NMDAR inhibition-independent antidepressant actions of ketamine metabolites

Nature. 2016 May 26;533(7604):481-6. doi: 10.1038/nature17998. Epub 2016 May 4.

Abstract

Major depressive disorder affects around 16 per cent of the world population at some point in their lives. Despite the availability of numerous monoaminergic-based antidepressants, most patients require several weeks, if not months, to respond to these treatments, and many patients never attain sustained remission of their symptoms. The non-competitive, glutamatergic NMDAR (N-methyl-d-aspartate receptor) antagonist (R,S)-ketamine exerts rapid and sustained antidepressant effects after a single dose in patients with depression, but its use is associated with undesirable side effects. Here we show that the metabolism of (R,S)-ketamine to (2S,6S;2R,6R)-hydroxynorketamine (HNK) is essential for its antidepressant effects, and that the (2R,6R)-HNK enantiomer exerts behavioural, electroencephalographic, electrophysiological and cellular antidepressant-related actions in mice. These antidepressant actions are independent of NMDAR inhibition but involve early and sustained activation of AMPARs (α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptors). We also establish that (2R,6R)-HNK lacks ketamine-related side effects. Our data implicate a novel mechanism underlying the antidepressant properties of (R,S)-ketamine and have relevance for the development of next-generation, rapid-acting antidepressants.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural

MeSH terms

  • Animals
  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / metabolism*
  • Antidepressive Agents / pharmacology*
  • Female
  • Ketamine / adverse effects
  • Ketamine / analogs & derivatives*
  • Ketamine / metabolism*
  • Ketamine / pharmacology
  • Male
  • Mice
  • Receptors, AMPA / agonists
  • Receptors, AMPA / metabolism
  • Receptors, N-Methyl-D-Aspartate / antagonists & inhibitors
  • Time Factors

Substances

  • Antidepressive Agents
  • Receptors, AMPA
  • Receptors, N-Methyl-D-Aspartate
  • Ketamine
  • 6-hydroxynorketamine