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The brain-derived neurotrophic factor (BDNF) and its receptor, tyrosine kinase receptor B (TrkB), are essential and common mechanisms for the antidepressant effects of both the parent molecules of ketamines [i.e., S, R()ketamine, S(+)ketamine, and R()ketamine] and their active metabolites [i.e., (2R,6R)-hydroxynorketamine and of S(+)norketamine] (Yang et al., 2019)

This G-protein coupled receptor is expressed predominantly in the anterior pituitary gland, where its activation triggers intracellular calcium mobilization and subsequent growth hormone release from somatotroph cells

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doi: 10.1016/j.cell.2008.01.020 75 DorringtonMGFraserIDC

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Therefore, while clinical data suggest rashes occur in about 3 percent of users, the real-world rate might be somewhat higher or lower depending on who is using the drug and how they use it