Abstract
Ketamine is known to have a rapid and lasting antidepressant effect. Recent studies have shown that ketamine exerts it rapid antidepressant effect by blocking burst firing in the lateral habenula (LHb). Whether the sustained antidepressant effect of ketamine occurs through the same mechanism has not been explored. Here, using male rats, we found that local infusion of (R,S)-ketamine into the LHb resulted in a rapid antidepressant-like effect 1 h after infusion, which almost returned to baseline levels after 24 h. Intra-LHb injection of (S)-ketamine also showed a significant antidepressant-like effect 1 h after injection, which recovered at 24 h. No significant antidepressant-like effect was found at 1 or 24 h after the administration of (R)-ketamine into the LHb. Injection of (2R,6R)-hydroxynorketamine, a ketamine metabolite, into the LHb did not result in any obvious antidepressant-like effect 1 or 24 h after injection. Systemic administration of (R,S)-ketamine (intraperitoneally) significantly suppressed LHb bursting activity at 1 h, but the inhibitory effect was reversed 24 h after injection. No significant effect of (R,S)-ketamine on miniature excitatory postsynaptic potentials of LHb neurons was found at 1 or 24 h after systemic application. Our study demonstrated that the sustained antidepressant-like effect of ketamine may not depend on burst firing of LHb neurons.
SIGNIFICANCE STATEMENT Ketamine exerts it rapid antidepressant effect by blocking burst firing in the lateral habenula (LHb). However, whether the sustained antidepressant effect of ketamine occurs through the same mechanism has not been explored. In the present study, we demonstrated that the sustained antidepressant effect of ketamine may not depend on the burst firing of LHb neurons. This finding may lead to a novel perspective on LHb in the antidepressant effect of ketamine.
Introduction
Depression is a very common and chronic psychiatric disease that negatively affects quality of life and increases cost to society. Traditional antidepressant drugs, such as tricyclic antidepressants, require a few days or weeks to achieve their antidepressant effects (MacGillivray et al., 2003). By contrast, ketamine, a NMDA receptor antagonist, has a rapid (within 40 min) and long-lasting (>1 week) antidepressant effect (Berman et al., 2000; Zarate et al., 2006). Importantly, some studies have reported that ketamine shows an obvious antidepressant effect on patients with treatment-resistant depression (Price et al., 2014; Reinstatler and Youssef, 2015). Therefore, ketamine is one of the most attractive drugs in the field of depression treatment. Despite these benefits, ketamine has many serious side effects including, for example, addiction, abuse, and separation effects (Short et al., 2018). Thus, understanding the molecular mechanism of the action of ketamine, and using this knowledge to develop new antidepressant drugs with fewer side effects but the same rapid and lasting action, is an important topic in antidepressant research.
It is well known that ketamine is a blocker of NMDA receptors. However, the antidepressant mechanisms of ketamine are highly complex and remain controversial (Zanos and Gould, 2018). Recently, Yang et al. (2018) proposed a model that the rapid antidepressant mechanism of ketamine is achieved via suppression of burst firing of lateral habenula (LHb) neurons. The LHb is an important anti-reward center in the brain that is activated by negative emotional stimuli (Matsumoto and Hikosaka, 2007). It achieves an antireward effect by inhibiting the activity of dopaminergic nuclei (e.g., the ventral tegmental area and dorsal raphe nuclei) in the midbrain (Jhou et al., 2009; Hong et al., 2011). In depressive conditions, the bursting activity of LHb neurons is significantly increased, which inhibits the activity of dopaminergic neurons in the midbrain (Matsumoto and Hikosaka, 2007; Lammel et al., 2012). Ketamine inhibits the increased bursting activity of LHb neurons through the NMDA receptor, and then disinhibits midbrain dopaminergic neurons to achieve a rapid antidepressant effect (Yang et al., 2018). Compared with other antidepressant models of ketamine, this model requires fewer steps to reach the reward center in the brain, making it easier to achieve the rapid antidepressant effect (Cui et al., 2019). However, whether ketamine exerts its long-lasting antidepressant effect through this model is unknown. Thus, the present study aimed to explore whether the long-lasting antidepressant effect of ketamine depends on the suppression of LHb bursting activity.
Materials and Methods
Animals.
Adult male congenitally learned helpless (cLH) rats and age-matched Sprague Dawley rats were used in the present study. Animals were purchased from Shanghai SLAC animal company. All experimental procedures were approved by the animal care and use committee of Zhejiang University.
Depression-like models.
Two depression-like models were used. In the chronic restraint stress (CRS) model, according to established methods (Kim and Han, 2006), the rats were placed in a custom-made polyethylene plastic tube with breathing holes for 2–3 h/d for 14 consecutive days. In the lipopolysaccharide (LPS)-induced depression-like model, according to established methods (Adzic et al., 2015), the rats received injections of LPS (0.5 mg/kg/d, i.p., dissolved in sterile saline) for 7 d.
Drug delivery.
Ketamines were purchased from Tocris Bioscience. They were dissolved in normal saline and administered by intraperitoneal injection or through a guided cannula to the LHb region. The dose of ketamine was 25 mg/kg, which was based on a previous study (Yang et al., 2018). For guided cannula infusion, based on previously described methods, a 26 gauge double guide cannula was inserted into the bilateral LHb (from bregma: anteroposterior, −3.7 mm; mediolateral, ±0.7 mm; dorsoventral, −4.05 mm) at a certain angle to the coronal plane and then a 33 gauge double dummy cannula was inserted to prevent clogging. After 7 d of recovery, ketamine (25 μg/μl, 1 μl/side) was administered locally through the cannula. The cannula positions were verified by injecting methylene blue dye through the cannula after all behavioral tests were completed.
Behavioral tests.
For locomotion testing, the rats were placed in the test box. Cumulative exercise over 60 min was recorded using an animal movement analysis system. In the forced swimming test (FST), the rats were placed in a cylinder containing water. Behavior was recorded by an animal movement analysis system for 6 min. The immobility time was calculated as total time – active time. In the sucrose preference test (SPT), the rats were single housed with access to water and 2% sucrose solution for 48 h. After deprivation of drinking water for 4 h, a bottle of water and a bottle of 2% sucrose solution were given for 2 h. The position of the bottles was switched after 1 h. The sucrose consumption ratio was calculated as the sugar solution consumption/total liquid consumption. All behavioral tests were performed in a double-blind manner.
LHb lesions.
Rats were anesthetized and positioned in the stereotaxic instrument. A bilateral electrolytic lesion of the LHb was performed using stainless steel electrodes, and a DC current of 1 mA for 30 s was applied using an electronic stimulator. Sham-operated rats were submitted to the same surgical procedure, but no electric current was applied through the electrode. The lesioned area was confirmed by Nissl staining.
Electrophysiological recording.
For in vivo electrophysiological recording, eight recording tetrodes were implanted into the LHB. Adaptive recording was started after a 2 week recovery period. On the day of the experiment, the spontaneous spiking activity was recorded for 30 min at 30 min before and 1 h after drug administration. Spike sorting was performed using an offline sorter. The burst events per minute, percentage of spike firing within bursts, and intraburst and interburst intervals were analyzed by Neuroexplorer and MATLAB. Refer to the previous study for more details (Yang et al., 2018). For in vitro electrophysiological recording, rats were anesthetized with isoflurane and perfused with iced artificial CSF (ACSF). Brain tissue was quickly removed after decapitation and submerged in oxygenated ACSF. Brain slices containing habenula were sectioned and incubated in ASCF at 32°C for functional recovery. Miniature EPSCs (mEPSCs) were measured under the whole-cell patch-clamp mode. Neurons were clamped at –60 mV in the presence of TTX and picrotoxin. Data were filtered at 2 kHz and sampled at 10 kHz using Digitata 1322a. Data were analyzed using the Mini Analysis Program.
Immunoblot.
Rats were killed under deep anesthesia. Brains were removed as quickly as possible, and habenula tissue was isolated and preserved in liquid nitrogen. After homogenizing and centrifuging, the protein samples were separated by SDS-PAGE. The transferred blots were incubated with anti-GluR1 antibody and anti-β-actin antibody at 4°C overnight. The next day, blots were washed and then incubated with the corresponding HRP-labeled secondary antibody at room temperature for 2 h. The protein bands were detected by enhanced chemiluminescence and analyzed using ImageJ software.
Statistical analysis.
Data are expressed as the mean± SEM. The animal sample size was chosen based on previous literature. All data were tested for normality and equality of variances (if necessary) before statistical analysis. The independent-samples t test, one-way ANOVA (followed by Tukey's test), or Fisher's exact test were used for comparisons. p < 0.05 indicated a statistically significant difference.
Results
Intra-LHb injection of (R,S)-ketamine rapidly relieves depression-like behaviors in CRS rats, but effects are not sustained
Similar to previous studies (Tan et al., 2017; Yang et al., 2018), intraperitoneal injection of (R,S)-ketamine did not affect the motor function of CRS rats (Fig. 1A,B), but significantly reduced immobility time in the FST (F(4,31) = 19.20, p < 0.001) and increased latency to immobility onset in the FST (F(4,29) = 5.638, p = 0.0018) at 1 and 24 h after single-dose administration (Fig. 1C,D). Furthermore, intraperitoneal injection of (R,S)-ketamine significantly reversed the reduced sucrose preference in CRS rats at 1 h and 24 h after injection (F(4,33) = 8.783, p < 0.001; Fig. 1E), suggesting that systemic administration of (R,S)-ketamine exerts rapid (at 1 h) and sustained (at 24 h) antidepressant-like effects. To determine whether the LHb also participates in the sustained antidepressant-like effect of ketamine, we locally infused (R,S)-ketamine into the LHb and assessed depressive-like behaviors (Fig. 1F,G). A single dose of (R,S)-ketamine into the LHb significantly reversed the increased immobility time (F(4,36) = 24.35, p < 0.001) and decreased latency to immobility onset (F(4,31) = 10.69, p < 0.001) in the FST at 1 h, but not at 24 h, after injection (Fig. 1I,J). The motor function of CRS rats was not affected by this single intra-LHb injection of (R,S)-ketamine (Fig. 1H). Similarly, intra-LHb injection of (R,S)-ketamine significantly improved the sucrose preference of CRS rats (F(4,35) = 12.21, p < 0.001). However, this improvement was reversed 24 h after ketamine administration (Fig. 1K). Neither intraperitoneal injection of (R,S)-ketamine nor intra-LHb injection of (R,S)-ketamine had no effect on the depressive-like behaviors in control rats (Fig. 1E–H, Extended Data Fig. 1-1A–D). These findings suggest that local infusion of (R,S)-ketamine into the LHb exerts an acute, rather than a sustained, antidepressant-like effect in rats.
The antidepressant effects of systemic or intra-LHb injection of (R,S)-ketamine in CRS rats. A, Schematic illustration of experimental protocol. B, Effect of intraperitoneal injection of (R,S)-ketamine on the LMA. n.s., Not significant. n = 6–9. C, Effect of intraperitoneal injection of (R,S)-ketamine on the immobile time in the FST. ***p < 0.001; n = 6–8. D, Effect of intraperitoneal injection of (R,S)-ketamine on the latency to immobility onset of FST. *p < 0.05, **p < 0.01; n = 6–8. E, Effect of intraperitoneal injection of (R,S)-ketamine on the SPT. *p < 0.05; n = 6–9. F, Schematic illustration of experimental protocol. G, The verified infusion sites. H, Effect of intra-LHb injection of (R,S)-ketamine on the LMA. n.s., Not significant. n = 7–10. I, Effect of intra-LHb injection of (R,S)-ketamine on the immobile time in the FST. ***p < 0.001, n.s., not significant. n = 7–9. J, Effect of intra-LHb injection of (R,S)-ketamine on the latency to immobility onset of FST. **p < 0.01, n.s., not significant. n = 6–8. K, Effect of intra-LHb injection of (R,S)-ketamine on SPT. ***p < 0.001, n.s., not significant. n = 6–9. Six rats were removed from the analysis for incorrect cannulae placement (H–K). LMA, Locomotion activity.
The sustained, not the acute, antidepressant-like effect of systemic administration of (R,S)-ketamine was found in CRS rats following LHb lesions
To determine whether the LHb per se is involved in the sustained antidepressant-like effects of ketamine, bilateral lesions of the LHb were performed and depressive-like behaviors of CRS rats after systemic administration of ketamine were assessed (Fig. 2A,B). The results showed that intraperitoneal injection of (R,S)-ketamine did not affect the motor function of CRS rats following LHb lesions (Fig. 2C), but significantly reduced immobility time in the FST (F(6,43) = 8.828, p < 0.001), increased latency to immobility onset in the FST (F(6,43) = 7.529, p < 0.001), and reversed the reduced sucrose preference (F(6,43) = 6.786, p < 0.001) at 24 h, but not 1 h, after single-dose administration (Fig. 2D–F), suggesting that the rapid, not the sustained, antidepressant-like effects of the systemic administration of (R,S)-ketamine was dependent on the LHb. Moreover, we found that bilateral lesions of the LHb improved the depressive-like behaviors of CRS rats, which were manifested as reduced immobility time, increased latency to immobility onset in the FST, and increased sucrose preference (Fig. 2C–F). Collectively, these results indicated that the LHb is important for the induction of depressive-like behaviors and is crucial to the acute, but not sustained, antidepressant-like effects of ketamine.
The antidepressant effects of systemic injection of (R,S)-ketamine in CRS rats following LHb lesions. A, Schematic illustration of experimental protocol. B, A representative Nissl-stained brain section from the lesion group. C, Effect of intraperitoneal injection of (R,S)-ketamine on the LMA. n.s., Not significant. n = 6–8. D, Effect of intraperitoneal injection of (R,S)-ketamine on the immobile time in the FST. *p < 0.05, **p < 0.01; n = 6–8. E, Effect of intraperitoneal injection of (R,S)-ketamine on the latency to immobility onset of FST. *p < 0.05, **p < 0.01; n = 6–8. F, Effect of intraperitoneal injection of (R,S)-ketamine on the SPT. *p < 0.05, **p < 0.01; n = 6–9. Seven rats were removed from the analysis for incorrect LHb lesions (C–F). LMA, Locomotion activity.
Intra-LHb injection of (R,S)-ketamine rapidly relieves depression-like behaviors in LPS and cLH rats, but the effect is not sustained
To further determine the sustained antidepressant-like effect of local injection of (R,S)-ketamine into the LHb, two other models [LPS-induced depression-like model (Adzic et al., 2015) and cLH model (Henn and Vollmayr, 2005)] were used. Compared with the saline group, intra-LHb injection of (R,S)-ketamine (Fig. 3A,B) did not affect motor function in LPS rats (Fig. 3C), but did significantly reduce immobility time (F(4,29) = 11.67, p < 0.001), prolong the latency to immobility onset (F(4,27) = 23.60, p < 0.001) in the FST, and increase sucrose preference (F(4,29) = 8.263, p < 0.001) at 1 h, but not 24 h, after injection (Fig. 3D–F). Similarly, local infusion of (R,S)-ketamine into the LHb (Fig. 3G,H) significantly decreased immobility time (F(4,32) = 11.12, p < 0.001), increased the latency to immobility onset (F(4,29) = 19.49, p < 0.001) in the FST, and increased sucrose preference (F(4,29) = 7.914, p < 0.001) in cLH rats 1 h after injection. This improvement of depressive-like behaviors in cLH rats was reversed at 24 h after (R,S)-ketamine administration. There was no significant change in immobility time, latency to immobility onset in the FST, and sucrose preference between saline and (R,S)-ketamine groups at 24 h (Fig. 3J–L). No significant difference in motor function was observed among all groups (Fig. 3I). These findings suggest that local injection of (R,S)-ketamine into the LHb exerts a transient, rather than a long-term, antidepressant-like effect. The LHb may only participate in the rapid, and not the sustained, antidepressant-like effect of ketamine.
The antidepressant effects of intra-LHb injection of (R)-ketamine or (S)-ketamine in CRS rats. A, Schematic illustration of experimental protocol of (R)-ketamine. B, The verified infusion sites. C, Effect of intra-LHb injection of (R)-ketamine on the LMA. n.s., Not significant. n = 6–10. D, Effect of intra-LHb injection of (R,S)-ketamine on the immobile time in the FST. n.s., Not significant. n = 6–9. E, Effect of intra-LHb injection of (R)-ketamine on the latency to immobility onset of FST. n.s., Not significant. n = 6 and 7. F, Effect of intra-LHb injection of (R)-ketamine on the SPT. n.s., Not significant. n = 6–8. Five rats were removed from the analysis for incorrect cannulae placement (C–F). G, Schematic illustration of experimental protocol of (S)-ketamine. H, The verified infusion sites. I, Effect of intra-LHb injection of (S)-ketamine on the LMA. n.s., Not significant. n = 6–10. J, Effect of intra-LHb injection of (S)-ketamine on the immobile time in the FST. ***p < 0.001, n.s., not significant. n = 6–8. K, Effect of intra-LHb injection of (S)-ketamine on the latency to immobility onset of FST. **p < 0.01, n.s., not significant. n = 6–9. L, Effect of intra-LHb injection of (S)-ketamine on SPT. *p < 0.05, n.s., not significant. n = 6–9. Four rats were removed from the analysis for incorrect cannulae placement (I–L). LMA, Locomotion activity.
Intra-LHb injection of (S)-ketamine, but not (R)-ketamine, rapidly relieves depression-like behaviors in CRS rats
(R,S)-ketamine is a racemic mixture comprising equal amounts of (R)-ketamine and (S)-ketamine. Previous studies have reported that (R)-ketamine has a stronger and longer-lasting antidepressant effect than (S)-ketamine (Zhang et al., 2014; Yang et al., 2015). To investigate whether a sustained antidepressant-like effect can be achieved by single application of (R)-ketamine, we injected (R)-ketamine into the LHb and tested its antidepressant-like effect in CRS rats (Fig. 4A,B). Our results showed that local infusion of (R)-ketamine into the LHb had no effect on immobility time, latency to immobility onset in the FST, and sucrose preference at 1 and 24 h after injection in CRS rats (Fig. 4C–F). Interestingly, intra-LHb injection of (R)-ketamine or (S)-ketamine (Fig. 4G,H) acutely improved depressive-like behaviors in CRS rats, which were manifested as reduced immobility time (F(4,29) = 13.65, p < 0.001), increased latency to immobility onset (F(4,31) = 10.75, p < 0.001) in the FST, and increased sucrose preference (F(4,33) = 6.446, p < 0.001) at 1 h, but not 24 h, after drug administration (Fig. 4I–L). Intra-LHb injection of (R)-ketamine or (S)-ketamine had no effect on the depressive-like behaviors in control rats (Fig. 2E–H, Extended Data Fig. 2-1A–D).
The antidepressant effects of intra-LHb injection of (S)-ketamine in CRS rats. A, Schematic illustration of experimental protocol of (S)-ketamine. B, The verified infusion sites. C, Effect of intra-LHb injection of (S)-ketamine on the LMA. n.s., Not significant. n = 6–10. D, Effect of intra-LHb injection of (S)-ketamine on the immobile time in the FST. ***p < 0.001, n.s., not significant. n = 6–8. E, Effect of intra-LHb injection of (S)-ketamine on the latency to immobility onset of FST. **p < 0.01, n.s., not significant. n = 6–9. F, Effect of intra-LHb injection of (S)-ketamine on SPT. *p < 0.05, n.s., not significant. n = 6–9. Four rats were removed from the analysis for incorrect cannulae placement (G–L). LMA, Locomotion activity.
Intra-LHb injection of (2R,6R)-hydroxynorketamine has no effect on depression in CRS rats
It has been reported that ketamine exerts its sustained antidepressant-like effect mainly through its metabolite (2R,6R)-hydroxynorketamine (HNK; Zanos et al., 2016). To determine the role of (2R,6R)-HNK in the antidepressant-like effect of LHb-mediated ketamine, (2R,6R)-HNK was locally injected into the LHb of rats and depressive-like behaviors were assessed. Our results showed that intra-LHb injection of (2R,6R)-HNK (Fig. 5A,B) did not affect locomotion activity (Fig. 5C). Furthermore, (2R,6R)-HNK had no effect on the immobility time, latency to immobility onset in the FST, or sucrose preference in CRS rats at 1 or 24 h after drug injection (Fig. 5D–F). Intra-LHb injection of 2R,6R-HNK had no effect on the depressive-like behaviors in control rats (Extended Data Fig. 2-1I–L).
The antidepressant effects of intra-LHb injection of (2R,6R)-HNK in CRS rats. A, Schematic illustration of experimental protocol. B, The verified infusion sites. C, Effect of intra-LHb injection of (2R,6R)-HNK on the LMA. n.s., Not significant. n = 6–8. D, Effect of intra-LHb injection of (2R,6R)-HNK on the immobile time in the FST. n.s., Not significant. n = 6–8. E, Effect of intra-LHb injection of (2R,6R)-HNK on the latency to immobility onset of FST. n.s., Not significant. n = 6 and 7. F, Effect of intra-LHb injection of (2R,6R)-HNK on the SPT. n.s., Not significant. n = 6–8. Three rats were removed from the analysis for incorrect cannulae placement (C–F). LMA, Locomotion activity.
Systemic administration of (R,S)-ketamine suppresses bursting in the LHb in an acute, but not a sustained, way
Recent studies have found that the rapid antidepressant effect of ketamine may be achieved by inhibiting the burst firing of LHb neurons (Yang et al., 2018). To investigate whether decreased bursting activity in the LHb is involved in the sustained antidepressant effect of ketamine, LHb bursting was assessed by in vivo electrophysiological recording at 1 and 24 h after intraperitoneal injection of (R,S)-ketamine in CRS rats (Fig. 6A). Consistent with previous studies, the bursting activity of LHb neurons was significantly increased in CRS rats compared with control rats (t(1) = 5.534, t(2) = 4.038, p < 0.001; Fig. 6B,C,E). Intraperitoneal injection of (R,S)-ketamine significantly reduced CRS-induced increases in the burst firings of LHb neurons at 1 h after (R,S)-ketamine injection. However, this inhibitory effect was reversed at 24 h (F(2,38) = 138.9, p < 0.001; F(2,38) = 45.64, p < 0.001; Fig. 6B,D,E), suggesting that (R,S)-ketamine has an acute, but not a sustained, suppressive effect on the bursting activity of LHb neurons. These results suggest that the sustained antidepressant-like effect of ketamine may not be achieved by suppressing burst firing in the LHb.
Effect of systemic injection of (R,S)-ketamine on bursting activity of LHb neurons. A, Schematic illustration of experimental protocol. B, Recording sites of each tetrode and example traces and average spike waveform of LHb neurons. C, Percentage of spikes in bursting and number of bursts per minute of LHb neurons from control and CRS rats. ***p < 0.001; n = 38 and 39. D, Effect of systemic administration of (R,S)-ketamine on the percentage of spikes in bursting and the number of bursts per minute of LHb neurons. **p < 0.01, ***p < 0.001, n.s., not significant. n = 20. E, Cumulative distribution of interspike intervals (ISIs). **p < 0.01, n.s., not significant.
Systemic administration of (R,S)-ketamine has no effect on mEPSCs or GluR1 expression in the LHb of CRS rats
In addition to increasing burst firing, the GluR1-type AMPA receptor-mediated increase in mEPSCs of LHb neurons leads to depression-like behaviors (Li et al., 2013). To investigate whether the antidepressant-like effect of ketamine is associated with the synaptic properties of LHb neurons, mEPSCs, and expression of GluR1 were examined at 1 and 24 h after ketamine administration (Fig. 7A). The results showed that CRS significantly increased the frequency and amplitude of mEPSCs in LHb neurons (F(3,50) = 13.89, p < 0.001; F(3,50) = 4.330, p < 0.001; Fig. 7B–D). However, there was no significant change in the frequency or amplitude of mEPSCs in LHb neurons at 1 or 24 h after intraperitoneal administration of (R,S)-ketamine relative to the control in CRS rats (Fig. 7B–D). Similarly, the increased GluR1 expression of LHb induced by CRS was not affected by systemic injection of ketamine at 1 or 24 h (Fig. 7E). These results suggest that the acute and sustained antidepressant-like effects of (R,S)-ketamine are not related to the synaptic properties of LHb neurons.
Effect of systemic injection of (R,S)-ketamine on mEPSC of LHb neurons and expression of GluR1. A, Schematic illustration of experimental protocol. B, Recording sites of each tetrode and example mEPSC traces of LHb neurons. C, Effect of systemic administration of (R,S)-ketamine on the cumulative distribution of mEPSC amplitude of LHb neurons. ***p < 0.001; n = 12–15. D, Effect of systemic administration of (R,S)-ketamine on the cumulative distribution of mEPSC interevents interval and average frequency of LHb neurons. *p < 0.05; n = 12–15. E, Effect of systemic administration of (R,S)-ketamine on the expression of GluR1 in LHb. **p < 0.01; n = 6–8.
Discussion
Previous studies have indicated that ketamine rapidly relieves depression by blocking bursting in the LHb (Yang et al., 2018). In the present study, we found that the sustained antidepressant-like effect of ketamine may not depend on the suppression of burst firing of LHb neurons.
Ketamine, which was discovered in the 1960s, is a psychotropic drug. Early on, ketamine was frequently used as an anesthetic. However, studies in 2000 and after found that ketamine is a rapid and effective antidepressant. A single dose of ketamine (0.5 mg/kg) can improve depressive symptoms in patients with major depressive disorder within 40 min and the effects can last for 1 week (Zarate et al., 2006). Animal experiments showed that systemic administration of ketamine significantly attenuated depressive-like behaviors within 1 h and could last for >1 week (Maeng et al., 2008; Li et al., 2010). In the present study, our results confirmed that systemic administration of (R,S)-ketamine rapidly (1 h after injection) improved depressive-like symptoms in CRS rats and that the effects were sustained for 24 h after injection.
The antidepressant mechanisms of ketamine are highly complex and controversial. Ketamine is proposed to block NMDARs on the presynaptic membranes of cortical GABAergic interneurons (specifically parvalbumin-positive neurons; Duman and Aghajanian, 2012; Duman et al., 2016), resulting in the disinhibition of pyramidal neurons (Widman and McMahon, 2018). This disinhibition of pyramidal neurons then causes a series of changes in synaptic communication, including enhanced AMPAR signaling (Maeng et al., 2008; Zanos et al., 2016), potentiated brain-derived neurotrophic factor synthesis and release (Jourdi et al., 2009; Monteggia and Zarate, 2015), and increased mammalian target of rapamycin-dependent synaptic synaptogenesis (Li et al., 2010; Lepack et al., 2014). Ketamine also acts on hippocampal neurons through its metabolite (2R,6R)-HNK and achieves a rapid antidepressant effect by activating AMPAR rather than NMDAR (Zanos et al., 2016). Recently, Yang et al. (2018) found that the LHb is a key nucleus for the development of depression (Li et al., 2013) and showed the rapid antidepressant effect of ketamine via inhibition of burst firing of LHb neurons (Cui et al., 2019). In the present study, we also found that intra-LHb injection of ketamine could rapidly (1 h after administration) improve depressive-like symptoms in CRS, LPS, and cLH rats. Systemic administration of ketamine significantly inhibited the bursting activity of LHb neurons 1 h after injection, confirming the importance of the LHb in the rapid antidepressant-like effect of ketamine. However, we did not observe a sustained antidepressant-like effect following local infusion of ketamine into the LHb in CRS, LP, and cLH rats. The suppressed bursting activity of LHB neurons recovered almost to control levels 24 h after ketamine injection. Our results therefore suggest that blockade of the burst firing of LHb neurons is essential for the acute antidepressant effect of ketamine, but it may not be the key factor for the sustained antidepressant effect of systemic application of ketamine.
Previous studies have reported that LHb-mediated depression is related to increased expression of GluR1 and enhancement of mEPSCs (Li et al., 2013). However, local injection of the AMPA receptor blocker NBQX into the LHb did not improve depressive-like behaviors in cLH rats. Infusion of NBQX only slightly reduced the bursting activity of LHb neurons (<20%; Yang et al., 2018). Ketamine markedly reduced the bursting activity of LHb neurons (∼80%; Yang et al., 2018) and therefore had a significant antidepressant effect, suggesting that LHb burst firing is a key factor in depression and in the antidepressant effect of ketamine. In our study, ketamine had neither an acute (1 h after injection) nor sustained (24 h after injection) effect on the mEPSCs of LHB neurons. Furthermore, no significant change in the expression of GluR1 was observed between the ketamine group and the control group at 1 or 24 h after drug injection. These findings suggest that synaptic transmission of LHb neurons may not be essential for the acute and persistent antidepressant effect of ketamine.
(R,S)-ketamine is a racemic mixture comprising (R)-ketamine and (S)-ketamine. The affinity of (S)-ketamine to the NMDA receptor is ∼4.5 times greater than that of (R)-ketamine (Domino, 2010). Many studies have shown that the NMDA receptor mediates the antidepressant effect of ketamine (Moghaddam et al., 1997; Khlestova et al., 2016; Perszyk et al., 2016), but other studies suggest otherwise (Yang et al., 2016; Zanos et al., 2016). Yang et al. (2018) showed that ketamine exerts its rapid antidepressant effect through NMDA receptor-mediated suppression of bursting in LHb neurons. In the present study, our results indicate that intra-LHb injection of (S)-ketamine has a strong affinity to the NMDA receptor, producing a significant antidepressant effect, whereas intra-LHb injection of (R)-ketamine has a weak affinity to the NMDA receptor and a much smaller antidepressant effect. These findings support that the NMDA receptor plays an important role in the LHb-mediated antidepressant effects of ketamine, at least during the acute period.
Ketamine is metabolized into a variety of metabolites, such as norketamine, hydroxyketamine, and HNK, by the liver. Zanos et al. (2016) reported that (2R,6R)-HNK, a ketamine metabolite, exerts a rapid and long-term antidepressant effect by activating the AMPA receptor rather than by blocking the NMDA receptor. Since ketamine is unlikely to be metabolized in the liver after local infusion into the LHb, it is possible that intra-LHb injection of ketamine does not produce a sustained antidepressant effect because of the lack of ketamine metabolites. Our results showed that intra-LHb injection of (2R,6R)-HNK did not produce acute or sustained antidepressant effects, suggesting that the antidepressant effect of locally administered ketamine is independent of (2R,6R)-HNK. This may because of the fact that intra-LHb application of ketamine exerts an antidepressant effect by blocking NMDA receptors, while (2R,6R)-HNK exerts an antidepressant effect by activating AMPA receptors.
The involvement of other brain regions may contribute to the sustained antidepressant effect of ketamine. Early studies reported that local infusion of ketamine into different brain regions, including the prefrontal cortex (PFC) and hippocampus, produced antidepressant effects at different times. For example, local injection of ketamine in the PFC produced significant antidepressant effects 24 h after injection, while intrahippocampus injection of ketamine produced significant antidepressant effects after 4 d (Rasmussen et al., 2013; Shirayama and Hashimoto, 2017). Therefore, the long-term antidepressant effect of ketamine may be caused by the different times of signaling mechanisms produced by different brain regions.
Many brain regions, including LHb, are reported to be involved in the generation of depression. Therefore, the lesions of LHb only partially improve the depressive symptoms. In our study, we found that LHb is the target of a rapid, rather than a sustained, antidepressant effect of ketamine. The sustained antidepressant effect of ketamine may depend on other brain regions. Administration of ketamine further improve the depressive-like behaviors through acting on these brain regions in LHb-lesioned animals. In the future, it will be necessary to explore the antidepressant effects and mechanisms of ketamine in different brain regions.
In conclusion, this study suggests that blocking burst firing of LHb neurons is not essential for the long-term antidepressant effect of ketamine.
Footnotes
This study was supported by the National Natural Science Foundation of China (Grant 82001173).
The authors declare no competing financial interests.
- Correspondence should be addressed to Cunming Liu at cunmingliu{at}njmu.edu.cn or Xuelong Zhou at 11318255{at}zju.edu.cn
