Weapons of stress reduction: (R,S)-ketamine and its metabolites as prophylactics for the prevention of stress-induced psychiatric disorders

• Published in: Neuropharmacology Vol. 224; p. 109345
• Main Authors: Chen, Briana K., Denny, Christine A.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 15.02.2023
• Subjects: (R,S)-ketamine; (R,S)-ketamine metabolites; Depression - drug therapy; Depression, Postpartum - drug therapy; Female; Hippocampus; Humans; Ketamine - therapeutic use; Neuronal Plasticity; Prefrontal Cortex; Prophylactics; Resilience; Stress; (R,S)-ketamine; Prophylactics; (R,S)-ketamine metabolites; Stress; Resilience
• ISSN: 0028-3908; 1873-7064
• DOI: 10.1016/j.neuropharm.2022.109345

Exposure to stress is one of the greatest contributing factors to developing a psychiatric disorder, particularly in susceptible populations. Enhancing resilience to stress could be a powerful intervention to reduce the incidence of psychiatric disease and reveal insight into the pathophysiology of psychiatric disorders. (R,S)-ketamine and its metabolites have recently been shown to exert protective effects when administered before or after a variety of stressors and may be effective, tractable prophylactic compounds against psychiatric disease. Drug dosing, sex, age, and strain in preclinical rodent studies, significantly influence the prophylactic effects of (R,S)-ketamine and related compounds. Due to the broad neurobiological actions of (R,S)-ketamine, a variety of mechanisms have been proposed to contribute to the resilience-enhancing effects of this drug, including altering various transcription factors across the genome, enhancing inhibitory connections from the prefrontal cortex, and increasing synaptic plasticity in the hippocampus. Promisingly, select data have shown that (R,S)-ketamine may be an effective prophylactic against psychiatric disorders, such as postpartum depression (PPD). Overall, this review will highlight a brief history of the prophylactic effects of (R,S)-ketamine, the potential mechanisms underlying its protective actions, and possible future directions for translating prophylactic compounds to the clinic. This article is part of the Special Issue on 'Ketamine and its Metabolites'. •(R,S)-ketamine and its metabolites are prophylactic against psychiatric disease.•Sex, age, dose, and strain influence the prophylactic effects of (R,S)-ketamine.•(R,S)-ketamine blocks stress-induced changes in reward signaling, PFC connectivity, and HPC function.•Investigating prophylactics reveals insight into the neurobiology of stress resilience.•Prophylactics are powerful tools to reduce the global burden of psychiatric disease.