针对治疗耐药抑郁症的 ketamine 和 esketamine 的个性化使用
Gustavo C Medeiros1,2, Isabella Demo3, Fernando S Goes3
1Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA. gustavo.medeiros@som.umaryland.edu.
Translational psychiatry
|November 29, 2024
概括
在治疗耐药性抑郁症 (TRD) 中,确定胺/胺反应的预测因子至关重要. 临床病史和EEG马功率显示出个性化TRD治疗的前景.
科学领域:
- 精神病学和神经科学 精神病学和神经科学
- 药理学 药理学是指药理学的学科.
- 生物标志物发现发现
背景情况:
- 重度抑郁症 (MDD) 构成了相当大的负担,特别是耐治疗抑郁症 (TRD).
- 静脉注射 (R,S) - 胺和鼻内注射 (S) - 胺为TRD提供快速抗抑郁作用,但表现出反应变化.
- 需要个性化治疗方法来优化在TRD中胺/胺的疗效.
研究的目的:
- 为了确定可靠的和临床可翻译的预测器的响应胺/胺对于TRD.
- 探索用于预测抗抑郁药反应的临床和生物标志物.
主要方法:
- 在TRD.中对胺素/胺素反应预测因子的现有文献的综述.
- 对潜在的临床预测因素的分析:家庭酒精使用障碍病史,童年创伤史.
- 基于大脑的生物标志物的评估:脑电图 (EEG) 马功率的变化.
- 基于血液的生物标志物的评估:来自大脑的神经营养因子 (BDNF).
主要成果:
- 在治疗前,酒精使用障碍的积极家族史和童年创伤史是潜在的临床预测因素.
- 脑电图上增加的前对对面性马功率显示出作为基于大脑的响应生物标志物具有前景.
- 包括BDNF在内的基于血液的生物标志物已经显示出有限但一致的实用性.
- 分离性症状的严重程度不能可靠地预测对胺/胺的反应.
结论:
- 临床病史和EEG马功率是个有希望的,易于翻译的预测因素,可以在TRD中个性化胺/胺治疗.
- 跨研究的生物标志物和临床变量获取标准化对于稳健的比较至关重要.
- 多变量预测模型可能是必要的,因为单个预测器的效果大小很小.
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