Glutamatergic Neurotransmission: Pathway to Developing Novel Rapid-Acting Antidepressant Treatments
Open accessAbstract
The underlying neurobiological basis of major depressive disorder remains elusive due to the severity, complexity, and heterogeneity of the disorder. While the traditional monoaminergic hypothesis has largely fallen short in its ability to provide a complete picture of major depressive disorder, emerging preclinical and clinical findings suggest that dysfunctional glutamatergic neurotransmission may underlie the pathophysiology of both major depressive disorder and bipolar depression. In particular, recent studies showing that a single intravenous infusion of the glutamatergic modulator ketamine elicits fast-acting, robust, and relatively sustained antidepressant, antisuicidal, and antianhedonic effects in individuals with treatment-resistant depression have prompted tremendous interest in understanding the mechanisms responsible for ketamine's clinical efficacy. These results, coupled with new evidence of the mechanistic processes underlying ketamine's effects, have led to inventive ways of investigating, repurposing, and expanding research into novel glutamate-based therapeutic targets with superior antidepressant effects but devoid of dissociative side effects. Ketamine's targets include noncompetitive N-methyl-D-aspartate receptor inhibition, α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid throughput potentiation coupled with downstream signaling changes, and N-methyl-D-aspartate receptor targets localized on gamma-aminobutyric acid-ergic interneurons. Here, we review ketamine and other potentially novel glutamate-based treatments for treatment-resistant depression, including N-methyl-D-aspartate receptor antagonists, glycine binding site ligands, metabotropic glutamate receptor modulators, and other glutamatergic modulators. Both the putative mechanisms of action of these agents and clinically relevant studies are described.
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Broadly, these agents demonstrated no significant antidepressant efficacy and an adverse events profile that led to early terminations of some clinical trials in MDD, TRD, and Parkinson's disease.
“Broadly, these agents demonstrated no significant antidepressant efficacy and an adverse events profile that led to the early terminations of some clinical trials in indications such as MDD, TRD, and Parkinson's disease [169,170]”
From Ketamine in neuropsychiatric disorders: an update (2024) · cites this paper as [170]
The MK-0657 (CERC-301) and JNJ40411813/ADX71149 sections report trials without significant antidepressant efficacy. The CP-101,606/Traxoprodil section reports adverse effects and discontinuation of that compound’s development, but it also reports significant antidepressant effects; it does not say a clinical trial ended early. The passages do not substantiate early trial terminations across MDD, TRD, and Parkinson’s disease. (LLM, conf=0.85)
Experimental — accuracy not yet measuredNR2B-specific subunit antagonists such as traxoprodil, MK-0657, and eliprodil were developed but suffered similar failures.
“NR2B-specific subunit antagonists such as traxoprodil (CP-101,606), MK-0657 (CERC-301), and eliprodil (EVT-101) were developed but suffered similar failures.”
From Ketamine in neuropsychiatric disorders: an update (2024) · cites this paper as [170]
The Subunit NR2B-Specific NMDAR Antagonists sections report that traxoprodil’s development was discontinued because of cardiotoxicity and that MK-0657/CERC-301 failed to meet a phase 2 efficacy endpoint. These are different kinds of setbacks, and the passages found in our copy do not address eliprodil/EVT-101 or a failure associated with it (searched: eliprodil, EVT-101). (LLM, conf=0.86)
Experimental — accuracy not yet measuredNuedexta is FDA-approved for pseudobulbar affect treatment.
“Nuedexta is FDA-approved for pseudobulbar affect treatment, and alternative formulations designed to increase DM’s bioavailability without the risk of quinidine toxicity are under investigation [144].”
From Pharmacotherapies Targeting GABA-Glutamate Neurotransmission for Treatment-Resistant Depression (2023) · cites this paper as [144]
In all reports, initial efficacy of memantine, lanicemine, and CERC 301 was either transient or inconsistent in larger studies.
“In all reports, initial efficacy was either transient or inconsistent in larger studies [97,103,144,145,146].”
From Pharmacotherapies Targeting GABA-Glutamate Neurotransmission for Treatment-Resistant Depression (2023) · cites this paper as [144]
In TRD, AD efficacy was seen in early open-label studies but not replicated by more rigorous clinical trials.
“In TRD, AD efficacy was seen in early open-label studies but not replicated by more rigorous clinical trials [144,179], (see Table 1).”
From Pharmacotherapies Targeting GABA-Glutamate Neurotransmission for Treatment-Resistant Depression (2023) · cites this paper as [144]
Riluzole promotes post-synaptic GABAA receptor allosteric modulation and reduces glutamatergic activity via direct NMDA and kainate receptor inhibition, blockade of TTX-sensitive sodium channels, and simultaneous reuptake acceleration and inhibition of release.
“Riluzole promotes post-synaptic GABAA receptor allosteric modulation and reduces glutamatergic activity via direct NMDA and kainate receptor inhibition, blockade of tetrodotoxin (TTX)-sensitive sodium channels, and simultaneous reuptake acceleration and inhibition of release [144].”
From Pharmacotherapies Targeting GABA-Glutamate Neurotransmission for Treatment-Resistant Depression (2023) · cites this paper as [144]
Riluzole increases glutamate-glutamine cycling, a potential explanation for in vitro observations of enhanced neuroplasticity and amelioration of excitotoxicity, as well as in vivo reductions in depressive behaviors.
“Riluzole also increases glutamate–glutamine cycling, a potential explanation for in vitro observations of enhanced neuroplasticity and amelioration of excitotoxicity [176,177], as well as in vivo reductions in depressive behaviors [144,178].”
From Pharmacotherapies Targeting GABA-Glutamate Neurotransmission for Treatment-Resistant Depression (2023) · cites this paper as [144]
According to meta-analysis findings, riluzole augmentation and monotherapy both demonstrate sustained antidepressant and anxiolytic efficacy for depressive disorders.
“According to meta-analysis findings, riluzole augmentation and monotherapy both demonstrate sustained antidepressant and anxiolytic efficacy for depressive disorders [144,179].”
From Pharmacotherapies Targeting GABA-Glutamate Neurotransmission for Treatment-Resistant Depression (2023) · cites this paper as [144]
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- Authors
- Kadriu, B., Musazzi, L., Henter, I. D., Graves, M., Popoli, M., & Zarate, C. A.
- Affiliations
- National Institutes of Health (US)
- University of Milan (IT)
- Corresponding author
- Kadriu, Bashkim
- Venue
- International Journal of Neuropsychopharmacology
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-11-16
- Volume
- 22
- Issue
- 2
- Pages
- 119-135
- ISSN
- 1461-1457 (ISSN-L)
- 1469-5111
- PMC
- PMC6368372
- OpenAlex
- W2900937351
- Cited by
- 165
- References
- 187
- Citations by year
- 2026: 10 · 2025: 14 · 2024: 16 · 2023: 21 · 2022: 31 · 2021: 24 · 2020: 29 · 2019: 19 · 2018: 1
- FWCI
- 2.13
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The International Journal of Neuropsychopharmacology (publishedVersion, public-domain)
- Europe PMC (PubMed Central) (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Funders
- National Institute of Mental Health
- National Institutes of Health (IRP-NIMH-NIH, ZIA MH002857)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neuropharmacology Research
- Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
- Keywords
- glutamatergic neurotransmission, ketamine, treatment-resistant depression, major depressive disorder, bipolar depression, NMDA receptor antagonists, AMPA receptor potentiation, GABAergic interneurons, rapid-acting antidepressants, antidepressant mechanism
- MeSH terms
- Antidepressive Agents, Humans, Ketamine, Receptors, N-Methyl-D-Aspartate, Excitatory Amino Acid Antagonists, Depressive Disorder, Treatment-Resistant
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