Research progress of rapid antidepressant mechanism and side effects of ketamine
Objective To systematically describe the possible mechanism of action and clinical side effects of ketamine in the treatment of depression,in order to provide ideas and reference for the clinical research of ketamine and the development of a new generation of antidepressants.Methods Relevant literatures were retrieved from CNKI,Wanfang Chinese Database,Web of Science database and PubMed database until May 2022."Ketamine,esketamine,depression,treatment-resistant depression(TRD),major depressive disorder(MMD),N-methyl-D-aspartate receptors(NMDAR),α-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptor(AMPAR),brain derived neurotrophic factor(BDNF),mammalian target of rapamycin(mTOR),gut microbiota,eukaryotic extended factor of 2 kinase(eEFK2)and side effect"for the word retrieval.Finally,83 literatures were included for research and analysis.Results & Conclusions Ketamine is a N-methyl-D-Aspartate receptor(NMDAR)antagonist,consisting of(S)-ketamine and(R)-ketamine enantiomers in a 1:1 ratio.It has turned out to be effective in the treatment of depression.Research demonstrated that the mechanism of ketamine may be related to NMDAR,AMPAR,BDNF,mTOR,gut microbiota and eEF2K.More importantly,a number of studies have shown that ketamine may cause neurotoxic reactions,psychosis,cardiovascular system diseases,urinary system diseases and other side effects,thus leading to some limitations in its clinical application and testing.Therefore,it is extremely important to explore the mechanism and clinical side effects of ketamine and the possible targets of ketamine.
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