D-serine plasma concentration is a potential biomarker of (R,S)-ketamine antidepressant response in subjects with treatment-resistant depression
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Rationale (R,S)-ketamine is a rapid and effective antidepressant drug that produces a response in two thirds of patients with treatment-resistant depression (TRD). The underlying biochemical differences between a (R,S)-ketamine responder (KET-R) and non-responder (KET-NR) have not been definitively identified but may involve serine metabolism. Objectives The aim of the study was to examine the relationship between baseline plasma concentrations of D-serine and its precursor L-serine and antidepressant response to (R,S)-ketamine in TRD patients. Methods Plasma samples were obtained from 21 TRD patients at baseline, 60 min before initiation of the (R,S)-ketamine infusion. Patients were classified as KET-Rs (n = 8) or KET-NRs (n = 13) based upon the difference in Montgomery-Åsberg Depression Rating Scale (MADRS) scores at baseline and 230 min after infusion, with response defined as a ≥50 % decrease in MADRS score. The plasma concentrations of D-serine and L-serine were determined using liquid chromatography-mass spectrometry. Results Baseline D-serine plasma concentrations were significantly lower in KET-Rs (3.02 ± 0.21 μM) than in KET-NRs (4.68 ± 0.81 μM), p < 0.001. A significant relationship between baseline D-serine plasma concentrations and percent change in MADRS at 230 min was determined using a Pearson correlation, r = 0.77, p < 0.001, with baseline D-serine explaining 60 % of the variance in (R,S)-ketamine response. The baseline concentrations of L-serine (L-Ser) in KET-Rs were also significantly lower than those measured in KET-NRs (66.2 ± 9.6 μM vs 242.9 ± 5.6 μM, respectively; p < 0.0001). Conclusions The results demonstrate that the baseline D-serine plasma concentrations were significantly lower in KET-Rs than in KET-NRs and suggest that this variable can be used to predict an antidepressant response following (R,S)-ketamine administration.
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Ketamine inhibits transport of D-serine, ketamine metabolites decrease intracellular concentrations of D-serine in PC-12 cells, and plasma D-serine levels predict a response to the antidepressant effects of ketamine.
“In this regard, it is interesting that ketamine inhibits transport of D-serine,124 ketamine metabolites decrease intracellular concentrations of D-serine in PC-12 cells,125 and that plasma D-serine levels predict a response to the antidepressant effects of ketamine.126,127”
From Ketamine as an antidepressant: Overview of its mechanisms of action and potential predictive biomarkers (2020) · cites this paper as [126]
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- Authors
- Moaddel, R., Luckenbaugh, D. A., Xie, Y., Villaseñor, A., Brutsche, N. E., Machado-Vieira, R., Ramamoorthy, A., Lorenzo, M. P., Garcia, A., Bernier, M., Torjman, M. C., Barbas, C., Zarate, C. A., & Wainer, I. W.
- Affiliations
- National Institutes of Health (US)
- Universidad San Pablo CEU (ES)
- Cooper Medical School of Rowan University (US)
- Corresponding author
- Wainer, Irving W.
- ORCID
- Venue
- Psychopharmacology
- Published
- 2014-07-24
- Volume
- 232
- Issue
- 2
- Pages
- 399-409
- ISSN
- 0033-3158 (ISSN-L)
- 1432-2072
- PMC
- PMC5990001
- OpenAlex
- W1972478979
- Cited by
- 86
- References
- 38
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 5 · 2023: 5 · 2022: 5 · 2021: 8 · 2020: 9 · 2019: 3 · 2018: 7 · 2017: 11 · 2016: 5 · 2015: 12 · 2014: 3
- FWCI
- 7.53
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- CEU Repositorio Institucional (Fundación Universitaria San Pablo CEU) (submittedVersion, cc-by-nc-nd)
- Funders
- National Institutes of Health (Z99 AG999999)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- D-serine, L-serine, treatment-resistant depression, antidepressant response prediction, biomarkers, serine metabolism, plasma concentration, rapid-acting antidepressants
- MeSH terms
- Adult, Antidepressive Agents, Chromatography, Liquid, Female, Humans, Infusions, Intravenous, Ketamine, Male, Middle Aged, Serine, Biomarkers, Tandem Mass Spectrometry, Depressive Disorder, Treatment-Resistant
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