Ketamine for treatment of mood disorders and suicidality: A narrative review of recent progress

Kritzer, Michael D.; Mischel, Nicholas; Young, Jonathan R.; Lai, Christopher; Masand, Prakash S.; Szabo, Steven T.; Mathew, Sanjay J.

doi:10.12788/acp.0048

Cited by 18 publications

(23 citation statements)

References 67 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is important to note that anesthetic doses of ketamine used for ECT seem to have different effects on mood when compared to subanesthetic doses used to treat depression. 74 Importantly, ketamine for the treatment of depression is used at a subanesthetic dose in awake patients, so findings in anesthetized patients with higher doses of ketamine may not reflect the identical mechanism of action. A recent meta-analysis of add-on ketamine to ECT has shown that ketamine enhances ECT's therapeutic effects but unfortunately also exacerbates its side effects.…”

Section: Ect-an Ultra-brief Historymentioning

confidence: 99%

“…Ketamine has been studied as a potential augmentation strategy coadministered with ECT to alleviate side effects and/or increase efficacy. It is important to note that anesthetic doses of ketamine used for ECT seem to have different effects on mood when compared to subanesthetic doses used to treat depression 74 . Importantly, ketamine for the treatment of depression is used at a subanesthetic dose in awake patients, so findings in anesthetized patients with higher doses of ketamine may not reflect the identical mechanism of action.…”

Section: Ect—an Ultra-brief Historymentioning

confidence: 99%

See 1 more Smart Citation

Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions

Kritzer

Peterchev

Camprodon

2023

Harv Rev Psychiatry

View full text Add to dashboard Cite

Learning objectives:• Outline and discuss the fundamental physiologic, cellular, and molecular mechanisms of ECT to devise strategies to optimize therapeutic outcomes• Summarize the overview of ECT, its efficacy in treating depression, the known effects on cognition, evidence of mechanisms, and future directions.AbstractElectroconvulsive therapy (ECT) is the most effective treatment for a variety of psychiatric illnesses, including treatment-resistant depression, bipolar depression, mania, catatonia, and clozapine-resistant schizophrenia. ECT is a medical and psychiatric procedure whereby electrical current is delivered to the brain under general anesthesia to induce a generalized seizure. ECT has evolved a great deal since the 1930s. Though it has been optimized for safety and to reduce adverse effects on cognition, issues persist. There is a need to understand fundamental physiologic, cellular, and molecular mechanisms of ECT to devise strategies to optimize therapeutic outcomes. Clinical trials that set out to adjust parameters, electrode placement, adjunctive medications, and patient selection are critical steps towards the goal of improving outcomes with ECT. This narrative review provides an overview of ECT, its efficacy in treating depression, its known effects on cognition, evidence of its mechanisms, and future directions.

show abstract

Section: Ect-an Ultra-brief Historymentioning

confidence: 99%

Section: Ect—an Ultra-brief Historymentioning

confidence: 99%

Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions

Kritzer

Peterchev

Camprodon

2023

Harv Rev Psychiatry

View full text Add to dashboard Cite

show abstract

“…This assumption is based on animal studies, which suggest that TSPO mediates fast-onset antidepressant-like effects of cognate ligands [85], the antidepressant potential of exogenous neurosteroids, e.g., brexanolone or zuranolone [16,18], and the discrete signs of neuroinflammation together with hypercortisolemia seen in depression. A particular advantage of this approach might be the shorter onset of action within 14 days compared to conventional antidepressants, as it has been noted for zuranolone and esketamine [18,111]. Currently, etifoxine and its derivatives such as GRX-917 [112] are of interest in this context, as we are not aware of other TSPO ligands under clinical development for stress-related disorders.…”

Section: Tspo Expression Neuroimaging and Therapeutic Effects Of Tspo...mentioning

confidence: 99%

Translocator protein (18kDa) TSPO: a new diagnostic or therapeutic target for stress-related disorders?

et al. 2022

View full text Add to dashboard Cite

Efficient treatment of stress-related disorders, such as depression, is still a major challenge. The onset of antidepressant drug action is generally quite slow, while the anxiolytic action of benzodiazepines is considerably faster. However, their long-term use is impaired by tolerance development, abuse liability and cognitive impairment. Benzodiazepines act as positive allosteric modulators of ɣ-aminobutyric acid type A (GABA A ) receptors. 3α-reduced neurosteroids such as allopregnanolone also are positive allosteric GABA A receptor modulators, however, through a site different from that targeted by benzodiazepines. Recently, the administration of neurosteroids such as brexanolone or zuranolone has been shown to rapidly ameliorate symptoms in post-partum depression or major depressive disorder. An attractive alternative to the administration of exogenous neurosteroids is promoting endogenous neurosteroidogenesis via the translocator protein 18k Da (TSPO). TSPO is a transmembrane protein located primarily in mitochondria, which mediates numerous biological functions, e.g., steroidogenesis and mitochondrial bioenergetics. TSPO ligands have been used in positron emission tomography (PET) studies as putative markers of microglia activation and neuroinflammation in stress-related disorders. Moreover, TSPO ligands have been shown to modulate neuroplasticity and to elicit antidepressant and anxiolytic therapeutic effects in animals and humans. As such, TSPO may open new avenues for understanding the pathophysiology of stress-related disorders and for the development of novel treatment options.

show abstract

“…Due to its chronic and recurrent nature, individuals with BD experience increased morbidity and mortality [ 6 ]. There is also a substantial burden related to suicidal ideation and attempted and completed suicide [ 4 , 7 ]. Though current treatments (i.e., mood stabilizers, antipsychotics) are effective, up to one-third of individuals with BD do not achieve sustained remission with currently available treatments [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Astrocytes in the Neuropathology of Bipolar Disorder: Review of Current Evidence

2022

View full text Add to dashboard Cite

(1) Background: Approximately one-third of patients with bipolar disorder (BD) do not experience sustained remission with current treatments. Presently, astrocytes, i.e., glial cells that act as key regulators of neuroinflammation, have been a target for therapeutic development. Research regarding their role in the neuropathology of BD is limited. We conducted a scoping review on evidence linking astrocytes to the pathology of BD. (2) Methods: The search was conducted in MEDLINE for studies published from inception to August 2022. Studies of interest were data-extracted and reported based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols. (3) Results: Overall, 650 publications were identified, of which 122 full texts were evaluated and 12 included. Four were in vitro, seven were ex vivo, and one study was both in vitro and in vivo. In vitro investigations focused on plasma levels of neuroinflammatory biomarkers S100B and glial fibrillary acidic protein (GFAP). Ex vivo investigations were post-mortem brain studies assessing astrocytes in regions of interest (i.e., anterior cingulate cortex, dorsolateral prefrontal cortex) using phosphorylated GFAP and ASCT-1. The in vivo and in vitro study evaluated morphological and chemical variations of YKL-40 between cohorts. (4) Conclusions: Reports indicate an association between astrocyte dysfunction and BD although larger studies are required to validate this association.

show abstract

Ketamine for treatment of mood disorders and suicidality: A narrative review of recent progress

Cited by 18 publications

References 67 publications

Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions

Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions

Translocator protein (18kDa) TSPO: a new diagnostic or therapeutic target for stress-related disorders?

Astrocytes in the Neuropathology of Bipolar Disorder: Review of Current Evidence

Contact Info

Product

Resources

About