重度抑郁症的谷氨酸调节剂从理论到临床使用
Roger S McIntyre1,2,3, Rakesh Jain4,5
1University of Toronto, Toronto, ON, Canada.
CNS drugs
|August 16, 2024
概括
大型抑郁症 (MDD) 治疗正在推进新的谷氨酸向疗法. 埃斯凯特胺和德克斯特罗梅索芬-布普罗为患有抑郁症的患者提供了新的选择,改进了传统治疗方法.
科学领域:
- 神经科学和精神病学 在
- 药理学 药理学是指药理学的学科.
背景情况:
- 大型抑郁症 (MDD) 存在重大挑战,因为目前使用的单胺基抗抑郁药的疗效延迟和缓解率低.
- 在过去的二十年中,谷氨酸信号传递已经成为新型抑郁症治疗的关键目标.
- 谷氨酸信号通路的失调与抑郁症的病理生理学有关.
研究的目的:
- 在抑郁症的背景下,审查谷氨酸信号在突触生成和神经可塑性中的作用.
- 检查N-甲基-D-酸盐 (NMDA) 向治疗MDD的开发和临床影响.
- 为了突出基于谷氨酸的抗抑郁药治疗的最新突破.
主要方法:
- 这是一篇叙事性综述,综合了关于谷氨酸类抗抑郁药的临床前证据和临床试验数据.
- 该审查侧重于新兴治疗方法的作用机制,临床疗效和监管状况.
- 讨论了关键的N-甲基-D-酸盐 (NMDA) 受体向疗法.
主要成果:
- 尽管研究了许多针对NMDA的向疗法,但许多开发都被停止了.
- 两种针对谷氨酸的抗抑郁药已获得FDA批准:埃斯基坦胺 (鼻腔) 和德克斯特罗梅索芬-布普罗 (口腔).
- 埃斯凯特胺被批准用于治疗耐药性抑郁症和MDD与急性自杀念头/行为.
- 德克斯特罗米多芬-布普罗已被批准用于成人MDD的治疗.
结论:
- 埃斯基坦胺和德克斯特罗米多芬-布普罗的批准证实了质质系统在抑郁症中的重要性.
- 这些新型疗法代表了精神病治疗的重大进步,为那些对传统抗抑郁药物不反应或不耐受的患者提供了替代方案.
- 谷氨酸向治疗提供了新的治疗途径,可能作为MDD管理的第一线选择或辅助.
相关概念视频
01:23Antidepressant Drugs: MAOIs and Other Agents
209
Atypical antidepressants, including bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), and vilazodone (Viibryd), offer unique mechanisms of action. Bupropion weakly inhibits dopamine and norepinephrine reuptake, aiding depression treatment and smoking cessation, with a low risk of sexual dysfunction. Mirtazapine enhances serotonin and norepinephrine neurotransmission, leading to sedation, increased appetite, and weight gain. As a result, it helps treat...
209
01:25Antidepressant Drugs: Overview
398
Antidepressant drugs are a class of medications primarily used for treating various mood disorders, including major depression, anxiety disorders, and other related conditions. These medicines work by modulating the neurotransmitter balance within the brain, alleviating depressive symptoms. Antidepressants can be broadly categorized into several groups according to their mechanism of action and chemical structure: Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine...
398
01:14Antiepileptic Drugs: Glutamate Antagonists
302
Glutamate is a fundamental neurotransmitter in the central nervous system, playing a vital role in neuronal communication and various cognitive processes. Glutamate stands as the principal excitatory neurotransmitter in the brain. Its presence is crucial for the communication between neurons, underpinning essential processes such as synaptic transmission, neuronal excitability, and plasticity. These functions are vital for higher-order cognitive processes, including learning and memory. The...
302
01:17Sedatives and Hypnotics Drugs: Miscellaneous Agents
163
Sedatives and hypnotics encompass a wide range of substances, each with its unique mechanism of action, uses, and potential adverse effects.
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
163
01:21G-protein Coupled Receptors
117.3K
G-protein coupled receptors are ligand binding receptors that indirectly affect changes in the cell. The actual receptor is a single polypeptide that transverses the cell membrane seven times creating intracellular and extracellular loops. The extracellular loops create a ligand specific pocket which binds to neurotransmitters or hormones. The intracellular loops holds onto the G-protein.
117.3K
01:28Antidepressant Drugs: Tricyclics, SSRIs, and SNRIs
339
Tricyclic Antidepressants (TCAs), including Desipramine (Norpramin), Imipramine (Tofranil), Clomipramine (Anafranil), and Amitriptyline (Elavil), inhibit serotonin and norepinephrine reuptake and also block other receptors. They are used for depression, pain conditions, and insomnia. Common adverse effects include anticholinergic effects, sedation, orthostatic hypotension, and weight gain. They have a narrow therapeutic window and so require plasma-level monitoring. Abrupt discontinuation can...
339