Department of Psychiatry and Behavioral Sciences, Mercer University School of Medicine, 1550 College Street, Macon, GA 31201, USA.
Med Hypotheses. 2011 May;76(5):717-9. doi: 10.1016/j.mehy.2011.02.003. Epub 2011 Mar 1.
Dextromethorphan shares pharmacological properties in common with antidepressants and, in particular, ketamine, a drug with demonstrated rapid-acting antidepressant activity. Pharmacodynamic similarities include actions on NMDA, μ opiate, sigma-1, calcium channel, serotonin transporter, and muscarinic sites. Additional unique properties potentially contributory to an antidepressant effect include actions at ß, alpha-2, and serotonin 1b/d receptors. It is therefore, hypothesized that dextromethorphan may have antidepressant efficacy in bipolar, unipolar, major depression, psychotic, and treatment-resistant depressive disorders, and may display rapid-onset of antidepressant response. An antidepressant response may be associated with a positive family history of alcoholism, prediction of ketamine response, increased AMPA-to-NMDA receptor activity ratio, antidepressant properties in animal models of depression, reward system activation, enhanced erythrocyte magnesium concentration, and correlation with frontal μ receptor binding potential. Clinical trials of dextromethorphan in depressive disorders, especially treatment-resistant depression, now seem warranted.
右美沙芬与抗抑郁药具有共同的药理学特性，特别是具有快速抗抑郁作用的药物氯胺酮。药效学相似之处包括对 NMDA、μ阿片受体、σ-1、钙通道、5-羟色胺转运体和毒蕈碱受体的作用。其他可能有助于抗抑郁作用的独特特性包括对β、α-2 和 5-羟色胺 1b/d 受体的作用。因此，有人假设右美沙芬可能对双相、单相、重性抑郁、精神病性和治疗抵抗性抑郁障碍具有抗抑郁作用，并可能表现出抗抑郁反应的快速发作。抗抑郁反应可能与酒精中毒的阳性家族史、氯胺酮反应的预测、AMPA 对 NMDA 受体活性比率的增加、抑郁动物模型中的抗抑郁特性、奖励系统激活、增强的红细胞镁浓度以及与额叶μ受体结合潜能相关。在抑郁障碍，特别是治疗抵抗性抑郁中，现在似乎有必要进行右美沙芬的临床试验。
