New insights into the antidepressant actions of substance P (NK1 receptor) antagonists

Considerable progress has been made in understanding the neural circuits involved the antidepressant and anxiolytic efficacy of substance P (NK, receptor) antagonists (SPAs). Progress has been hampered by species differences in the pharmacology of the NK1 receptor, and the availability of NK1R-/- mice has been a particularly useful resource in overcoming this difficulty. Using neuroanatomical, behavioural, and electrophysiological techniques, studies have now established that pharmacological blockade or deletion of the NK1 receptor produces an antidepressant and anxiolytic-like profile in a range of behavioural assays that is distinct from that of established drugs. There is evidence from focal injection studies that some of these effects may be mediated directly by blockade of NK, receptors in the amygdala and its projections to the hypothalamus, periaqueductal gray, and reticulopontine nucleus. Substance P and NK1 receptors are also intimately associated with ascending 5-HT and norepinephrine projections to the forebrain, and alterations in the function of these systems are also likely to be related to the antidepressant efficacy of SPAs. Unlike some established drugs, SPAs are generally well tolerated and do not induce sedation or motor impairment in preclinical species. These findings are consistent with a novel antidepressant mechanism of action of SPAs.