中国神经再生研究(英文版) ›› 2016, Vol. 11 ›› Issue (2): 195-200.doi: 10.4103/1673-5374.177708

• 综述:神经损伤修复保护与再生 • 上一篇    下一篇

氯胺酮神经再生性能的临床应用:现实世界中的治疗经验

  

  • 收稿日期:2015-12-22 出版日期:2016-02-15 发布日期:2016-02-15

Practical application of the neuroregenerative properties of ketamine: real world treatment experience

Theodore A. Henderson   

  1. Neuro-Luminance, The Synaptic Space, Neuro-Laser Foundation, Centennial, CO, USA
  • Received:2015-12-22 Online:2016-02-15 Published:2016-02-15
  • Contact: Theodore A. Henderson, M.D., Ph.D.,Thesynapticspace7@gmail.com.

摘要:

氯胺酮通过激活分子通路,从而提高脑源性神经营养因子表达,缓解抑郁症临床表现。持续的、重复多次的氯胺酮灌注也可能使神经细胞、轴突和神经回路生长发生长程变化。Neuro-Luminance氯胺酮灌注中心应用将氯胺酮用于神经再生的治疗已有3年的时间。

美国麻突触间隙公司/神经激光基金会Theodore A. Henderson博士所在机构,临床应用氯胺酮用在促进神经再生的治疗过程中。他们每周只进行一次临床输液,而且通常情况下也不会进行五次以上的输液治疗。他们的数据显示,100个患者中,80%都有好转反应,并且,这种治疗效果经常会持续几个月之久。

Abstract:

While controversial, ketamine has emerged as an effective treatment for refractory depression. Serial infusions have been performed 3 times per week, but our practical experience has challenged this precept concerning infusion frequency. Depression is associated with neuron loss, reduced synapse numbers, and dearborization of dendrites. Ketamine appears to potently induce mechanisms which reverse these neurodegenerative processes. Ketamine not only blocks the glutamate receptor, it activates eukaroyotic elongation factor 2 (eEF2). This, in turn, activates brain-derived neurotrophic factor (BDNF) protein synthesis. This is thought to underlie ketamine’s enduring benefits. In addition, ketamine alters glycogen synthase kinase-3 (GSK-3) phosphorylation, probably responsible for its rapid antidepressant effect. Notably, inhibition of the BDNF receptor does not block the immediate benefits of ketamine, but does prevent the enduring effects. Neuro-Luminance Ketamine Infusion Centers have been treating patients with serial ketamine infusions for over three years. Our methods differ from what is often reported, as we perform infusions only once per week and generally do not perform more than five infusions. Data from 100 patients showed that 80% of the patients responded. The baseline Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) score was 17.8 ± 2.8. Responders to ketamine showed a drop in QIDS-SR score of 10.8 ± 3.5, while non-responders showed a 0.8 ± 1.8 change. Moreover, they often had persistent benefits over several months. Recently, it was proposed that psychotomimetic effects are necessary during a ketamine infusion to yield effective antidepressant benefits. Yet, only one patient in our clinic has experienced hallucinations in three years. Nevertheless, 80% of our patients show clinical improvement. Further studies of clinical methods for ketamine infusion therapy are encouraged.

Key words: Ketamine, brain-derived neurotrophic factor, infusion therapy, depression, safety