Tadler Scott C, Mickey Brian J
Departments of Anesthesiology and Psychiatry.
Departments of Psychiatry, Anesthesiology, Bioengineering and Neuroscience, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Curr Opin Anaesthesiol. 2018 Aug;31(4):439-445. doi: 10.1097/ACO.0000000000000617.
After decades without substantial advances, multiple novel antidepressants show promise against treatment-resistant depression. Interestingly, many of these are anesthetics. The purpose of this review is to discuss the evidence for the antidepressant effects of ketamine, nitrous oxide, isoflurane and propofol and to consider potential clinical, administrative and research implications for anesthesiologists.
Ketamine has acute, transient antidepressant and antisuicidal effects. Nitrous oxide has also shown antidepressant efficacy. There are converging preclinical and clinical data that isoflurane (and perhaps propofol), dosed to burst suppression, has relatively rapid, robust and durable antidepressant effects and lacks the adverse effects associated with electroconvulsive therapy (ECT).
Several anesthetics show promise as novel antidepressants. Ketamine is the most well studied. Anesthetic-induced burst-suppression may provide an alternative to ECT that lacks adverse cognitive effects. Further study is necessary to better understand how these drugs work and how they might be used as effective antidepressant therapy.
在数十年没有实质性进展之后，多种新型抗抑郁药显示出对抗难治性抑郁症的前景。有趣的是，其中许多是麻醉剂。本综述的目的是讨论氯胺酮、一氧化二氮、异氟烷和丙泊酚抗抑郁作用的证据，并考虑对麻醉医生潜在的临床、管理和研究意义。
氯胺酮具有急性、短暂的抗抑郁和抗自杀作用。一氧化二氮也显示出抗抑郁疗效。有越来越多的临床前和临床数据表明，给予异氟烷（可能还有丙泊酚）达到爆发抑制剂量时，具有相对快速、强大且持久的抗抑郁作用，并且没有与电休克疗法（ECT）相关的不良反应。
几种麻醉剂显示出作为新型抗抑郁药的前景。氯胺酮是研究最充分的。麻醉诱导的爆发抑制可能提供一种没有不良认知影响的ECT替代方法。有必要进一步研究以更好地理解这些药物的作用机制以及它们如何用作有效的抗抑郁治疗。
