Ready for a "breakthrough" with ketamine? A look at recent pharmacological insights!
Journal
Current opinion in anaesthesiology
ISSN: 1473-6500
Titre abrégé: Curr Opin Anaesthesiol
Pays: United States
ID NLM: 8813436
Informations de publication
Date de publication:
01 Aug 2021
01 Aug 2021
Historique:
pubmed:
31
5
2021
medline:
1
7
2021
entrez:
30
5
2021
Statut:
ppublish
Résumé
To update pharmacological insights on ketamine integrating information from different disciplines for developing steps to "breakthrough" approaches in clinical challenges. Pharmacokinetic/pharmacodynamic (PK/PD) models have incorporated recirculation, ketamine metabolites, drug-drug interaction, and covariates such as age. Ketamine-induced relief from treatment-resistant depression has been explained by "disinhibition" of gamma-aminobutyric acid-ergic interneurons and synaptogenic mechanisms requiring neurotrophic signals. Neuroimaging/electroencephalographic investigations have shown an increase in gamma spectral power in healthy volunteers and patients with depression, but also opposite changes in functional network connectivity after subanesthetic ketamine. Volunteer data may not be transferable to clinical conditions. Altered states of consciousness induced by subanesthetic ketamine have been described by disruption of resisting-state functional networks and frontoparietal connectivity with preservation of multisensory and sensor-motor networks. This has been interpreted as a "disconnected consciousness". More precise PK/PD models may improve the ketamine use regimen. The findings from research on depression are an important discovery because ketamine's impact on neuronal plasticity and synaptogenesis in human brain disease has directly been documented. Psychic adverse effects with subanesthetic ketamine are related to a "disconnected consciousness". Overall, progress has been made, but the "breakthrough" still has to come.
Identifiants
pubmed: 34052823
doi: 10.1097/ACO.0000000000001017
pii: 00001503-202108000-00002
doi:
Substances chimiques
Antidepressive Agents
0
Ketamine
690G0D6V8H
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
393-401Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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