Risks Associated with Misuse of Ketamine as a Rapid-Acting Antidepressant
Risks Associated with Misuse of Ketamine as a Rapid-Acting Antidepressant
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滥用氯胺酮作为速效抗抑郁药的相关风险
DOI：
10.1007/s12264-016-0081-2
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发表时间：
2016-11
影响因子：
5.6
通讯作者：
Lu Lin
中科院分区：
文献类型：
--
作者：
Zhu Weili;Ding Zengbo;Zhang Yinan;Shi Jie;Hashimoto Kenji;Lu Lin
重度抑郁症是一种严重的精神疾病，在世界范围内仍然是导致残疾的主要原因。传统的抗抑郁药至少需要几个星期才能达到治疗效果，这一滞后期阻碍了它们对自杀风险高的抑郁症患者产生有益效果的能力。非竞争性的en -甲基- d -天冬氨酸谷氨酸受体拮抗剂氯胺酮已被证明对啮齿动物和人类都有快速的抗抑郁作用。氯胺酮作为一种速效抗抑郁药的出现，为临床抑郁症患者的快速治疗反应的发展提供了有希望的新见解。然而，它的安全性和毒性仍然令人担忧。在这篇综述中，我们关注氯胺酮的局限性，包括神经毒性、认知功能障碍、与精神状态相关的不良事件、拟精神效应、心血管事件和尿病效应。研究表明，在低剂量和短期治疗抑郁症患者时，其安全性和耐受性一般都很好。与氯胺酮相关的不良事件通常发生在非常大剂量的情况下，需要长时间服用，并且可以通过停止服用来缓解。它的两个对映体，s -氯胺酮（艾氯胺酮）和r -氯胺酮的抗抑郁作用也进行了讨论。r -氯胺酮比-氯胺酮有更强的抗抑郁作用，而且没有氯胺酮相关的副作用。未来的治疗策略应考虑使用r -氯胺酮治疗抑郁症患者，以降低与长期使用氯胺酮相关的不良事件的风险。
Major depression is a serious psychiatric disorder and remains a leading cause of disability worldwide. Conventional antidepressants take at least several weeks to achieve a therapeutic response and this lag period has hindered their ability to attain beneficial effects in depressed individuals at high risk of suicide. The non-competitiveN-methyl-D-aspartate glutamate receptor antagonist ketamine has been shown to have rapid antidepressant effects in both rodents and humans. The emergence of ketamine as a fast-acting antidepressant provides promising new insights into the development of a rapid treatment response in patients with clinical depression. However, its safety and toxicity remain a concern. In this review, we focus on the limitations of ketamine, including neurotoxicity, cognitive dysfunction, adverse events associated with mental status, psychotomimetic effects, cardiovascular events, and uropathic effects. Studies have shown that its safety and tolerability profiles are generally good at low doses and with short-term treatment in depressed patients. The adverse events associated with ketamine usually occur with very high doses that are administered for prolonged periods of time and can be relieved by cessation. The antidepressant actions of its two enantiomers,S-ketamine (esketamine) andR-ketamine, are also discussed.R-ketamine has greater antidepressant actions thanS-ketamine, without ketamine-related side-effects. Future treatment strategies should consider usingR-ketamine for the treatment of depressed patients to decrease the risk of adverse events associated with long-term ketamine use.
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影响因子：
7.4
作者：
P. Eide;A. Stubhaug;H. Breivik;I. Øye
通讯作者：
P. Eide;A. Stubhaug;H. Breivik;I. Øye
影响因子：
4.2
作者：
Morgan, CJA;Riccelli, M;Curran, HV
通讯作者：
Curran, HV
影响因子：
10.6
作者：
Singh, Jaskaran B.;Fedgchin, Maggie;Van Nueten, Luc
通讯作者：
Van Nueten, Luc
DOI：
10.1176/appi.ajp.2013.13030392
发表时间：
2013-10
期刊：
The American journal of psychiatry
影响因子：
--
作者：
Murrough JW;Iosifescu DV;Chang LC;Al Jurdi RK;Green CE;Perez AM;Iqbal S;Pillemer S;Foulkes A;Shah A;Charney DS;Mathew SJ
通讯作者：
Mathew SJ
影响因子：
6.8
作者：
Yang C;Shirayama Y;Zhang JC;Ren Q;Yao W;Ma M;Dong C;Hashimoto K
通讯作者：
Hashimoto K