GSK-3 inhibition potentiates the synaptogenic and antidepressant-like effects of subthreshold doses of ketamine
Open accessAbstract
A single dose of the short-acting NMDA antagonist ketamine produces rapid and prolonged antidepressant effects in treatment-resistant patients with major depressive disorder (MDD), which are thought to occur via restoration of synaptic connectivity. However, acute dissociative side effects and eventual fading of antidepressant effects limit widespread clinical use of ketamine. Recent studies in medial prefrontal cortex (mPFC) show that the synaptogenic and antidepressant-like effects of a single standard dose of ketamine in rodents are dependent upon activation of the mammalian target of rapamycin (mTOR) complex 1 (mTORC1) signaling pathway together with inhibitory phosphorylation of glycogen synthase kinase-3 (GSK-3), which relieves its inhibitory in influence on mTOR. Here, we found that the synaptogenic and antidepressant-like effects of a single otherwise subthreshold dose of ketamine were potentiated when given together with a single dose of lithium chloride (a nonselective GSK-3 inhibitor) or a preferential GSK-3β inhibitor; these effects included rapid activation of the mTORC1 signaling pathway, increased inhibitory phosphorylation of GSK-3β, increased synaptic spine density/diameter, increased excitatory postsynaptic currents in mPFC layer V pyramidal neurons, and antidepressant responses that persist for up to 1 week in the forced-swim test model of depression. The results demonstrate that low, subthreshold doses of ketamine combined with lithium or a selective GSK-3 inhibitor are equivalent to higher doses of ketamine, indicating the pivotal role of the GSK-3 pathway in modulating the synaptogenic and antidepressant responses to ketamine. The possible mitigation by GSK-3 inhibitors of the eventual fading of ketamine's antidepressant effects remains to be explored.
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Multiple studies reported ketamine increasing dendritic spine density within 12-24 h.
“Multiple studies have reported similar occurrences with ketamine increasing dendritic spine density within 12–24 h of administration (Li et al., 2010; Liu et al., 2013; Moda-Sava et al., 2019).”
From A single subanaesthetic dose of the rapid-acting antidepressant S-ketamine raises presynaptic SV2A density in limbic regions of the Wistar Kyoto rat model of depression (2024) · cites this paper as Liu et al., 2013
Currently MDD is typically treated with monoamine neurotransmission drugs, but these drugs can take weeks to months to produce therapeutic response, have limited efficacy, and low rates of full remission.
“Currently, MDD is typically treated with drugs that influence monoamine neurotransmission, but large-scale clinical trials (i.e., STAR*D) show that these drugs can take weeks to months to produce a therapeutic response, have limited efficacy, and result in low rates of full remission (24).”
From Sestrin modulator NV-5138 produces rapid antidepressant effects via direct mTORC1 activation (2019) · cites this paper as [24]
A single dose of ketamine (10 mg/kg) produced similar effects on mTORC1 signaling proteins.
“A single dose of ketamine (10 mg/kg) produced effects (Figure 4, C-E) similar to those previously reported (7, 8, 11, 24).”
From Sestrin modulator NV-5138 produces rapid antidepressant effects via direct mTORC1 activation (2019) · cites this paper as [24]
Heterozygous deletion of BDNF decreases spine density and dendrite length of hippocampal and PFC neurons, decreases hippocampal volume, and occludes the effects of chronic stress.
“Heterozygous deletion of BDNF also decreases spine density and dendrite length of hippocampal and PFC neurons, decreases hippocampal volume, and occludes the effects of chronic stress39,40.”
From Synaptic plasticity and depression: new insights from stress and rapid-acting antidepressants (2016) · cites this paper as [39]
mTORC1 activation and phosphorylation of GSK-3 might be a convergent mechanism involved in ketamine's antidepressant actions.
“Administration of combined subthreshold doses of ketamine and lithium (a non-selective GSK-3 inhibitor), or a selective GSK-3 inhibitor, induced an activation of the mTORC1 signaling pathway, phosphorylation of GSK-3, synaptoneurogenesis and enhanced antidepressant actions 187, suggesting that mTORC1 activation and phosphorylation of GSK-3 might be a convergent mechanism involved in ketamine’s ant”
From Mechanisms of ketamine action as an antidepressant (2018) · cites this paper as [187]
Administration of combined subthreshold doses of ketamine and lithium (a non-selective GSK-3 inhibitor), or a selective GSK-3 inhibitor, induces an activation of the mTORC1 signaling pathway, phosphorylation of GSK-3, synaptoneurogenesis and enhanced antidepressant actions.
“Administration of combined subthreshold doses of ketamine and lithium (a non-selective GSK-3 inhibitor), or a selective GSK-3 inhibitor, induced an activation of the mTORC1 signaling pathway, phosphorylation of GSK-3, synaptoneurogenesis and enhanced antidepressant actions 187, suggesting that mTORC1 activation and phosphorylation of GSK-3 might be a convergent mechanism involved in ketamine’s ant”
From Mechanisms of ketamine action as an antidepressant (2018) · cites this paper as [187]
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- Authors
- Liu, R.-J., Fuchikami, M., Dwyer, J. M., Lepack, A. E., Duman, R. S., & Aghajanian, G. K.
- Affiliations
- Yale University (US)
- Corresponding author
- Aghajanian, George K
- Venue
- Neuropsychopharmacology
- Published
- 2013-05-17
- Volume
- 38
- Issue
- 11
- Pages
- 2268-2277
- ISSN
- 0893-133X (ISSN-L)
- 1740-634X
- PMC
- PMC3773678
- OpenAlex
- W2051187163
- Cited by
- 256
- References
- 32
- Citations by year
- 2026: 7 · 2025: 14 · 2024: 13 · 2023: 18 · 2022: 21 · 2021: 22 · 2020: 25 · 2019: 27 · 2018: 17 · 2017: 18 · 2016: 28 · 2015: 23 · 2014: 14 · 2013: 7
- FWCI
- 17.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Neuropsychopharmacology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health (MH093897, R01MH093897)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neuropharmacology Research
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- ketamine, glycogen synthase kinase-3, GSK3 inhibition, lithium chloride, mTORC1 signaling, antidepressant effects, synaptogenesis, medial prefrontal cortex, excitatory postsynaptic currents, major depressive disorder, forced swim test
- MeSH terms
- Mechanistic Target of Rapamycin Complex 1, Animals, Antidepressive Agents, Dose-Response Relationship, Drug, Drug Synergism, Indoles, Ketamine, Male, Maleimides, Phosphorylation, Synapses, Signal Transduction, Prefrontal Cortex, Lithium Chloride, Excitatory Postsynaptic Potentials, Glycogen Synthase Kinase 3, Immobility Response, Tonic, Multiprotein Complexes, Dendritic Spines, Rats, TOR Serine-Threonine Kinases
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