Revisiones_bibliográficas TyO

Neurosci Biobehav Rev. 2018 Jan;84:352-358. doi: 10.1016/j.neubiorev.2017.08.012. Epub 2017 Aug 23.

Abstract

A growing body of evidence supports the idea that drugs targeting the glutamate system may represent a valuable therapeutic alternative in major depressive disorders (MDD). The rapid and prolonged mood elevating effect of the NMDA receptor (NMDAR) antagonist ketamine has been studied intensely. However, its clinical use is hampered by deleterious side-effects, such as psychosis. Therefore, a better understanding of the mechanisms of the psychotropic effects after NMDAR blockade is necessary to develop glutamatergic antidepressants with improved therapeutic profile. Here we review recent experimental data that addressed molecular/cellular determinants of the antidepressant effect mediated by inactivating NMDAR subtypes. We refer to results obtained both in pharmacological and genetic animal models, ranging from global to conditional NMDAR manipulation. Our main focus is on the contribution of different NMDAR subtypes to the psychoactive effects induced by NMDAR ablation/blockade. We review data analyzing the effect of NMDAR subtype deletions limited to specific neuronal populations/brain areas in the regulation of mood. Altogether, these studies suggest effective and putative specific NMDAR drug targets for MDD treatment.

KEYWORDS: Depression; GluN2 subunits; Glutamate; Ketamine; Molecular biology; NMDA receptors

Uso de terapia repetida con ketamina intravenosa en la depresión bipolar resistente al tratamiento con comportamiento suicida: informe de un caso de España.

Use of repeated intravenous ketamine therapy in treatment-resistant bipolar depression with suicidal behaviour: a case report from Spain.

López-Díaz Á1, Fernández-González JL1, Luján-Jiménez JE1, Galiano-Rus S1, Gutiérrez-Rojas L1.

Ther Adv Psychopharmacol. 2017 Apr;7(4):137-140. doi: 10.1177/2045125316675578. Epub 2017 Jan 1.

Abstract

The rapidly-acting antidepressant properties of ketamine are a trend topic in psychiatry. Despite its robust effects, these are ephemeral and can lead to certain adverse events. For this reason, there is still a general concern around the off-label use of ketamine in clinical practice settings. Nonetheless, for refractory depression, it should be an indication to consider. We report the case of a female patient admitted for several months due to a treatment-resistant depressive bipolar episode with chronic suicidal behaviour. After repeated intravenous ketamine infusions without remarkable side effects, the patient experienced a complete clinical recovery during the 4 weeks following hospital discharge. Unfortunately, depressive symptoms reappeared in the 5th week, and the patient was finally readmitted to hospital as a result of a suicide attempt.

KEYWORDS: antidepressive agents; bipolar disorder; depression; ketamine; suicide

La administración aguda de ketamina corrige los marcadores óseos inflamatorios anormales en el trastorno depresivo mayor.

Acute ketamine administration corrects abnormal inflammatory bone markers in major depressive disorder.

Kadriu B1, Gold PW2, Luckenbaugh DA1, Lener MS1, Ballard ED1, Niciu MJ1, Henter ID1, Park LT1, De Sousa RT1, Yuan P1, Machado-Vieira R1, Zarate CA Jr1.

Mol Psychiatry. 2017 May 30. doi: 10.1038/mp.2017.109. [Epub ahead of print]

Abstract

Patients with major depressive disorder (MDD) have clinically relevant, significant decreases in bone mineral density (BMD). We sought to determine if predictive markers of bone inflammation-the osteoprotegerin (OPG)-RANK-RANKL system or osteopontin (OPN)-play a role in the bone abnormalities associated with MDD and, if so, whether ketamine treatment corrected the abnormalities. The OPG-RANK-RANKL system plays the principal role in determining the balance between bone resorption and bone formation. RANKL is the osteoclast differentiating factor and diminishes BMD. OPG is a decoy receptor for RANKL, thereby increasing BMD. OPN is the bone glue that acts as a scaffold between bone tissues matrix composition to bind them together and is an important component of bone strength and fracture resistance. ...

We conclude that the OPG-RANK-RANKL system and the OPN system play important roles in the serious bone abnormalities associated with MDD. These data suggest that, in addition to its antidepressant effects, ketamine also has a salutary effect on a major medical complication of depressive illness.

Nuevas estrategias de tratamiento de la depresión: basadas en mecanismos relacionados con la neuroplasticidad.

New Treatment Strategies of Depression: Based on Mechanisms Related to Neuroplasticity.

Huang YJ1, Lane HY1,2,3, Lin CH2,4,5.

Neural Plast. 2017;2017:4605971. doi: 10.1155/2017/4605971. Epub 2017 Apr 11.

Abstract

Major depressive disorder is a severe and complex mental disorder. Impaired neurotransmission and disrupted signalling pathways may influence neuroplasticity, which is involved in the brain dysfunction in depression. Traditional neurobiological theories of depression, such as monoamine hypothesis, cannot fully explain the whole picture of depressive disorders. In this review, we discussed new treatment directions of depression, including modulation of glutamatergic system and noninvasive brain stimulation. Dysfunction of glutamatergic neurotransmission plays an important role in the pathophysiology of depression. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has rapid and lasting antidepressive effects in previous studies. In addition to ketamine, other glutamatergic modulators, such as sarcosine, also show potential antidepressant effect in animal models or clinical trials. Noninvasive brain stimulation is another new treatment strategy beyond pharmacotherapy. Growing evidence has demonstrated that superficial brain stimulations, such as transcranial magnetic stimulation, transcranial direct current stimulation, cranial electrotherapy stimulation, and magnetic seizure therapy, can improve depressive symptoms. The antidepressive effect of these brain stimulations may be through modulating neuroplasticity. In conclusion, drugs that modulate neurotransmission via NMDA receptor and noninvasive brain stimulation may provide new directions of treatment for depression. Furthermore, exploring the underlying mechanisms will help in developing novel therapies for depression in the future.

¿ENCENDIDO o APAGADO ?: Modulando el Receptor de N-Metil-D-Aspartato en la Depresión Mayor.

ON or OFF?: Modulating the N-Methyl-D-Aspartate Receptor in Major Depression.

Chan SY1, Matthews E2, Burnet PW1.

Front Mol Neurosci. 2017 Jan 13;9:169. doi: 10.3389/fnmol.2016.00169. eCollection 2016.

Abstract

Since the discovery that a single dose of ketamine, an N-methyl-D-aspartate receptor (NMDAR) antagonist, had rapid and long-lasting antidepressant effects, there has been increased interest in using NMDAR modulators in the pharmacotherapy of depression. Ketamine's efficacy seems to imply that depression is a disorder of NMDAR hyperfunctionality. However, studies showing that not all NMDAR antagonists are able to act as antidepressants challenge this notion. Furthermore, NMDAR co-agonists have also been gaining attention as possible treatments. Co-agonists such as D-serine and sarcosine have shown efficacy in both pre-clinical models and human trials. This raises the question of how both NMDAR antagonists and agonists are able to have converging behavioral effects. Here we critically review the evidence and proposed therapeutic mechanisms for both NMDAR antagonists and agonists, and collate several theories on how both activation and inhibition of NMDARs appear to have antidepressant effects.

KEYWORDS: NMDAR antagonist; depression; glycine site; mTOR; subuni

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

World Congress on Regional Anesthesia & Pain Medicine

April 19-21, 2018, New York City, USA

vwhizar@anestesia-dolor.org

Anestesiología y Medicina del Dolor

52 664 6848905

anestesia-dolor.org

sábado, 16 de septiembre de 2017

Ketamina en suicidio / Ketamine for suicide

Septiembre 16, 2017. No. 2813

¿Es ketamina la nueva droga maravilla para tratar el suicidio?

Is Ketamine the New Wonder Drug for Treating Suicide?

Henry Boilini, MD; Madeleine Baldwin, LCSW; and Georgine Lamvu, MD

Fed Pract. 2017 September;34(9):12-16

Although the initial findings involving the use of ketamine in suicidal patients are promising, further research is needed on the short - and long-term effects of this medication.

In 2014 the suicide rate in the U.S. was 13/100,000, the highest recorded in 28 years.1 Suicide is now considered the 10th leading cause of death for all ages, and the rate has increased every year from 2000 to 2014 among both women and men and in every age group except those aged ≥ 75 years.1-3 For those aged 15 to 44 years, suicide is among the top 3 causes of death worldwide.4-6

Convocatoria para el Curso de Posgrado en Medicina del Dolor y Paliativa 2018 para Mexicanos y extranjeros.

Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Informes (52) 55 5487 0900 ext. 5011 de lunes a viernes de 9.00 a 14 h (hora de Ciudad de México).

XIV Congreso Virtual Mexicano de Anestesiología 2017

Octubre 1-Diciembre 31, 2017

Información / Information

Video informativo

LI Congreso Mexicano de Anestesiología

Mérida Yucatán, Noviembre 21-25, 2017

vwhizar@anestesia-dolor.org

Anestesiología y Medicina del Dolor

52 664 6848905

anestesia-dolor.org

lunes, 10 de abril de 2017

Ketamina / Ketamine

Abril 8 2017. No. 2653

Ketamina perioperatoria para dolor post toracotomía

Perioperative Ketamine Administration for Thoracotomy Pain.

Moyse DW1, Kaye AD, Diaz JH2, Qadri MY1, Lindsay D1, Pyati S3.

Pain Physician. 2017 Mar;20(3):173-184.

Abstract

BACKGROUND: Of all the postsurgical pain conditions, thoracotomy pain poses a particular therapeutic challenge in terms of its prevalence, severity, and ensuing postoperative morbidity. Multiple pain generators contribute to the severity of post-thoracotomy pain, and therefore a multimodal analgesic therapy is considered to be a necessary strategy. Along with opioids, thoracic epidural analgesia, and paravertebral blocks, N-Methyl-D-Aspartate (NMDA) receptor antagonists such as ketamine have been used as adjuvants to improve analgesia. OBJECTIVE: We reviewed the evidence for the efficacy of intravenous and epidural administration of ketamine in acute post-thoracotomy pain management, and its effectiveness in reducing chronic post-thoracotomy pain. STUDY DESIGN: Systematic literature review and an analytic study of a data subset were performed. METHODS: We searched PubMed, Embase, and Cochrane reviews using the key terms "ketamine," "neuropathic pain," "postoperative," and "post-thoracotomy pain syndrome." The search was limited to human trials and included all studies published before January 2015. Data from animal studies, abstracts, and letters were excluded. All studies not available in the English language were excluded. The manuscript bibliographies were reviewed for additional related articles. We included randomized controlled trials and retrospective studies, while excluding individual case reports. RESULTS: This systematic literature search yielded 15 randomized control trials evaluating the efficacy of ketamine in the treatment of acute post-thoracotomy pain; fewer studies assessed its effect on attenuating chronic post-thoracotomy pain. The majority of reviewed studies demonstrated that ketamine has efficacy in reduction of acute pain, but the evidence is limited on the long-term benefits of ketamine to prevent post-thoracotomy pain syndrome, regardless of the route of administration. A nested analytical study found there is a statistically significant reduction in acute post-thoracotomy pain with IV or epidural ketamine. However currently, the evidence for a role of ketamine as a preventative agent for chronic post-thoracotomy pain is insufficient due to the heterogeneity of the studies reviewed with regard to the route of administration, dosage, and outcome measures. LIMITATIONS: The evidence for a role of ketamine as a preventative agent for chronic post-thoracotomy pain is insufficient due to the heterogeneity of the studies reviewed. CONCLUSION: The majority of randomized controlled trials reviewed show no role for ketamine in attenuating or preventing post-thoracotomy pain syndrome at variable follow-up lengths. Therefore, additional research is warranted with consideration of risk factors and long-term follow-up for chronic post-thoracotomy pain though the evidence for benefit appears clear for acute post-thoracotomy pain.Key words: Ketamine, postoperative, thoracotomy pain, post thoracotomy pain syndrome, neuropathic pain.