Mani Yavi, Holim Lee, Ioline D Henter, Lawrence T Park, Carlos A Zarate
{"title":"氯胺酮治疗抑郁症综述","authors":"Mani Yavi, Holim Lee, Ioline D Henter, Lawrence T Park, Carlos A Zarate","doi":"10.1007/s44192-022-00012-3","DOIUrl":null,"url":null,"abstract":"<p><p>This manuscript reviews the clinical evidence regarding single-dose intravenous (IV) administration of the novel glutamatergic modulator racemic (<i>R,S</i>)-ketamine (hereafter referred to as ketamine) as well as its <i>S</i>-enantiomer, intranasal esketamine, for the treatment of major depressive disorder (MDD). Initial studies found that a single subanesthetic-dose IV ketamine infusion rapidly (within one day) improved depressive symptoms in individuals with MDD and bipolar depression, with antidepressant effects lasting three to seven days. In 2019, esketamine received FDA approval as an adjunctive treatment for treatment-resistant depression (TRD) in adults. Esketamine was approved under a risk evaluation and mitigation strategy (REMS) that requires administration under medical supervision. Both ketamine and esketamine are currently viable treatment options for TRD that offer the possibility of rapid symptom improvement. The manuscript also reviews ketamine's use in other psychiatric diagnoses-including suicidality, obsessive-compulsive disorder, post-traumatic stress disorder, substance abuse, and social anxiety disorder-and its potential adverse effects. Despite limited data, side effects for antidepressant-dose ketamine-including dissociative symptoms, hypertension, and confusion/agitation-appear to be tolerable and limited to around the time of treatment. Relatively little is known about ketamine's longer-term effects, including increased risks of abuse and/or dependence. Attempts to prolong ketamine's effects with combined therapy or a repeat-dose strategy are also reviewed, as are current guidelines for its clinical use. In addition to presenting a novel and valuable treatment option, studying ketamine also has the potential to transform our understanding of the mechanisms underlying mood disorders and the development of novel therapeutics.</p>","PeriodicalId":72827,"journal":{"name":"Discover mental health","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9010394/pdf/","citationCount":"0","resultStr":"{\"title\":\"Ketamine treatment for depression: a review.\",\"authors\":\"Mani Yavi, Holim Lee, Ioline D Henter, Lawrence T Park, Carlos A Zarate\",\"doi\":\"10.1007/s44192-022-00012-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>This manuscript reviews the clinical evidence regarding single-dose intravenous (IV) administration of the novel glutamatergic modulator racemic (<i>R,S</i>)-ketamine (hereafter referred to as ketamine) as well as its <i>S</i>-enantiomer, intranasal esketamine, for the treatment of major depressive disorder (MDD). Initial studies found that a single subanesthetic-dose IV ketamine infusion rapidly (within one day) improved depressive symptoms in individuals with MDD and bipolar depression, with antidepressant effects lasting three to seven days. In 2019, esketamine received FDA approval as an adjunctive treatment for treatment-resistant depression (TRD) in adults. Esketamine was approved under a risk evaluation and mitigation strategy (REMS) that requires administration under medical supervision. Both ketamine and esketamine are currently viable treatment options for TRD that offer the possibility of rapid symptom improvement. The manuscript also reviews ketamine's use in other psychiatric diagnoses-including suicidality, obsessive-compulsive disorder, post-traumatic stress disorder, substance abuse, and social anxiety disorder-and its potential adverse effects. Despite limited data, side effects for antidepressant-dose ketamine-including dissociative symptoms, hypertension, and confusion/agitation-appear to be tolerable and limited to around the time of treatment. Relatively little is known about ketamine's longer-term effects, including increased risks of abuse and/or dependence. Attempts to prolong ketamine's effects with combined therapy or a repeat-dose strategy are also reviewed, as are current guidelines for its clinical use. In addition to presenting a novel and valuable treatment option, studying ketamine also has the potential to transform our understanding of the mechanisms underlying mood disorders and the development of novel therapeutics.</p>\",\"PeriodicalId\":72827,\"journal\":{\"name\":\"Discover mental health\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9010394/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Discover mental health\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s44192-022-00012-3\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/4/15 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Discover mental health","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s44192-022-00012-3","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/4/15 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
本手稿回顾了有关单剂量静脉注射新型谷氨酸能调节剂外消旋(R,S)-氯胺酮(以下简称 "氯胺酮")及其S-对映体--鼻内氯胺酮(intranasal esketamine)治疗重度抑郁症(MDD)的临床证据。初步研究发现,单次亚麻醉剂量静脉注射氯胺酮可迅速(一天内)改善重度抑郁症和双相抑郁症患者的抑郁症状,抗抑郁效果可持续三至七天。2019 年,埃斯氯胺酮获得 FDA 批准,可作为治疗成人难治性抑郁症(TRD)的辅助疗法。艾司氯胺酮是在风险评估和缓解策略(REMS)下获批的,该策略要求在医疗监督下用药。氯胺酮和艾司氯胺酮目前都是治疗TRD的可行疗法,可迅速改善症状。手稿还回顾了氯胺酮在其他精神疾病(包括自杀、强迫症、创伤后应激障碍、药物滥用和社交焦虑症)中的应用及其潜在的不良反应。尽管数据有限,但抗抑郁剂量氯胺酮的副作用--包括分离症状、高血压和混乱/激动--似乎是可以忍受的,而且仅限于治疗前后。至于氯胺酮的长期影响,包括增加滥用和/或依赖的风险,目前还知之甚少。此外,还回顾了通过联合疗法或重复剂量策略来延长氯胺酮疗效的尝试,以及目前氯胺酮的临床使用指南。除了提供一种新颖而有价值的治疗选择外,对氯胺酮的研究还有可能改变我们对情绪障碍内在机制的理解,并促进新型疗法的开发。
This manuscript reviews the clinical evidence regarding single-dose intravenous (IV) administration of the novel glutamatergic modulator racemic (R,S)-ketamine (hereafter referred to as ketamine) as well as its S-enantiomer, intranasal esketamine, for the treatment of major depressive disorder (MDD). Initial studies found that a single subanesthetic-dose IV ketamine infusion rapidly (within one day) improved depressive symptoms in individuals with MDD and bipolar depression, with antidepressant effects lasting three to seven days. In 2019, esketamine received FDA approval as an adjunctive treatment for treatment-resistant depression (TRD) in adults. Esketamine was approved under a risk evaluation and mitigation strategy (REMS) that requires administration under medical supervision. Both ketamine and esketamine are currently viable treatment options for TRD that offer the possibility of rapid symptom improvement. The manuscript also reviews ketamine's use in other psychiatric diagnoses-including suicidality, obsessive-compulsive disorder, post-traumatic stress disorder, substance abuse, and social anxiety disorder-and its potential adverse effects. Despite limited data, side effects for antidepressant-dose ketamine-including dissociative symptoms, hypertension, and confusion/agitation-appear to be tolerable and limited to around the time of treatment. Relatively little is known about ketamine's longer-term effects, including increased risks of abuse and/or dependence. Attempts to prolong ketamine's effects with combined therapy or a repeat-dose strategy are also reviewed, as are current guidelines for its clinical use. In addition to presenting a novel and valuable treatment option, studying ketamine also has the potential to transform our understanding of the mechanisms underlying mood disorders and the development of novel therapeutics.