Effect of naltrexone pretreatment on ketamine-induced glutamatergic activity and symptoms of depression: a randomized crossover study.
Luke A. Jelen, David J Lythgoe, James Stone, Allan H. Young, Mitul A. Mehta
Nature Medicine July 24, 2025 DOI: 10.1038/s41591-025-03800-w (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Double-blind crossover study Randomized Peer reviewed |
|---|---|
| Sample size | 26 |
| Population | Adults with major depressive disorder |
| Interventions | Naltrexone Ketamine |
| Dose | 50 mg naltrexone, 0.5 mg per kg ketamine |
| Topics | Ketamine Depression Esketamine |
| Keywords | Depression treatment Opioid system Mechanism of action |
| Citations | 29 |
| Registration | NCT04977674 |
| Key points | Naltrexone attenuated the ketamine-induced increase in glutamatergic activity in the anterior cingulate cortex and reduced the antidepressant effect on day 1, indicating the opioid system modulates ketamine's acute and sustained effects. |
Abstract
We investigated the potential role of the opioid system in modulating glutamatergic effects of ketamine administration in major depressive disorder. Twenty-six adults with major depressive disorder participated in a double-blind crossover study, receiving oral placebo or 50 mg naltrexone before an intravenous infusion of 0.5 mg per kg ketamine. Brain glutamatergic activity in the anterior cingulate cortex was measured using functional magnetic resonance spectroscopy and depressive symptoms were assessed with the Montgomery-Åsberg Depression Rating Scale. Naltrexone attenuated the increase in glutamate + glutamine to total N-acetylaspartate ratio during ketamine infusion compared to placebo (F1,253 = 4.83, P = 0.029) and also attenuated the reduction in Montgomery-Åsberg Depression Rating Scale scores on day 1 (condition-by-time interaction, F1,74 = 5.39, P = 0.023). These findings demonstrate that the opioid system modulates the acute response to ketamine and subsequent antidepressant effects. Interactions between the glutamate and opioid systems may have implications for the development of new depression treatment strategies. ClinicalTrials.gov registration: NCT04977674 .