Kotoula Vasileia, Webster Toby, Stone James, Mehta Mitul A
Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
GKT School of Medical Education, London, UK.
Brain Neurosci Adv. 2021 Nov 15;5:23982128211055426. doi: 10.1177/23982128211055426. eCollection 2021 Jan-Dec.
Acute ketamine administration has been widely used in neuroimaging research to mimic psychosis-like symptoms. Within the last two decades, ketamine has also emerged as a potent, fast-acting antidepressant. The delayed effects of the drug, observed 2-48 h after a single infusion, are associated with marked improvements in depressive symptoms. At the systems' level, several studies have investigated the acute ketamine effects on brain activity and connectivity; however, several questions remain unanswered around the brain changes that accompany the drug's antidepressant effects and how these changes relate to the brain areas that appear with altered function and connectivity in depression. This review aims to address some of these questions by focusing on resting-state brain connectivity. We summarise the studies that have examined connectivity changes in treatment-naïve, depressed individuals and those studies that have looked at the acute and delayed effects of ketamine in healthy and depressed volunteers. We conclude that brain areas that are important for emotional regulation and reward processing appear with altered connectivity in depression whereas the default mode network presents with increased connectivity in depressed individuals compared to healthy controls. This finding, however, is not as prominent as the literature often assumes. Acute ketamine administration causes an increase in brain connectivity in healthy volunteers. The delayed effects of ketamine on brain connectivity vary in direction and appear to be consistent with the drug normalising the changes observed in depression. The limited number of studies however, as well as the different approaches for resting-state connectivity analysis make it very difficult to draw firm conclusions and highlight the importance of data sharing and larger future studies.
急性给予氯胺酮已广泛应用于神经影像学研究,以模拟类似精神病的症状。在过去二十年中,氯胺酮还成为一种强效、速效的抗抑郁药。单次输注后2 - 48小时观察到的药物延迟效应与抑郁症状的显著改善相关。在系统层面,多项研究调查了氯胺酮对大脑活动和连通性的急性影响;然而,围绕药物抗抑郁作用伴随的大脑变化以及这些变化如何与抑郁症中功能和连通性改变的脑区相关等问题,仍有几个未得到解答。本综述旨在通过关注静息态脑连通性来解决其中一些问题。我们总结了那些研究初治抑郁症患者连通性变化的研究,以及那些研究氯胺酮对健康和抑郁症志愿者急性和延迟效应的研究。我们得出结论,对情绪调节和奖赏处理重要的脑区在抑郁症中连通性发生改变,而与健康对照相比,默认模式网络在抑郁症患者中连通性增加。然而,这一发现并不像文献中经常假设的那么突出。急性给予氯胺酮会使健康志愿者的脑连通性增加。氯胺酮对脑连通性的延迟效应在方向上有所不同,似乎与药物使抑郁症中观察到的变化正常化一致。然而,研究数量有限,以及静息态连通性分析的不同方法使得很难得出确凿结论,并凸显了数据共享和未来更大规模研究的重要性。