Letters to the Editor |

Dextromethorphan Challenge in Alcohol-Dependent Patients and Controls—Reply

John H. Krystal, MD; Ismene L. Petrakis, MD
Arch Gen Psychiatry. 2000;57(3):292. doi:.
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We thank Drs Schütz and Soyka for their interest in our article.1 We appreciate their sharing data consistent with the hypothesis that N-methyl-D-aspartate (NMDA) antagonist actions of ethanol contribute to its subjective effects and its abuse potential. Their data also suggested that dextromethorphan effects were blunted in patients.

Schütz and Soyka suggest that NMDA antagonists prime ethanol craving. In our study, ketamine did not evoke craving despite producing effects that were both less (0.1 mg/kg) and greater (0.5 mg/kg) in intensity than their dextromethorphan data. This pattern suggests an "inverted-U" dose-response relationship between NMDA-receptor blockade and the elicitation of craving. However, craving is notoriously difficult to study in the laboratory. Therefore, we await further studies evaluating the capacity of NMDA antagonists to elicit ethanol craving.


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