Freudenberg Florian, Reif-Leonhard Christine, Reif Andreas
Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Heinrich-Hoffmann-Str. 10, 60528, Frankfurt am Main, Germany.
Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt Am Main, Germany.
Eur Arch Psychiatry Clin Neurosci. 2024 Aug 29. doi: 10.1007/s00406-024-01875-z.
Changes in glutamatergic neuroplasticity has been proposed as one of the core mechanisms underlying the pathophysiology of depression. In consequence components of the glutamatergic synapse have been explored as potential targets for antidepressant treatment. The rapid antidepressant effect of the NMDA receptor antagonist ketamine and subsequent approval of its S-enantiomer (i.e. esketamine), have set the precedent for investigation into other glutamatergic rapid acting antidepressants (RAADs). In this review, we discuss the potential of the different glutamatergic targets for antidepressant treatment. We describe important clinical outcomes of several key molecules targeting components of the glutamatergic synapse and their applicability as RAADs. Specifically, here we focus on substances beyond (es)ketamine, for which meaningful data from clinical trials are available, including arketamine, esmethadone, nitrous oxide and other glutamate receptor modulators. Molecules only successful in preclinical settings and case reports/series are only marginally discussed. With this review, we aim underscore the critical role of glutamatergic modulation in advancing antidepressant therapy, thereby possibly enhancing clinical outcomes but also to reducing the burden of depression through faster therapeutic effects.
谷氨酸能神经可塑性的变化被认为是抑郁症病理生理学的核心机制之一。因此,谷氨酸能突触的组成部分已被探索为抗抑郁治疗的潜在靶点。NMDA受体拮抗剂氯胺酮的快速抗抑郁作用及其S-对映体(即艾司氯胺酮)随后的获批,为研究其他谷氨酸能速效抗抑郁药(RAADs)开创了先例。在本综述中,我们讨论了不同谷氨酸能靶点用于抗抑郁治疗的潜力。我们描述了几种针对谷氨酸能突触组成部分的关键分子的重要临床结果及其作为RAADs的适用性。具体而言,我们在此关注(艾司)氯胺酮以外的物质,对于这些物质,有来自临床试验的有意义的数据,包括阿氯胺酮、艾司美沙酮、一氧化二氮和其他谷氨酸受体调节剂。仅在临床前研究以及病例报告/系列中取得成功的分子仅作了少量讨论。通过本综述,我们旨在强调谷氨酸能调节在推进抗抑郁治疗中的关键作用,从而可能改善临床结果,同时通过更快的治疗效果减轻抑郁症的负担。
Eur Arch Psychiatry Clin Neurosci. 2024-8-29
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