Ketamin: Yeni Bir Antidepresan?

Öz

Major depresif bozukluğu olan bir çok hastada standart antidepresanlara ihtiyaç duyulmaktadır. Ancak tedavi edici etkilerin ortaya çıkması için haftalar gerektiğinden yeterli yanıt alınamamaktadır. Son çalışmalar subanestezik dozlardaki ketaminin depresyon tedavisinde etkin ve güvenilir olduğunu göstermiştir. Ketaminin antidepresan etkilerinin kısa süreli olduğu görülmüştür ve psikomimetik yan etkileri depresif hastalarda kullanımını kısıtlayabilir. Gelecekte yapılacak çalışmaların yanıtı belirleyecek faktörlere (klinik ve farmakolojik olarak), farklı doz uygulamalarının ve uygulama yollarının araştırılmasına ve antidepresan etkinin sürdürülmesine odaklanması gerekmektedir.

Anahtar Kelimeler

• Ketamin, major depresif bozukluk

Ketamine: A New Antidepressant?

Abstract

Standart antidepressants are needed for the many individuals with major depressive disorder. However they do not respond adequately to treatment and because of a delay of weeks before the emergence of therapeutic effects. Recent studies show that subanesthetic dose of ketamine is efficacy and safety for the treatment of depression. Antidepressant effects of ketamine have been found to be short-lived and its psychotomimetic properties may limit the use of ketamine to depressive patients. Future research studies should focus on identifying predictors of response (pharmalogical and clinical) , investigating application of different doses and routes of administration and maintaining antidepressant effect.

Keywords

• Ketamine, major depressive disorder

References

1. Aan het Rot M, Collins KA, Murrough JW, Perez AM, Reich DL, Charney DS et al. (2010) Safety and efficacy of repeated-dose intravenous ketamine for treatment-resistant depression. Biol Psychiatry, 67:139-145.
2. Aan Het Rot M, Zarate CA Jr, Charney DS, Mathew SJ (2012) Ketamine for depression : where do we go from here? Biol Psychiatry, 72:537-547.
3. Abelaira HM, Reus GZ, Neotti MV, Quevedo J (2014) The role of mTOR in depression and antidepressant responses. Life Sci, 101:10-14.
4. Argiriadou H, Himmelseher S, Papagiannopoulou, Georgiou M, Kanakoudis F, Giala M et al. (2004) Improvement of pain treatment after major abdominal surgery with intravenous S+ ketamine. Anesth Analg, 98:1413–1418.
5. Berman RM, Cappiello A, Anand A, Oren DA, Heninger GR, Charney DS et al. (2000) Antidepressant effects of ketamine in depressed patients. Biol Psychiatry, 47:351-354.
6. Bez Y (2013) İki uçlu depresyonun farmakolojik tedavisinde yenilikler. Journal of Mood Disorders, 3:559-562.
7. Browne CA, Lucki I (2013) Antidepressant effects of ketamine: mechanisms underlying fast-acting novel antidepressants. Front Pharmacol, 4:161.
8. Clements JA, Nimmo WS (1981) Pharmacokinetics and analgesic effects of ketamine in man. Br J Anaesth, 53:27–30.

9. Collier BB (1981) Long-term dangers of ketamine anaesthesia. Br J Anaesth, 53:552.
10. Craven R (2007) Ketamine. Anaesthesia, 62:48-53
11. De Gioannis A, De Leo D (2014) Oral ketamine augmentation for chronic suicidality in treatment-resistant depression. Aust N Z J Psychiatry, 48:686.
12. Denk MC, Rewerts C, Holsboer F, Erhardt-Lehmann A, Turck CW (2011) Monitoring ketamine treatment response in a depressed patient via peripheral mammalian target of rapamycin activation. Am J Psychiatry, 168:751-752.
13. Diazgranados N, Ibrahim L, Brutsche N, Newberg A, Kronstein P, Khalife S et al. (2010) A randomized add-on trial of an n-methyl- d-aspartate antagonist in treatment-resistant bipolar depression. Arch Gen Psychiatry, 67:793-802.
14. Ebrinç S (2013) Tedaviye dirençli tek uçlu depresyonun tedavisinde yenilikler. Journal of Mood Disorders, 3:551-553.
15. Flower O, Hellings S (2012) Sedation in traumatic brain injury. Emerg Med Int, 2012:637171.
16. Glue P, Gulati A, Le Nedelec M, Duffull S (2011) Dose- and exposure-response to ketamine in depression. Biol Psychiatry, 70:e9- e10.
17. Goforth HW, Holsinger T (2007) Rapid relief of severe major depressive disorder by use of preoperative ketamine and electroconvulsive therapy. J ECT, 23: 23-25.
18. Grant IS, Nimmo WS, Clements JA (1981) Pharmacokinetics and analgesic effects of im and oral ketamine. Br J Anaesth, 53:805– 809.
19. Green SM, Li J (2000) Ketamine in adults: what emergency physicians need to know about patient selection and emergence reactions. Acad Emerg Med, 7:278-281.
20. Hocking G, Cousins MJ (2003) Ketamine in chronic pain management: an evidence-based review. Anesth Analg, 97:1730-1739.
21. Honey GD, Honey RA, Sharar SR, Turner DC, Pomarol-Clotet E, Kumaran D et al. (2005) Impairment of specific episodic memory processes by sub-psychotic doses of ketamine: the effects of levels of processing at encoding and of the subsequent retrieval task. Psychopharmacology (Berl), 181:445-457.
22. Hoyer C, Kranaster L, Janke C, Sartorius A (2014) Impact of the anesthetic agents ketamine, etomidate, thiopental, and propofol on seizure parameters and seizure quality in electroconvulsive therapy: a retrospective study. Eur Arch Psychiatry Clin Neurosci, 264:255-261.
23. Ibrahim L, Diazdranados N, Luckenbaugh DA, Machado-Vieira R, Baumann J, Mallinger AG et al. (2011) Rapid decrease in depressive symptoms with an N-methyl-d-aspartate antagonist in ECT-resistant major depression. Prog Neuropsychopharmacol Biol Psychiatry, 35:1155-1159.
24. Ibrahim L, Diazgranados N, Franco-Chaves J, Brutsche N, Henter ID, Kronstein P et al. (2012) Course of improvement in depressive symptoms to a single intravenous infusion of ketamine vs add-on riluzole: results from a 4-week, double-blind, placebo- controlled study. Neuropsychopharmacology, 37:1526-1533
25. Irwin SA, Iglewicz A (2010) Oral ketamine for the rapid treatment of depression and anxiety in patients receiving hospice care. J Palliat Med, 13:903-908.
26. Katalinic N, Lai R, Somogyi A, Mitchell PB, Glue P, Loo CK (2013) Ketamine as a new treatment for depression: a review of its efficacy and adverse effects. Aust N Z J Psychiatry, 47:710-727.
27. Kollmar R, Markovic K, Thürauf N, Schmitt H, Kornhuber J (2008) Ketamine followed by memantine for the treatment of major depression. Aust N Z J Psychiatry, 42:170.
28. Kudoh A, Takahira Y, Kataqai H, Takazawa T (2002) Small-dose ketamine improves the postoperative state of depressed patients. Anesth Analg, 95:114-118.
29. Lahti AC, Warfel D, Michaelidis T, Weiler MA, Frey K, Taminga CA (2001) Long-term outcome of patients who receive ketamine during research. Biol Psychiatry, 49:869-875.
30. Larkin GL, Beautrais AL (2011) A preliminary naturalistic study of low-dose ketamine for depression and suicide ideation in the emergency department. Int J Neuropsychopharmacol, 14:1127-1131.
31. Larsen MH, Mikkelsen JD, Hay-Schmidt A, Sandi C (2010) Regulation of brain-derived neurotrophic factor in the chronic unpredictable stress rat model and the effects of chronic antidepressant treatment. J Psychiatr Res, 44:808–816.
32. Lenze EJ (2003) Comorbidity of depression and anxiety in the elderly. Curr Psychiatry Rep, 5:62-67.
33. Liebrenz M, Borgeat A, Leisinger R, Stohler R (2007) Intravenous ketamine therapy in a patient with a treatment-resistant major depression. Swiss Med Wkly, 137:234-236.
34. Liebrenz M, Stohler R, Borgeat A (2009) Repeated intravenous ketamine therapy in a patient with treatment-resistant major depression. World J Biol Psychiatry, 10:640-643.
35. Machado-Vieira R, Salvadore G, Diazgranados N, Zarate Jr CA (2009) Ketamine and the next generation of antidepressants with a rapid onset of action. Pharmacol Ther, 123:143-150.
36. Malinovsky JM, Lapage JY, Cozian A, Mussini JM, Pinaudt M, Souron R (1993) Is ketamine or its preservative responsible for neurotoxicity in rabbits? Anesthesiology, 78:109–115.
37. Manji HK, Quiroz JA, Sporn J, Payne JL, Denicoff K, A Gray N et al. (2003) Enhancing neuronal plasticity and cellular resilience to develop novel, improved therapeutics for difficult-to-treat depression. Biol Psychiatry, 53:707-741.
38. Mathew SJ, Murrough JW, Aan het Rot M, Collins KA, Reich DL, Charney DS (2010) Riluzole for relapse prevention following intravenous ketamine in treatment-resistant depression: a pilot randomized, placebo-controlled continuation trial. Int J Neuropsychopharmacol, 13:71-82.
39. Mathew SJ, Shah A, Lapidus K, Clark C, Jarun N, Ostermeyer B et al. (2012) Ketamine for treatment-resistant unipolar depression: current evidence. CNS Drugs, 26:189-204
40. Messer M, Haller IV, Larson P, Pattison-Crisostomo J, Gessert CE (2010) The use of a series of ketamine infusions in two patients with treatment-resistant depression. J Neuropsychiatry Clin Neurosci, 22:442-444.
41. Mjellem N, Lund A, Hole K (1993) Reduction of NMDA induced behaviour after acute and chronic administration of desipramine in mice. Neuropharmacology, 32:591-595.
42. Morgan CJ, Mofeez A, Bradner B, Bromley L, Curan HV (2004) Acute effects of ketamine on memory systems and psychotic symptoms in healthy volunteers. Neuropsychopharmacology, 29: 208-218.
43. Morgan CJ, Curran HV, Independent Scientific Committee on Drugs (2012) Ketamine use: a review. Addiction, 107:27-38
44. Murrough JW, Iosifescu DV, Chang LC, Al Jurdi RK, Green CE, Perez AM et al. (2013) Antidepressant efficacy of ketamine in treatment –resistant major depression : a two-site randomized controlled trial. Am J Psychiatry, 170:1134-1142.
45. Naughton M, Clarke G, O’Leary OF, Cryan JF, Dinan TG (2014) A review of ketamine in affective disorders: current evidence of clinical efficacy, limitations of use and pre-clinical evidence on proposed mechanisms of action. J Affect Disord, 156:24-35.
46. Niemegeers P, Schrijvers D, Madani Y, Sabbe BG (2014) Remission of treatment-resistant depression with electroconvulsive therapy and ketamine. J ECT, 30(3):e31-e32.
47. O'Connor RM, Finger BC, Flor PJ, Cryan JF (2010) Metabotropic glutamate receptor 7: at the interface of cognition and emotion. Eur J Pharmacol. 639:123-131.
48. Okamoto N, Nakai T, Sakamoto K, Nagafusa Y, Higuchi T, Nishikawa T (2010) Rapid antidepressant effect of ketamine anesthesia during electroconvulsive therapy of treatment-resistant depression: comparing ketamine and propofol anesthesia. J ECT, 26:223-227.
49. Orrego F, Villanueva S (1993) The chemical nature of the main central excitatory transmitter: a critical appraisal based upon release studies and synaptic vesicle localization. Neuroscience, 56:539-555.
50. Ostroff R, Gonzales M, Sanacora G (2005) Antidepressant effect of ketamine during ECT. Am J Psychiatry, 162:1385-1386.
51. Passie T, Karst M, Wiese B, Emrich HM, Schneider U (2005) Effects of different subanesthetic doses of s-ketamine on neuropsychology, psychopathology, and state of consciousness in man. Neuropsychobiology, 51:226-233.
52. Paul R, Schaaf N, Padberg F, Möller HJ, Frodl T (2009) Comparison of racemic ketamine and s-ketamine in treatment-resistant major depression: report of two cases. World J Biol Psychiatry, 10:241-244.
53. Peltoniemi MA, Saari TI, Hagelberg NM, Laine K, Neuvonen PJ, Olkkola KT (2012) St John's wort greatly decreases the plasma concentrations of oral S-ketamine. Fundam Clin Pharmacol, 26:743-750.
54. Perry EB Jr, Cramer JA, Cho HS, Petrakis IL, Karper LP, Genovese A et al. (2007) Psychiatric safety of ketamine in psychopharmacology research. Psychopharmacology (Berl) 192:253-260.
55. Pfenninger EG, Durieux ME, Himmelseher S (2002) Cognitive impairment after small-dose ketamine isomers in comparison to equianalgesic racemic ketamine in human volunteers. Anesthesiology, 96:357-366.
56. Price RB, Nock MK, Charney DS, Mathew SJ (2009) Effects of intravenous ketamine on explicit and implicit measures of suicidality in treatment-resistant depression. Biol Psychiatry, 66:522-526.
57. Sachs-Ericsson N, Corsentino E, Moxley J, Hames JL, Rushing NC, Sawyer K (2013) A longitudinal study of differences in late- and early-onset geriatric depression: depressive symptoms and psychosocial, cognitive, and neurological functioning. Aging Ment Health, 17:11.
58. Sanacora G, Zarate CA, Krystal JH, Manji HK (2008) Targeting the glutamatergic system to develop novel, improved therapeutics for mood disorders. Nat Rev Drug Discovery, 7:426-437.
59. Skolnick P, Layer RT, Popik P, Nowak G, Pauli A, Trullas R (1996) Adaptation of N-methyl-D-aspartate (NMDA) receptors following antidepressant treatment: implications for the pharmacotherapy of depression. Pharmacopsychiatry, 29:23–26.
60. Skolnick P, Legutko B, Li X, Bymaster FP (2001) Current perspectives on the development of non-biogenic amine-based antidepressants. Pharmacol Res, 43:411-423.
61. Szymkowicz SM, Finnegan N, Dale RM (2014) Failed response to repeat intravenous ketamine infusions in geriatric patients with major depressive disorder. J Clin Psychopharmacol, 34:285-286.
62. Thakurta RG, Das R, Bhattacharya AK, Saha D, Sen S, Singh OP et al. (2012) Rapid response with ketamine on suicidal cognition in resistant depression. Indian J Psychol Med, 34:170-175.
63. Wang X, Chen Y, Zhou X, Liu F, Zhang T, Zhang C (2012) Effects of propofol and ketamine as combined anesthesia for electroconvulsive therapy in patients with depressive disorder. J ECT, 28:128-132.
64. White PF, Schuttler J, Shafer A, Stanski DR, Horai Y, Trevor AJ (1985) Comparative pharmacology of the ketamine isomers: studies in volunteers. Br J Anaesth, 57: 197–203.
65. Zarate CA Jr, Singh JB, Carlson PJ, Brutsche NE, Ameli R, Luckenbaugh DA et al. (2006) A randomized trial of an n-methyl-d- aspartate antagonist in treatment-resistant major depression. Arch Gen Psychiatry, 63:856-864.
66. Zarate CA Jr, Brutsche N, Ibrahim L, Franco-Chaves J, Diazgranados N, Cravchik A et al. (2012) Replication of ketamine's antidepressant efficacy in bipolar depression: a randomized controlled add-on trial. Biol Psychiatry, 71:939-946.
67. Feride Karacer, Uz.Dr., Çukurova Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon ABD, Adana.