J Psychopharmacol:吸食氯胺酮是快速治疗抑郁症的更佳途径?研究提出异议

2018-03-21 佚名 sciencealert

麻醉药物氯胺酮最近成为一种很有前途的新的抑郁症治疗方法,特别是对那些对常规抗抑郁药没有反应的顽固病患者。但是,目前对氯胺酮鼻腔喷雾剂进行的一项试验研究结果并不理想,在我们找到使用这种药物作为抑郁症治疗的最佳方法之前,还有更多的工作要做。

麻醉药物氯胺酮最近成为一种很有前途的新的抑郁症治疗方法,特别是对那些对常规抗抑郁药没有反应的顽固病患者。但是,目前对氯胺酮鼻腔喷雾剂进行的一项试验研究结果并不理想,在我们找到使用这种药物作为抑郁症治疗的最佳方法之前,还有更多的工作要做。

由来自澳大利亚的黑狗研究所的研究人员表示,小的试点应该探讨如何反复吸食氯胺酮作为一种鼻喷剂可能重度难治性抑郁症患者和治疗工作的第一步。不幸的是,他们发现鼻内氯胺酮喷雾剂的副作用比任何人都预料的要糟糕。

以前的临床试验表明,单剂量静脉注射氯胺酮可以作为一种速效抗抑郁药非常有效。但是这种单一剂量往往在几周后逐渐消失。

如果我们要给抗抑郁药库添加氯胺酮,我们需要知道更长时间内的重复剂量是否安全可行,这正是试点试验的目的。研究人员把注意力转向了鼻腔喷雾路线,因为吸食药物可以有几个好处,进入血液的速度,不需要经过胃部。

研究小组计划招募十名患有难治性抑郁症的参与者,但前五名患者经历了一些严重的副作用后,他们就中断了这项研究。在一项双盲、随机和对照的研究中,每个病人花了四周的时间接受十种剂量的八种治疗,氯胺酮或鼻喷剂,或咪唑安定,一种镇静和镇静的药物。

所有受试者都接受了自我管理鼻腔喷雾剂,这一过程与感冒时使用的任何其他喷雾药物没有什么不同。当血液中氯胺酮开始失去,情况开始变得糟糕,当研究人员试图用五分钟的间隔间隔鼻腔喷雾剂时,事情只会变得更糟,受试者的血压突然升高,他们也开始出现类似精神病的效果。

氯胺酮是众所周知的迷幻派对药物,吸食它对参与者造成一些疯狂的经历。“氯胺酮滴鼻传递是非常有效的,这是因为它绕过的代谢途径,与氯胺酮被迅速吸收进入血液有关。但是,正如我们的研究结果所显示的,这可能会导致一些人体内的高浓度的氯胺酮引起一些问题。”

研究小组在研究报告中写道:“我们的研究结果表明,通过对鼻腔粘膜的吸收可能过于迅速,从而导致快速而强烈的副作用的产生”。

因为这项研究必须缩短,研究小组还没有结论性的结果,即氯胺酮是否有助于减轻抑郁。但这并不意味着氯胺酮是无用的抗抑郁药,即使吸食标准剂量变成灾难性,但是对于治疗抑郁症状,保持清醒还是有作用的。

科学家还有更多的选择可供探索。目前,团队现在正在招募参与世界上最大的氯胺酮抑郁治疗试验的参与者。鼻腔喷雾剂也不能完全排除。

“我们先前的研究已经表明,根据个别病人改变剂量是很重要的。在鼻喷雾剂可以被认为是可行的治疗方案之前,还需要更多的研究来确定每一种具体应用方法的氯胺酮最佳剂量。”

这项研究发表在《心理药理学杂志》上。

原始出处:

Verònica Gálvez, Adrienne Li, Christina Huggins, et.al. Repeated intranasal ketamine for treatment-resistant depression – the way to go? Results from a pilot randomised controlled trial. Journal of Psychopharmacology March 15, 2018 

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    2019-02-11 jj000001
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    2018-05-18 yb6560
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    2018-03-23 jml2009

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