Jamali Qutub, Abdelgawad Ahmed S, Soliman Heidi, Alam Faisal S, Solanki Kalpesh
Liaison Psychiatry, Lancashire & South Cumbria NHS Foundation Trust, Preston, United Kingdom.
General Adult Psychiatry, Lancashire & South Cumbria NHS Foundation Trust, Preston, United Kingdom.
Alpha Psychiatry. 2024 Nov 1;25(6):685-691. doi: 10.5152/alphapsychiatry.2024.241651. eCollection 2024 Nov.
Addiction comes in various forms and can be related to substances like cocaine, opioids, alcohol, cannabis, amphetamine, and nicotine, as well as behaviors like gambling or sex addiction. The impact of addiction places increased economic and medical burdens on society. Currently, the management of addiction is more focused on symptomatic relief rather than targeting the reinforcing mechanisms of dependence on addictive substances and behaviors. The aim of this review is to identify the specific roles of dopamine and glutamate in addiction, which can guide us to treat the cause rather than the symptoms. The synergistic effect of glutamate and dopamine neurotransmitters plays a crucial role in the development of pathological neuroplasticity in the mesolimbic system, causing compulsive consumption of the substance. Utilizing the brain's natural synthesis of substances such as Kynurenic acid (KYNA) derivatives could potentially disrupt the synergistic effect of glutamate and dopamine. By blocking glutamate release and increasing dopamine release, individuals may experience reward or pleasure without the need for addictive substances. Under this pretext, the review article explores the possibility of memantine and galantamine as maintenance treatment for addiction of various forms.
成瘾有多种形式，可能与可卡因、阿片类药物、酒精、大麻、安非他命和尼古丁等物质有关，也与赌博或性成瘾等行为有关。成瘾的影响给社会带来了越来越大的经济和医疗负担。目前，成瘾的管理更多地集中在症状缓解上，而不是针对对成瘾物质和行为的依赖强化机制。本综述的目的是确定多巴胺和谷氨酸在成瘾中的具体作用，这可以指导我们治疗病因而非症状。谷氨酸和多巴胺神经递质的协同作用在中脑边缘系统病理性神经可塑性的发展中起着关键作用，导致对物质的强迫性消费。利用大脑天然合成的物质，如犬尿氨酸（KYNA）衍生物，可能会破坏谷氨酸和多巴胺的协同作用。通过阻断谷氨酸释放并增加多巴胺释放，个体可能无需成瘾物质就能体验到奖励或愉悦。在此前提下，这篇综述文章探讨了美金刚和加兰他敏作为各种形式成瘾维持治疗的可能性。
