Synaptic potentiation is critical for rapid antidepressant response to ketamine in treatment-resistant major depression

Biol Psychiatry. 2012 Oct 1;72(7):555-61. doi: 10.1016/j.biopsych.2012.03.029. Epub 2012 Apr 21.


Background: Clinical evidence that ketamine, a nonselective N-methyl-D-aspartate receptor (NMDAR) antagonist, has therapeutic effects within hours in people suffering from depression suggests that modulating glutamatergic neurotransmission is a fundamental step in alleviating the debilitating symptoms of mood disorders. Acutely, ketamine increases extracellular glutamate levels, neuronal excitability, and spontaneous γ oscillations, but it is unknown whether these effects are key to the mechanism of antidepressant action of ketamine.

Methods: Twenty drug-free major depressive disorder patients received a single, open-label intravenous infusion of ketamine hydrochloride (.5 mg/kg). Magnetoencephalographic recordings were made approximately 3 days before and approximately 6.5 hours after the infusion, whereas patients passively received tactile stimulation to the right and left index fingers and also while they rested (eyes-closed). Antidepressant response was assessed by percentage change in Montgomery-Åsberg Depression Rating Scale scores.

Results: Patients with robust improvements in depressive symptoms 230 min after infusion (responders) exhibited increased cortical excitability within this antidepressant response window. Specifically, we found that stimulus-evoked somatosensory cortical responses increase after infusion, relative to pretreatment responses in responders but not in treatment nonresponders. Spontaneous somatosensory cortical γ-band activity during rest did not change within the same timeframe after ketamine in either responders or nonresponders.

Conclusions: These findings suggest NMDAR antagonism does not lead directly to increased cortical excitability hours later and thus might not be sufficient for therapeutic effects of ketamine to take hold. Rather, increased cortical excitability as depressive symptoms improve is consistent with the hypothesis that enhanced non-NMDAR-mediated glutamatergic neurotransmission via synaptic potentiation is central to the antidepressant effect of ketamine.

Trial registration: NCT00088699.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Intramural

MeSH terms

  • Adult
  • Analysis of Variance
  • Antidepressive Agents / administration & dosage*
  • Antidepressive Agents / blood
  • Antidepressive Agents / pharmacology
  • Brain Mapping
  • Cerebral Cortex / drug effects*
  • Cerebral Cortex / physiopathology
  • Depressive Disorder, Major / blood
  • Depressive Disorder, Major / drug therapy*
  • Depressive Disorder, Major / pathology*
  • Depressive Disorder, Treatment-Resistant / drug therapy
  • Depressive Disorder, Treatment-Resistant / pathology
  • Electric Stimulation
  • Female
  • Fingers / innervation
  • Functional Laterality
  • Humans
  • Ketamine / administration & dosage*
  • Ketamine / analogs & derivatives
  • Ketamine / blood
  • Ketamine / pharmacology
  • Magnetoencephalography
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales
  • Reaction Time / drug effects
  • Synaptic Potentials / drug effects*
  • Time Factors
  • Treatment Outcome


  • Antidepressive Agents
  • Ketamine
  • norketamine

Associated data