艾司氯胺酮作为一种新型抗抑郁药物,不同于传统抗抑郁药物的作用机制,主要通过拮抗N-甲基-D-天冬氨酸受体,激活α-氨基-3-羟基-5-甲基-4-异恶唑丙酸受体,增加脑源性神经营养因子(brain-derived neurotrophic factor, BDNF)及单胺类神经递质的释放,促进突触可再生等机制而发挥抗抑郁作用。服用艾司氯胺酮可快速缓解难治性抑郁症抑郁症状,迅速消除自杀意图,患者耐受性良好。本文就艾司氯胺酮治疗难治性抑郁症的作用机制及疗效做一综述。
Asketamine, as a new antidepressant, is different from traditional antidepressants in its mecha-nism of action, mainly through antagonizing n-methyl-D-aspartic acid receptor, activating α-amino- 3-hydroxy-5-methyl-4-isooxazolpropionic acid receptor. It increases the release of brain-derived neurotrophic factor (BDNF) and monoamine neurotransmitter, promotes synaptic regeneration and other mechanisms to exert antidepressant effects. The administration of esketamine can quickly relieve the depressive symptoms of refractory depression and quickly eliminate the suicidal inten-tion, which is well tolerated by patients. This article reviews the mechanism and efficacy of esketa-mine in the treatment of refractory depression.
New Progress in the Treatment of Refractory Depression with Esticketamine
Shili Sun1, Yong Fan2, Chunxia Wang2
1Jining Medical College, Jining Shandong
2Qingdao Mental Health Center, Qingdao Shandong
Received: Apr. 16th, 2022; accepted: May 11th, 2022; published: May 18th, 2022
ABSTRACT
Asketamine, as a new antidepressant, is different from traditional antidepressants in its mechanism of action, mainly through antagonizing n-methyl-D-aspartic acid receptor, activating α-amino-3-hydroxy-5-methyl-4-isooxazolpropionic acid receptor. It increases the release of brain-derived neurotrophic factor (BDNF) and monoamine neurotransmitter, promotes synaptic regeneration and other mechanisms to exert antidepressant effects. The administration of esketamine can quickly relieve the depressive symptoms of refractory depression and quickly eliminate the suicidal intention, which is well tolerated by patients. This article reviews the mechanism and efficacy of esketamine in the treatment of refractory depression.
艾司氯胺酮常用的给药方式有皮下注射、静脉注射及鼻喷雾三种。实验表明,艾司氯胺酮经鼻喷雾给药优势明显,是最佳的给药途径,鼻喷剂主要通过鼻腔黏膜丰富的血管吸收,可减少味觉障碍的产生及对肝脏的损伤,生物利用度大大增加。艾司氯胺酮(Esketamine)治疗难治性抑郁症的有效性及安全性已被多项随机对照临床试验证实 [5],美国食品和药物管理局(Food and Drug Administration, FDA)于2019年3月4日批准用于成年难治性抑郁症的治疗,这是近十年来FDA首次批准的新型抗抑郁药物 [6]。艾司氯胺酮鼻喷雾剂已在2019年3月5日经FDA批准在美国上市,我国恒瑞医药的艾司氯胺酮鼻喷雾剂也于2019年5月获批临床试验。
孙诗立,范 勇,王春霞. 艾司氯胺酮治疗难治性抑郁症研究新进展New Progress in the Treatment of Refractory Depression with Esticketamine[J]. 临床医学进展, 2022, 12(05): 4090-4095. https://doi.org/10.12677/ACM.2022.125592
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