Ketamine for depression via neurogenesis?

A lot of fuss has been made recently about the street drug "Special K" (ketamine). It's basically an anesthetic used in labs and veterinary offices to tranquilize mice, rats, cats, and (famously) horses, but recently its been lauded as a newer faster anti-depressant.


Ketamine: from the dealer or from the doctor? (image source)

The possibility that it might have near immediate anti-depressant effects on humans has been around for a little while, but the concept is picking up steam as new research finds mechanisms for how it might actually work in depressed patients. (I briefly mention one new study in an SfN neuroblogging post. )

An emerging theory is that depression is not so much a chemical imbalance as it is a loss of neurons. Thus the cure for depression is not restoring the balance of serotonin or dopamine, but restoring the growth of new neurons. Some suggest that this is how classic anti-depressants (like Zoloft) work, by fixing the neuron atrophy problem. This could also explain why these anti-depressants take so long to work, though I have expressed skepticism about this hypothesis.

So the question is: Does ketamine cause the growth of new neurons, help in their maturation, or prevent neuronal atrophy? Ketamine is an NMDA receptor antagonist, so it inhibits synaptic transmission. It doesn't inhibit all synaptic transmission like deadly poisons do (tetrodotoxin for example), but enough of it to change something in the brain. Knowing something about NMDA receptors, it was still hard for me to conceive of a connection between blocking them and neuronal growth.

A nice review by Duman and Li (2012) spells it out for me, explaining new research that links ketamine with the growth of new synapses.

Duman and Li 2012 figure 3

The idea is that ketamine blocks the NMDA receptors on the GABAergic (inhibitory) neurons, so there is less inhibition and more glutamate. When there is more glutamate, there is more BDNF (brain derived neurotrophic factor). BDNF helps synapsse grow by triggering a cascade of events (via mTOR) which causes more AMPA receptors to be inserted into the synapse, making the synapse stronger, more stable, and more mature.

The authors cite their previous Li et al., 2010 Science paper explaining that when they block mTOR with the drug rapamycin, the effects of ketamine on new spine growth disappear and its anti-depressant effects disappear. However, this is a study in rats and assessing the depressed state of a rat is as tricky as assessing a rat's post-traumatic stress. So the claim here isn't so much that ketamine causes neurogenesis, but that it could help new neurons become synaptically mature, and thus functionally useful. (Carter et al. is investigating this further)

As shiny and interesting as this is, I am not quite sold on it. I don't see how the NMDA antagonist is going to inhibit the inhibitory neurons more than the excitatory neurons, and I would love to see research showing how ketamine causes glutamate accumulation.

And as far as actually using it as a treatment for depression, there are some serious side-effects. Ketamine is a hallucinagenic street drug which can cause a schizophrenia-like state. Therefore, it seems unlikely that ketamine itself will ever be prescribed as an anti-depressant, but new research could reveal (or synthesize) other molecules that activate mTOR directly or somehow bypass the hallucinogenic aspect of ketamine.

For more, see some skeptical and critical analyses of human ketamine studies.

© TheCellularScale

Duman RS, & Li N (2012). A neurotrophic hypothesis of depression: role of synaptogenesis in the actions of NMDA receptor antagonists. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 367 (1601), 2475-84 PMID: 22826346

Li N, Lee B, Liu RJ, Banasr M, Dwyer JM, Iwata M, Li XY, Aghajanian G, & Duman RS (2010). mTOR-dependent synapse formation underlies the rapid antidepressant effects of NMDA antagonists. Science (New York, N.Y.), 329 (5994), 959-64 PMID: 20724638