Background Despite widely reported clinical and preclinical studies of rapid antidepressant actions of glutamate N-methyl-D-aspartic acid (NMDA) receptor antagonists, there has been very little work examining the effects of these drugs in stress models of depression that require chronic administration of antidepressants, or the molecular mechanisms that could account for the rapid responses. Methods We used a rat 21-day chronic unpredictable stress (CUS) model to test the rapid actions of NMDA receptor antagonists on depressant-like behavior, neurochemistry, and spine density and synaptic function of prefrontal cortex (PFC) neurons. Results The results demonstrate that acute treatment with the non-competitive NMDA channel blocker ketamine or the selective NR2B antagonist Ro 25-6981 rapidly ameliorates CUS-induced anhedonia and anxiogenic behaviors. We also find that CUS exposure decreases the expression levels of synaptic proteins and spine number and the frequency/amplitude of synaptic currents (EPSCs) in layer V pyramidal neurons in the PFC, and that these deficits are rapidly reversed by ketamine. Blockade of the mammalian target of rapamycin (mTOR) protein synthesis cascade abolishes both the behavioral and biochemical effects of ketamine. Conclusions The results indicate that the structural and functional deficits resulting from long-term stress exposure, which could contribute to the pathophysiology of depression, are rapidly reversed by NMDA receptor antagonists in an mTOR-dependent manner.

Currently available medications have significant limitations, most notably low response rate and time lag for treatment response. Recent clinical studies have demonstrated that ketamine, an NMDA receptor antagonist produces a rapid antidepressant response (within hours) and is effective in treatment resistant depressed patients. Molecular and cellular studies in rodent models demonstrate that ketamine rapidly increases synaptogenesis, including increased density and function of spine synapses, in the prefrontal cortex (PFC). Ketamine also produces rapid antidepressant actions in behavioral models of depression, and reverses the deficits in synapse number and behavior resulting from chronic stress exposure. These effects of ketamine are accompanied by stimulation of the mammalian target of rapamycin (mTOR), and increased levels of synaptic proteins. Together these studies indicate that ketamine rapidly reverses the atrophy of spines in the PFC and thereby causes a functional reconnection of neurons that underlies the rapid behavioral responses. These studies identify new targets for rapid acting antidepressants that are safer than ketamine.

Background Knock-in mice with the common human BDNF Val66Met polymorphism have impaired trafficking of BDNF mRNA to dendrites. Given evidence that local synapse formation is dependent on dendritic translation of BDNF mRNA, it was hypothesized that loss-of-function Met allele mice would show synaptic deficits both at baseline and in response to ketamine, an NMDA antagonist that stimulates synaptogenesis in prefrontal cortex (PFC). Methods Whole-cell recordings from layer V medial PFC pyramidal cells in brain slices were combined with 2-photon laser scanning for analysis of WT, Val/Met, and Met/Met mice both at baseline and in response to a low dose of ketamine. Results Val/Met and Met/Met mice were found to have constitutive atrophy of distal apical dendrites and decrements in apically-targeted excitatory postsynaptic currents (EPSCs) in layer V pyramidal cells of PFC. In addition, spine density and diameter were decreased, indicative of impaired synaptic formation/maturation (synaptogenesis). In Met/Met mice the synaptogenic effect of ketamine was markedly impaired, consistent with the idea that synaptogenesis is dependent on dendritic translation/release of BDNF. In parallel behavioral studies we found that the antidepressant response to ketamine in the forced swim test was blocked in Met/Met mice. Conclusions The results demonstrate that expression of the BDNF Met allele in mice results in basal synaptic deficits and blocks synaptogenic and antidepressant actions of ketamine in PFC, suggesting that the therapeutic response to this drug may be attenuated or blocked in depressed patients who carry the loss of function Met allele.

Morphological studies show that repeated restraint stress leads to selective atrophy in the apical dendritic field of pyramidal cells in the medial prefrontal cortex (mPFC). However, the functional consequence of this selectivity remains unclear. The apical dendrite of layer V pyramidal neurons in the mPFC is a selective locus for the generation of increased excitatory postsynaptic currents (EPSCs) by serotonin (5-HT) and hypocretin (orexin). On that basis, we hypothesized that apical dendritic atrophy might result in a blunting of 5-HT-and hypocretin-induced excitatory responses. Using a combination of whole-cell recording and two-photon imaging in rat mPFC slices, we were able to correlate electrophysiological and morphological changes in the same layer V pyramidal neurons. Repeated mild restraint stress produced a decrement in both 5-HTand hypocretin-induced EPSCs, an effect that was correlated with a decrease in apical tuft dendritic branch length and spine density in the distal tuft branches. Chronic treatment with the stress hormone corticosterone, while reducing 5-HT responses and generally mimicking the morphological effects of stress, failed to produce a significant decrease in hypocretin-induced EPSCs. Accentuating this difference, pretreatment of stressed animals with the glucocorticoid receptor antagonist RU486 blocked reductions in 5-HT-induced EPSCs but not hypocretin-induced EPSCs. We conclude: (i) stress-induced apical dendritic atrophy results in diminished responses to apically targeted excitatory inputs and (ii) corticosterone plays a greater role in stress-induced reductions in EPSCs evoked by 5-HT as compared with hypocretin, possibly reflecting the different pathways activated by the two transmitters.two-photon imaging ͉ apical tuft ͉ slice ͉ spine ͉ rat S tress induces neuronal atrophy in key limbic brain regions such as the hippocampus and medial prefrontal cortex (mPFC) that have been implicated in depressive illness (1). In layer II/III pyramidal neurons of the mPFC, repeated restraint stress has been shown to produce dendritic atrophy (2-5), an effect mimicked by high levels of corticosterone (6). Notably, these atrophic changes are restricted to the apical dendritic field. However, the functional implications at a cellular level of these localized effects of stress in the apical dendritic field are unclear. In a separate line of experiments in brain slices, we found that the apical dendrites are also the selective target of several stress-linked neurotransmitters/modulators, including serotonin (5-HT) and hypocretin/orexin, both of which induce a large increase in nonelectrically evoked (''spontaneous'') excitatory postsynaptic currents (EPSCs) in layer V mPFC pyramidal cells in brain slices (7,8). The effect of 5-HT is mediated by activation of 5-HT 2A receptors (7, 9), which are highly expressed on apical dendrites of layer V pyramidal neurons (10-13), and can be induced rapidly by the focal application of 5-HT to the apical but not basilar dendritic field in layer V pyramidal cells...