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产后抑郁(PPD)是围生期常见的并发症,近年来已成为重要的公共卫生问题,对母亲、儿童和家庭产生不利影响,因此,如何预防与早期治疗PPD越来越引起人们的重视。氯胺酮作为抗抑郁药在精神疾病治疗中受到越来越多的关注,而作为新型抗抑郁药和麻醉药的艾司氯胺酮是氯胺酮的S-对映异构体,与NMDA受体(NMDAR)有更强大的亲和力,初步研究发现其治疗难治性抑郁症(TRD)不但起效快速,迅速改善患者抑郁症(MDD)并降低自杀意图,且不良反应较少。本文结合近期国内外文献,对艾司氯胺酮的药理学及其在防治PPD的研究及相关进展做一综述。
Abstract：Maternal postpartum depression, which is a common complication in the perinatal period, has become an important public health problem recently, and it adversely affects the health and well-being of parturients, their infants and families, therefore how to prevent and early treat postpartum depression has attracted more and more attention. Ketamine as an antidepressant has attracted more and more attention in the treatment of mental illness. Esketamine, a new type of antidepressant and anesthetic, is the S-enantiomer of ketamine and has greater affinity with NMDAR. Preliminary studies have found that its treatment of treatment-resistant depression not only has a rapid effect, but also can quickly improve patients' depressive symptoms and reduce the risk of suicide significantly, with less adverse reactions. With the analysis of recent domestic and foreign papers, this article reviews the research progress on the pharmacology of esketamine and its prevention and treatment of postpartum depression.
[1] Companies of Johnson.FDA approves new nasal spray medication for treatment-resistant depression;available only at a certified doctor's office or clinic [EB/OL].(2019-03-04).https://www.fda.gov/news-events/press-announcements/fda-approves-new-nasal-spray-medication-treatment-resistant-depression-available-only-certified.
[2] GAVIN N I,GAYNES B N,LOHR K N,et al.Perinatal depression:a systematic review of prevalence and incidence [J].Obstet Gynecol,2005,106(5 Pt 1):1071-1083.DOI:10.1097/01.AOG.0000183597.31630.db.
[3] NORHAYATI M N,HAZLINA N H,ASRENEE A R,et al.Magnitude and risk factors for postpartum symptoms:a literature review[J].J Affect Disord,2015,175:34-52.DOI:10.1016/j.jad.2014.12.041.
[4] WISNER K L,SIT D K Y,MCSHEA M C,et al.Onset timing,thoughts of self-harm,and diagnoses in postpartum women with screen-positive depression findings[J].JAMA Psychiatry,2013,70(5):490-498.DOI:10.1001/jamapsychiatry.2013.87.
[5] American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders[M].Fifth Edition.USA:American Psychiatric Publishing,2013.
[6] STEWART D E,VIGOD S.Postpartum depression[J].N Engl J Med,2016,375(22):2177-2186.DOI:10.1056/NEJMcp1607649.
[7] SCHILLER C E,MELTZER-BRODY S,RUBINOW D R.The role of reproductive hormones in postpartum depression[J].CNS Spectr,2015,20(1):48-59.DOI:10.1017/S1092852914000480.
[8] National collaborating centre for mental health.Antenatal and postnatal mental health:the NICE guideline on clinical management and service guidance[M].UK:The British Psychological Society & The Royal College of Psychiatrists,2007.
[9] The American College of Obstetricians and Gynecologists Committee Opinion no.630.Screening for perinatal depression[J].Obstet Gynecol,2015,125(5):1268-1271.DOI:10.1097/01.AOG.0000465192.34779.dc.
[10] RAFFERTY J,MATTSON G,EARLS M F,et al.Incorporating recognition and management of perinatal and postpartum depression into pediatric practice[J/OL].Pediatrics,2019,143(1):e20183260.DOI:10.1542/peds.2018-3260.
[11] SIU A L,BIBBIN-DOMINGO K,GROSSMAN D C,et al.Screening for depression in adults:US Preventive Services Task Force recommendation statement[J].JAMA,2016,315(4):380-387.DOI:10.1001/jama.2015.18392.
[12] STEWART D E,VIGOD S.Postpartum depression[J].N Engl J Med,2016,375(22):2177-2186.DOI:10.1056/NEJMcp1607649.
[13] BERMAN R M,CAPPIELLO A,ANAND A,et al.Antidepressant effects of ketamine in depressed patients[J].Biol Psychiatry,2000,47(4):351-354.DOI:10.1016/s0006-3223(99)00230-9.
[14] DALY E J,SINGH J B,FEDGCHIN M,et al.Efficacy and safety of intranasal esketamine adjunctive to oral antidepressant therapy in treatment-resistant depression:a randomized clinical trial[J].JAMA Psychiatry,2018,75(2):139-148.DOI:10.1001/jamapsychiatry.2017.3739.
[15] CANUSO C M,SINGH J B,FEDGCHIN M,et al.Efficacy and safety of intranasal esketamine for the rapid reduction of symptoms of depression and suicidality in patients at imminent risk for suicide:results of a double-blind,randomized,placebo-controlled study[J].Am J Psychiatry,2018,175(7):620-630.DOI:10.1176/appi.ajp.2018.17060720.
[16] VON KORFF M,SIMON G.The relationship between pain and depression[J].Br J Psychiatry Suppl,1996,168(30):101-108.DOI:10.1192/50007125000298474.
[17] MA J H,WANG S Y,YU H Y,et al.Prophylactic use of ketamine reduces postpartum depression in Chinese women undergoing cesarean section[J].Psychiatry Res,2019,279:252-258.DOI:10.1016/j.psychres.2019.03.026.
[18] 徐阳.剖宫产术中小剂量氯胺酮应用预防产后抑郁的疗效评价[D].广州：南方医科大学，2017.
[19] YAMAKURA T,SAKIMURA K,SHIMOJI K.The stereoselective effects of ketamine isomers on heteromeric N-methyl-D-aspartate receptor channels[J].Anesth Analg,2000,91(1):225-229.DOI:10.1097/00000539-200007000-00042.
[20] FUKUMOTO K,TOKI H,IIJIMA M,et al.Antidepressant potential of (R)-ketamine in rodent models:comparison with (S)-ketamine[J].J Pharmacol Exp Ther,2017,361(1):9-16.DOI:10.1124/jpet.116.239228.
[21] HASHIMOTO K,KAKIUCHI T,OHBA H,et al.Reduction of dopamine D2/3 receptor binding in the striatum after a single administration of esketamine,but not R-ketamine:a PET study in conscious monkeys[J].Eur Arch Psychiatry Clin Neurosci,2017,267(2):173-176.DOI:10.1007/s00406-016-0692-7.
[22] YANG C,HAN M,ZHANG J C,et al.Loss of parvalbumin-immunoreactivity in mouse brain regions after repeated intermittent administration of esketamine,but not Rketamine[J].Psychiatry Res,2016,239:281-283.DOI:10.1016/j.psychres.2016.03.034.
[23] ZANOS P,GOULD T D.Mechanisms of ketamine action as an antidepressant[J].Mol Psychiatry,2018,23(4):801-811.DOI:10.1038/mp.2017.255.
[24] AUTRY A E,ADACHI M,NOSYREVA E,et al.NMDA receptor blockade at rest triggers rapid behavioural antidepressant responses[J].Nature,2011,475(7354):91-95.DOI:10.1038/nature10130.
[25] LI N,LEE B,LIU R J,et al.mTOR-dependent synapse formation underlies the rapid antidepressant effects of NMDA antagonists[J].Science,2010,329(5994):959-964.DOI:10.1126/science.1190287.
[26] ZHANG K,HASHIMOTO K.An update on ketamine and its two enantiomers as rapidacting antidepressants[J].Expert Rev Neurother,2019,19(1):83-92.DOI:10.1080/14737175.2019.1554434.
[27] PORTMANN S,KWAN H Y,THEURILLAT R,et al.Enantioselective capillary electrophoresis for identification and characterization of human cytochrome P450 enzymes which metabolize ketamine and norketamine in vitro[J].J Chromatogr A,2010,1217(51):7942-7948.DOI:10.1016/j.chroma.2010.06.028.
[28] FDA.SpravatoTM (esketamine) tablets,for nasal spray prescribinginformation [EB/OL].(2019-03).http://www.janssenlabels.com/package-insert/product-monograph/prescrib-ing-information/SPRAVATO-pi.pdf.
[29] IHMSEN H,GEISSLINGER G,SCHUTTLER J.Stereoselective pharmacokinetics of ketamine:R(-)-ketamine inhibits the elimination of S(+)-ketamine[J].Clin Pharmacol Ther,2001,70(5):431-438.DOI:10.1067/mcp.2001.119722.
[30] CRISTEA I A,NAUDET F.US Food and Drug Administration approval of esketamine and brexanolone[J].Lancet Psychiatry,2019,6(12):975-977.DOI:10.1016/S2215-0366(19)30292-5.
[31] FEDGCHIN M,TRIVEDI M,DALY E J,et al.Randomized,double-blind study of fixeddosed intranasal esketamine plus oral antidepressant vs.active control in treatment-resistant depression[C].Presented at the 9th Biennial Conference of the International Society for Affective Disorders (ISAD) and the Houston Mood Disorders Conference,September 21,2018.
[32] POPOVA V,DALY E J,TRIVEDI M,et al.Efficacy and safety of flexibly dosed esketamine nasal spray combined with a newly initiated oral antidepressant in treatment-resistant depression:a randomized double-blind active-controlled study[J].Am J Psychiatry,2019,176(6):428-438.DOI:10.1176/appi.ajp.2019.19020172.
[33] OCHS-ROSS R,DALY E J,ZHANG Y,et al.Efficacy and safety of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression-transform-3[J].Am J Geriatr Psychiatry,2020,28(2):121-141.DOI:10.1016/j.jagp.2019.10.008.
[34] DALY E J,TRIVEDI M H,JANIK A,et al.Efficacy of esketamine nasal spray plus oral antidepressant treatment for relapse prevention in patients with treatment-resistant depression:A randomized clinical trial[J].JAMA Psychiatry,2019,76(9):893-903.DOI:10.1001/jamapsychiatry.2019.1189.
[35] WAJS E,ALUISIO L,HOLDER R,et al.Esketamine nasal spray plus oral antidepressant in patients with treatment-resistant depression:assessment of long-term safety in a Phase 3,open-label study (SUSTAIN-2)[J/OL].J Clin Psychiatry,2020,81(3):19m12891.DOI:10.4088/JCP.19m12891.
[36] CORREIA-MELO F S,LEAL GC,CARVALHO M S,et al.Comparative study of esketamine and racemic ketamine in treatment-resistant depression:Protocol for a noninferiority clinical trial[J/OL].Medicine (Baltimore),2018,97(38):e12414.DOI:10.1097/MD.0000000000012414.
[37] SHORT B,FONG J,GALVEZ V,et al.Side-effects associated with ketamine use in depression:a systematic review[J].Lancet Psychiatry,2018,5(1):65-78.DOI:10.1016/S2215-0366(17)30272-9.
[38] SUPPA E,VALENTE A,CATARCI S,et al.A study of low-dose S-ketamine infusion as “preventive” pain treatment for cesarean section with spinal anesthesia:benefits and side effects[J].Minerva Anestesiol,2012,78(7):774-781.
[39] JAAFARPOUR M,VASIHG A,KHAJAVIKHAN J,et al.Effect of ketofol on pain and complication after Caesarean delivery under spinal anaesthesia:a randomized double-blind clinical trial[J].J Clin Diagn Res,2017,11(3):UC04-UC07.DOI:10.7860/JCDR/2017/21437.9434.
基本信息:
中图分类号:R969
引用信息:
[1]宋丛中,孙建良.艾司氯胺酮的药理学及其在产后抑郁防治的研究进展[J].麻醉安全与质控,2021,5(06):483-488.
基金信息:
浙江省自然科学基金(LY21H090005)
2021-11-15
2021-11-15