Professional Documents
Culture Documents
Neuroplasticity As A Convergent Mechanism of Ketamine and Classical Psychedelics Lily R Aleksandrova Anthony G Phillips Full Chapter PDF
Neuroplasticity As A Convergent Mechanism of Ketamine and Classical Psychedelics Lily R Aleksandrova Anthony G Phillips Full Chapter PDF
https://ebookmass.com/product/psychedelics-as-psychiatric-
medications-david-nutt/
https://ebookmass.com/product/building-the-classical-world-
bauforschung-as-a-contemporary-approach-dorian-borbonus/
https://ebookmass.com/product/philosophy-of-psychedelics-chris-
letheby/
https://ebookmass.com/product/morality-and-responsibility-of-
rulers-european-and-chinese-origins-of-a-rule-of-law-as-justice-
for-world-order-anthony-carty/
Defensive Expectations: Reinventing the Phillips Curve
as a Policy Mix 1st ed. Edition Liviu Voinea
https://ebookmass.com/product/defensive-expectations-reinventing-
the-phillips-curve-as-a-policy-mix-1st-ed-edition-liviu-voinea/
https://ebookmass.com/product/solid-state-chemistry-and-its-
applications-2nd-edition-anthony-r-west/
https://ebookmass.com/product/searching-for-a-mechanism-a-
history-of-cell-bioenergetics-john-n-prebble/
https://ebookmass.com/product/diplomacy-theory-and-practice-6th-
edition-g-r-berridge/
https://ebookmass.com/product/just-a-little-promise-phillips/
Trends in
Pharmacological Sciences
Review
The emerging therapeutic efficacy of ketamine and classical psychedelics for Highlights
depression has inspired tremendous interest in the underlying neurobiological Region-specific dysregulation of
mechanisms. We review preclinical and clinical evidence supporting neuroplasticity neuroplasticity is implicated in depression.
as a convergent downstream mechanism of action for these novel fast-acting
Ketamine (NMDAR antagonism) and clas-
antidepressants. Through their primary glutamate or serotonin receptor targets, sical psychedelics (5-HT2AR agonism)
ketamine and psychedelics [psilocybin, lysergic acid diethylamide (LSD), and N, trigger a long-lasting state of enhanced
N-dimethyltryptamine (DMT)] induce synaptic, structural, and functional changes, glutamate-driven neuroplasticity in
frontocorticolimbic pyramidal neurons.
particularly in pyramidal neurons in the prefrontal cortex. These include increased
glutamate release, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid recep- Shared neurobiological mechanisms
tor (AMPAR) activation, brain-derived neurotrophic factor (BDNF) and mammalian involve complex interactions between
target of rapamycin (mTOR)-mediated signaling, expression of synaptic proteins, glutamate, serotonin, and regional
synaptic homeostasis.
and synaptogenesis. Such influences may facilitate adaptive rewiring of patholog-
ical neurocircuitry, thus providing a neuroplasticity-focused framework to explain Effects may 'reset the system' by
the robust and sustained therapeutic effects of these compounds. counteracting synaptic deficits, neu-
ronal atrophy, and loss of connectivity
in depression, leading to behavioral
plasticity and symptom reduction.
Novel pharmacotherapies for disorders of neuroplasticity
Ketamine (see Glossary), a glutamate N-methyl-D-aspartate receptor (NMDAR) antagonist, Ketamine and psychedelics engage
mechanisms rapidly and appear to in-
and classical serotonergic psychedelics are the focus of recent attention as novel fast-
duce long-lasting structural adaptations
acting pharmacotherapies for depression and related disorders, especially in the context of that sustain therapeutic activity without
psychotherapy [1–7]. The emerging clinical data (Box 1) support the robust, rapid, and sustained the need for chronic dosing.
therapeutic efficacy of these diverse compounds in treatment-resistant depression (TRD) and
Neuroplasticity substrates serve as
major depressive disorder (MDD), and intranasal esketamine was approved by the FDA for
potential targets for clinical interven-
TRD in 2019. tion and drug development related to
mental ill-health.
Dysregulation of neural plasticity is implicated in the pathophysiology of depression (Box 2),
consistent with synaptic weakening, neuronal atrophy, and loss of connectivity in vulnerable
brain regions, particularly the prefrontal cortex (PFC) and hippocampus (HPC) (panel 1 in
Figure 1, Key figure) [8–12]. This review integrates preclinical and clinical data from molecular,
electrophysiological, neuroimaging, and behavioral studies which support the hypothesis that
ketamine and classical psychedelics, including psilocybin, LSD, and DMT, all modulate glutamater-
gic neurotransmission, synaptic remodeling, and network activity within circuits implicated in mood 1
Djavad Mowafaghian Centre for Brain
disorders [7,9,10,13–20]. The growing literature suggests that these compounds share key down- Health and Department of Psychiatry,
stream neurobiological mechanisms related to facilitating adaptive neuroplasticity at multiple levels University of British Columbia,
(synaptic plasticity, structural plasticity, and behavioral plasticity). Vancouver, BC, Canada
Via their primary receptor targets, ketamine and psychedelics can both upregulate glutamate
release and excitatory neuronal activity [21–33], brain-derived neurotrophic factor (BDNF)
and mammalian target of rapamycin (mTOR) signaling [18,20,29,32,34–38], the expression *Correspondence:
lily.aleksandrova@ubc.ca
of synaptic proteins [22,23,25,35,39–43], and long-term frontocortical structural plasticity (L.R. Aleksandrova) and
[22,25,32,37,44–48], predominantly in the PFC (Figure 1, panels 2–9). This is thought to reverse aphillips@psych.ubc.ca (A.G. Phillips).
Trends in Pharmacological Sciences, November 2021, Vol. 42, No. 11 https://doi.org/10.1016/j.tips.2021.08.003 929
© 2021 Elsevier Ltd. All rights reserved.
Trends in Pharmacological Sciences
Box 2. Neuroplasticity theory of depression and antidepressant response and disease. mTOR signaling regulates
The monoamine hypothesis of depression has recently been superseded, and attention is shifting towards other promising activity-dependent translation of
treatment targets, especially those related to dysregulation of neural/synaptic plasticity and dysfunction in glutamatergic synaptic proteins, neural plasticity, and
systems [8,10–12,16,79]. In major depressive disorder (MDD) and preclinical models of depression, chronic stress and antidepressant response.
sustained elevations of circulating glucocorticoids are thought to exert neurotoxic effects, particularly within the PFC Neural plasticity: also known as
and HPC [8,10,12,16,79]. Specific stress-induced synaptic, morphological, and functional deficits include loss of long-term neuroplasticity, this underlies the ability
potentiation (LTP) and/or facilitation of long-term depression (LTD), impaired brain-derived neurotrophic factor (BDNF) and of the nervous system to change in
mammalian target of rapamycin (mTOR) signaling, and decreased neurogenesis, synaptogenesis, and dendritic complexity, response to intrinsic or extrinsic stimuli
eventually leading to neuronal atrophy, dysfunction in corticolimbic circuits, and the development/exacerbation of depres- by reorganizing its activity, structure,
sive-like phenotypes in rodent models [8,10,17,20,79]. This is consistent with structural and functional findings in MDD functions, or connections. It plays an
reflecting hypofunction, progressive grey matter volume loss, and reduced functional connectivity in the PFC, HPC, and as- essential role in the capacity of the brain
sociated networks, decreased levels of neurotrophic factors such as BDNF, downregulation of synaptic proteins and genes, to sense, assess, and store information,
and various cognitive deficits in subjects with depression [8,10,12,16,20,79]. In particular, impairments in attention, episodic guide behavior, and adapt to a dynamic
memory, and executive function, as well as the core symptoms of emotional dysregulation, rigid, negative thinking, and environment. This construct has recently
anhedonia, could be mediated by impaired synaptic plasticity processes and loss of connectivity between key brain regions emerged as a promising target for the
that are particularly vulnerable to stress [8,10,12,16,79]. When neuroplasticity is compromised, pathologic and/or beneficial treatment of various neuropsychiatric
circuits cannot be appropriately modulated, ultimately leading to inflexible and maladaptive cognitive/behavioral responses, disorders.
including compromised learning, emotional processing, and stress coping [8,50]. Serotonin (5-HT): a monoamine
neurotransmitter implicated in the
Notably, neuroplasticity across the brain is not uniformly impaired in MDD or indiscriminately enhanced following ketamine regulation of mood, cognition,
and classical psychedelics (Box 3). The medial PFC is thought to serve as the primary site for the therapeutic action of novel neuroplasticity, reward, learning, etc. It
fast-acting antidepressants [8,16,79], where region-specific differences in the relative expression of different receptor acts through a variety of serotonin
subtypes steer effects towards a select subpopulations of neurons, particularly pyramidal cells in layer 5 [14,66]. Because receptors, that are almost exclusively G
the mPFC innervates many subcortical brain areas implicated in depressive symptomatology, including other parts of the protein-coupled receptors (GPCRs),
PFC, limbic structures (HPC and amygdala), nucleus accumbens, dorsal raphe, and hypothalamus, modulation of and which couple to various down-
frontocortical function in depression has a far-reaching impact on brain function and symptom reduction [8–12]. Finally, stream signaling cascades. Of particular
the broad therapeutic potential of neuroplasticity-based pharmacotherapies for conditions that share common neural importance is 5-HT2AR, the canonical
circuitry pathology or display high comorbidity with depression, including bipolar disorder, anxiety, post-traumatic stress hallucinogenic receptor.
disorder (PTSD), substance use disorders, and neurodegenerative diseases, is gaining prominence [16,50,79]. Structural plasticity: physical modifi-
cations of axonal/dendritic branches,
spine morphology, and synaptic
numbers that mediate sustained adap-
Accordingly, sustained modulation of glutamatergic neurotransmission in pyramidal neurons of the tations to environmental stimuli such as
PFC and HPC has emerged as a promising therapeutic target for depression and related disorders learning events or pathophysiological
processes (e.g., synaptogenesis vs.
[5,8,13,55,58]. These opposing/dual actions of ketamine, via direct inhibition of NMDARs, thereby
synaptic atrophy).
enhancing AMPAR function indirectly, and effectively shifting the local excitation–inhibition balance Synaptic plasticity: neural activity-
by targeting pyramidal or GABAergic neurons, appear to serve as crucial triggers of adaptive neural dependent changes in the efficacy of
plasticity and antidepressant response [5,8,13,21,35,55–59]. Importantly, these effects of synaptic transmission at glutamatergic
synapses. In particular, these changes
ketamine are somewhat unique in its drug class because other NMDAR antagonists have failed manifest as long-term potentiation (LTP)
to consistently show robust and/or long-lasting antidepressant effects, presumably owing to key and long-term depression (LTD), which
differences in their pharmacological properties (e.g., receptor affinity, trapping, state-dependency, are thought to represent the cellular
subtype, subcellular location, and intracellular consequences) [5,13,14,55]. Several NMDAR- substrates of learning and memory in the
brain.
independent mechanisms of ketamine, such as the active metabolite (2R,6R)-hydroxynorketamine
(HNK), metabotropic glutamate mGluR2 receptors, and opioid receptor signaling, are beyond the
scope of this review [23,60,61].
Key figure
Neuroplasticity as a convergent mechanism for ketamine and classical
psychedelics
Figure 1. Dysregulation of neural plasticity is implicated in depression, consistent with the observed synaptic weakening,
neuronal atrophy, and loss of connectivity in vulnerable brain regions (panel 1, far left). Accumulating evidence indicates
that ketamine (KET) and classical psychedelics (CPs) share key downstream neurobiological mechanisms related to
neuroplasticity, including modulation of excitatory glutamatergic transmission, dendritic spine remodeling, and frontocortico-
limbic network activity. Specifically, KET acts via N-methyl-D-aspartate receptor (NMDAR) antagonism on inhibitory interneurons
(INs) (disinhibition hypothesis, 2a) and on pyramidal neurons (PNs) (direct inhibition hypothesis, 2b), whereas CPs are thought to
predominantly activate serotonin 5-HT2A receptors within PNs (3a,b), particularly within layer 5 of the medial prefrontal cortex
(mPFC). Through their specific receptor actions, ketamine and psychedelics can both induce a burst of glutamate release and
sustained α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) activation (4) in excitatory PNs. This in
turn potentiates brain-derived neurotrophic factor-tropomyosin receptor kinase B (BDNF-TrkB) (5) and mammalian target of
rapamycin (mTOR) (6) signaling, thus upregulating the expression of neuroplasticity-related genes (7) and protein synthesis
(e.g., via eukaryotic elongation factor 2, eEF2) of synaptic components (8), which triggers an amplification mechanism and
ultimately drives rapid and long-lasting local synaptogenesis (9). These effects are thought to reverse stress-induced structural
and functional deficits in depression by promoting synaptic homeostasis and adaptive rewiring of pathological neural
corticolimbic circuitry, and these effects presumably contribute to the remarkable clinical efficacy of these diverse compounds
(10, far right). Figure created with BioRender.com.
ketanserin blocks the acute subjective effects [67,68]. Similarly, blocking 5-HT2ARs in animals
eliminates many, but not all, of the molecular, synaptic, and behavioral effects of these compounds
[31,32,36,37,48].
Preclinical studies also implicate 5-HT1A receptors, which are densely expressed in midbrain,
limbic, and cortical regions, as well as in serotonergic neurons of the dorsal and median raphe
nuclei, where they act as somatodendritic autoreceptors [65]. The dual effects of psychedelics
on 5-HT2AR (excitatory, coupling to Gq) and 5-HT1AR (inhibitory, coupling to Gi/o) signaling
may be key in mediating their unique, circuit-specific effects on neuronal excitability and synaptic
remodeling, thereby ultimately contributing to their antidepressant/anxiolytic effects [14,16,62].
Importantly, serotonergic psychedelics show biased agonist activity at 5-HT2AR [62,64]. Unlike
serotonin, they are linked to preferential activation of non-canonical β2-arrestin-mediated signaling,
where β-arrestin acts as a key molecular scaffold linking the receptor to unique downstream trans-
ducers [62,64], although the exact mechanisms and their clinical implications are under
investigation.
Psychedelics
Although preliminary, converging biochemical and electrophysiological evidence supports a sim-
ilar glutamatergic mechanism in classical psychedelic action. Activating postsynaptic 5-HT2ARs
on pyramidal cells, particularly those in layer 5 of the PFC, is generally associated with an
increased frequency of spontaneous and evoked EPSP/EPSC responses [29–32,66,70].
Consistent with this, LSD (systemic or intra-PFC) and the related psychedelic compound 2,5-
dimethoxy-4-iodoamphetamine (DOI) can elevate frontocortical asynchronous glutamate release
in vitro and in vivo in a time-dependent manner (4 minutes to at least 1 h after systemic LSD),
leading to subsequent activation of postsynaptic AMPARs (Figure 1, panel 4) [29,30,36,46].
Importantly, this effect is blocked by antagonists of 5-HT2AR, AMPAR, and NR2B subunit-
containing NMDARs [19,29,30,66,70], as well as by mGluR2 modulators, implicating a
5-HT2A–mGluR2 receptor complex in psychedelic drug action [71]. Repeated LSD treatment
potentiated AMPAR and 5-HT2AR synaptic responses in vivo and increased the burst firing activity
of rodent mPFC pyramidal neurons, whose optogenetic inhibition eliminated the prosocial effects
of LSD [36]. Multimodal neuroimaging studies in animals and humans suggest that classical
psychedelics induce a hypermetabolic state, especially in frontocortical regions, which may
correlate with their downstream effects and therapeutic efficacy [16,29,30,72]; however, direct
measurements of glutamate levels in humans are scarce [73].
Psychedelics
Classical psychedelics, acting via 5-HT2AR, are associated with glutamate release and sustained
AMPAR signaling in the PFC, which in turn engages key synaptogenic signaling cascades, par-
ticularly BDNF and mTOR, as seen with ketamine (Figure 1, panels 6,7) [15,18,29,32,36–38].
Consistent with the known, close bidirectional interaction between serotonin and BDNF
function, 5-HT2AR activation is linked to neuroplasticity and neurotrophins via several possible
mechanisms including non-canonical β2-arrestin-mediated signaling, ERK, Akt-mTOR,
phosphoinositide 3-kinase (PI3K), NMDARs, and kalirin-7 [62,64,79,80]. Specifically, acute or
repeated administration of various classical psychedelics, including LSD, DOI, and DMT, is
associated with increases in BDNF levels/function and Akt-mTOR activation in the PFC or HPC
[15,18,32,36–38,52]. Accordingly, inhibition of either 5-HT2AR, AMPAR, BDNF-TrkB, or mTOR
signaling consistently abolishes the structural and behavioral effects of psychedelics (discussed
later) [32,36,37,52]. Furthermore, intact mTOR complex 1 (mTORC1) function in glutamatergic
excitatory but not GABAergic inhibitory neurons mediates the prosocial effects of repeated LSD
administration in mice [36]. Human research on this topic is still sparse; although the preliminary
preclinical [32,38] and clinical [81] data are encouraging, they indicate a complex relationship
between psychedelic treatment and BDNF levels, dependent on the treatment protocol (compound,
dose, frequency, etc.) and outcome measure (e.g., levels in serum vs. different brain regions),
warranting further investigation.
mediated protein synthesis, and subcellular trafficking of several key components of the
excitatory synapse and glutamate signaling-related neuroplasticity genes/protein (Figure 1,
panels 7,8) [8,12,15,17,20,22,23,25,26,35,56,57]. These include AMPAR subunits (GluR1,2),
postsynaptic density protein 95 (PSD95), synapsin 1, the immediate-early genes cFos (marker
of neuronal activity) and Arc (activity-dependent cytoskeleton associated protein), reelin
(glycoprotein involved in neuronal cell–cell interactions), and Homer1a (regulator of glutamatergic
synapse homeostasis), as well as of mTOR and BDNF themselves, in the PFC and HPC
[8,12,15,17,20,22,23,25,26,35,56,57]. With a few exceptions (e.g., increased serum BDNF levels),
ketamine regulation of neuroplasticity-related genes/proteins remains to be confirmed in the
context of clinical depression.
Psychedelics
Similarly, acute administration of classical psychedelics, particularly LSD, DOI and psilocybin
(or psilocin), is associated with dose- and time-dependent upregulation of various genes/proteins
related to synaptic plasticity, predominantly in cortical regions (Figure 1, panels 7,8) [15,16,62,70].
Psychedelic transcriptional targets are wide-ranging and include cFos, Arc, and BDNF, as well as
early growth response factors EGR1/2, β-arrestin 2, serum glucocorticoid kinase (Sgk), neuron-
derived orphan receptor 1 (Nor1), Ania3 (Homer1 transcript), Iκβ-α (NF-κB inhibitor), mitogen-
activated protein kinase phosphatase 1 (Mkp1), core/enhancer binding protein b (C/EBP-b),
dual-specificity phosphatase 1 (DUSP1), Period1 and others [39–43,62,82,83]. All these genes
are linked to different aspects of synaptic function and neural plasticity, and many act as activity-
dependent enzymes or transcription factors that are involved in regulating LTP expression/
maintenance, structural plasticity, and long-term memory formation [15,16,70]. Pharmacological
inhibition or genetic deletion of 5-HT2AR or mGluR2 blocks many of these transcriptional effects
[39,41–43,82,83]. The EGR family of immediate early genes/transcription factors, which regulate
neuronal activity and synaptic plasticity under both physiological and pathological conditions, is
the most highly validated gene target of psychedelics in the rodent brain [40–43,62,82]. The only
study to investigate the effects of LSD on acute gene expression in healthy subjects focused solely
on EGR1–3 and failed to detect significant changes in mRNA levels in whole blood samples up to
24 h after administration [84].
Psychedelics
Preclinical studies evaluating the antidepressant-like effects of psychedelics are limited, but
generally support the therapeutic potential observed clinically [17,31,36,48,51–53]. Several com-
pounds, including DMT (single high dose or chronic, intermittent low doses), LSD, and psilocybin,
exert antidepressant-like effects in the FST in rats [51–53]. Repeated but not acute LSD treatment
enhanced social behavior in mice via 5-HT2AR, AMPAR, and mTOR signaling in excitatory mPFC
neurons, supporting the neuroplasticity theory and the potential usefulness of psychedelics
in treating social deficits, as in depression [36]. Notably, this study found no antidepressant/
anxiolytic-like effects of LSD in the FST, SPT, or the novelty-suppressed feeding test in naïve mice
[36]. By contrast, LSD and psilocybin produced a sustained FST antidepressant-like effect in the
Wistar-Kyoto model of depression at 5 weeks after a single dose, whereas the effects of ketamine
were only transient [53]. Repeated LSD treatment also reversed the deficits in active avoidance
learning in the olfactory bulbectomy model of depression, without affecting control rats [91].
In two separate studies, a single psilocybin injection reversed the hedonic and active avoidance
deficits in mice subjected to chronic stress, accompanied by a strengthening of excitatory neuro-
transmission in the HPC or mPFC [31,48]. In these studies, partial (~30%) 5-HT2AR antagonism
using low-dose ketanserin was only sufficient to block the psilocybin-induced psychotomimetic
(i.e., head-twitch) but not synaptic or antidepressant-like responses, possibly implicating
5-HT2AR-independent mechanisms [31,48]. Although limited, preclinical studies also suggest
that psychedelics can enhance the acquisition of associative learning with both aversive or
appetitive unconditioned stimuli [17,91,92], while also facilitating the extinction of fear memory
[51,52,87]. Finally, psilocybin enhances measures of motivation and attention in poor-performing
rats, as does ketamine [88]. Clinical implications of these findings may include treatment of
cognitive deficits, depression, PTSD, and related conditions.
Whereas the molecular, structural, and behavioral effects of ketamine and psychedelics are
of considerable interest, the effects of these drugs on the induction, maintenance, and decay
of LTP/LTD are rarely studied, with the exception of our own studies [10,49]. Interestingly,
we found that a single low dose of ketamine, or of its metabolite HNK, rescued the dorsal
hippocampal LTP deficit observed in the Wistar-Kyoto (WKY) rat model of stress susceptibility
and depression, at 3.5 h but not at 30 minutes post-injection, with subsequent synaptic
strengthening at 24 h [49]. Furthermore, WKY rats exhibited impaired hippocampus-dependent
long-term spatial memory compared to control rats, which was effectively restored by ketamine/
HNK, consistent with their positive effects on LTP [49]. These findings support ketamine-induced
reversal of HPC-dependent cognitive deficits which are key features of clinical depression
[8,10,49,89,90]. However, the effects of ketamine on LTP/LTD in other regions implicated
in depression and/or other animal models remain unclear, highlighting the need for future
investigation. Preliminary human evidence suggests that low-dose ketamine enhances
visual sensory evoked potential LTP in patients with MDD at 3–4 h post-administration
[94]. Because serotonin is known to modulate synaptic plasticity [80], and ketamine may
restore LTP in the context of depression [10,49,94], determining how ketamine and classi-
cal psychedelics affect region-specific synaptic plasticity processes is of great importance.
Incorporating synaptic plasticity into the current framework of ketamine/psychedelic drug
action may serve to bridge understanding of their molecular and cellular effects with knowl-
edge related to neural circuit functioning and structural plasticity, underscoring the urgent
need for further studies.
correlated with enduring therapeutic outcomes at the cognitive and behavioral levels that are Do ketamine and psychedelics engage
essential for improvement of coping strategies and alleviation of depression symptomology a summative therapeutic response by
[8,10,16,17,23,24,32,35–37,45,49,50,53,89,90] acting at various molecular targets,
while limiting adverse effects and
excessive action at a single target
In summary, clinical research has inspired tremendous interest in identifying the mechanisms (‘magic shotgun’ vs. ‘magic bullet’
mediating the efficacy of ketamine and classical psychedelics in treating depression and related approach)?
disorders, moving beyond the outdated monoamine theory. Importantly, these effects are
Are the acute dissociative/hallucinogenic
hypothesized to mediate the rapid (within hours) and sustained (week to months) therapeutic
effects necessary for long-lasting
activity of these unique molecules following single/infrequent administration, especially in the therapeutic efficacy? Do they corre-
context of psychotherapy (Box 3) [7,14–16,50,72,85,95]. The duration of therapeutic effects late with the magnitude/duration of
observed following psilocybin (up to 6 months) is much longer than with ketamine (average of 1 treatment response? Is administra-
tion of repeated, sub-hallucinogenic
week), which seems to correlate well with their time-dependent effects on PFC spine density doses ('microdosing') sufficient to trig-
[37,44–46,48,85]. Taken together, these discoveries indicate that ketamine and classical psyche- ger neuroplasticity/therapeutic effects?
delics share a common neurobiological mechanism that involves complex interactions between Do non-hallucinogenic analogs that are
glutamate, serotonin, and region-specific synaptic homeostasis. Notably, the muscarinic recep- capable of promoting neuroplasticity
represent promising novel pharmaco-
tor antagonist scopolamine, the NMDA receptor partial agonist GLYX-13 (i.e., rapastinel), and therapies?
mGluR2/3 antagonists, which all possess some ketamine-like antidepressant activity in animal
models, appear to engage similar convergent downstream mechanisms related to neuroplasticity Can neuroplastic effects and neuro-
trophin levels be reliably studied in
[5,8,12,50,58].
humans in vivo to establish a causal link
between potential biomarkers and long-
Given major challenges in translating these findings to the human brain, the causal link between lasting symptom improvements? Can
drug-induced neuroplasticity and therapeutic efficacy has yet to be established in clinical settings. valid biomarkers related to human
neuroplasticity be developed?
Several methods can be utilized in humans to examine potential biomarkers related to neural
plasticity, including EEG, functional [e.g., positron emission tomography (PET), functional Are there additive or synergistic
magnetic resonance imaging (fMRI), and auditory/visual evoked potentials] and structural effects with psychotherapy and
[e.g., diffusion tensor imaging (DTI), voxel-based morphometry (VBM)] imaging techniques, as lifestyle interventions (e.g., exercise,
social support, diet)?
well as non-invasive brain stimulation (NIBS) [e.g., transcranial magnetic simulation (TMS) and
repetitive sensory stimulation] [96,97]. Currently, TMS [96,97] and novel PET ligands such as
Box 3. Adaptive neuroplasticity and the effects of psychotherapy Can ketamine and psychedelics treat
other neuropsychiatric disorders
Neuroplasticity in depression and related conditions is not uniformly impaired across the brain, and neuroplasticity
involving abnormalities in neuroplasticity
changes may be adaptive or maladaptive depending on the brain region, context, and functional consequences.
and glutamatergic homeostasis?
In MDD, regional differences in stress-induced synaptic/structural plasticity lead to progressive frontocortical
hypofunction/atrophy and loss of top-down inhibitory control, accompanied by hyperactivity/hypertrophy in downstream
regions such as the amygdala, hypothalamic–pituitary–adrenal axis (HPA) axis, and the ventral tegmental area–nucleus
accumbens (VTA-NAc) dopamine system, which may underlie different depression-related symptoms (e.g., cognitive, stress,
anxiety, aversive and anhedonic responses) [8,16,79]. Accordingly, indiscriminate enhancement of neuroplasticity may
not be beneficial, whereas successful treatment of depression may involve region-specific reversal of pathological circuit
dysfunction, in which the mPFC has a far-reaching impact on brain function and symptom reduction [8].
Psychedelic-assisted psychotherapy for depression and other psychiatric disorders has recently demonstrated unprece-
dented efficacy in clinical trials [1,3,7,16,17]. This strategy, as recently applied to ketamine treatment [4], is not only safer
but may also potentiate therapeutic effects via converging drug- and experience-dependent neuroplasticity mechanisms
[1,17]. The window of heightened neuroplasticity with ketamine/psychedelics offers an important opportunity for psycho-
therapeutic interventions, and there is preliminary evidence of synergistic effects and the potential for adaptive rewiring of
beneficial/pathological circuits [65,98]. Because the transient drug-induced neuroplastic state is susceptible to environ-
mental inputs, concomitant therapy may steer towards therapeutically relevant new neural connections [14]. Conversely,
combining a neuroplasticity-inducing agent with stress, adversity, or pre-existing psychopathology may promote negative
neuroplasticity, thus strengthening pathological network activity and/or maladaptive learning of negative associations [8].
Accordingly, the use of psychedelics to treat neuropsychiatric disorders should proceed with caution. Fortunately, in the
context of psychotherapy (i.e., with proper screening, preparation, supervision, integration, and follow-up), ketamine/psy-
chedelics appear to promote the perception and extinction of negative thought/behavioral patterns, as well as the
reframing and recontextualization of emotional experiences/memories or trauma, which, in conjunction with synaptogen-
esis and long-lasting network adaptations, may ultimately lead to enhanced cognitive/behavioral flexibility, thus enabling
the acquisition new coping strategies [2,8,17,50,100]. In depression, rigid, negative, and maladaptive thought/behavioral
patterns may be gradually replaced by improved cognitive control, emotional processing, and stress coping, whereas in
PTSD or substance use disorders, extinguishing fear/trauma or drug-cue memories, respectively, would be the desired
functional outcomes [2,8,17,50,100]. Importantly, the pharmacology-assisted therapy approach represents a potential
paradigm shift in psychiatry, and the concepts of 'set and setting' may tap into important determinants of treatment out-
comes related to adaptive neuroplasticity and symptom reduction [4,17,62], warranting further investigation.
Preliminary studies suggest that psychedelics may be significantly more potent/long-lasting than ketamine in promoting
structural plasticity [37,44–46,48,85], consistent with their more enduring clinical effects [7,16,95]. The time between
dosing and testing is another important factor, and thus therapeutically relevant functional/behavioral outcomes should
be assayed at various timepoints after drug administration, in particular following a ‘growth’ period that allows
neuroplasticity mechanisms to be fully engaged, and at longer intervals to determine the timecourse of the effects
[17,37]. Finally, in animals as in humans, set (mindset, i.e., internal context) and setting (environment, i.e., external context)
are likely to modulate the long-term functional outcomes of psychedelic and ketamine treatment [17,53,62]. Experiences
prior to (e.g., naïve vs. depressive-like state) and subsequent to (e.g., negative vs. positive reinforcement) treatment with a
neuroplasticity-inducing agent may be crucial in steering the effects towards adaptive plasticity and enduring therapeutic ef-
fects.
SV2A [47] represent particularly promising research avenues to study, and in the case of NIBS
modify, long-lasting neuronal function in the human brain. Finally, based on current understanding
of key experimental variables and research considerations (Box 4), future studies should address
current gaps in knowledge (see Outstanding questions), while further refining neuroplasticity
theories of depression and antidepressant response. Ultimately, the evolving framework of keta-
mine and psychedelic drug action can provide several promising neuroplasticity-related substrates
for clinical intervention that may serve as potential targets for development of next-generation
pharmacotherapies for various neuropsychiatric disorders.
Acknowledgments
This work was supported by grants from the Canadian Institutes of Health Research (to A.G.P.).
Declaration of interests
L.A. reports receiving consulting fees from Resilience Biosciences Inc., Psygen Labs Inc., and MindCure Health Inc. A.G.P.
holds shares in Resilience Biosciences Inc. and declares two patents related to a peptide blocker of AMPAR endocytosis and
hippocampal LTD, as well as to the use of D-govadine to enhance dopamine function in the prefrontal cortex.
References
1. Galvao-Coelho, N.L. et al. (2021) Classic serotonergic psychedelics 15. Kadriu, B. et al. (2021) Ketamine and serotonergic psychedelics:
for mood and depressive symptoms: a meta-analysis of mood common mechanisms underlying the effects of rapid-acting
disorder patients and healthy participants. Psychopharmacology antidepressants. Int. J. Neuropsychopharmacol. 24, 8–21
238, 341–354 16. Inserra, A. et al. (2021) Psychedelics in psychiatry: neuroplastic,
2. Dos Santos, R.G. et al. (2021) Hallucinogenic/psychedelic 5HT2A immunomodulatory, and neurotransmitter mechanisms. Pharmacol.
receptor agonists as rapid antidepressant therapeutics: evidence Rev. 73, 202–277
and mechanisms of action. J. Psychopharmacol. 35, 453–458 17. De Gregorio, D. et al. (2021) Hallucinogens in mental health:
3. Andersen, K.A.A. et al. (2021) Therapeutic effects of classic preclinical and clinical studies on LSD, psilocybin, MDMA,
serotonergic psychedelics: a systematic review of modern-era and ketamine. J. Neurosci. 41, 891–900
clinical studies. Acta Psychiatr. Scand. 143, 101–118 18. Vollenweider, F.X. and Preller, K.H. (2020) Psychedelic drugs:
4. Dore, J. et al. (2019) Ketamine assisted psychotherapy (KAP): neurobiology and potential for treatment of psychiatric disorders.
patient demographics, clinical data and outcomes in three Nat. Rev. Neurosci. 21, 611–624
large practices administering ketamine with psychotherapy. 19. De Gregorio, D. et al. (2018) D-lysergic acid diethylamide,
J. Psychoactive Drugs 51, 189–198 psilocybin, and other classic hallucinogens: mechanism of action
5. Newport, D.J. et al. (2015) Ketamine and other NMDA antagonists: and potential therapeutic applications in mood disorders. Prog.
early clinical trials and possible mechanisms in depression. Brain Res. 242, 69–96
Am. J. Psychiatry 172, 950–966 20. Castren, E. and Monteggia, L.M. (2021) Brain-berived neuro-
6. Zarate Jr., C.A. et al. (2012) Relationship of ketamine’s plasma trophic factor signaling in depression and antidepressant
metabolites with response, diagnosis, and side effects in major action. Biol. Psychiatry 90, 128–136
depression. Biol. Psychiatry 72, 331–338 21. Maeng, S. et al. (2008) Cellular mechanisms underlying the
7. Dos Santos, R.G. and Hallak, J.E.C. (2020) Therapeutic use antidepressant effects of ketamine: role of alpha-amino-3-
of serotoninergic hallucinogens: a review of the evidence and hydroxy-5-methylisoxazole-4-propionic acid receptors. Biol.
of the biological and psychological mechanisms. Neurosci. Psychiatry 63, 349–352
Biobehav. Rev. 108, 423–434 22. Li, N. et al. (2011) Glutamate N-methyl-D-aspartate receptor
8. Price, R.B. and Duman, R. (2020) Neuroplasticity in cognitive antagonists rapidly reverse behavioral and synaptic deficits
and psychological mechanisms of depression: an integrative caused by chronic stress exposure. Biol. Psychiatry 69,
model. Mol. Psychiatry 25, 530–543 754–761
9. Aleksandrova, L.R. et al. (2017) Antidepressant effects of 23. Zanos, P. et al. (2016) NMDAR inhibition-independent
ketamine and the roles of AMPA glutamate receptors and antidepressant actions of ketamine metabolites. Nature 533,
other mechanisms beyond NMDA receptor antagonism. 481–486
J. Psychiatry Neurosci. 42, 222–229 24. Zhou, W. et al. (2014) Ketamine-induced antidepressant
10. Aleksandrova, L.R. et al. (2019) Evaluation of the Wistar-Kyoto effects are associated with AMPA receptors-mediated upregu-
rat model of depression and the role of synaptic plasticity in lation of mTOR and BDNF in rat hippocampus and prefrontal
depression and antidepressant response. Neurosci. Biobehav. cortex. Eur. Psychiatry 29, 419–423
Rev. 105, 1–23 25. Li, N. et al. (2010) mTOR-dependent synapse formation underlies
11. Marsden, W.N. (2013) Synaptic plasticity in depression: molecular, the rapid antidepressant effects of NMDA antagonists. Science
cellular and functional correlates. Prog. Neuro-Psychopharmacol. 329, 959–964
Biol. Psychiatry 43, 168–184 26. Kim, J.W. et al. (2021) A key requirement for synaptic reelin sig-
12. Duman, R.S. et al. (2016) Synaptic plasticity and depression: naling in ketamine-mediated behavioral and synaptic action.
new insights from stress and rapid-acting antidepressants. Proc. Natl. Acad. Sci. U. S. A. 118, e2103079118
Nat. Med. 22, 238–249 27. Moghaddam, B. et al. (1997) Activation of glutamatergic neuro-
13. Aleksandrova, L.R. et al. (2017) Hydroxynorketamine: implica- transmission by ketamine: a novel step in the pathway from
tions for the NMDA receptor hypothesis of ketamine’s antide- NMDA receptor blockade to dopaminergic and cognitive
pressant action. Chron. Stress (Thousand Oaks) 1, disruptions associated with the prefrontal cortex. J. Neurosci.
2470547017743511 17, 2921–2927
14. Savalia, N.K. et al. (2021) A dendrite-focused framework for 28. Gerhard, D.M. et al. (2020) GABA interneurons are the cellular
understanding the actions of ketamine and psychedelics. trigger for ketamine's rapid antidepressant actions. J. Clin. Invest.
Trends Neurosci. 44, 260–275 130, 1336–1349
29. Aghajanian, G.K. and Marek, G.J. (1999) Serotonin and 52. Cameron, L.P. et al. (2018) Effects of N,N-dimethyltryptamine
hallucinogens. Neuropsychopharmacology 21, 16S–23S on rat behaviors relevant to anxiety and depression. ACS
30. Muschamp, J.W. et al. (2004) Lysergic acid diethylamide and Chem. Neurosci. 9, 1582–1590
[−]-2,5-dimethoxy-4-methylamphetamine increase extracellu- 53. Hibicke, M. et al. (2020) Psychedelics, but not ketamine,
lar glutamate in rat prefrontal cortex. Brain Res. 1023, 134–140 produce persistent antidepressant-like effects in a rodent
31. Hesselgrave, N. et al. (2021) Harnessing psilocybin: antide- experimental system for the study of depression. ACS Chem.
pressant-like behavioral and synaptic actions of psilocybin Neurosci. 11, 864–871
are independent of 5-HT2R activation in mice. Proc. Natl. 54. Berman, R.M. et al. (2000) Antidepressant effects of ketamine
Acad. Sci. U. S. A. 118, e2022489118 in depressed patients. Biol. Psychiatry 47, 351–354
32. Ly, C. et al. (2018) Psychedelics promote structural and 55. Miller, O.H. et al. (2016) Two cellular hypotheses explaining the
functional neural plasticity. Cell Rep. 23, 3170–3182 initiation of ketamine's antidepressant actions: direct inhibition
33. Chowdhury, G.M. et al. (2017) Transiently increased glutamate and disinhibition. Neuropharmacology 100, 17–26
cycling in rat PFC is associated with rapid onset of antidepressant- 56. Nosyreva, E. et al. (2013) Acute suppression of spontaneous
like effects. Mol. Psychiatry 22, 120–126 neurotransmission drives synaptic potentiation. J. Neurosci.
34. Yang, C. et al. (2013) Acute administration of ketamine in rats 33, 6990–7002
increases hippocampal BDNF and mTOR levels during forced 57. Kavalali, E.T. and Monteggia, L.M. (2012) Synaptic mecha-
swimming test. Ups. J. Med. Sci. 118, 3–8 nisms underlying rapid antidepressant action of ketamine.
35. Autry, A.E. et al. (2011) NMDA receptor blockade at rest Am. J. Psychiatry 169, 1150–1156
triggers rapid behavioural antidepressant responses. Nature 58. Abdallah, C.G. et al. (2015) Ketamine and rapid-acting
475, 91–95 antidepressants: a window into a new neurobiology for mood
36. De Gregorio, D. et al. (2021) Lysergic acid diethylamide (LSD) disorder therapeutics. Annu. Rev. Med. 66, 509–523
promotes social behavior through mTORC1 in the excitatory 59. Yin, Y.Y. et al. (2021) The role of the excitation:inhibition func-
neurotransmission. Proc. Natl. Acad. Sci. U. S. A. 118 tional balance in the mPFC in the onset of antidepressants.
37. Ly, C. et al. (2021) Transient stimulation with psychoplastogens Neuropharmacology 191, 108573
is sufficient to initiate neuronal growth. ACS Pharmacol. Transl. 60. Zanos, P. et al. (2019) (2R,6R)-hydroxynorketamine exerts
Sci. 4, 452–460 mGlu2 receptor-dependent antidepressant actions. Proc.
38. Vaidya, V.A. et al. (1997) 5-HT2A receptor-mediated regulation of Natl. Acad. Sci. U. S. A. 116, 6441–6450
brain-derived neurotrophic factor mRNA in the hippocampus 61. Williams, N.R. et al. (2018) Attenuation of antidepressant
and the neocortex. J. Neurosci. 17, 2785–2795 effects of ketamine by opioid receptor antagonism. Am.
39. Nichols, C.D. and Sanders-Bush, E. (2004) Molecular genetic J. Psychiatry 175, 1205–1215
responses to lysergic acid diethylamide include transcriptional 62. Halberstadt, A. et al. (2018) Behavioral Neurobiology of Psychedelic
activation of MAP kinase phosphatase-1, C/EBP-beta and Drugs, Springer
ILAD-1, a novel gene with homology to arrestins. J. Neurochem. 63. Nichols, D.E. (2016) Psychedelics. Pharmacol. Rev. 68, 264–355
90, 576–584 64. Kim, K. et al. (2020) Structure of a hallucinogen-activated
40. Nichols, C.D. and Sanders-Bush, E. (2002) A single dose of Gq-coupled 5-HT2A serotonin receptor. Cell 182, 1574–1588
lysergic acid diethylamide influences gene expression patterns 65. Carhart-Harris, R.L. and Nutt, D.J. (2017) Serotonin and brain
within the mammalian brain. Neuropsychopharmacology 26, function: a tale of two receptors. J. Psychopharmacol. 31,
634–642 1091–1120
41. Moreno, J.L. et al. (2011) Metabotropic glutamate mGlu2 66. Marek, G.J. and Schoepp, D.D. (2021) Cortical influences of
receptor is necessary for the pharmacological and behavioral serotonin and glutamate on layer V pyramidal neurons. Prog.
effects induced by hallucinogenic 5-HT2A receptor agonists. Brain Res. 261, 341–378
Neurosci. Lett. 493, 76–79 67. Madsen, M.K. et al. (2019) Psychedelic effects of psilocybin
42. Jefsen, O.H. et al. (2021) Transcriptional regulation in the rat correlate with serotonin 2A receptor occupancy and plasma
prefrontal cortex and hippocampus after a single administration psilocin levels. Neuropsychopharmacology 44, 1328–1334
of psilocybin. J. Psychopharmacol. 35, 483–493 68. Holze, F. et al. (2021) Acute dose-dependent effects of lysergic
43. Gonzalez-Maeso, J. et al. (2003) Transcriptome fingerprints distin- acid diethylamide in a double-blind placebo-controlled study in
guish hallucinogenic and nonhallucinogenic 5-hydroxytryptamine healthy subjects. Neuropsychopharmacology 46, 537–544
2A receptor agonist effects in mouse somatosensory cortex. 69. Lazarevic, V. et al. (2021) Ketamine decreases neuronally
J. Neurosci. 23, 8836–8843 released glutamate via retrograde stimulation of presynaptic
44. Phoumthipphavong, V. et al. (2016) Longitudinal effects of ke- adenosine A1 receptors. Mol. Psychiatry. Published online August
tamine on dendritic architecture in vivo in the mouse medial 11, 2021. https://doi.org/10.1038/s41380-021-01246-3
frontal cortex. eNeuro 3 ENEURO.0133-15.2016 70. Vollenweider, F.X. and Kometer, M. (2010) The neurobiology
45. Moda-Sava, R.N. et al. (2019) Sustained rescue of prefrontal of psychedelic drugs: implications for the treatment of mood
circuit dysfunction by antidepressant-induced spine formation. disorders. Nat. Rev. Neurosci. 11, 642–651
Science 364, eaat8078 71. Gonzalez-Maeso, J. et al. (2008) Identification of a serotonin/
46. Wu, M. et al. (2021) Ketamine rapidly enhances glutamate-evoked glutamate receptor complex implicated in psychosis. Nature
dendritic spinogenesis in medial prefrontal cortex through dopami- 452, 93–97
nergic mechanisms. Biol. Psychiatry 89, 1096–1105 72. Carhart-Harris, R.L. et al. (2016) Psilocybin with psychological
47. Raval, N.R. et al. (2021) A single dose of psilocybin increases support for treatment-resistant depression: an open-label
synaptic density and decreases 5-HT2A receptor density in feasibility study. Lancet Psychiatry 3, 619–627
the pig brain. Int. J. Mol. Sci. 22, 835 73. Mason, N.L. et al. (2020) Me, myself, bye: regional alterations in
48. Shao, L.X. et al. (2021) Psilocybin induces rapid and persistent glutamate and the experience of ego dissolution with psilocybin.
growth of dendritic spines in frontal cortex in vivo. Neuron 109, Neuropsychopharmacology 45, 2003–2011
2535–2544.e4 74. Kim, J.W. et al. (2021) Sustained effects of rapidly acting antide-
49. Aleksandrova, L.R. et al. (2020) Ketamine and its metabolite, pressants require BDNF-dependent MeCP2 phosphorylation.
(2R,6R)-HNK, restore hippocampal LTP and long-term spatial Nat. Neurosci. 24, 1100–1109
memory in the Wistar-Kyoto rat model of depression. Mol. 75. Girgenti, M.J. et al. (2017) Ketamine accelerates fear extinction
Brain 13, 92 via mTORC1 signaling. Neurobiol. Dis. 100, 1–8
50. Olson, D.E. (2018) Psychoplastogens: a promising class of 76. Haile, C.N. et al. (2014) Plasma brain derived neurotrophic
plasticity-promoting neurotherapeutics. J. Exp. Neurosci. 12, factor (BDNF) and response to ketamine in treatment-resistant
1179069518800508 depression. Int. J. Neuropsychopharmacol. 17, 331–336
51. Cameron, L.P. et al. (2019) Chronic, intermittent microdoses of 77. Woelfer, M. et al. (2020) Ketamine-induced changes in plasma
the psychedelic N,N-dimethyltryptamine (DMT) produce brain-derived neurotrophic factor (BDNF) levels are associated
positive effects on mood and anxiety in rodents. ACS Chem. with the resting-state functional connectivity of the prefrontal
Neurosci. 10, 3261–3270 cortex. World J. Biol. Psychiatry 21, 696–710
78. Abdallah, C.G. et al. (2020) Modulation of the antidepressant resistant depression: a comparative, randomized and double-
effects of ketamine by the mTORC1 inhibitor rapamycin. blind study. Psychiatry Res. 303, 114058
Neuropsychopharmacology 45, 990–997 90. Stippl, A. et al. (2021) Ketamine specifically reduces cognitive
79. Liu, B. et al. (2017) From serotonin to neuroplasticity: evolvement symptoms in depressed patients: An investigation of associ-
of theories for major depressive disorder. Front. Cell. Neurosci. ated neural activation patterns. J. Psychiatr. Res. 136,
11, 305 402–408
80. Kraus, C. et al. (2017) Serotonin and neuroplasticity – links 91. Buchborn, T. et al. (2014) Repeated lysergic acid diethylamide
between molecular, functional and structural pathophysiology in an animal model of depression: normalisation of learning
in depression. Neurosci. Biobehav. Rev. 77, 317–326 behaviour and hippocampal serotonin 5-HT2 signalling.
81. Hutten, N. et al. (2021) Low doses of LSD acutely increase J. Psychopharmacol. 28, 545–552
BDNF blood plasma levels in healthy volunteers. ACS 92. Harvey, J.A. (2003) Role of the serotonin 5-HT(2A) receptor in
Pharmacol. Transl. Sci. 4, 461–466 learning. Learn. Mem. 10, 355–362
82. Nichols, C.D. et al. (2003) Dynamic changes in prefrontal 93. Citri, A. and Malenka, R.C. (2008) Synaptic plasticity: multiple
cortex gene expression following lysergic acid diethylamide forms, functions, and mechanisms. Neuropsychopharmacology
administration. Brain Res. Mol. Brain Res. 111, 182–188 33, 18–41
83. Gonzalez-Maeso, J. et al. (2007) Hallucinogens recruit specific 94. Sumner, R.L. et al. (2020) Ketamine enhances visual sensory
cortical 5-HT(2A) receptor-mediated signaling pathways to evoked potential long-term potentiation in patients with major
affect behavior. Neuron 53, 439–452 depressive disorder. Biol. Psychiatry Cogn. Neurosci. Neuroimaging
84. Dolder, P.C. et al. (2017) A single dose of LSD does not alter 5, 45–55
gene expression of the serotonin 2A receptor gene (HTR2A) 95. Carhart-Harris, R.L. et al. (2018) Psilocybin with psychological
or early growth response genes (EGR1–3) in healthy subjects. support for treatment-resistant depression: six-month follow-
Front. Pharmacol. 8, 423 up. Psychopharmacology 235, 399–408
85. Wu, H. et al. (2021) Ketamine for a boost of neural plasticity: 96. Nathan, P.J. et al. (2011) Studying synaptic plasticity in the
how, but also when? Biol. Psychiatry 89, 1030–1032 human brain and opportunities for drug discovery. Curr.
86. Cavalleri, L. et al. (2018) Ketamine enhances structural plasticity in Opin. Pharmacol. 11, 540–548
mouse mesencephalic and human iPSC-derived dopaminergic 97. Polania, R. et al. (2018) Studying and modifying brain function
neurons via AMPAR-driven BDNF and mTOR signaling. Mol. with non-invasive brain stimulation. Nat. Neurosci. 21, 174–187
Psychiatry 23, 812–823 98. Heuschkel, K. and Kuypers, K.P.C. (2020) Depression, mind-
87. Catlow, B.J. et al. (2013) Effects of psilocybin on hippocampal fulness, and psilocybin: possible complementary effects of
neurogenesis and extinction of trace fear conditioning. Exp. mindfulness meditation and psilocybin in the treatment of
Brain Res. 228, 481–491 depression. A review. Front Psychiatry 11, 224
88. Higgins, G.A. et al. (2021) Low doses of psilocybin and ketamine 99. Murrough, J.W. et al. (2013) Rapid and longer-term antide-
enhance motivation and attention in poor performing rats: pressant effects of repeated ketamine infusions in treatment-
evidence for an antidepressant property. Front. Pharmacol. 12, resistant major depression. Biol. Psychiatry 74, 250–256
640241 100. Magaraggia, I. et al. (2021) Improving cognitive functioning in
89. Araujo-de-Freitas, L. et al. (2021) Neurocognitive aspects major depressive disorder with psychedelics: a dimensional
of ketamine and esketamine on subjects with treatment- approach. Neurobiol. Learn. Mem. 183, 107467
7.
METSIKANAN POIKANEN.
Karoliinan vasikatko?
Ei.
Villen varsako?
Hän katseli miltei kadehtien Villeä ja Ollia, jotka joskus saivat ajaa
niittokonetta muutaman kierroksen. Ja hän oli ylpeämpi kuin
kuningas — käyttääkseni hyvin vanhentunutta sananpartta — kun
hän itse eräänä ihanana aamuna istui koneen istuimella ja piteli
ohjasparia. Lehtinen seurasi kintereillä ja laski viikatteen käyntiin,
kun kone kulki tarpeeksi kiireesti.
— "Elä itke!" sanoi isä. "Me emme tiedä, mistä kaikesta pikku
metsikananpoikanen on varjeleutunut: kylmistä niukkaruokaisista
talvista ja verenhimoisista koirista tai ehkä pitkällisestä kitumisesta,
kun huvimetsästäjä olisi sen rammaksi ampunut."
Mutta Rainaria itketti vain, varsinkin kun hän näki Villen ja Ollin
surun.
8.
METSÄNPEITOSSA.
Rainar näki vain pölyä tai savua peltojen välissä, vaikka miten olisi
koettanut katsoa.
Ihan kuin olisi hän arvannut, mitä he kaksi kokonaista päivää olivat
mielessään hautoneet.
— "Olli, mitä tuo nyt on!" nuhteli Ville. "Sinähän tiedät, että isä on
kieltänyt meitä milloinkaan tähtäämästä elävää olentoa, paitsi tietysti
petoeläimiä. Emmekö mieluimmin laulaisi?"
Sinne oli keräytynyt jo koko joukko miehiä ja toista tuli. Kun oli
päätetty, miten kulettaisiin, oli ainakin seitsemänkymmentä miestä
koolla siihen luettuna Ville ja Olli ja Rainar.
Metsä oli alussa niin tiheä, että pojat ja Antti vain silloin tällöin
näkivät jonkun toisista miehistä, mutta koko aika huudettiin toisilleen.
"Hohoi! Hohoi!" kuului joka suunnalta. Taas kuului metsästystorven
törähys ja etäällä tuntui joku kauheasti rämyyttävän
jäniksenpelätintä. Säikähtyneet linnut piiloutuivat ääneti tiheimpiin
puihin ja pensaihin.
Olli oli löytänyt vatukon, jota oli miltei mahdoton jättää, ja hän jäi
mielellään. "Mikäs ilo on juoksennella sillä lailla salon halki", hän
tuumi.