The American journal of psychiatry
January 1, 2025
Roger S McIntyre, Angela T H Kwan, Rodrigo B Mansur et al.
23 citations
Psychedelics show promise for treating difficult-to-treat psychiatric disorders like major depressive disorder, treatment-resistant depression, and posttraumatic stress disorder, with preliminary evidence also supporting efficacy in tobacco and alcohol use disorders. However, concerns exist about the interpretability and translatability of study results due to insufficiently characterized short- and long-term safety, abuse liability, and the essentiality of the psychedelic experience and psychological support. This overview reviews methodological aspects affecting inferences and interpretation of extant psychedelic studies and provides guidance for future research and development critical to study interpretation and clinical implementation.
Pharmaceuticals (Basel, Switzerland)
January 24, 2025
John E Donello, Roger S McIntyre, Donald B Pickel et al.
14 citations
Plastogens are a class of therapeutics that rapidly promote changes in neuroplasticity. Ketamine, a notable example, is an N-methyl-D-aspartate receptor (NMDAR) antagonist with rapid and long-term antidepressant effects but also psychotomimetic and dissociative side effects. Stinels—rapastinel, apimostinel, and zelquistinel—are plastogens with improved safety and tolerability profiles. This review clarifies the mechanism of stinels, defining them as positive allosteric modulators of NMDAR activity with a novel regulatory binding site, contrasting with earlier descriptions of glycine-like partial agonists. The review presents the rationale for targeting NMDARs in treatment-resistant depression and other psychiatric conditions.
General hospital psychiatry
July 3, 2025
Kush V Bhatt, James D Asuncion, Al Alam et al.
4 citations
Classical psychedelics show therapeutic promise for mental health conditions, but their acute subjective effects—while possibly enhancing outcomes—also pose clinical challenges. This review examines the phenomenology, benefits, risks, and implementation issues tied to these subjective experiences. Emerging research on nonhallucinogenic analogues may preserve neuroplastic benefits without inducing intense subjective effects. The authors argue that a debate over the necessity of acute subjective effects may be avoidable, and clinical psychiatry should accommodate both approaches. Future research should explore both the role of subjective experience and alternative compounds to expand treatment options.
International journal of molecular sciences
October 13, 2022
Stephen M Stahl, Sara De Martin, Andrea Mattarei et al.
Esmethadone (REL-1017) and other uncompetitive NMDAR antagonists may rapidly relieve depression by preferentially blocking hyperactive GluN2D subtypes, restoring physiological neural plasticity. In major depressive disorder, upregulated tonic calcium currents through GluN2D subtypes reduce homeostatic availability of synaptic proteins, contributing to depressive behaviors. Low-potency NMDAR antagonists' selectivity for GluN2D may explain their rapid antidepressant effects without dissociative side effects.