino
- Department of Pharmacy, Unit of Pharmacology and Toxicology, University of Genoa, Genoa, Italy
| | - Jessica Mingardi
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Emanuele Schiavon
- Department of Biotechnology and Life Sciences, University of Insubria, Busto Arsizio, Italy
| | - Luca La Via
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Marco Milanese
- Department of Pharmacy, Unit of Pharmacology and Toxicology, University of Genoa, Genoa, Italy
| | - Paolo Tornese
- Laboratory of Neuropsychopharmacology and Functional Neurogenomics, Dipartimento di Scienze Farmaceutiche, Università Degli Studi di Milano, Milano, Italy
| | - Ashok K Datusalia
- Laboratory of Neuropsychopharmacology and Functional Neurogenomics, Dipartimento di Scienze Farmaceutiche, Università Degli Studi di Milano, Milano, Italy.,Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Raebareli, India
| | - Jessica Rosa
- Laboratory of Neuropsychopharmacology and Functional Neurogenomics, Dipartimento di Scienze Farmaceutiche, Università Degli Studi di Milano, Milano, Italy.,Department of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, Brazil
| | - Roberta Facchinetti
- Department of Physiology and Pharmacology "Vittorio Erspamer", SAPIENZA University of Rome, Rome, Italy
| | - Giulia Frumento
- Department of Pharmacy, Unit of Pharmacology and Toxicology, University of Genoa, Genoa, Italy
| | - Giulia Carini
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | | | - Caterina Scuderi
- Department of Physiology and Pharmacology "Vittorio Erspamer", SAPIENZA University of Rome, Rome, Italy
| | - Lia Forti
- Department of Biotechnology and Life Sciences, University of Insubria, Busto Arsizio, Italy
| | - Alessandro Barbon
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Giambattista Bonanno
- Department of Pharmacy, Unit of Pharmacology and Toxicology, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maurizio Popoli
- Laboratory of Neuropsychopharmacology and Functional Neurogenomics, Dipartimento di Scienze Farmaceutiche, Università Degli Studi di Milano, Milano, Italy
| | - Laura Musazzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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19
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Dwyer JB, Landeros-Weisenberger A, Johnson JA, Londono Tobon A, Flores JM, Nasir M, Couloures K, Sanacora G, Bloch MH. Efficacy of Intravenous Ketamine in Adolescent Treatment-Resistant Depression: A Randomized Midazolam-Controlled Trial. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:241-251. [PMID: 37153136 PMCID: PMC10153503 DOI: 10.1176/appi.focus.22020004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 09/22/2020] [Accepted: 11/25/2020] [Indexed: 05/09/2023]
Abstract
Objective Adolescent depression is prevalent and is associated with significant morbidity and mortality. Although intravenous ketamine has shown efficacy in adult treatment-resistant depression, its efficacy in pediatric populations is unknown. The authors conducted an active-placebo-controlled study of ketamine's safety and efficacy in adolescents. Methods In this proof-of-concept randomized, double-blind, single-dose crossover clinical trial, 17 adolescents (ages 13-17) with a diagnosis of major depressive disorder received a single intravenous infusion of either ketamine (0.5 mg/kg over 40 minutes) or midazolam (0.045 mg/kg over 40 minutes), and the alternate compound 2 weeks later. All participants had previously tried at least one antidepressant medication and met the severity criterion of a score >40 on the Children's Depression Rating Scale-Revised. The primary outcome measure was score on the Montgomery-Åsberg Depression Rating Scale (MADRS) 24 hours after treatment. Results A single ketamine infusion significantly reduced depressive symptoms 24 hours after infusion compared with midazolam (MADRS score: midazolam, mean=24.13, SD=12.08, 95% CI=18.21, 30.04; ketamine, mean=15.44, SD=10.07, 95% CI=10.51, 20.37; mean difference=-8.69, SD=15.08, 95% CI=-16.72, -0.65, df=15; effect size=0.78). In secondary analyses, the treatment gains associated with ketamine appeared to remain 14 days after treatment, the latest time point assessed, as measured by the MADRS (but not as measured by the Children's Depression Rating Scale-Revised). A significantly greater proportion of participants experienced a response to ketamine during the first 3 days following infusion as compared with midazolam (76% and 35%, respectively). Ketamine was associated with transient, self-limited dissociative symptoms that affected participant blinding, but there were no serious adverse events. Conclusions In this first randomized placebo-controlled clinical trial of intravenous ketamine in adolescents with depression, the findings suggest that it is well tolerated acutely and has significant short-term (2-week) efficacy in reducing depressive symptoms compared with an active placebo.Reprinted from Am J Psychiatry 2021; 178:352-362 with permission from American Psychiatric Association Publishing.
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Affiliation(s)
- Jennifer B Dwyer
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
| | - Angeli Landeros-Weisenberger
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
| | - Jessica A Johnson
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
| | - Amalia Londono Tobon
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
| | - José M Flores
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
| | - Madeeha Nasir
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
| | - Kevin Couloures
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
| | - Gerard Sanacora
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
| | - Michael H Bloch
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
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20
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Mohammad Shehata I, Masood W, Nemr N, Anderson A, Bhusal K, Edinoff AN, Cornett EM, Kaye AM, Kaye AD. The Possible Application of Ketamine in the Treatment of Depression in Alzheimer’s Disease. Neurol Int 2022; 14:310-321. [PMID: 35466206 PMCID: PMC9036213 DOI: 10.3390/neurolint14020025] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 12/12/2022] Open
Abstract
Depression is a leading cause of disability globally, with a prevalence of 3.8% among the whole population, 5% of the adult population, and 5.7% of the elderly population over 60 years of age. There is evidence that depression is linked to certain neurodegenerative diseases, one being Alzheimer’s disease (AD). The efficacy of conventional antidepressants to treat depression in AD is conflicting, especially regarding selective serotonin reuptake inhibitors (SSRIs). A recent systemic review and meta-analysis of 25 randomized controlled trials including fourteen antidepressant medications showed no high efficacy in treating AD patients’ symptoms. However, ketamine, a nonselective N-methyl-D-aspartate (NMDA) receptor antagonist, can mediate a wide range of pharmacological effects, including neuroprotection, anti-inflammatory and anticancer properties, multimodal analgesia, and treatment of depression, suicidal attempts, and status epilepticus. Esketamine, which is ketamine formulated as a nasal spray, was approved by the Federal Drug Administration (FDA) in March 2019 as an adjuvant drug to treat treatment-resistant depression. NMDA receptor antagonists treat AD through offsetting AD-related pathological stimulation of subtypes of glutamate receptors in the central nervous system. Recent clinical findings suggest that ketamine may provide neuroprotection and reduce neuropsychiatric symptoms associated with AD. In the present investigation, we evaluate the potential role of ketamine and its postulated mechanism in AD management.
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Affiliation(s)
| | - Waniyah Masood
- Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi 74200, Pakistan;
| | - Nouran Nemr
- ICU and Pain Management, Faculty of Medicine, Ain Shams University, Cairo 11517, Egypt;
| | - Alexandra Anderson
- Department of Medicine, LSU Health Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA; (A.A.); (K.B.)
| | - Kamal Bhusal
- Department of Medicine, LSU Health Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA; (A.A.); (K.B.)
| | - Amber N. Edinoff
- Department of Psychiatry and Behavioral Medicine, LSU Health Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA
- Correspondence:
| | - Elyse M. Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA; (E.M.C.); (A.D.K.)
| | - Adam M. Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA 95211, USA;
| | - Alan D. Kaye
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA; (E.M.C.); (A.D.K.)
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21
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Strous JFM, Weeland CJ, van der Draai FA, Daams JG, Denys D, Lok A, Schoevers RA, Figee M. Brain Changes Associated With Long-Term Ketamine Abuse, A Systematic Review. Front Neuroanat 2022; 16:795231. [PMID: 35370568 PMCID: PMC8972190 DOI: 10.3389/fnana.2022.795231] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/10/2022] [Indexed: 12/28/2022] Open
Abstract
Recently, the abuse of ketamine has soared. Therefore, it is of great importance to study its potential risks. The effects of prolonged ketamine on the brain can be observationally studied in chronic recreational users. We performed a systematic review of studies reporting functional and structural brain changes after repeated ketamine abuse. We searched the following electronic databases: Medline, Embase and PsycINFO We screened 11,438 records and 16 met inclusion criteria, totaling 440 chronic recreational ketamine users (2–9.7 years; mean use 2.4 g/day), 259 drug-free controls and 44 poly-drug controls. Long-term recreational ketamine use was associated with lower gray matter volume and less white matter integrity, lower functional thalamocortical and corticocortical connectivity. The observed differences in both structural and functional neuroanatomy between ketamine users and controls may explain some of its long-term cognitive and psychiatric side effects, such as memory impairment and executive functioning. Given the effect that long-term ketamine exposure may yield, an effort should be made to curb its abuse.
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Affiliation(s)
- Jurriaan F. M. Strous
- Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
- *Correspondence: Jurriaan F. M. Strous
| | - Cees J. Weeland
- Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Joost G. Daams
- Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, Netherlands
| | - Damiaan Denys
- Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, Netherlands
- Netherlands Institute for Neuroscience, Royal Academy of Arts and Sciences, Amsterdam, Netherlands
| | - Anja Lok
- Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, Netherlands
| | - Robert A. Schoevers
- Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Martijn Figee
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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22
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Sim HI, Kim DH, Kim M. Cellular messenger molecules mediating addictive drug-induced cognitive impairment: cannabinoids, ketamine, methamphetamine, and cocaine. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2022. [DOI: 10.1186/s43094-022-00408-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cognitive impairment is a commonly reported symptom with increasing life spans. Numerous studies have focused on identifying precise targets to relieve or reduce cognitive impairment; however, its underlying mechanism remains elusive. Most patients or animals exposed to addictive drugs exhibit cognitive impairment. Accordingly, the present review discusses the molecular changes induced by addictive drugs to clarify potential mechanisms that mediate cognitive impairments.
Main body
We investigated changes in cognitive function using four drugs: cannabinoids, ketamine, methamphetamine, and cocaine. Chronic administration of most addictive drugs reduces overall cognitive functions, such as working, spatial, and long-term recognition memories. Levels of several transcription factors involved in neuronal differentiation, as well as functional components of neurotransmitter receptors in neuronal cells, are reportedly altered. In addition, inflammatory factors showed a generally increasing trend. These impairments could be mediated by neuroinflammation, synaptic activity, and neuronal plasticity.
Conclusion
This review outlines the effects of acute or chronic drug use and potential molecular alterations in the central nervous system. In the central nervous system, addictive drug-induced changes in molecular pathways associated with cognitive function might play a pivotal role in elucidating the pathogenesis of cognitive impairment.
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Dai D, Miller C, Valdivia V, Boyle B, Bolton P, Li S, Seiner S, Meisner R. Neurocognitive effects of repeated ketamine infusion treatments in patients with treatment resistant depression: a retrospective chart review. BMC Psychiatry 2022; 22:140. [PMID: 35193541 PMCID: PMC8862573 DOI: 10.1186/s12888-022-03789-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ketamine has emerged as a rapid-acting antidepressant in treatment-resistant depression (TRD) increasingly used in non-research, clinical settings. Few studies, however, have examined neurocognitive effects of repeated racemic ketamine infusion treatments in patients with TRD. In an effort to identify potential effects after serial infusions, we conducted a retrospective chart review to identify statistically significant changes in cognition in patient undergoing serial intravenous infusions; concomitantly, we examined baseline cognition as potential predictor of anti-depressant potential. METHODS Twenty-two patients with TRD were examined after they finished the induction phase of 8-10 repeated intravenous ketamine infusions and completed the assessments of their depressive symptoms (measured by the 16-item Quick Inventory of Depressive Symptomatology-Self Report Scale: QIDS-SR16) and cognitive function (measured by the Montreal Cognitive Assessment: MoCA) before the first and the last ketamine treatments. RESULTS Repeated ketamine infusions administered through an escalating dose protocol with 8-10 infusion sessions produced a 47.2% reduction response in depression; there was no evidence of impairment as reflected in MoCA testing. There was a moderate association between baseline cognition and antidepressant response with a Pearson correlation of 0.453. CONCLUSION In this naturalistic sample of patients with TRD in our clinical service, repeated ketamine infusions significantly decreased depression symptoms without impairing cognitive performance. The baseline cognition may positively predict antidepressant responses of repeated ketamine treatment.
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Affiliation(s)
- Danika Dai
- grid.240206.20000 0000 8795 072XPsychiatric Neurotherapeutics Program, McLean Hospital, 115 Mill St, Belmont, MA 02478 USA
| | - Courtney Miller
- grid.240206.20000 0000 8795 072XPsychiatric Neurotherapeutics Program, McLean Hospital, 115 Mill St, Belmont, MA 02478 USA
| | - Violeta Valdivia
- grid.240206.20000 0000 8795 072XPsychiatric Neurotherapeutics Program, McLean Hospital, 115 Mill St, Belmont, MA 02478 USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Brian Boyle
- grid.240206.20000 0000 8795 072XPsychiatric Neurotherapeutics Program, McLean Hospital, 115 Mill St, Belmont, MA 02478 USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Paula Bolton
- grid.240206.20000 0000 8795 072XPsychiatric Neurotherapeutics Program, McLean Hospital, 115 Mill St, Belmont, MA 02478 USA
| | - Shuang Li
- Psychiatric Neurotherapeutics Program, McLean Hospital, 115 Mill St, Belmont, MA, 02478, USA. .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Steve Seiner
- grid.240206.20000 0000 8795 072XPsychiatric Neurotherapeutics Program, McLean Hospital, 115 Mill St, Belmont, MA 02478 USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Robert Meisner
- grid.240206.20000 0000 8795 072XPsychiatric Neurotherapeutics Program, McLean Hospital, 115 Mill St, Belmont, MA 02478 USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA
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Goswamee P, Rice R, Leggett E, Zhang F, Manicka S, Porter JH, McQuiston AR. Effects of subanesthetic ketamine and (2R,6R) hydroxynorketamine on working memory and synaptic transmission in the nucleus reuniens in mice. Neuropharmacology 2022; 208:108965. [PMID: 35065945 PMCID: PMC8885971 DOI: 10.1016/j.neuropharm.2022.108965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 01/07/2022] [Accepted: 01/15/2022] [Indexed: 01/16/2023]
Abstract
RATIONALE Acute cognitive impairment and abuse potential of ketamine incentivizes the search for alternatives to ketamine for clinical management of treatment-resistant depression. Recently, (2R,6R) hydroxynorketamine ((2R,6R)-HNK), a metabolite of ketamine, has shown promise due to its reported lack of ketamine-like reinforcing properties. Nonetheless, the effect of (2R,6R)-HNK on cognition has not been reported. METHOD Adult male mice were placed in a Y-maze to measure spatial working memory (SWM) 24 h after treatment with either a single or repeated subanesthetic dose of (2R,6R)-HNK or ketamine. To determine the effect of the drug regimens on synaptic mechanisms in neural circuits deemed critical for SWM, we conducted patch-clamp electrophysiological recordings from neurons in the midline thalamic nucleus reuniens (RE) in response to optogenetic stimulation of medial prefrontal cortex (mPFC) inputs in acutely prepared brain slices. RESULTS Single or repeated treatment with a 10 mg/kg dose of either drug did not impact performance in a Y-maze. However, single administration of a ½-log higher dose (32 mg/kg) of ketamine significantly reduced SWM. The same dose of (2R,6R)-HNK did not produce SWM deficits. Interestingly, repeated administration of either drugs at the 32 mg/kg had no effect on SWM performances. Concomitant to these effects on SWM, only single injection of 32 mg/kg of ketamine was found to increase the mPFC-driven action potential firing activity in the RE neurons. Conversely, both single and repeated administration of the 32 mg/kg dose of (2R,6R)-HNK but not ketamine, increased the input resistance of the RE neurons. CONCLUSION Our results indicate that acute treatment of ketamine at 32 mg/kg increases mPFC-driven firing activity of RE neurons, and this contributes to the ketamine-mediated cognitive deficit. Secondly, sub-chronic treatment with the same dose of ketamine likely induces tolerance. Although single or repeated administration of the 32 mg/kg dose of (2R,6R)-HNK can alter intrinsic properties of RE neurons, this dose does not produce cognitive deficit or changes in synaptic mechanism in the RE.
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Affiliation(s)
- Priyodarshan Goswamee
- Department of Anatomy and Neurobiology, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Remington Rice
- Department of Psychology, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, United States
| | - Elizabeth Leggett
- Department of Anatomy and Neurobiology, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Fan Zhang
- Department of Psychology, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, United States
| | - Sofia Manicka
- Department of Psychology, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, United States
| | - Joseph H Porter
- Department of Psychology, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, United States
| | - A Rory McQuiston
- Department of Anatomy and Neurobiology, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States.
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Yin Y, Li H, Wang J, Kong Y, Chang J, Chu G. Implication of microglia in ketamine-induced long-term cognitive impairment in murine pups. Hum Exp Toxicol 2022; 41:9603271221128739. [PMID: 36172893 DOI: 10.1177/09603271221128739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ketamine, a non-competitive N-methyl-D-aspartate receptor (NMDAR) antagonist, is widely applicable to anesthesia, analgesia, and sedation. However, the function and mechanisms of ketamine in the long-term learning and memory function of neonatal mice are unclear. OBJECTIVE The present study aims to investigate whether long-term learning and memory function will be affected by multiple ketamine exposures in the early development period. METHODS The mRNA and protein levels were measured by RT-qPCR and western blot, respectively. The Morris Water Maze test was performed to assess spatial learning and memory. RESULTS We identified that neonatal exposure to ketamine downsized the positive neurons for microtubule-associated protein doublecortin (DCX) and Ki67 in hippocampal dentate gyrus at the juvenile and late adolescence stages. Double-labeling tests demonstrated that the counts of Iba1+ cells and Ki67+ cells were pronouncedly diminished with exposure to ketamine. Further, qPCR assays to screen the key factors predisposing the populations and maturation of microglia exhibited remarkable decline of CX3CR1 mRNA levels in ketamine group versus the control group. The close relation of microglia to synaptic plasticity was depicted by the significantly downregulated synaptic plasticity-related proteins NR2B and PSD-95 subsequent to multiple exposures to ketamine. Finally, we found that both the protein and mRNA levels of BDNF were markedly decreased in ketamine group versus the control group. CONCLUSION We found that multiple exposures to ketamine in neonatal mice lead to spatial learning and memory dysfunction. The alterations of microglial development and function are the possible mechanisms of long-term learning and memory impairment.
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Affiliation(s)
- Y Yin
- Department of Anesthesiology, 117851Changzhou Maternity and Child Health Care Hospital, Changzhou, China
| | - H Li
- Department of Anesthesiology, 66322Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - J Wang
- Department of Anesthesiology, 56695Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Y Kong
- Department of Anesthesiology, 117851Changzhou Maternity and Child Health Care Hospital, Changzhou, China
| | - J Chang
- Department of Anesthesiology, 117851Changzhou Maternity and Child Health Care Hospital, Changzhou, China
| | - G Chu
- Department of Anesthesiology, 117851Changzhou Maternity and Child Health Care Hospital, Changzhou, China
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Bayes A, Dong V, Martin D, Alonzo A, Kabourakis M, Loo C. Ketamine treatment for depression: A model of care. Aust N Z J Psychiatry 2021; 55:1134-1143. [PMID: 34384256 DOI: 10.1177/00048674211039166] [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: 11/17/2022]
Abstract
OBJECTIVE Ketamine and related compounds are emerging as rapidly acting therapies for treatment-resistant depression. Ketamine differs from standard antidepressants in its speed of action, specific acute and cumulative side effects, risk of dependence and regulatory requirements. However, there is currently little guidance offering translation from research studies into clinical practice. We therefore detail a comprehensive model of care for ketamine treatment of depression. METHOD We formulated a set of policies and procedures for a 'compassionate use' ketamine programme that developed out of our clinical research in ketamine. These policies and procedures were formulated into a detailed model of care. RESULTS The current Australian and New Zealand regulatory frameworks and professional bodies' recommendations regarding ketamine are detailed along with clinical governance and infrastructure considerations. We next describe a four-step model comprising initial assessment, pre-treatment, treatment and post-treatment phases. The model comprises thorough psychiatric and medical assessments examining patient suitability, a rigorous consenting process and structured safety monitoring across an acute treatment course or maintenance therapy. Our ketamine dose-titration method is detailed allowing flexible dosing of patients across a treatment course enabling individualised treatment. CONCLUSION The model of care aims to bridge the gap between efficacy studies and clinical care outside of research settings as ketamine and related compounds become increasingly important therapies for treatment-resistant depression.
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Affiliation(s)
- Adam Bayes
- Black Dog Institute, Sydney Neurostimulation Centre (SyNC), Sydney, NSW, Australia.,School of Psychiatry, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Vanessa Dong
- School of Psychiatry, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Donel Martin
- School of Psychiatry, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Angelo Alonzo
- School of Psychiatry, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Michael Kabourakis
- School of Psychiatry, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Colleen Loo
- Black Dog Institute, Sydney Neurostimulation Centre (SyNC), Sydney, NSW, Australia.,School of Psychiatry, University of New South Wales Sydney, Sydney, NSW, Australia
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Chen ST, Hsieh CP, Lee MY, Chen LC, Huang CM, Chen HH, Chan MH. Betaine prevents and reverses the behavioral deficits and synaptic dysfunction induced by repeated ketamine exposure in mice. Biomed Pharmacother 2021; 144:112369. [PMID: 34715446 DOI: 10.1016/j.biopha.2021.112369] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/16/2022] Open
Abstract
As an N-methyl-D-aspartate (NMDA) receptor inhibitor, ketamine has become a popular recreational substance and currently is used to address treatment-resistant depression. Since heavy ketamine use is associated with persisting psychosis, cognitive impairments, and neuronal damage, the safety of ketamine treatment for depression should be concerned. The nutrient supplement betaine has been shown to counteract the acute ketamine-induced psychotomimetic effects and cognitive dysfunction through modulating NMDA receptors. This study aimed to determine whether the adjunctive or subsequent betaine treatment would improve the enduring behavioral disturbances and hippocampal synaptic abnormality induced by repeated ketamine exposure. Mice received ketamine twice daily for 14 days, either combined with betaine co-treatment or subsequent betaine post-treatment for 7 days. Thereafter, three-chamber social approach test, reciprocal social interaction, novel location/object recognition test, forced swimming test, and head-twitch response induced by serotonergic hallucinogen were monitored. Data showed that the enduring behavioral abnormalities after repeated ketamine exposure, including disrupted social behaviors, recognition memory impairments, and increased depression-like and hallucinogen-induced head-twitch responses, were remarkably improved by betaine co-treatment or post-treatment. Consistently, betaine protected and reversed the reduced hippocampal synaptic activity, such as decreases in field excitatory post-synaptic potentiation (fEPSP), long-term potentiation (LTP), and PSD-95 levels, after repeated ketamine treatment. These results demonstrated that both co-treatment and post-treatment with betaine could effectively prevent and reverse the adverse behavioral manifestations and hippocampal synaptic plasticity after repeated ketamine use, suggesting that betaine can be used as a novel adjunct therapy with ketamine for treatment-resistant depression and provide benefits for ketamine use disorders.
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Affiliation(s)
- Shao-Tsu Chen
- Department of Psychiatry, Tzu Chi University, 701, Section 3, Chung-Yang Road, Hualien, Taiwan
| | - Chung-Pin Hsieh
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Mei-Yi Lee
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Liao-Chen Chen
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Chien-Min Huang
- Animal Behavior Core National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli, Taiwan
| | - Hwei-Hsien Chen
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan; Animal Behavior Core National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli, Taiwan; Institute of Neuroscience, National Chengchi Uinversity, Taipei, Taiwan.
| | - Ming-Huan Chan
- Institute of Neuroscience, National Chengchi Uinversity, Taipei, Taiwan; Research Center for Mind, Brain, and Learning, National Changchi University, 64, Section 2, Zhinan Road, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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Hsieh CP, Chen ST, Lee MY, Huang CM, Chen HH, Chan MH. N, N-dimethylglycine Protects Behavioral Disturbances and Synaptic Deficits Induced by Repeated Ketamine Exposure in Mice. Neuroscience 2021; 472:128-137. [PMID: 34400248 DOI: 10.1016/j.neuroscience.2021.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/31/2022]
Abstract
Ketamine, an N-methyl-d-aspartate receptor (NMDAR) blocker, is gaining ground as a treatment option for depression. The occurrence of persistent psychosis and cognitive impairment after repeated use of ketamine remains a concern. N, N-dimethylglycine (DMG) is a nutrient supplement and acts as an NMDAR glycine site partial agonist. The objective of this study was to assess whether DMG could potentially prevent the behavioral and synaptic deficits in mice after repeated ketamine exposure. Male ICR mice received ketamine (20 mg/kg) from postnatal day (PN) 33-46, twice daily, for 14 days. The locomotor activity, novel location recognition test (NLRT), novel object recognition test (NORT), social interaction test, head twitch response induced by serotonergic hallucinogen, and the basal synaptic transmission and long-term potentiation (LTP) in the hippocampal slices were monitored after repeated ketamine treatment. Furthermore, the protective effects of repeated combined administration of DMG (30 and 100 mg/kg) with ketamine on behavioral abnormalities and synaptic dysfunction were assessed. The results showed that mice exhibited memory impairments, social withdrawal, increased head twitch response, reduced excitatory synaptic transmission, and lower LTP after repeated ketamine exposure. The ketamine-induced behavioral and synaptic deficits were prevented by co-treatment with DMG. In conclusion, these findings may pave a new path forward to developing a combination formula with ketamine and DMG for the treatment of depression and other mood disorders.
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Affiliation(s)
- Chung-Pin Hsieh
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Shao-Tsu Chen
- Department of Psychiatry, Buddhist Tzu Chi General Hospital, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Mei-Yi Lee
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Chieh-Min Huang
- Animal Behavioral Core, National Health Research Institutes, Miaoli, Taiwan
| | - Hwei-Hsien Chen
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan; Animal Behavioral Core, National Health Research Institutes, Miaoli, Taiwan; Institute of Neuroscience, Research Center for Mind, Brain, and Learning, National Chengchi University, Taipei, Taiwan.
| | - Ming-Huan Chan
- Institute of Neuroscience, Research Center for Mind, Brain, and Learning, National Chengchi University, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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Araújo-de-Freitas L, Santos-Lima C, Mendonça-Filho E, Vieira F, França RJAF, Magnavita G, Cardoso TL, Correia-Melo FS, Leal GC, Jesus-Nunes AP, Souza-Marques B, Marback R, Teles M, Echegaray MV, Beanes G, Guerreiro-Costa LNF, Mello RP, Rabanea T, Lucchese AC, Abreu N, Lacerda ALT, Quarantini LC. Neurocognitive aspects of ketamine and esketamine on subjects with treatment-resistant depression: A comparative, randomized and double-blind study. Psychiatry Res 2021; 303:114058. [PMID: 34153630 DOI: 10.1016/j.psychres.2021.114058] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 06/05/2021] [Indexed: 01/28/2023]
Abstract
The objective of this study is to evaluate cognition in patients using either ketamine or esketamine to treat TRD. We also evaluate if both ketamine and esketamine as one group influence cognition in patients with TRD. Fifty-four patients with TRD were infused with either ketamine or esketamine and were assessed at three time points: baseline, 24 h, and 7 days after infusion. We applied neuropsychological tests to evaluate executive functions, processing speed, short term memory, and auditory-verbal episodic memory. There is no cognitive difference between ketamine and esketamine, with the exception of one variable. When considered as one group, ketamine and esketamine do not impair cognition; on the contrary, they improve some neuropsychological functions such as visuospatial short-term memory, executive functions, processing speed, and several measures related to episodic verbal memory. Ketamine and esketamine do not present differing cognitive effects when used in antidepressant doses to treat TRD. Furthermore, they rapidly improve many cognitive aspects of patients with TRD at 24 h after the infusion and maintain these effects for at least 7 days.
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Affiliation(s)
- Lucas Araújo-de-Freitas
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil; Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, UFBA, Salvador, Brazil; Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, UFBA, Salvador, Brazil; Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Cassio Santos-Lima
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil; Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil; Laboratório de Pesquisa em Neuropsicologia Clínica e Cognitiva, UFBA, Salvador, Brazil; Programa de Pós-graduação em Psicologia, Instituto de Psicologia, UFBA, Salvador, Brazil
| | - Euclides Mendonça-Filho
- Programa de Pós-graduação em Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Department of Psychiatry, McGill University, Montreal, Canada
| | - Flávia Vieira
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil; Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, UFBA, Salvador, Brazil
| | - Ricardo J A F França
- Laboratório de Pesquisa em Neuropsicologia Clínica e Cognitiva, UFBA, Salvador, Brazil; Programa de Pós-graduação em Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Guilherme Magnavita
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Tanise L Cardoso
- Laboratório de Pesquisa em Neuropsicologia Clínica e Cognitiva, UFBA, Salvador, Brazil; Programa de Pós-graduação em Psicologia, Instituto de Psicologia, UFBA, Salvador, Brazil
| | - Fernanda S Correia-Melo
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil; Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, UFBA, Salvador, Brazil; Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Gustavo C Leal
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil; Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, UFBA, Salvador, Brazil; Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Ana Paula Jesus-Nunes
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil; Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, UFBA, Salvador, Brazil
| | - Breno Souza-Marques
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil; Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, UFBA, Salvador, Brazil
| | - Roberta Marback
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Manuela Teles
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil; Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, UFBA, Salvador, Brazil
| | - Mariana Vf Echegaray
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Graziele Beanes
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil; Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, UFBA, Salvador, Brazil
| | - Lívia N F Guerreiro-Costa
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil; Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, UFBA, Salvador, Brazil
| | - Rodrigo P Mello
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil; Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, UFBA, Salvador, Brazil
| | - Thaís Rabanea
- Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de São Paulo, São Paulo, Brazil; Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ana Cecília Lucchese
- Programa de Pós-graduação em Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil; Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Neander Abreu
- Laboratório de Pesquisa em Neuropsicologia Clínica e Cognitiva, UFBA, Salvador, Brazil; Programa de Pós-graduação em Psicologia, Instituto de Psicologia, UFBA, Salvador, Brazil
| | - Acioly L T Lacerda
- Programa de Pós-graduação em Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil; Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de São Paulo, São Paulo, Brazil; Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil; Instituto Sinapse de Neurociências Clínicas, Campinas, Brazil
| | - Lucas C Quarantini
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil; Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, UFBA, Salvador, Brazil; Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, UFBA, Salvador, Brazil.
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30
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Chronic administration of ketamine induces cognitive deterioration by restraining synaptic signaling. Mol Psychiatry 2021; 26:4702-4718. [PMID: 32488127 DOI: 10.1038/s41380-020-0793-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 12/20/2022]
Abstract
The discovery of the rapid antidepressant effects of ketamine has arguably been the most important advance in depression treatment. Recently, it was reported that repeated long-term ketamine administration is effective in preventing relapse of depression, which may broaden the clinical use of ketamine. However, long-term treatment with ketamine produces cognitive impairments, and the underlying molecular mechanisms for these impairments are largely unknown. Here, we found that chronic in vivo exposure to ketamine for 28 days led to decreased expression of the glutamate receptor subunits GluA1, GluA2, GluN2A, and GluN2B; decreased expression of the synaptic proteins Syn and PSD-95; decreased dendrite spine density; impairments in long-term potentiation (LTP) and synaptic transmission in the hippocampal CA1 area; and deterioration of learning and memory in mice. Furthermore, the reduced glutamate receptor subunit and synaptic protein expression and the LTP deficits were still observed on day 28 after the last injection of ketamine. We found that the expression and phosphorylation of CaMKIIβ, ERK1/2, CREB, and NF-κB were inhibited by ketamine. The reductions in glutamate receptor subunit expression and dendritic spine density and the deficits in LTP, synaptic transmission, and cognition were alleviated by overexpression of CaMKIIβ. Our study indicates that inhibition of CaMKIIβ-ERK1/2-CREB/NF-κB signaling may mediate chronic ketamine use-associated cognitive impairments by restraining synaptic signaling. Hypofunction of the glutamatergic system might be the underlying mechanism accounting for chronic ketamine use-associated cognitive impairments. Our findings may suggest possible strategies to alleviate ketamine use-associated cognitive deficits and broaden the clinical use of ketamine in depression treatment.
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Davis MT, DellaGiogia N, Maruff P, Pietrzak RH, Esterlis I. Acute cognitive effects of single-dose intravenous ketamine in major depressive and posttraumatic stress disorder. Transl Psychiatry 2021; 11:205. [PMID: 33833217 PMCID: PMC8032778 DOI: 10.1038/s41398-021-01327-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/19/2021] [Accepted: 03/17/2021] [Indexed: 02/02/2023] Open
Abstract
Intravenous (IV) subanesthetic doses of ketamine have been shown to reduce psychiatric distress in both major depressive (MDD) and posttraumatic stress disorder (PTSD). However, the effect of ketamine on cognitive function in these disorders is not well understood. To address this gap, we examined the effect of a single dose of IV ketamine on cognition in individuals with MDD and/or PTSD relative to healthy controls (HC). Psychiatric (n = 29; 15 PTSD, 14 MDD) and sex- age- and IQ matched HC (n = 29) groups were recruited from the community. A single subanesthetic dose of IV ketamine was administered. Mood and cognitive measures were collected prior to, 2 h and 1 day post-ketamine administration. MDD/PTSD individuals evidenced a large-magnitude improvement in severity of depressive symptoms at both 2-hours and 1 day post-ketamine administration (p's < .001, Cohen d's = 0.80-1.02). Controlling for baseline performance and years of education, IV ketamine induced declines in attention (ATTN), executive function (EF), and verbal memory (VM) 2 h post-administration, all of which had resolved by 1 day post-ketamine across groups. The magnitude of cognitive decline was significantly larger in MDD/PTSD relative to HC on attention only (p = .012, d = 0.56). Ketamine did not affect working memory (WM) performance. Cognitive function (baseline, change from baseline to post-ketamine) was not associated with antidepressant response to ketamine. Results suggest that while ketamine may have an acute deleterious effect on some cognitive domains in both MDD/PTSD and HC individuals, most notably attention, this reduction is transient and there is no evidence of ketamine-related cognitive dysfunction at 1 day post-administration.
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Affiliation(s)
- Margaret T Davis
- Yale University School of Medicine, Department of Psychiatry, New Haven, USA
- Yale University, Department of Psychology, New Haven, USA
- U.S. Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Washington, DC, USA
| | - Nicole DellaGiogia
- Yale University School of Medicine, Department of Psychiatry, New Haven, USA
| | | | - Robert H Pietrzak
- Yale University School of Medicine, Department of Psychiatry, New Haven, USA
- U.S. Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Washington, DC, USA
| | - Irina Esterlis
- Yale University School of Medicine, Department of Psychiatry, New Haven, USA.
- Yale University, Department of Psychology, New Haven, USA.
- U.S. Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Washington, DC, USA.
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Chen X, Wang M, Hu Y, Zhan Y, Zhou Y, Zheng W, Liu W, Wang C, Zhong X, Li H, Lan X, Ning Y, Zhang B. Working memory associated with anti-suicidal ideation effect of repeated-dose intravenous ketamine in depressed patients. Eur Arch Psychiatry Clin Neurosci 2021; 271:431-438. [PMID: 33386430 DOI: 10.1007/s00406-020-01221-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
Suicide is a tremendous threat to global public health, and a large number of people who committed suicide suffered the pain of mental diseases, especially major depressive disorder (MDD). Previous study showed that ketamine could reduce suicidal ideation (SI), potentially by improving the impaired working memory (WM). The objective of current study was to illuminate the relationship between WM and SI in MDD with repeated ketamine treatment. MDD patients with SI (n = 59) and without SI (n = 37) completed six intravenous infusions of ketamine (0.5 mg/kg over 40 min) over 12 days (Day 1, 3, 5, 8, 10 and 12). The severity of depressive symptoms, SI and WM were assessed at baseline, day 13 and day 26. We found that WM was significantly improved after 6 ketamine infusions (F = 161.284, p = 0.009) in a linear mixed model. Correlation analysis showed that the improvement of depressive symptom was significantly associated with WM at baseline (r = - 0.265, p = 0.042) and the reduction in SSI-part I was related to the change of WM (r = 0.276, p = 0.034) in the MDD patients with SI. Furthermore, Logistic regression analysis showed that improvement in WM might predict the anti-SI response of ketamine. Our findings suggest that the improvement of working memory may partly account for the anti-SI effect of ketamine, and intervention of improving working memory function may be capable of reducing suicidal ideation.
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Affiliation(s)
- Xiaoyu Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, 510370, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Mingxin Rd.36, Guangzhou, 510370, Guangdong, China
| | - Mingqia Wang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, 510370, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Mingxin Rd.36, Guangzhou, 510370, Guangdong, China
| | - Yiru Hu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, 510370, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Mingxin Rd.36, Guangzhou, 510370, Guangdong, China
| | - Yanni Zhan
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, 510370, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Mingxin Rd.36, Guangzhou, 510370, Guangdong, China
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, 510370, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Mingxin Rd.36, Guangzhou, 510370, Guangdong, China
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, 510370, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Mingxin Rd.36, Guangzhou, 510370, Guangdong, China
| | - Weijian Liu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, 510370, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Mingxin Rd.36, Guangzhou, 510370, Guangdong, China
| | - Chengyu Wang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, 510370, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Mingxin Rd.36, Guangzhou, 510370, Guangdong, China
| | - Xiaomei Zhong
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, 510370, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Mingxin Rd.36, Guangzhou, 510370, Guangdong, China
| | - Hanqiu Li
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, 510370, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Mingxin Rd.36, Guangzhou, 510370, Guangdong, China
| | - Xiaofeng Lan
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, 510370, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Mingxin Rd.36, Guangzhou, 510370, Guangdong, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, 510370, China. .,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Mingxin Rd.36, Guangzhou, 510370, Guangdong, China.
| | - Bin Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, 510370, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Mingxin Rd.36, Guangzhou, 510370, Guangdong, China
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Dwyer JB, Landeros-Weisenberger A, Johnson JA, Londono Tobon A, Flores JM, Nasir M, Couloures K, Sanacora G, Bloch MH. Efficacy of Intravenous Ketamine in Adolescent Treatment-Resistant Depression: A Randomized Midazolam-Controlled Trial. Am J Psychiatry 2021; 178:352-362. [PMID: 33653121 DOI: 10.1176/appi.ajp.2020.20010018] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Adolescent depression is prevalent and is associated with significant morbidity and mortality. Although intravenous ketamine has shown efficacy in adult treatment-resistant depression, its efficacy in pediatric populations is unknown. The authors conducted an active-placebo-controlled study of ketamine's safety and efficacy in adolescents. METHODS In this proof-of-concept randomized, double-blind, single-dose crossover clinical trial, 17 adolescents (ages 13-17) with a diagnosis of major depressive disorder received a single intravenous infusion of either ketamine (0.5 mg/kg over 40 minutes) or midazolam (0.045 mg/kg over 40 minutes), and the alternate compound 2 weeks later. All participants had previously tried at least one antidepressant medication and met the severity criterion of a score >40 on the Children's Depression Rating Scale-Revised. The primary outcome measure was score on the Montgomery-Åsberg Depression Rating Scale (MADRS) 24 hours after treatment. RESULTS A single ketamine infusion significantly reduced depressive symptoms 24 hours after infusion compared with midazolam (MADRS score: midazolam, mean=24.13, SD=12.08, 95% CI=18.21, 30.04; ketamine, mean=15.44, SD=10.07, 95% CI=10.51, 20.37; mean difference=-8.69, SD=15.08, 95% CI=-16.72, -0.65, df=15; effect size=0.78). In secondary analyses, the treatment gains associated with ketamine appeared to remain 14 days after treatment, the latest time point assessed, as measured by the MADRS (but not as measured by the Children's Depression Rating Scale-Revised). A significantly greater proportion of participants experienced a response to ketamine during the first 3 days following infusion as compared with midazolam (76% and 35%, respectively). Ketamine was associated with transient, self-limited dissociative symptoms that affected participant blinding, but there were no serious adverse events. CONCLUSIONS In this first randomized placebo-controlled clinical trial of intravenous ketamine in adolescents with depression, the findings suggest that it is well tolerated acutely and has significant short-term (2-week) efficacy in reducing depressive symptoms compared with an active placebo.
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Affiliation(s)
- Jennifer B Dwyer
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
| | - Angeli Landeros-Weisenberger
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
| | - Jessica A Johnson
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
| | - Amalia Londono Tobon
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
| | - José M Flores
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
| | - Madeeha Nasir
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
| | - Kevin Couloures
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
| | - Gerard Sanacora
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
| | - Michael H Bloch
- Yale Child Study Center (Dwyer, Landeros-Weisenberger, Johnson, Londono Tobon, Flores, Nasir, Bloch), Department of Radiology and Biomedical Imaging (Dwyer), and Department of Psychiatry (Londono Tobon, Flores, Sanacora, Bloch), Yale School of Medicine, New Haven, Conn.; Department of Pediatrics, Stanford University, Stanford, Calif. (Couloures)
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Is ketamine an appropriate alternative to ECT for patients with treatment resistant depression? A systematic review. J Affect Disord 2021; 281:82-89. [PMID: 33307338 DOI: 10.1016/j.jad.2020.11.123] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Ketamine has repeatedly shown to have rapid and robust antidepressant effects in patients with treatment resistant depression (TRD). An important question is whether ketamine is as effective and safe as the current gold standard electroconvulsive therapy (ECT). METHODS The literature was searched for trials comparing ketamine treatment with ECT for depression in the Pubmed/MEDLINE database and Cochrane Trials Library. RESULTS A total of 137 manuscripts were identified, 6 articles were included in this review. Overall quality of the included studies was diverse with relevant risk of bias for some of the studies. Results suggest that ketamine treatment might give faster but perhaps less durable antidepressant effects. Side effects differed from ECT, in particular less cognitive impairment was apparent in ketamine treatment. LIMITATIONS The included studies have limited sample sizes, use different treatment protocols and in most trials, longer term follow up is lacking. Furthermore, allocation bias appears likely in the non-randomized trials. CONCLUSIONS Current available literature does not yet provide convincing evidence to consider ketamine as an equally effective treatment alternative to ECT in patients with TRD. There are indications for a more favourable short term cognitive side effect profile after ketamine treatment. Methodologically well-designed studies with larger sample sizes and longer follow up duration are warranted.
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Zheng W, Zhou YL, Wang CY, Lan XF, Zhang B, Yang MZ, Nie S, Ning YP. Neurocognitive effects of six ketamine infusions and the association with antidepressant effects in treatment-resistant bipolar depression: a preliminary study. PeerJ 2020; 8:e10208. [PMID: 33194410 PMCID: PMC7646297 DOI: 10.7717/peerj.10208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/28/2020] [Indexed: 12/27/2022] Open
Abstract
Objective The N-methyl-D-aspartate subtype glutamate receptor antagonist ketamine has rapid antidepressant and antisuicidal effects in treating treatment-resistant bipolar depression (TRBD). The neurocognitive effects of repeated ketamine infusions in TRBD are not known. Methods Six intravenous infusions of ketamine (0.5 mg/kg over 40 min) were administered on a Monday–Wednesday–Friday schedule during a 12-day period on 16 patients with TRBD followed by a 2-week observational period. The assessment of neurocognitive function was conducted using the MATRICS Consensus Cognitive Battery at baseline, 13 and 26 days. Tasks were designed to test speed of processing, working memory, visual learning and verbal learning. Results A significant improvement was found only in scores of speed of processing (F = 9.9, p = 0.001) after a 2-week observational period, which was accounted for by the improvement of depression symptoms. There were no significant changes over time in terms of working memory, visual learning and verbal learning. Pearson correlation analysis showed that the improvement of depression symptoms through six ketamine infusions was greater among TRBD patients with lower working memory at baseline (r = 0.54, p = 0.03). In multiple regression analysis, the significant correlation was still maintained (beta = 0.67, t = 2.2, p = 0.04). Conclusion This preliminary study indicated that six ketamine infusions were not harmful but were slightly beneficial for speed of processing in TRBD. However, this change was mainly accounted for the improvement of depression symptoms over time. Lower baseline working memory appears to be associated with greater antidepressant response after completion of six ketamine infusions in patients with TRBD.
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Affiliation(s)
- Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yan-Ling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Cheng-Yu Wang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiao-Feng Lan
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bin Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ming-Zhe Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Sha Nie
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yu-Ping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China, Guangzhou, China
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Philipsen MH, Gu C, Ewing AG. Zinc Deficiency Leads to Lipid Changes in Drosophila Brain Similar to Cognitive-Impairing Drugs: An Imaging Mass Spectrometry Study. Chembiochem 2020; 21:2755-2758. [PMID: 32402134 PMCID: PMC7586942 DOI: 10.1002/cbic.202000197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/09/2020] [Indexed: 12/21/2022]
Abstract
Several diseases and disorders have been suggested to be associated with zinc deficiency, especially learning and memory impairment. To have better understanding about the connection between lipid changes and cognitive impairments, we investigated the effects of a zinc-chelated diet on certain brain lipids of Drosophila melanogaster by using time-of-flight secondary ion mass spectrometry (ToF-SIMS). The data revealed that there are increases in the levels of phosphatidylcholine and phosphatidylinositol in the central brains of the zinc-deficient flies compared to the control flies. In contrast, the abundance of phosphatidylethanolamine in the brains of the zinc-deficient flies is lower. These data are consistent with that of cognitive-diminishing drugs, thus providing insight into the biological and molecular effects of zinc deficiency on the major brain lipids and opening a new treatment target for cognitive deficit in zinc deficiency.
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Affiliation(s)
- Mai H. Philipsen
- Department of Chemistry and Chemical EngineeringChalmers University of TechnologyKemigården 4412 96GöteborgSweden
| | - Chaoyi Gu
- Department of Chemistry and Molecular BiologyUniversity of GothenburgKemigården 4412 96GöteborgSweden
| | - Andrew G. Ewing
- Department of Chemistry and Molecular BiologyUniversity of GothenburgKemigården 4412 96GöteborgSweden
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McCarberg B, Peppin J. Pain Pathways and Nervous System Plasticity: Learning and Memory in Pain. PAIN MEDICINE 2020; 20:2421-2437. [PMID: 30865778 DOI: 10.1093/pm/pnz017] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective This article reviews the structural and functional changes in pain chronification and explores the association between memory and the development of chronic pain. Methods PubMed was searched using the terms "chronic pain," "central sensitization," "learning," "memory," "long-term potentiation," "long-term depression," and "pain memory." Relevant findings were synthesized into a narrative of the processes affecting pain chronification. Results Pain pathways represent a complex sensory system with cognitive, emotional, and behavioral influences. Anatomically, the hippocampus, amygdala, and anterior cortex-central to the encoding and consolidation of memory-are also implicated in experiential aspects of pain. Common neurotransmitters and similar mechanisms of neural plasticity (eg, central sensitization, long-term potentiation) suggest a mechanistic overlap between chronic pain and memory. These anatomic and mechanistic correlates indicate that chronic pain and memory intimately interact on several levels. Longitudinal imaging studies suggest that spatiotemporal reorganization of brain activity accompanies the transition to chronic pain, during which the representation of pain gradually shifts from sensory to emotional and limbic structures. Conclusions The chronification of pain can be conceptualized as activity-induced plasticity of the limbic-cortical circuitry resulting in reorganization of the neocortex. The state of the limbic-cortical network determines whether nociceptive signals are transient or chronic by extinguishing pathways or amplifying signals that intensify the emotional component of nociceptive inputs. Thus, chronic pain can be seen as the persistence of the memory of pain and/or the inability to extinguish painful memories. Ideally, pharmacologic, physical, and/or psychological approaches should reverse the reorganization accompanying chronic pain.
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Affiliation(s)
- Bill McCarberg
- Chronic Pain Management Program, Kaiser Permanente, San Diego, California; †University of California, San Diego, California; ‡Neighborhood Health, San Diego, California; §College of Osteopathic Medicine, Marian University, Indianapolis, Indiana; ¶John F. Peppin, DO, LLC, Hamden, Connecticut
| | - John Peppin
- Chronic Pain Management Program, Kaiser Permanente, San Diego, California; †University of California, San Diego, California; ‡Neighborhood Health, San Diego, California; §College of Osteopathic Medicine, Marian University, Indianapolis, Indiana; ¶John F. Peppin, DO, LLC, Hamden, Connecticut
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Zhang Z, Zhang M, Luo Y, Ni X, Lu H, Wen Y, Fan N. Preliminary comparative analysis of kynurenine pathway metabolites in chronic ketamine users, schizophrenic patients, and healthy controls. Hum Psychopharmacol 2020; 35:e2738. [PMID: 32352599 DOI: 10.1002/hup.2738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The serum kynurenine pathway metabolites kynurenic acid (KYNA), kynurenine (KYN), and tryptophan (TRP) were examined in chronic ketamine users and in schizophrenic patients. The correlations of the metabolites with sociodemographic data, clinical characteristics, and drug use status were analyzed. METHODS Seventy-nine healthy controls, 78 ketamine users, and 80 schizophrenic patients were recruited. Serum TRP, KYN, and KYNA levels were measured by high-performance liquid chromatography following tandem mass spectrometry (MS/MS). Psychotic symptoms were evaluated using the positive and negative syndrome scale (PANSS), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). RESULTS Serum levels of TRP, KYNA, and KYN (in ketamine users only) were lower in ketamine users and schizophrenic patients than in controls (p < .05). TRP and KYN were lower in ketamine users than in schizophrenic patients (p < .01). KYNA levels were positively correlated with the current frequency of ketamine use in ketamine users (p = .031), and serum KYNA levels were negatively correlated with the duration of schizophrenia (p = .015). CONCLUSION TRP, KYNA, and KYN were lower in chronic ketamine users than in controls, and the alterations were in the same direction as those observed in schizophrenic patients.
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Affiliation(s)
- Zhaohua Zhang
- Department of Substance Dependence, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Minling Zhang
- Department of Substance Dependence, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yayan Luo
- Department of Substance Dependence, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xiaojia Ni
- Department of Substance Dependence, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Haoyang Lu
- Department of Substance Dependence, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yuguan Wen
- Department of Substance Dependence, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Ni Fan
- Department of Substance Dependence, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
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Matveychuk D, Thomas RK, Swainson J, Khullar A, MacKay MA, Baker GB, Dursun SM. Ketamine as an antidepressant: overview of its mechanisms of action and potential predictive biomarkers. Ther Adv Psychopharmacol 2020; 10:2045125320916657. [PMID: 32440333 PMCID: PMC7225830 DOI: 10.1177/2045125320916657] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/02/2020] [Indexed: 12/15/2022] Open
Abstract
Ketamine, a drug introduced in the 1960s as an anesthetic agent and still used for that purpose, has garnered marked interest over the past two decades as an emerging treatment for major depressive disorder. With increasing evidence of its efficacy in treatment-resistant depression and its potential anti-suicidal action, a great deal of investigation has been conducted on elucidating ketamine's effects on the brain. Of particular interest and therapeutic potential is the ability of ketamine to exert rapid antidepressant properties as early as several hours after administration. This is in stark contrast to the delayed effects observed with traditional antidepressants, often requiring several weeks of therapy for a clinical response. Furthermore, ketamine appears to have a unique mechanism of action involving glutamate modulation via actions at the N-methyl-D-aspartate (NMDA) and α -amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, as well as downstream activation of brain-derived neurotrophic factor (BDNF) and mechanistic target of rapamycin (mTOR) signaling pathways to potentiate synaptic plasticity. This paper provides a brief overview of ketamine with regard to pharmacology/pharmacokinetics, toxicology, the current state of clinical trials on depression, postulated antidepressant mechanisms and potential biomarkers (biochemical, inflammatory, metabolic, neuroimaging sleep-related and cognitive) for predicting response to and/or monitoring of therapeutic outcome with ketamine.
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Affiliation(s)
- Dmitriy Matveychuk
- Department of Psychiatry, Neurochemical Research Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Rejish K. Thomas
- Grey Nuns Community Hospital and Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Swainson
- Misericordia Community Hospital and Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Atul Khullar
- Grey Nuns Community Hospital and Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Mary-Anne MacKay
- Department of Psychiatry, Neurochemical Research Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Glen B. Baker
- Department of Psychiatry, Neurochemical Research Unit, University of Alberta, 12-105B Clin Sci Bldg, Edmonton, Alberta T6G 2G3, Canada
| | - Serdar M. Dursun
- Department of Psychiatry, Neurochemical Research Unit, University of Alberta, Edmonton, Alberta, Canada
- Grey Nuns Community Hospital, Edmonton, Alberta, Canada
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Xu J, Herndon C, Anderson S, Getson P, Foorsov V, Harbut RE, Moskovitz P, Harden RN. Intravenous Ketamine Infusion for Complex Regional Pain Syndrome: Survey, Consensus, and a Reference Protocol. PAIN MEDICINE 2020. [PMID: 29534218 DOI: 10.1093/pm/pny024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To find and reach a consensus on the usage of ketamine in the treatment of complex regional pain syndrome and to determine a reference protocol for future studies. DESIGN Three hundred fifty-one medical professionals participated in our survey on practice procedures, with 104 respondents providing information on their usage of ketamine for treating the pain associated with complex regional pain syndrome. Respondents answered questions about inpatient treatment, outpatient treatment, children vs adults, safety, and basic demographic information. An expert group then met to reach a consensus for a reference protocol. RESULTS There is a difference in how inpatients are treated compared with outpatients, making it necessary to have two different reference protocols. The duration of pain relief varied from one to 10 days to one to six months, with a correlation between the duration of pain relief and total infusion hours per round. CONCLUSIONS The consensus reference protocols are made up of nine recommended topics. Reference protocols need to be validated by extensive research before guidelines can be created.
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Affiliation(s)
- Jijun Xu
- Department of Pain Management, Anesthesiology Institute.,Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christopher Herndon
- School of Pharmacy, Southern Illinois University Edwardsville.,School of Medicine, St. Louis University, St. Louis, Missouri
| | - Samantha Anderson
- Department of Orthopaedic Surgery and Neurological Surgery, George Washington University. Washington, DC; Reflex Sympathetic Dystrophy Syndrome Association, Milford, Connecticut
| | - Philip Getson
- Department of Neurology, Drexel University, Philadelphia, Pennsylvania; **Infusion Centers of America, Little Rock, Arkansas
| | - Victor Foorsov
- Department of Pain Management, Anesthesiology Institute.,George Washington University, Washington, DC
| | | | - Peter Moskovitz
- Department of Orthopaedic Surgery and Neurological Surgery, George Washington University. Washington, DC; Reflex Sympathetic Dystrophy Syndrome Association, Milford, Connecticut
| | - R Norm Harden
- Departments of ††Physical Medicine and Rehabilitation.,Physical Therapy and Movement Sciences, Northwestern University, Chicago, Illinois, USA
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Piva A, Caffino L, Padovani L, Pintori N, Mottarlini F, Sferrazza G, Paolone G, Fumagalli F, Chiamulera C. The metaplastic effects of ketamine on sucrose renewal and contextual memory reconsolidation in rats. Behav Brain Res 2020; 379:112347. [DOI: 10.1016/j.bbr.2019.112347] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 12/15/2022]
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Robertson OD, Coronado NG, Sethi R, Berk M, Dodd S. Putative neuroprotective pharmacotherapies to target the staged progression of mental illness. Early Interv Psychiatry 2019; 13:1032-1049. [PMID: 30690898 DOI: 10.1111/eip.12775] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/26/2018] [Indexed: 12/22/2022]
Abstract
AIM Neuropsychiatric disorders including depression, bipolar and schizophrenia frequently exhibit a neuroprogressive course from prodrome to chronicity. There are a range of agents exhibiting capacity to attenuate biological mechanisms associated with neuroprogression. This review will update the evidence for putative neuroprotective agents including clinical efficacy, mechanisms of action and limitations in current assessment tools, and identify novel agents with neuroprotective potential. METHOD Data for this review were sourced from online databases PUBMED, Embase and Web of Science. Only data published since 2012 were included in this review, no data were excluded based on language or publication origin. RESULTS Each of the agents reviewed inhibit one or multiple pathways of neuroprogression including: inflammatory gene expression and cytokine release, oxidative and nitrosative stress, mitochondrial dysfunction, neurotrophin dysregulation and apoptotic signalling. Some demonstrate clinical efficacy in preventing neural damage or loss, relapse or cognitive/functional decline. Agents include: the psychotropic medications lithium, second generation antipsychotics and antidepressants; other pharmacological agents such as minocycline, aspirin, cyclooxygenase-2 inhibitors, statins, ketamine and alpha-2-delta ligands; and others such as erythropoietin, oestrogen, leptin, N-acetylcysteine, curcumin, melatonin and ebselen. CONCLUSIONS Signals of evidence of clinical neuroprotection are evident for a number of candidate agents. Adjunctive use of multiple agents may present a viable avenue to clinical realization of neuroprotection. Definitive prospective studies of neuroprotection with multimodal assessment tools are required.
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Affiliation(s)
- Oliver D Robertson
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia.,Mental Health, Drugs and Alcohol Services, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Nieves G Coronado
- Unidad de Gestión Clinica Salud Mental, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Rickinder Sethi
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia.,Mental Health, Drugs and Alcohol Services, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia.,Mood Disorders Research Program, Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Seetal Dodd
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia.,Mental Health, Drugs and Alcohol Services, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia.,Mood Disorders Research Program, Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
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Zheng W, Zhou YL, Liu WJ, Wang CY, Zhan YN, Li HQ, Chen LJ, Li MD, Ning YP. Neurocognitive performance and repeated-dose intravenous ketamine in major depressive disorder. J Affect Disord 2019; 246:241-247. [PMID: 30590286 DOI: 10.1016/j.jad.2018.12.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/21/2018] [Accepted: 12/08/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Ketamine has demonstrated a rapid antidepressant and antisuicidal effect in patients with major depressive disorder (MDD), but the neurocognitive effects of ketamine are relatively unknown. This study aims to examine the neurocognitive effects of six ketamine infusions and the association of baseline neurocognitive function and the change in severity of depressive symptoms after the last infusions. METHODS Sixty-four patients with MDD completed six intravenous infusions of ketamine (0.5 mg/kg over 40 min) administered over a 12-day period (Monday-Wednesday-Friday), and were followed by a 2-week observational period. Four domains of neurocognitive function (including speed of processing, working memory, visual learning and verbal learning) were assessed using the MATRICS Consensus Cognitive Battery (MCCB) at 0, 13 and 26 days. RESULTS In linear mixed model, significant improvements were found in terms of speed of processing (F = 20.7, p < 0.001) and verbal learning (F = 11.1, p < 0.001). The Sobel test showed the improvement of speed of processing (Sobel test = 2.8, p < 0.001) and verbal learning (Sobel test = 3.6, p < 0.001) were significantly mediated by change in depressive symptoms. Other two neurocognitive domains showed no significant changes over time. Correlation analysis showed no significant association of change in depressive symptoms with neurocognitive function at baseline. CONCLUSION Our findings suggest that six ketamine infusions were associated with the improvement of speed of processing and verbal learning, which were partly accounted for by improvement in the severity of depression symptoms over time.
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Affiliation(s)
- Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yan-Ling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Wei-Jian Liu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Cheng-Yu Wang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yan-Ni Zhan
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Han-Qiu Li
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Li-Jian Chen
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Ming-D Li
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, China
| | - Yu-Ping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
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Jin G, Mao X, Qiao Z, Chen B, Jin F. RAP80 expression in breast cancer and its relationship with apoptosis in breast cancer cells. Onco Targets Ther 2019; 12:625-634. [PMID: 30705591 PMCID: PMC6343510 DOI: 10.2147/ott.s186981] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background RAP80 is a member of BRCA1-A complex, which plays an important role in regulating the cell cycle checkpoint and DNA damage repair in the nucleus. Method We investigated RAP80 expression in breast cancer and its paired normal breast tissues to further analyze its role in the biological behavior of breast cancer cells. Results RAP80 expression in breast cancer (62.3%, 101/162) was significantly lower than that in adjacent normal breast tissues (P<0.05). RAP80 expression was related to tumor size, lymph node metastasis, TNM stage, and molecular subtype (P<0.05). RAP80 mRNA expression was significantly lower in triple-negative breast cancer than other types. The mRNA and protein of RAP80 were obvious in MCF-7 and very weak in ZR-75 or MDA-MB-231, so we picked MCF-7 to be transfected with RAP80 siRNA. The survival rate of both cells decreased in a dose-dependent manner and the IC50 value for cisplatin in MCF-7 RAP80 siRNA cells was 0.83 µg/mL, and 1.69 µg/mL in wild-type MCF-7 according to MTT. RAP80 siRNA transfection upregulated the apoptosis and downregulated invasive or migrating ability of MCF-7. RAP80 siRNA also upregulated the protein expression of Caspase-3, cleaved Caspase-3, Apaf-1, Cytochrome C, Bax, and Fas, and downregulated the protein expression of Bcl-2. Conclusion RAP80 expression was related to ER or PR activity. Inhibition of RAP80 expression can induce apoptosis in breast cancer cells and improve chemosensitivity to cisplatin. Tumor cells can activate protective responses to inhibit cell cycle progression, which may be related to RAP80, and repair cisplatin-induced DNA damage. RAP80 is related to BRCA1's effect, which can be used as an interesting target for pharmacological modulation that can increase the efficiency of cisplatin chemotherapy.
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Affiliation(s)
- Guanghua Jin
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, People's Republic of China,
| | - Xiaoyun Mao
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, People's Republic of China,
| | - Zhen Qiao
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, People's Republic of China,
| | - Bo Chen
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, People's Republic of China,
| | - Feng Jin
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, People's Republic of China,
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Williams NR, Heifets BD, Blasey C, Sudheimer K, Pannu J, Pankow H, Hawkins J, Birnbaum J, Lyons DM, Rodriguez CI, Schatzberg AF. Attenuation of Antidepressant Effects of Ketamine by Opioid Receptor Antagonism. Am J Psychiatry 2018; 175:1205-1215. [PMID: 30153752 PMCID: PMC6395554 DOI: 10.1176/appi.ajp.2018.18020138] [Citation(s) in RCA: 292] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE In addition to N-methyl-d-aspartate receptor antagonism, ketamine produces opioid system activation. The objective of this study was to determine whether opioid receptor antagonism prior to administration of intravenous ketamine attenuates its acute antidepressant or dissociative effects. METHOD In a proposed double-blind crossover study of 30 adults with treatment-resistant depression, the authors performed a planned interim analysis after studying 14 participants, 12 of whom completed both conditions in randomized order: placebo or 50 mg of naltrexone preceding intravenous infusion of 0.5 mg/kg of ketamine. Response was defined as a reduction ≥50% in score on the 17-item Hamilton Depression Rating Scale (HAM-D) score on postinfusion day 1. RESULTS In the interim analysis, seven of 12 adults with treatment-resistant depression met the response criterion during the ketamine plus placebo condition. Reductions in 6-item and 17-item HAM-D scores among participants in the ketamine plus naltrexone condition were significantly lower than those of participants in the ketamine plus placebo condition on postinfusion days 1 and 3. Secondary analysis of all participants who completed the placebo and naltrexone conditions, regardless of the robustness of response to ketamine, showed similar results. There were no differences in ketamine-induced dissociation between conditions. Because naltrexone dramatically blocked the antidepressant but not the dissociative effects of ketamine, the trial was halted at the interim analysis. CONCLUSIONS The findings suggest that ketamine's acute antidepressant effect requires opioid system activation. The dissociative effects of ketamine are not mediated by the opioid system, and they do not appear sufficient without the opioid effect to produce the acute antidepressant effects of ketamine in adults with treatment-resistant depression.
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Affiliation(s)
- Nolan R. Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University
| | - Boris D. Heifets
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University
| | - Christine Blasey
- Department of Psychiatry and Behavioral Sciences, Stanford University
- Palo Alto University
| | - Keith Sudheimer
- Department of Psychiatry and Behavioral Sciences, Stanford University
| | - Jaspreet Pannu
- Department of Psychiatry and Behavioral Sciences, Stanford University
| | - Heather Pankow
- Department of Psychiatry and Behavioral Sciences, Stanford University
| | - Jessica Hawkins
- Department of Psychiatry and Behavioral Sciences, Stanford University
| | - Justin Birnbaum
- Department of Psychiatry and Behavioral Sciences, Stanford University
| | - David M. Lyons
- Department of Psychiatry and Behavioral Sciences, Stanford University
| | - Carolyn I. Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University
- Veterans Affairs Palo Alto Health Care System
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Zhou Y, Zheng W, Liu W, Wang C, Zhan Y, Li H, Chen L, Li M, Ning Y. Neurocognitive effects of six ketamine infusions and the association with antidepressant response in patients with unipolar and bipolar depression. J Psychopharmacol 2018; 32:1118-1126. [PMID: 30260273 DOI: 10.1177/0269881118798614] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Ketamine has proven to have rapid, robust antidepressant effects on treatment-resistant depression. However, whether repeated ketamine infusions would cause short-and long-term neurocognitive impairments was not clear. Our aims were to investigate the neurocognitive effects of six ketamine infusions and to examine the association between these infusions and the antidepressant response in patients with unipolar and bipolar depression. METHODS Six intravenous infusions of ketamine (0.5 mg/kg) over a 12-day period were administered to 84 patients with unipolar and bipolar depression. Severity of depressive symptoms and four domains of neurocognition, including speed of processing, working memory, visual learning and verbal learning, were assessed at baseline, one day following the last infusion and again two weeks post-infusion. RESULTS Significant improvements were found on speed of processing ( F=9.344, p<0.001) and verbal learning ( F=5.647, p=0.004) in a linear mixed model. The Sobel test showed significant indirect effects between time and improvement in speed of processing (Sobel test=3.573, p<0.001) as well as improvement in verbal learning (Sobel test=6.649, p<0.001), which were both significantly mediated by change in depressive symptoms. Logistic regression analysis showed ketamine responders had better visual learning at baseline than non-responders (B=0.118, p<0.001). CONCLUSIONS Our findings suggest that neurocognitive function would not deteriorate after six ketamine infusions, while verbal learning and speed of processing improved over 13 days and 26 days of observation, respectively. However, this change was mainly accounted for by improvements in severity of depressive symptoms over time. Greater baseline visual learning predicted an antidepressant response over six ketamine infusions.
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Affiliation(s)
- Yanling Zhou
- 1 The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), China
| | - Wei Zheng
- 1 The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), China
| | - Weijian Liu
- 1 The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), China
| | - Chengyu Wang
- 1 The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), China
| | - Yanni Zhan
- 1 The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), China
| | - Hanqiu Li
- 1 The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), China
| | - Lijian Chen
- 1 The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), China
| | - Mingding Li
- 2 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuping Ning
- 1 The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), China
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Individual and combined effects of acute delta-9-tetrahydrocannabinol and cannabidiol on psychotomimetic symptoms and memory function. Transl Psychiatry 2018; 8:181. [PMID: 30185793 PMCID: PMC6125482 DOI: 10.1038/s41398-018-0191-x] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 05/18/2018] [Accepted: 06/05/2018] [Indexed: 12/31/2022] Open
Abstract
The main active ingredient in cannabis, delta-9-tetrahydrocannabinol (THC), can acutely induce psychotic symptoms and impair episodic and working memory. Another major constituent, cannabidiol (CBD), may attenuate these effects. This study aimed to determine the effects of THC and CBD, both alone and in combination on psychotic symptoms and memory function. A randomised, double-blind crossover design compared the effects of (i) placebo, (ii) THC 8 mg, (iii) CBD 16 mg and (iv) THC 8 mg + CBD 16 mg administered by inhalation through a vaporiser. Using an experimental medicine approach to predict treatment sensitivity, we selected 48 cannabis users from the community on the basis of (1) schizotypal personality questionnaire scores (low, high) and (2) frequency of cannabis use (light, heavy). The Brief Psychiatric Rating Scale (BPRS), Psychotomimetic States Inventory (PSI), immediate and delayed prose recall (episodic memory), 1- and 2-back (working memory) were assessed on each day. Results indicated that THC increased overall scores on the PSI, negative symptoms on BPRS, and robustly impaired episodic and working memory. Co-administration of CBD did not attenuate these effects. CBD alone reduced PSI scores in light users only. At a ratio of 2:1, CBD does not attenuate the acute psychotic and memory impairing effects of vaporised THC. Frequent cannabis users may show a blunted anti- psychotic response to CBD, which is of concern due to the high rates of cannabis use disorders in patients with schizophrenia.
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Ke X, Ding Y, Xu K, He H, Wang D, Deng X, Zhang X, Zhou Y, Zhou C, Liu Y, Ning Y, Fan N. The profile of cognitive impairments in chronic ketamine users. Psychiatry Res 2018; 266:124-131. [PMID: 29864611 DOI: 10.1016/j.psychres.2018.05.050] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 04/20/2018] [Accepted: 05/22/2018] [Indexed: 01/25/2023]
Abstract
The aim of this study was to examine the cognitive function in chronic ketamine users. Factors correlated to cognition impairments were analyzed. Sixty-three chronic ketamine users and 65 healthy subjects were recruited. Cognitive function was assessed by using immediate/delayed visual reproduction (IVR/DVR) tasks, immediate/delayed logical memory (ILM/DLM) tasks, Stroop test, Wisconsin card sorting test (WCST), and continuous performance test (CPT). Psychopathological symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Ketamine users performed worse than controls on the IVR, ILM, DLM, Stroop and auditory CPT tests. IVR and DVR, color-naming and color-interference-reading scores were positively correlated with education level. In ketamine users ILM scores were negatively correlated with the negative subscale of PANSS. DLM score was positively correlated with average dose of ketamine use. Word-reading score was positively correlated with education level, and negatively correlated with duration of ketamine use. False hits in auditory CPT was positively correlated with duration of ketamine use. Number of trials to complete the first category and perseverative errors on WCST were positively correlated with the duration between the test and last ketamine use. Chronic ketamine users had cognitive impairments across multiple domains.
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Affiliation(s)
- Xiaoyin Ke
- The Affiliated Brain Hospital of Guangzhou Medical University(Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong 510370, China; Shenzhen Kangning Hospital (Mental Health College of Shenzhen University), 1080 Cuizhu Rd., Luohu District, Shenzhen, Guangdong 518020, China
| | - Yi Ding
- The Affiliated Brain Hospital of Guangzhou Medical University(Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong 510370, China
| | - Ke Xu
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06510, USA
| | - Hongbo He
- The Affiliated Brain Hospital of Guangzhou Medical University(Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong 510370, China
| | - Daping Wang
- The Affiliated Brain Hospital of Guangzhou Medical University(Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong 510370, China
| | - Xuefeng Deng
- Guangzhou Baiyun voluntary drug rehabilitation hospital, 586 North of Baiyun Road, Baiyun District, Guangzhou, Guangdong 510440, China
| | - Xifan Zhang
- Guangzhou Baiyun voluntary drug rehabilitation hospital, 586 North of Baiyun Road, Baiyun District, Guangzhou, Guangdong 510440, China
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University(Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong 510370, China
| | - Chao Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University(Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong 510370, China
| | - Yuping Liu
- The Affiliated Brain Hospital of Guangzhou Medical University(Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong 510370, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University(Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong 510370, China.
| | - Ni Fan
- The Affiliated Brain Hospital of Guangzhou Medical University(Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong 510370, China.
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Hindocha C, Freeman TP, Xia JX, Shaban NDC, Curran HV. Acute memory and psychotomimetic effects of cannabis and tobacco both 'joint' and individually: a placebo-controlled trial. Psychol Med 2017; 47:2708-2719. [PMID: 28558859 PMCID: PMC5647681 DOI: 10.1017/s0033291717001222] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 04/07/2017] [Accepted: 04/07/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cannabis and tobacco have contrasting cognitive effects. Smoking cannabis with tobacco is prevalent in many countries and although this may well influence cognitive and mental health outcomes, the possibility has rarely been investigated in human experimental psychopharmacological research. METHOD The individual and interactive effects of cannabis and tobacco were evaluated in 24 non-dependent cannabis and tobacco smokers in a randomized, placebo-controlled, double-blind, 2 (cannabis, placebo) × 2 (tobacco, placebo) crossover design. Verbal memory (prose recall), working memory (WM) performance including maintenance, manipulation and attention (N-back), psychotomimetic, subjective and cardiovascular measures were recorded on each of four sessions. RESULTS Cannabis alone impaired verbal memory. A priori contrasts indicated that tobacco offset the effects of cannabis on delayed recall. However, this was not supported by linear mixed model analysis. Cannabis load-dependently impaired WM. By contrast, tobacco improved WM across all load levels. The acute psychotomimetic effects and ratings of 'stoned' and 'dizzy' induced by cannabis were not altered by tobacco. Cannabis and tobacco had independent effects on increasing heart rate and interacting effects on increasing diastolic blood pressure. CONCLUSIONS Relative to placebo, acute cannabis impaired verbal memory and WM. Tobacco enhanced performance on WM, independently of cannabis. Moreover, we found some preliminary evidence that tobacco may offset the effects of cannabis on delayed, but not immediate, verbal recall. In contrast, the psychotomimetic and subjective effects of cannabis were unaffected by tobacco co-administration. By reducing the cognitive impairment from cannabis, tobacco co-administration may perpetuate use despite adverse health consequences.
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Affiliation(s)
- C. Hindocha
- Clincial Psychopharmacology Unit,
University College London, Gower St,
London, UK
| | - T. P. Freeman
- Clincial Psychopharmacology Unit,
University College London, Gower St,
London, UK
| | - J. X. Xia
- The Sophie Davis School of Biomedical Education,
The City College of New York, NY,
USA
| | - N. D. C. Shaban
- Clincial Psychopharmacology Unit,
University College London, Gower St,
London, UK
| | - H. V. Curran
- Clincial Psychopharmacology Unit,
University College London, Gower St,
London, UK
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Hauser MJ, Isbrandt D, Roeper J. Disturbances of novel object exploration and recognition in a chronic ketamine mouse model of schizophrenia. Behav Brain Res 2017. [PMID: 28634108 DOI: 10.1016/j.bbr.2017.06.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Schizophrenia is a chronic and devastating disease with an overall lifetime risk of 1%. While positive symptoms of schizophrenia such as hallucinations and delusions are reduced by antipsychotic medication based on the inhibition of type 2 dopaminergic receptors (D2R), negative symptoms (e.g. reduced motivation) and cognitive symptoms (e.g. impaired working memory) of schizophrenia are not effectively treated by current medication. This dichotomy might arise in part because of our limited understanding of the pathophysiology of negative and cognitive symptoms in schizophrenia. In addition to genetic approaches, chronic systemic application of NMDA inhibitors such as ketamine have been used to generate rodent models, which displayed several relevant endophenotypes related to negative and cognitive symptoms and might thus facilitate mechanistic studies into the underlying pathophysiology. In this context, previous behavioral testing identified impairments in novel object recognition memory as a key feature in chronic NMDA-inhibitor schizophrenia rodent models. Using a chronic ketamine mouse model, we have however identified are more complex behavioral phenotype including deficits in novel space and novel object exploration in combination deficits in short-term novel object recognition memory. These impairments in novelty discrimination are in line with prefrontal and hippocampal reductions in parvalbumin-expression as well as reduced expression of the early immediate gene c-fos after novel-object exploration in hippocampal areas in our model. Our results indicate that adult C57Bl6N mice chronically treated with ketamine display combined impairments in novelty exploration and recognition, which might represent both motivational (negative) and cognitive symptoms of schizophrenia.
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Affiliation(s)
- Maria Jelena Hauser
- Institute of Neurophysiology, Neuroscience Center, Goethe University Frankfurt, Germany
| | - Dirk Isbrandt
- DZNE Research Team Experimental Neurophysiology, University Hospital Cologne, Germany
| | - Jochen Roeper
- Institute of Neurophysiology, Neuroscience Center, Goethe University Frankfurt, Germany.
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