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Therapeutic Modalities for Treatment Resistant Depression: Focus on Vagal Nerve Stimulation and Ketamine

Aparna Shah|Flavia Regina Carreno|Alan Frazer
대한정신약물학회 (Korean College of Neuropsychopharmacology)|2014.08|Clinical Psychopharmacology and Neuroscience|제12권 제2호|pp. 83-93

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키워드

DepressionKetamineVagal nerve stimulationTrkB.

초록

Treatment resistant depression (TRD) is a global health concern affecting a large proportion of depressed patients who thenrequire novel therapeutic options. One such treatment option that has received some attention in the past several years is vagalnerve stimulation (VNS). The present review briefly describes the relevance of this treatment in the light of other existing pharmacologicaland non-pharmacological options. It then summarizes clinical findings with respect to the efficacy of VNS. The anatomicalrationale for its efficacy and other potential mechanisms of its antidepressant effects as compared to those employed byclassical antidepressant drugs are discussed. VNS has been approved in some countries and has been used for patients withTRD for quite some time. A newer, fast-acting, non-invasive pharmacological option called ketamine is currently in the limelightwith reference to TRD. This drug is currently in the investigational phase but shows promise. The clinical and preclinical findingsrelated to ketamine have also been summarized and compared with those for VNS. The role of neurotrophin factors, specificallybrain derived neurotrophic factor and its receptor, in the beneficial effects of both VNS and ketamine have been highlighted. It can be concluded that both these therapeutic modalities, while effective, need further research that can reveal specific targetsfor intervention by novel drugs and address concerns related to side-effects, especially those seen with ketamine.

Abstract

Treatment resistant depression (TRD) is a global health concern affecting a large proportion of depressed patients who thenrequire novel therapeutic options. One such treatment option that has received some attention in the past several years is vagalnerve stimulation (VNS). The present review briefly describes the relevance of this treatment in the light of other existing pharmacologicaland non-pharmacological options. It then summarizes clinical findings with respect to the efficacy of VNS. The anatomicalrationale for its efficacy and other potential mechanisms of its antidepressant effects as compared to those employed byclassical antidepressant drugs are discussed. VNS has been approved in some countries and has been used for patients withTRD for quite some time. A newer, fast-acting, non-invasive pharmacological option called ketamine is currently in the limelightwith reference to TRD. This drug is currently in the investigational phase but shows promise. The clinical and preclinical findingsrelated to ketamine have also been summarized and compared with those for VNS. The role of neurotrophin factors, specificallybrain derived neurotrophic factor and its receptor, in the beneficial effects of both VNS and ketamine have been highlighted. It can be concluded that both these therapeutic modalities, while effective, need further research that can reveal specific targetsfor intervention by novel drugs and address concerns related to side-effects, especially those seen with ketamine.

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