NOVA Health Recovery Ketamine Infusion Center– 703-844-0184 | Ketamine Therapies in Northern Virginia
Infusions of Scopolamine can be used alone or added to Ketamine therapy for rapid antidepressant treatment. Below is information regarding this treatment offered in NOVA Heath Recovery Ketamine Infusion Center in Alexandra, Virginia.
The cholinergic system is one of the neurotransmitter systems implicated in the pathophysiologic mechanism of mood disorders. Increasing cholinergic activity using physostigmine (an anticholinesterase inhibitor) provides a challenge uniquely capable of exacerbating depressive symptoms in currently depressed patients with MDD and inducing depressive symptoms in currently manic patients with Bipolar disorder. The cholinergic system also is implicated in depression by evidence showing that polysomnographic responses to muscarinic receptor agonists and neuroendocrine and pupillary responses to cholinomimetics13–16 are exaggerated in depressed patients and that some muscarinic receptor gene polymorphisms are associated with an elevated incidence of depression Elevated cholinergic function thus was hypothesized to participate in the pathogenesis of mood disorders Putative animal models of depression also have implicated the muscarinic system. The Porsolt “behavioral despair” model of depression that uses the forced swim test is used broadly to evaluate the effect of pharmacologic agents on depressive behaviors. In the context of this model, antimuscarinic agents produced antidepressant-like effects, although these findings were considered “false-positives” based on the assumption that these agents did not exert antidepressant effects in humans. Moreover, rats bred selectively for increased sensitivity of muscarinic receptors showed putative behavioral analogues of depression, such as lethargy, reductions in self-stimulation, and increased behavioral despair, in the forced swim test in response to cholinomimetic drugs.
In 2006, Maura Furey, Ph.D., and Wayne Drevets, M.D., of
the National Institute of Mental Health DISCOVERED that
symptoms of depression and anxiety decreased quickly in
patients with major depressive disorder or bipolar disorder
who received scopolamine intravenously. The researchers
compared nine patients who received three infusions of
scopolamine over approximately 10 days, followed by three
infusions of placebo over the same timeframe with nine
patients who first received three infusions of placebo,
followed by three infusions of scopolamine.
The patients—many of whom had a poor prognosis for
response to treatment—who received scopolamine first
showed a greater reduction in Montgomery–Åsberg
Depression Rating Scale (MADRS) score compared with
patients who received placebo first.
The antidepressant effects began as early as 24 hours after the first infusion and continued to improve over the next two infusions. These
improvements lasted at least 10 days following the last
scopolamine dose. A FOLLOW-UP STUDY of 23 patients with
MDD found scopolamine produced similar antidepressant
In 2012, researchers in Iran led by Danial Khajavi, M.D.,
compared 40 patients with MDD randomly assigned to either
oral scopolamine plus citalopram or citalopram plus placebo.
Augmentation with scopolamine was significantly more
effective than placebo, with 65 percent of patients receiving
scopolamine showing higher rates of response at week 4 and
remission at week 6 than patients receiving placebo.
Scopolamine infused at 4.0 μg/kg intravenously produced robust antidepressant effects versus placebo, which were evident within 3 days after the initial infusion. Placebo-adjusted remission rates were 56% and 45% for the initial and subsequent replication studies, respectively. While effective in male and female subjects, the change in depression ratings was greater in female subjects. Clinical improvement persisted more than 2 weeks following the final infusion. The timing and persistence of the antidepressant response to scopolamine suggest a mechanism beyond that of direct muscarinic cholinergic antagonism. These temporal relationships suggest that scopolamine induced changes in gene expression and synaptic plasticity may confer the therapeutic mechanism .