氯胺酮抗抑郁作用的 -甲基-d-天冬氨酸受体假说:证据与争议。
The -methyl-d-aspartate receptor hypothesis of ketamine's antidepressant action: evidence and controversies.
机构信息
Department of Affiliated Mental Health Center & Hangzhou Seventh People's Hospital and School of Brain Science and Brain Medicine, Zhejiang University School of Medicine , Hangzhou 310058, People's Republic of China.
Nanhu Brain-Computer Interface Institute, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, New Cornerstone Science Laboratory, Zhejiang University , Hangzhou 311100, People's Republic of China.
出版信息
Philos Trans R Soc Lond B Biol Sci. 2024 Jul 29;379(1906):20230225. doi: 10.1098/rstb.2023.0225. Epub 2024 Jun 10.
Substantial clinical evidence has unravelled the superior antidepressant efficacy of ketamine: in comparison to traditional antidepressants targeting the monoamine systems, ketamine, as an -methyl-d-aspartate receptor (NMDAR) antagonist, acts much faster and more potently. Surrounding the antidepressant mechanisms of ketamine, there is ample evidence supporting an NMDAR-antagonism-based hypothesis. However, alternative arguments also exist, mostly derived from the controversial clinical results of other NMDAR inhibitors. In this article, we first summarize the historical development of the NMDAR-centred hypothesis of rapid antidepressants. We then classify different NMDAR inhibitors based on their mechanisms of inhibition and evaluate preclinical as well as clinical evidence of their antidepressant effects. Finally, we critically analyse controversies and arguments surrounding ketamine's NMDAR-dependent and NMDAR-independent antidepressant action. A better understanding of ketamine's molecular targets and antidepressant mechanisms should shed light on the future development of better treatment for depression. This article is part of a discussion meeting issue 'Long-term potentiation: 50 years on'.
大量临床证据揭示了氯胺酮在抗抑郁方面的卓越疗效
与针对单胺系统的传统抗抑郁药相比,氯胺酮作为一种 N-甲基-D-天冬氨酸受体(NMDAR)拮抗剂,起效更快、作用更强。围绕氯胺酮的抗抑郁机制,有大量证据支持基于 NMDAR 拮抗作用的假说。然而,也存在其他观点,主要来源于其他 NMDAR 抑制剂有争议的临床结果。在本文中,我们首先总结了以 NMDAR 为中心的快速抗抑郁药假说的历史发展。然后,我们根据抑制机制对不同的 NMDAR 抑制剂进行分类,并评估其抗抑郁作用的临床前和临床证据。最后,我们批判性地分析了氯胺酮的 NMDAR 依赖性和非依赖性抗抑郁作用的争议和观点。更好地理解氯胺酮的分子靶点和抗抑郁机制应该为未来开发更好的抑郁症治疗方法提供启示。本文是“长时程增强:50 年”讨论专题的一部分。