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Review
, 152, 21-37

New Targets for Rapid Antidepressant Action

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Review

New Targets for Rapid Antidepressant Action

Rodrigo Machado-Vieira et al. Prog Neurobiol.

Abstract

Current therapeutic options for major depressive disorder (MDD) and bipolar disorder (BD) are associated with a lag of onset that can prolong distress and impairment for patients, and their antidepressant efficacy is often limited. All currently approved antidepressant medications for MDD act primarily through monoaminergic mechanisms. Glutamate is the major excitatory neurotransmitter in the central nervous system, and glutamate and its cognate receptors are implicated in the pathophysiology of MDD, and in the development of novel therapeutics for this disorder. The rapid and robust antidepressant effects of the N-methyl-d-aspartate (NMDA) antagonist ketamine were first observed in 2000. Since then, other NMDA receptor antagonists have been studied in MDD. Most have demonstrated relatively modest antidepressant effects compared to ketamine, but some have shown more favorable characteristics. This article reviews the clinical evidence supporting the use of novel glutamate receptor modulators with direct affinity for cognate receptors: (1) non-competitive NMDA receptor antagonists (ketamine, memantine, dextromethorphan, AZD6765); (2) subunit (GluN2B)-specific NMDA receptor antagonists (CP-101,606/traxoprodil, MK-0657); (3) NMDA receptor glycine-site partial agonists (GLYX-13); and (4) metabotropic glutamate receptor (mGluR) modulators (AZD2066, RO4917523/basimglurant). We also briefly discuss several other theoretical glutamate receptor targets with preclinical antidepressant-like efficacy that have yet to be studied clinically; these include α-amino-3-hydroxyl-5-methyl-4-isoxazoleproprionic acid (AMPA) agonists and mGluR2/3 negative allosteric modulators. The review also discusses other promising, non-glutamatergic targets for potential rapid antidepressant effects, including the cholinergic system (scopolamine), the opioid system (ALKS-5461), corticotropin releasing factor (CRF) receptor antagonists (CP-316,311), and others.

Keywords: Antidepressant; Bipolar disorder; Depression; Glutamate; Rapid; Treatment.

Figures

Fig. 1
Fig. 1
Schematic representation of postulated targets implicated in ketamine’s mechanism of rapid antidepressant action that are amenable to pharmacological manipulation: A) GABA interneuron inhibition that leads to increased glutamate transmission, B) enhanced AMPA throughput, and C) mTOR activation. AKT3: protein kinase B3; AMPAR: alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor; BDNF: brain-derived neurotrophic factor; GABA: gamma aminobutyric acid; GluA1: AMPA receptor subunit 1; IRS: insulin receptor substrate; mTOR: mammalian target of rapamycin; NMDA: N-methyl-D-aspartate; PI3K: phosphoinositide-3 kinase; PSD95: postsynaptic density protein 95; TrkB: tropomyosin receptor kinase B; VOCC: voltage-operated calcium channel.

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