Inhibition of SERT and NMDAR synergistically confers rapid antidepressant effects of ketamine
Huoqing Luo, Ming Chen, Yingjie Ning, Li Ren, Yiping Lu, Junyou Sun, Xiaona Zhu, Mingzi Ran, Juan Guo, Chen Lu, Chengyu Fan, Jianjun Cheng, Weimin Zheng, Yue Hu, Tangsheng Lu, Gang Wang, Wenzhi Sun, Hailong Dong, Jingpeng Ge, Ji Hu
National Science Review September 5, 2025 DOI: 10.1093/nsr/nwaf367 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Experimental study Peer reviewed |
|---|---|
| Intervention | Ketamine |
| Topics | Ketamine Serotonin Esketamine |
| Keywords | Antidepressant Nmda receptor Neurotransmitter Reuptake inhibitor Escape response Pharmacology 5-HT Receptor Blockade Serotonin uptake inhibitors |
| Citations | 1 |
| Key findings | Ketamine elevates serotonin by inhibiting the serotonin transporter, and this increase activates VIP-expressing interneurons, which are essential for its rapid antidepressant effects. |
Abstract
-methyl-d-aspartate receptor (NMDAR) blockade is crucial for the rapid antidepressant effects of ketamine, the involvement of other mechanisms remains contentious, particularly regarding the role of serotonin, a key neurotransmitter in the target of traditional antidepressants. Here, we demonstrate that ketamine elevates serotonin levels by inhibiting the serotonin transporter (SERT). A cryogenic electron microscopy structure of ketamine-bound SERT in the outward-open conformation, resolved at 3.2 Å, indicates that ketamine binds to the central site of SERT. Elevated serotonin, along with NMDAR inhibition, induces ketamine-like rapid antidepressant effects. This increase in serotonin leads to the activation of vasoactive intestinal peptide (VIP)-expressing interneurons, which are essential for the rapid antidepressant effects of ketamine. Inhibition of VIP neurons blocks these effects and ketamine-like effects, highlighting a crucial cell type-specific mechanism. These findings identify a critical pathway in the rapid antidepressant actions of ketamine and offer potential pharmacological strategies for developing rapidly acting antidepressants.
Comparable studies
Other experimental studies on ketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Ketamine activates psychosis and alters limbic blood flow in schizophrenia Schizophrenic individuals | 1995 | Experimental study | |
| The spectral exponent of the resting EEG indexes the presence of consciousness during unresponsiveness induced by propofol, xenon, and ketamine Healthy participants | 2019 | Controlled experimental study | n = 15 |
| Ketamine Increases Human Motor Cortex Excitability to Transcranial Magnetic Stimulation Normal human subjects | 2003 | Experimental study | n = 7 |
| Evidence that Subanesthetic Doses of Ketamine Cause Sustained Disruptions of NMDA and AMPA-Mediated Frontoparietal Connectivity in Humans Human participants | 2015 | Experimental study | |
| Simultaneous population pharmacokinetic modelling of ketamine and three major metabolites in patients with treatment‐resistant bipolar depression Patients with treatment-resistant bipolar depression | 2012 | Population pharmacokinetic analysis | n = 9 |
Citations in the library
Cites 31
- A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression Archives of General Psychiatry August 1, 2006
- mTOR-Dependent Synapse Formation Underlies the Rapid Antidepressant Effects of NMDA Antagonists Science August 19, 2010
- NMDAR inhibition-independent antidepressant actions of ketamine metabolites Nature April 24, 2016
- Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms Pharmacological Reviews June 26, 2018
- Antidepressant Efficacy of Ketamine in Treatment-Resistant Major Depression: A Two-Site Randomized Controlled Trial American Journal of Psychiatry August 28, 2013
and 26 more in the library