Kétamine, psilocybine, et antidépresseurs d'action rapide : de nouvelles promesses pour la psychiatrie?

The long-standing hypothesis that depression stems from a deficiency in monoamines (serotonin, norepinephrine, dopamine) has guided antidepressant development, but conventional treatments targeting these systems have limitations. The success of ketamine has revived interest in other substances, including the hallucinogen psilocybin (which targets serotonin 5HT2A receptors) and the neurosteroid brexanolone (a GABA-A receptor modulator). Unlike standard antidepressants, these modulators of glutamatergic, serotonergic, and GABAergic systems produce rapid antidepressant effects within 24 hours to a week. Beyond the search for a "miracle" molecule, these new targets may help identify biomarkers for rapid-acting antidepressants and reshape treatment strategies for mood disorders.

Study at a glance

Abstract

The hypothesis of monoaminergic deficiency has long dominated the conceptual framework for the development of new antidepressant strategies, but the limits of conventional antidepressant treatments targeting monoaminergic signaling have motivated the search for new antidepressant pathways. The success of ketamine in the management of depressive disorders has provoked a renewed interest in hallucinogenic substances such as psilocybin targeting the serotonergic signaling 5HT2A and neurosteroid allosteric modulator of γ-aminobutyric acid (GABAA) receptors such as brexanolone. Unlike conventional treatments, these modulators of glutamatergic, serotonergic and GABAergic systems exert a rapid antidepressant effect ranging from 24hours to a week. Apart from their clinical interest and the fantasized search for a "miracle" molecule that jointly meets the expectations of patients and clinicians, these new targets could lead to the identification of potential new biomarkers for the development of rapid-acting antidepressants and redefine therapeutic strategies in mood disorders.