WHAT DO ECT RTMS AND KETAMINE SHARE FOR TREATMENT REFRACTORY DEPRESSION

Alen J. Salerian*

ABSTRACT

This study reviews the common pathways of antidepressant action of electroconvulsive treatment (repetitive trans magnetic stimulation and ketamine which have distinguished themselves as potentially effective treatments for major depression. In general, traditional antidepressants-mono amine oxidase inhibitors, selective serotonin reuptake inhibitors and norepinephrine re update inhibitors - exert antidepressant influence by normalizing prefrontal cortex dopamine function over several weeks. Diverse and converging evidence suggests that ketamine, rTMS and ECT share common biological properties to induce anesthesia, analgesia, antidepressant effect and elevation of serum endorphins and these observations highlight the central importance of the endorphin-opioid system in normal brain function, mood and pain regulation. Furthermore, it seems that, their antidepressant effects may correspond to a triad of signature traits of anti-glutamatergic, dopaminergic. and opioid agonistic influences. rTMS and Ketamine enhance PFC metabolism and regional blood flow in contrast to ECT which shows negative or no effect on these functions. These intzimate associations involving glutamate opioid and dopamine pathways are worthy of emphasis especially in the context of the global connectivity and complexity of human brain function governed by the evolutionary predominant influence of prefrontal cortex.

Keywords: Ketamine; ECT; rTMS, Opiates; Endorphines.