Cited by 195Treatment of Major DepressionNeurotransmitter Receptor Influence on BehaviorNeuroscience and Neuropharmacology Research

Antidepressant Effects of the Muscarinic Cholinergic Receptor Antagonist Scopolamine: A Review

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Drevets, Wayne C., Zarate, Carlos A., Furey, Maura L.·2013·Biological Psychiatry

Abstract

The muscarinic cholinergic receptor system has been implicated in the pathophysiology of depression, with physiological evidence indicating this system is overactive or hyperresponsive in depression and with genetic evidence showing that variation in genes coding for receptors within this system are associated with higher risk for depression. In studies aimed at assessing whether a reduction in muscarinic cholinergic receptor function would improve depressive symptoms, the muscarinic receptor antagonist scopolamine manifested antidepressant effects that were robust and rapid relative to conventional pharmacotherapies. Here, we review the data from a series of randomized, double-blind, placebo-controlled studies involving subjects with unipolar or bipolar depression treated with parenteral doses of scopolamine. The onset and duration of the antidepressant response are considered in light of scopolamine's pharmacokinetic properties and an emerging literature that characterizes scopolamine's effects on neurobiological systems beyond the cholinergic system that appear relevant to the neurobiology of mood disorders. Scopolamine infused at 4.0 μg/kg intravenously produced robust antidepressant effects versus placebo, which were evident within 3 days after the initial infusion. Placebo-adjusted remission rates were 56% and 45% for the initial and subsequent replication studies, respectively. While effective in male and female subjects, the change in depression ratings was greater in female subjects. Clinical improvement persisted more than 2 weeks following the final infusion. The timing and persistence of the antidepressant response to scopolamine suggest a mechanism beyond that of direct muscarinic cholinergic antagonism. These temporal relationships suggest that scopolamine-induced changes in gene expression and synaptic plasticity may confer the therapeutic mechanism.

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Crossref · 10.1016/j.biopsych.2012.09.031

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  • dTMS in TRD patients is effective both as a monotherapy and as an add-on treatment.

    “A recent review concluded that dTMS in TRD patients is effective both as a monotherapy and as an add-on treatment 189 .”

    From Major depressive disorder (2016) · cites this paper as [189]

    The section “Preliminary Observations Using Scopolamine in Treatment-Resistant Depression” discusses scopolamine in 11 treatment-resistant participants, not dTMS. Searches for dTMS and deep transcranial magnetic stimulation found no passage addressing its effectiveness as monotherapy or add-on treatment. Page numbers were not available in our copy. (LLM, conf=0.76)

    Experimental — accuracy not yet measured
  • Scopolamine, a potent muscarinic antagonist, promotes a rapid and enduring antidepressant effect.

    “Scopolamine, a potent muscarinic antagonist, promotes a rapid and enduring antidepressant effect [153].”

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Authors
Drevets, W. C., Zarate, C. A., & Furey, M. L.
Affiliations
  • Laureate Institute for Brain Research (US)
  • National Institutes of Health (US)
Corresponding author
Furey, Maura L.
Venue
Biological Psychiatry
Publisher
Elsevier BV
Published
2013-06
Volume
73
Issue
12
Pages
1156-1163
ISSN
0006-3223 (ISSN-L)
OpenAlex
W2053956493
Cited by
195
References
75
Citations by year
2026: 4 · 2025: 9 · 2024: 12 · 2023: 12 · 2022: 14 · 2021: 14 · 2020: 14 · 2019: 18 · 2018: 15 · 2017: 23 · 2016: 20 · 2015: 21 · 2014: 11 · 2013: 8
FWCI
1.44
Type
journal article
Language
en
Open access
Locations
  • Biological Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Institute of Mental Health (ZIAMH002813)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neuropharmacology Research
Keywords
scopolamine, muscarinic receptors, antidepressant effects, depression, bipolar depression, major depressive disorder, intravenous infusion, rapid antidepressant response, remission, sex differences, gene expression, synaptic plasticity
MeSH terms
Adolescent, Adult, Antidepressive Agents, Depression, Female, Humans, Male, Middle Aged, Scopolamine, Randomized Controlled Trials as Topic, Muscarinic Antagonists, Young Adult

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