Major Depressive Disorder (MDD)Treatment-Resistant Depression (TRD)Depressive DisordersKetamine

Ketamine and Rapid-Acting Antidepressants: A Window into a New Neurobiology for Mood Disorder Therapeutics

This review (2014) examines the efficacy, safety, and tolerability of ketamine, summarizes the neurobiology of depression, reviews the mechanisms underlying the rapid antidepressant effects of ketamine, and discusses the prospects for next-generation rapid-acting antidepressants.

Authors

  • Gerard Sanacora
  • John Krystal
  • Chadi Abdallah

Published

Annual Review of Medicine
meta Study

Abstract

Ketamine is the prototype for a new generation of glutamate-based antidepressants that rapidly alleviate depression within hours of treatment. Over the past decade, there has been replicated evidence demonstrating the rapid and potent antidepressant effects of ketamine in treatment-resistant depression. Moreover, preclinical and biomarker studies have begun to elucidate the mechanism underlying the rapid antidepressant effects of ketamine, offering a new window into the biology of depression and identifying a plethora of potential treatment targets. This article discusses the efficacy, safety, and tolerability of ketamine, summarizes the neurobiology of depression, reviews the mechanisms underlying the rapid antidepressant effects of ketamine, and discusses the prospects for next-generation rapid-acting antidepressants.

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Research Summary of 'Ketamine and Rapid-Acting Antidepressants: A Window into a New Neurobiology for Mood Disorder Therapeutics'

Introduction

Major depressive disorder (MDD) is a leading global cause of disability with an estimated lifetime prevalence of about 17% in the United States. Existing antidepressant medications largely target monoaminergic systems, but their efficacy is limited for a substantial subgroup of patients and clinical benefit typically requires weeks to months to emerge. This delay and incomplete response in many patients create an urgent need for rapid-acting treatments with efficacy in treatment-refractory cases. Ari and colleagues present a narrative synthesis of clinical, preclinical, and biomarker research on ketamine as a prototype rapid-acting, glutamate-based antidepressant. The review summarises evidence for ketamine’s rapid antidepressant and antisuicidal effects, examines proposed neurobiological mechanisms (notably synaptic plasticity involving BDNF and mTORC1), and discusses biomarkers, safety, and the prospects for next-generation rapid-acting therapeutics for mood disorders.

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Study Details

References (6)

Papers cited by this study that are also in Blossom

Antidepressant effects of ketamine in depressed patients

Berman, R. M., Cappiello, A., Anand, A. et al. · Biological Psychiatry (2000)

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Zarate, C. A., Brutsche, N. E., Ibrahim, L. et al. · Biological Psychiatry (2012)

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Rapid and Longer-Term Antidepressant Effects of Repeated Ketamine Infusions in Treatment-Resistant Major Depression

Murrough, J. W., Perez, A. M., Pillemer, S. et al. · Biological Psychiatry (2012)

Relationship of ketamine’s antidepressant and psychotomimetic effects in unipolar depression

Sos, P., Klirova, M., Novák, T. et al. · Neuropsychiatric Disease And Treatment (2013)

Do the dissociative side effects of ketamine mediate its antidepressant effects?

Luckenbaugh, D. A., Niciu, M. J., Ionescu, D. F. et al. · Journal of Affective Disorders (2014)

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Shivanekar, S., Pizon, A., Spotts, C. et al. · International Journal of Environmental Research and Public Health (2022)

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Abdallah, C. G., Averill, C. L., Salas, R. et al. · Biological Psychiatry (2017)

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Abdallah, C. G., Jackowski, A., Salas, R. et al. · Neuropsychopharmacology (2017)

Use of repeated intravenous ketamine therapy in treatment-resistant bipolar depression with suicidal behaviour: a case report from Spain

López-Díaz, A., Fernández-González, J. L., Luján-Jiménez, J. E. et al. · Therapeutic Advances in Psychopharmacology (2017)

Ketamine Treatment and Global Brain Connectivity in Major Depression

Abdallah, C. G., Averill, L. A., Collins, K. A. et al. · Neuropsychopharmacology (2016)

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Ketamine as a promising prototype for a new generation of rapid-acting antidepressants

Abdallah, C. G., Averill, L. A., Krystal, J. H. · Annals of the New York Academy of Sciences (2015)

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