Ketamine metabolite may hold a key to novel antidepressants

People waiting for a conference about antidepressants.

From horse tranquilizer and 60’s recreational drug, ketamine has a long history of bad press. Its rapid antidepressant effects in those for whom nothing else works is tempered by its addictive potential and harmful safety profile. Now, however, it appears the antidepressant effect is actually brought about by one of ketamine’s metabolites, possibly paving the way for new, better-tolerated antidepressant therapies.

Is K now okay?

 

Our understanding of ketamine’s MOA is flawed

What has brought about the revision of our views on ketamine?  It appears that our understanding of how ketamine exerted its antidepressant effects was flawed. It was thought that ketamine worked by directly inhibiting the N-methyl-D-aspartate glutamate receptor (NMDAR).  However, other NMDAR inhibitors could never generate ketamine’s depth of antidepressant effect. This suggests there was something special about ketamine’s mode of action. By examining what happens to ketamine as it is metabolised in depressed mice, National Institute of Health (NIMH) researchers have uncovered something quite new.1

 

It’s the metabolite that’s special

 

Metabolism of (R,S)-ketamine to (2R,6R)-HNK generates antidepressant effects in rodents

The NIMH group have shown that the metabolism of (R,S)-ketamine to (2S,6S;2R,6R)-hydroxynorketamine (HNK) is essential to promote antidepressant effects. And just one form of HNK - the (2R,6R)-HNK enantiomer - exerts behavioural, electroencephalographic, electrophysiological and cellular antidepressant-related actions in mice. Importantly, if ketamine metabolism is blocked, the anti-depressant effects of ketamine do not occur. This suggests that the metabolite and not ketamine itself is responsible for these beneficial effect.

 

Lack of side-effects

 

But it may be even better. Firstly, (2R,6R)-HNK exerted its anti-depressive effects without generating any of the unwanted cognitive and motor side-effects normally observed with ketamine in rodent studies.

(2R,6R)-HNK acts on AMPA not NMDA receptors

The reason for the lack of side-effects is thought to be because (2R,6R)-HNK doesn’t act on NMDA but on another glutamate receptor  - the α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptors. Experiments have shown that if the AMPA receptors are blocked, so are the antidepressant effects of (2R,6R)-HNK.

 

Long lasting and non-addictive

 

Just like ketamine, a single dose of (2R,6R)-HNK promotes long-lasting antidepressant effects in treated mice. Finally, the ketamine metabolite appears not to be addictive. When mice were allowed to ‘self-administer’ the two compounds, they only helped themselves to ketamine and not to (2R,6R)-HNK.

Uncovering the mechanism behind ketamine’s actions may open the way for the development of specific rapid and long-acting antidepressants. Human studies are planned to start next year and, not surprisingly, are generating considerable interest. At long last, ketamine’s press coverage is positive.

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

Country selection
We are registering that you are located in Brazil - if that's correct then please continue to Progress in Mind Brazil
You are leaving Progress in Mind
Hello
Please confirm your email
We have just sent you an email, with a confirmation link.
Before you can gain full access - you need to confirm your email.
The information on this site is exclusively intented for health care professionals.
All the information included in the Website is related to products of the local market and, therefore, directed to health professionals legally authorized to prescribe or dispense medications with professional practice. The technical information of the drugs is provided merely informative, being the responsibility of the professionals authorized to prescribe drugs and decide, in each concrete case, the most appropriate treatment to the needs of the patient.
Congress
Register for access to Progress in Mind in your country