[Ketamine in antidepressant treatment: a revolution?]
Évolution ou révolution dans le traitement des dépressions avec la kétamine ?
algorithme de traitement
depression
dissociation
dépression résistante
ketamine
kétamine
meta-analysis
méta-analyse
optimism bias
treatment resistant depression
Journal
Biologie aujourd'hui
ISSN: 2105-0686
Titre abrégé: Biol Aujourdhui
Pays: France
ID NLM: 101544020
Informations de publication
Date de publication:
2023
2023
Historique:
received:
03
05
2023
medline:
30
11
2023
pubmed:
29
11
2023
entrez:
29
11
2023
Statut:
ppublish
Résumé
Thirty percent of depressed patients are treatment resistant (TRD) suggesting the need of new therapeutic strategy. Recently, it has been shown that ketamine, an anesthetic agent with dissociative effects, has potent and rapid antidepressant properties. Ketamine is a ionotropic glutamatergic NMDA antagonist that inhibits gabaergic neurons. Its antidepressant effect peaks at 24 h post-treatment. Several meta-analyses of placebo randomized clinical trials emphasized its efficacy. More recently, a meta-analysis showed its efficiency in real-world population of TRD patients. Although there is no clear biological or clinical predictors of response or remission to ketamine, patients with high level of resistance were found to remit less often. Restoring both the optimism bias and the asymmetry in belief updating mediates the antidepressant ketamine's effect. Consistent with predictive bayesian model and terror management theory, this suggests that dissociation induced by ketamine may contribute to its clinical antidepressant action. Although increasing access to ketamine and esketamine is welcome, legitimate concerns have been raised with respect to long-term safety and abuse risk. Évolution ou révolution dans le traitement des dépressions avec la kétamine ? Définie par l’échec d’au moins deux antidépresseurs de mécanismes d’action différents, la dépression résistante est fréquente et concerne 30 % des patients déprimés. Elle justifie le recours à des stratégies thérapeutiques innovantes. Depuis quelques années, on utilise un agent anesthésiant et dissociatif, la kétamine, et ses dérivés, dans le traitement de la dépression résistante. Dans cette brève revue de la littérature, nous rapportons les données attestant de l’efficacité et de l’efficience de la kétamine dans cette indication. Certains patients bénéficient plus que d’autres de la kétamine qui est recommandée pour un niveau modéré de résistance. Même si cela reste débattu, la dissociation pourrait contribuer aux effets bénéfiques de la kétamine.
Autres résumés
Type: Publisher
(fre)
Évolution ou révolution dans le traitement des dépressions avec la kétamine ?
Identifiants
pubmed: 38018942
doi: 10.1051/jbio/2023023
pii: jbio230023
doi:
Substances chimiques
Antidepressive Agents
0
Ketamine
690G0D6V8H
Types de publication
English Abstract
Journal Article
Langues
fre
Sous-ensembles de citation
IM
Pagination
151-154Informations de copyright
© Société de Biologie, 2023.
Références
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