Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80-952 Gdańsk, Poland.
Medicina (Kaunas). 2020 Feb 9;56(2):67. doi: 10.3390/medicina56020067.
The current psychopharmacological treatment approaches for major depression focus on monoaminergic interventions, which are ineffective in a large proportion of patients. Globally, treatment-resistant bipolar depression (TRBD) affects up to 33% of depressive patients receiving treatment. Certain needs are still unmet and require new approaches. Many studies are in favor of treatments with ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, even in single use, whose effects emerge in minutes to hours post administration. However, little data are available on ketamine performance in TRBD patients with somatic comorbidities, including highly prevalent ones, i.e., cardiovascular disease (heart failure, hypertension, post-myocardial infarct, arrhythmias, etc.) diabetes, and obesity, and depression-associated comorbidities such as stroke, epilepsy, as well as in the elderly population. The literature shows that treatment with ketamine is efficacious and safe, and the majority of adverse drug reactions are mild and tend to mostly disappear within 30 min to 2 h of ketamine administration.
目前，针对重度抑郁症的精神药理学治疗方法主要集中在单胺能干预上，但在很大一部分患者中效果并不理想。在全球范围内，接受治疗的抑郁症患者中有高达 33%的人患有治疗抵抗性双相情感障碍（TRBD）。仍有一些未被满足的需求，需要新的治疗方法。许多研究都支持使用氯胺酮治疗，氯胺酮是一种 N-甲基-D-天冬氨酸（NMDA）受体拮抗剂，即使单次使用，其效果也会在给药后几分钟到几小时内显现。然而，关于氯胺酮在伴有躯体合并症（包括高发的心血管疾病（心力衰竭、高血压、心肌梗死后、心律失常等）、糖尿病和肥胖症）的 TRBD 患者中的疗效的数据有限，以及与抑郁症相关的合并症，如中风、癫痫，以及老年人群。文献表明，氯胺酮治疗有效且安全，大多数药物不良反应为轻度，且在给药后 30 分钟至 2 小时内大多会消失。
