Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation.
Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation.
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DOI：
10.1176/appi.ajp.2020.20081251
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发表时间：
2021-05-01
影响因子：
17.7
通讯作者：
Stahl, Stephen
中科院分区：
文献类型：
--
作者：
McIntyre, Roger S.;Rosenblat, Joshua D.;Nemeroff, Charles B.;Sanacora, Gerard;Murrough, James W.;Berk, Michael;Brietzke, Elisa;Dodd, Seetal;Gorwood, Philip;Ho, Roger;Iosifescu, Dan, V;Jaramillo, Carlos Lopez;Kasper, Siegfried;Kratiuk, Kevin;Lee, Jung Goo;Lee, Yena;Lui, Leanna M. W.;Mansur, Rodrigo B.;Papakostas, George, I;Subramaniapillai, Mehala;Thase, Michael;Vieta, Eduard;Young, Allan H.;Zarate, Carlos A., Jr.;Stahl, Stephen
重复的国际研究强调了与重度抑郁症相关的人类和社会成本。尽管单胺类抗抑郁药在重度抑郁症中的疗效已得到证实，但大多数接受治疗的个体在指数和随后的药物治疗下未能实现完全的综合征和功能恢复。氯胺酮和艾司氯胺酮代表了难治性抑郁症成人患者的新治疗途径。除了为受影响的人提供希望之外，这些药物还代表了第一种在重度抑郁症中具有快速起效疗效的非单胺能药物。然而，氯胺酮和艾司氯胺酮在情绪障碍中的安全性和耐受性仍然令人担忧。此外，这些药物在治疗算法中的适当位置、其相对有效性以及其胜任和安全实施所需的适当环境、基础设施和人员都存在不确定性。在这篇文章中，一个国际心境障碍专家小组提供了关于氯胺酮和艾司氯胺酮在难治性抑郁症成人中的疗效、安全性和耐受性的文献综述。作者还为这些药物在临床实践中的实施提供了指导，特别关注护理点的实践参数。共识和未来的研究前景进行了讨论。
Replicated international studies have underscored the human and societal costs associated with major depressive disorder. Despite the proven efficacy of monoamine-based antidepressants in major depression, the majority of treated individuals fail to achieve full syndromal and functional recovery with the index and subsequent pharmacological treatments. Ketamine and esketamine represent pharmacologically novel treatment avenues for adults with treatment-resistant depression. In addition to providing hope to affected persons, these agents represent the first non-monoaminergic agents with proven rapid-onset efficacy in major depressive disorder. Nevertheless, concerns remain about the safety and tolerability of ketamine and esketamine in mood disorders. Moreover, there is uncertainty about the appropriate position of these agents in treatment algorithms, their comparative effectiveness, and the appropriate setting, infrastructure, and personnel required for their competent and safe implementation. In this article, an international group of mood disorder experts provides a synthesis of the literature with respect to the efficacy, safety, and tolerability of ketamine and esketamine in adults with treatment-resistant depression. The authors also provide guidance for the implementation of these agents in clinical practice, with particular attention to practice parameters at point of care. Areas of consensus and future research vistas are discussed.
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