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2017 ; 152
(ä): 21-37
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New targets for rapid antidepressant action
#MMPMID26724279
Machado-Vieira R
; Henter ID
; Zarate CA Jr
Prog Neurobiol
2017[May]; 152
(ä): 21-37
PMID26724279
show ga
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 ?-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.