Lipid emulsion as a new antidote—current use, extension from lipophilic local anesthetics to other drugs, and state of the art

Abstract

e112 Volume 35 Number 8S ments. However, these drugs show slow onset of action and limited efficacy, making necessary the use of drug augmentation strategies or more aggressive interventions. Two important observations have emerged in recent years indicating that more rapid and effective antidepressant treatments are possible. On the one hand, the deep brain stimulation (DBS) of ventral anterior (subgenual) cingulate cortex (Cg25) evokes rapid mood improvements in subgroups of treatment-resistant depressive patients, likely mediated by a functional remodeling of cortico-limbic circuits. On the other hand, the noncompetitive NDMA receptor antagonist ketamine can also evoke raid (eg, 2 hours) and persistent (up to 1 week) improvements in some treatment-resistant patients. Moreover, recent preclinical observations indicate the antidepressant capacity of nGluR agents. Overall, this supports the usefulness of glutamatergic transmission as a new area in antidepressant drug development. On the monoamine side, new preclinical and clinical research should clarify the different roles played by 5-HT receptors in depression as well as the brain areas and circuits responsible for therapeutic improvement. This will lead to the synthesis of new agents blocking the serotonin (and possibly norepinephrine) transporter, which will also activate or block 5-HT receptors playing, respectively, positive (eg, postsynaptic 5-HT1A, 5-HT4) or negative (eg, presynaptic 5-HT1A,/1B, 5-HT2A, 5-HT2C,5-HT3) roles in antidepressant effects. Disclosure of Interest: None declared.