Bratsos Sosipatros, Saleh Sohag N
Cardiology, Imperial College London, London, GBR.
Pharmacology, Imperial College London, London, GBR.
Cureus. 2019 Jul 22;11(7):e5189. doi: 10.7759/cureus.5189.
Depression is a common psychiatric disorder affecting more than 300 million people worldwide. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnosis of depression requires at least two weeks of either low mood or anhedonia as well as four or more other symptoms such as appetite or weight changes, insomnia or hypersomnia, psychomotor agitation or retardation, loss of energy, inability to concentrate, feelings of worthlessness or excessive guilt, and suicidality. Selective serotonin reuptake inhibitors (SSRIs) target the monoaminergic system and are the commonest drugs used for treating depression, but have certain limitations, such as their delayed onset of action. Ketamine, a non-competitive NMDA receptor antagonist, has shown in several randomized controlled trials (RCTs) promising results with rapid antidepressant effects, especially in patients with severe treatment-resistant depression (TRD), which is depression that has not responded to more than two antidepressants. In this review, the clinical efficacy of ketamine in TRD has been discussed, with emphasis placed on the evidence from RCTs.
抑郁症是一种常见的精神障碍，全球有超过3亿人受其影响。根据《精神疾病诊断与统计手册》第五版（DSM-5），抑郁症的诊断需要至少两周的情绪低落或快感缺乏，以及其他四种或更多症状，如食欲或体重变化、失眠或嗜睡、精神运动性激越或迟缓、精力丧失、注意力不集中、无价值感或过度内疚感以及自杀观念。选择性5-羟色胺再摄取抑制剂（SSRI）作用于单胺能系统，是治疗抑郁症最常用的药物，但有一定局限性，比如起效延迟。氯胺酮是一种非竞争性N-甲基-D-天冬氨酸（NMDA）受体拮抗剂，多项随机对照试验表明其具有快速抗抑郁效果，前景良好，尤其是对重度难治性抑郁症（TRD）患者，即对两种以上抗抑郁药无反应的抑郁症患者。在本综述中，已讨论了氯胺酮治疗TRD的临床疗效，重点是来自随机对照试验的证据。
