a Division of Clinical Neuroscience , Chiba University Center for Forensic Mental Health , Chiba , Japan.
b Wuxi Mental Health Center , Nanjing Medical University , Wuxi , China.
Expert Rev Neurother. 2019 Jan;19(1):83-92. doi: 10.1080/14737175.2019.1554434. Epub 2018 Dec 4.
: Depression is one of the most disabling diseases worldwide. Approximately one-third of depressed patients are treatment-resistant to the currently available antidepressants and there is a significant therapeutic time lag of weeks to months. There is a clear unmet need for rapid-acting and more efficacious treatments. ()-ketamine, an old anesthetic drug, appears now to be going through a renaissance. : This paper reviews recent literature describing the antidepressant effects of ketamine and its enantiomer ()-ketamine in patients with major depressive disorder (MDD) and bipolar disorder (BD). Furthermore, the authors discuss the therapeutic potential of ()-ketamine, another enantiomer of ()-ketamine, and ()-norketamine. : A number of clinical studies have demonstrated that ()-ketamine has rapid-acting and sustained antidepressant activity in treatment-resistant patients with MDD, BD, and other psychiatric disorders. Off-label use of ketamine for mood disorders is proving popular in the United States. Meanwhile, preclinical data suggests that ()-ketamine can exert longer-lasting antidepressant effects than ()-ketamine in animal models of depression, and ()-ketamine may have less detrimental side effects than ()-ketamine and ()-ketamine. Additionally, ()-norketamine exhibits rapid and sustained antidepressant effects, with a potency similar to that of ()-ketamine. Unlike ()-ketamine, ()-norketamine does not cause behavioral and biochemical abnormalities and could be a safer than ()-ketamine too.
抑郁症是全球最致残的疾病之一。大约三分之一的抑郁症患者对目前可用的抗抑郁药有抗药性，而且治疗的时间滞后数周到数月。因此，急需快速起效和更有效的治疗方法。(-) - 氯胺酮，一种古老的麻醉药物，现在似乎正在复兴。本文回顾了最近的文献，描述了氯胺酮及其对映异构体(-) - 氯胺酮在重度抑郁症（MDD）和双相情感障碍（BD）患者中的抗抑郁作用。此外，作者还讨论了(-) - 氯胺酮和(-) - 去甲氯胺酮这一对映异构体的治疗潜力。一些临床研究表明，(-) - 氯胺酮在治疗抵抗的 MDD、BD 和其他精神障碍患者中具有快速起效和持续的抗抑郁作用。在美国，氯胺酮被非标签使用于治疗情绪障碍越来越受欢迎。同时，临床前数据表明，(-) - 氯胺酮在抑郁症动物模型中比(-) - 氯胺酮具有更长的抗抑郁作用，而且(-) - 氯胺酮的副作用比(-) - 氯胺酮和(-) - 氯胺酮更小。此外，(-) - 去甲氯胺酮具有快速和持续的抗抑郁作用，其效力与(-) - 氯胺酮相似。与(-) - 氯胺酮不同，(-) - 去甲氯胺酮不会引起行为和生化异常，可能比(-) - 氯胺酮更安全。
