Controversies of the Effect of Ketamine on Cognition.

摘要: Over the last couple of years, there have been numerous studies investigating efficacy ketamine, a non-competitive N-methyl-d-aspartic acid (NMDA) receptor antagonist as rapid antidepressant. Most existing published literature describes purported effectiveness ketamine The clinical intravenous in reduction suicidal ideations ranged between that 29% to much 79%. Researchers noted transient nature ketamine’s antidepressant and hence has recommended for long-term continued administration (1, 2). Clearly, with utilization are safety concerns adverse effects need be considered. Prior systematic reviews highlighted acute could potential arise from (3). These include dissociation, perceptual abnormalities, confusion, instability vital signs Although shown serial infusions short term (of 4 weeks) does not result cognitive impairments (4), other demonstrated chronically would lead memory (5). More recently, Morgan et al. (5) their recent article only increasing incidence abuse globally but also mechanisms implications on spatial memory. According study 11 participants which 1 had another mental health condition) who using recreationally, they discovered, through functional imaging abusers experience disturbances largely due decreased activation right hippocampus left parahippocampus gyrus chronic do tend dissociative symptoms, accounted increased hippocampal activation. In addition, revealed underlying disruption medial temporal lobe functioning. resultant disruptions might psychotic symptoms experience. findings presented by concerning if is being approved clinically depressed individuals receiving continuous administrations ketamine. seem like promising relieve treatment refractory depressive induction longer concern. Memory further disabilities consequential overall quality life. Aside used chronically, usage urological problems, such cystitis (6). Although it commonly assumed deleterious effect cognition, researchers looked at sublingual despite its inherent lower bioavailability 30%, variant helped mitigate against (7). trial, 77% patients improvement mood cognition Lee (8) review proposed procognitive raises discrepancies controversies previous established cognition. Based review, low dosages did affect terms improving visual memory, simple working complex treatment-resistant depression. It acutely, doses, mechanism action intracellular proteins, BDNF mTORC1. Through these executive functioning affected (Figure ​(Figure1).1). mediating factor helps hence, relief ideations. postulated planning suicide act involves capability. Usually, dysfunctional control poor impulse disinhibition. Thus, help improve dysfunctions usually accompanies depression, well reduce degree ideations, enhancements better control. Figure 1 Overview precognitive effects. Much current focused Given about repeated administration, drive toward evaluating racemic mixture started determine comparable conventional antidepressant, whether an added augmentation strategy. controversy believed this certainly area deserves more research work look into. order understand truly effect, worthwhile compare or antidepressants, Vortioxetine (9, 10), hypothesized modulation 5HT7 5HT3 receptors. Comparison [R(−) ketamine] key, given prior how R(−) greater potency acting (11).