What are the prospects for improvement in the pharmacotherapy of depressive illness
What are the prospects for improvements in the pharmacology of depression? Depression, depressive illness, or affective disorder refers to disorders of the affect or mood. ... The unipolar/bipolar distinction is useful, with separate genetic basis for each; and brings up the question as to whether the same treatments are useful across the spectrum of depressive disorders. ... To answer the question regarding prospects for improvements of treatments, I will review the abnormalities thought to be manifest in depression, including early hypotheses through to more recent cellular developments, and how current treatments are thought to intervene and thus have clinical efficacy for improvement of symptoms. ... The monoamine hypothesis, that depressive symptoms are associated with reductions in monoamine neurotransmission, particularly serotonin and noradrenaline, is supported by both neurochemical findings (at the synaptic level) and the successful treatment of major depression (MD) with compounds that enhance monoaminergic neurotransmission. ... There is no robust evidence for selective NA augmentation leading to improvement; however amphetamine and cocaine do not reduce core symptoms, although some selective NA reuptake inhibitors are antidepressant (Blier and Montigny 1994), which clouds the opinion on NA facilitation being a useful area of future research. ... Therefore new receptor subtypes open up an area for pharmacotherapy in the future. ... The learned helplessness test in rats, an animal model for antidepressants, VN2222 reduced significantly the number of escape failures, and has very good prospects regarding future treatments. ... SSRIs are no more effective at treating symptoms than old TCA agents, it seems that the only real improvement is greatly reduced side effects. ... There is in fact debate as to which monoamine systems are most important in depressive illness. ... Returning to possible structural pathophysiology; some depressive patients have episodic illness with complete remission for substantial periods in-between. ... This determines whether glutamate antagonists would have potential for large proportions of depressive illness. If the same mechanisms but less severe are leading to moderate depression as opposed to MD and bipolar disorders, then this could have good prospects. ... Lithium, traditionally a mood stabiliser in bipolar and manic illness. ... Neurotrophin-boosting pharmacotherapy could potentially ‘cure’ depression, ‘reversing’ degeneration, and producing adaptive changes in brain circuitry. ... It is impossible to mimic major depressive disorders completely in rodents.