Pharmacotherapy Of Depression Research Articles

5-HT Receptors and the Development of New Antidepressants.

Serotonin modulates several physiological and cognitive pathways throughout the human body that affect emotions, memory, sleep, and thermal regulation. The complex nature of the serotonergic system and interactions with other neurochemical systems indicate that the development of depression may be mediated by various pathomechanisms, the common denominator of which is undoubtedly the disturbed transmission in central 5-HT synapses. Therefore, the deliberate pharmacological modulation of serotonergic transmission in the brain seems to be one of the most appropriate strategies for the search for new antidepressants. As discussed in this review, the serotonergic system offers great potential for the development of new antidepressant therapies based on the combination of SERT inhibition with different pharmacological activity towards the 5-HT system. The aim of this article is to summarize the search for new antidepressants in recent years, focusing primarily on the possibility of benefiting from interactions with various 5-HT receptors in the pharmacotherapy of depression.

Association of the neutrophil to lymphocyte ratio and white blood cell count with response to pharmacotherapy in unipolar psychotic depression: An exploratory analysis

BackgroundLow-grade inflammation occurs in a subgroup of patients with Major Depressive Disorder (MDD) and may be associated with response to antidepressant medications. The Neutrophil to Lymphocyte Ratio (NLR) and total White Blood cell Count (WBC) are markers of systemic inflammation which have not been investigated as predictors for outcome to pharmacotherapy in unipolar depression yet. Moreover, the association between inflammation and treatment response has not been studied in unipolar Psychotic Depression (PD). We conducted an exploratory analysis to examine the prognostic significance of NLR and WBC in pharmacotherapy of PD. MethodsBaseline NLR and WBC were examined in their association with response to seven weeks of treatment with antidepressants (venlafaxine or imipramine) and the combination of an antidepressant with an antipsychotic (venlafaxine plus quetiapine) in 87 patients with PD. Logistic regression models were adjusted for age, gender, Body Mass Index (BMI), depression severity, duration of the current episode and number of previous depressive episodes. Secondary outcomes were remission of depression and disappearance of psychotic symptoms. ResultsHigher NLR was associated with increased response to pharmacotherapy (Exp(B) 1.66, 95 ​% CI 1.03–2.66, p ​= ​0.036), but not with remission of depression or disappearance of psychotic symptoms. WBC was not associated with any of the outcome measures. ConclusionNLR may be a novel, inexpensive and widely available biomarker associated with response to pharmacotherapy in PD. The association between white blood cell measures and treatment outcome should be further investigated for different types of antidepressants in PD and in non-psychotic MDD.

Lithium as a first‐step option for acute phase pharmacotherapy of bipolar depression

A recently published summary of the 2020 clinical practice guidelines from the Royal Australian and New Zealand College of Psychiatrists provides recommendations on management of bipolar disorder (1). The acute phase pharmacotherapy of a depressive episode in patients with bipolar disorder, in the following referred to as treatment of bipolar depression, is especially challenging. The evidence for lithium as a treatment of bipolar depression is limited and conflicting (2), and therefore the positioning of this drug for the treatment of bipolar depression in upcoming guidelines is of particular interest.

Transcranial Magnetic Stimulation Indices of Cortical Excitability Enhance the Prediction of Response to Pharmacotherapy in Late-Life Depression

BackgroundOlder adults with late-life depression (LLD) often experience incomplete or lack of response to first-line pharmacotherapy. The treatment of LLD could be improved using objective biological measures to predict response. Transcranial magnetic stimulation (TMS) can be used to measure cortical excitability, inhibition, and plasticity, which have been implicated in LLD pathophysiology and associated with brain stimulation treatment outcomes in younger adults with depression. TMS measures have not yet been investigated as predictors of treatment outcomes in LLD or pharmacotherapy outcomes in adults of any age with depression. MethodsWe assessed whether pretreatment single-pulse and paired-pulse TMS measures, combined with clinical and demographic measures, predict venlafaxine treatment response in 76 outpatients with LLD. We compared the predictive performance of machine learning models including or excluding TMS predictors. ResultsTwo single-pulse TMS measures predicted venlafaxine response: cortical excitability (neuronal membrane excitability) and the variability of cortical excitability (dynamic fluctuations in excitability levels). In cross-validation, models using a combination of these TMS predictors, clinical markers of treatment resistance, and age classified patients with 73% ± 11% balanced accuracy (average correct classification rate of responders and nonresponders; permutation testing, p < .005); these models significantly outperformed (corrected t test, p = .025) models using clinical and demographic predictors alone (60% ± 10% balanced accuracy). ConclusionsThese preliminary findings suggest that single-pulse TMS measures of cortical excitability may be useful predictors of response to pharmacotherapy in LLD. Future studies are needed to confirm these findings and determine whether combining TMS predictors with other biomarkers further improves the accuracy of predicting LLD treatment outcome.

Differences in antipsychotic treatment between depressive patients with and without a suicide attempt

BackgroundDepressed suicide attempters are, according to some earlier studies, treated more often with antipsychotics than depressive non-suicide attempters. Cluster B personality disorders, especially borderline personality disorder, are associated with a high suicide risk, and antipsychotics are commonly used for the reduction of symptoms. However, no previous study has taken comorbid personality disorders into account when assessing the use of antipsychotics in patients with unipolar depression. Therefore, the aim of this study was to investigate the clinical selection of pharmacotherapy in unipolar depression with and without a previous suicide attempt, taking into account potential confounders such as cluster B personality disorders. MethodsThe study sample consisted of 247 patients with unipolar depression. The study was approved by the Regional Ethical Review Board in Lund, Sweden. Study participants were recruited from 4 different secondary psychiatric care clinics in Sweden and were diagnosed according to the DSM-IV-TR with the MINI and SCID II. Previous and ongoing psychiatric treatments were investigated in detail and medical records were assessed. ResultsThirty percent of the patients had made previous suicide attempts. Depressed suicide attempters underwent both lifetime treatment with antipsychotics and an ongoing antipsychotic treatment significantly more often than non-attempters. Significances remained after a regression analysis, adjusting for cluster B personality disorders, symptom severity, age at the onset of depression, and lifetime psychotic symptoms. ConclusionsThis is the first study to consider the effect of comorbidity with cluster B personality disorders when comparing treatment of depressive suicide and non-suicide attempters.Our findings suggest that suicide attempters are more frequently treated with antipsychotics compared to non-suicide attempters, regardless of cluster B personality disorder comorbidity. These findings are important for clinicians to consider and would also be relevant to future studies evaluating reduction of suicide risk with antipsychotics in patients with psychiatric comorbidity and a history of attempted suicide.

Diagnosis and Pharmacotherapy of Bipolar Depression in Adults

Approximately 60% of patients with bipolar disorder (BD) who present with depression are misdiagnosed as having recurrent unipolar depression, which may lead to inappropriate treatment and potential worsening of symptoms. Several factors may interfere with a positive screen and an accurate BD diagnosis-especially substance use disorders. By facilitating effective communication with patients, implementing diagnostic criteria, and using assessment tools, clinicians can accurately identify the often subtle indicators of the disorder and recommend individualized treatment. Whichever pharmacologic is prescribed, it is important to tailor treatment for patients with BD by considering the disease course, potential adverse effects, and comorbidities.

Recent trends in the management of depression in persons with cancer.

Depression is a prevalent comorbidity in cancer that significantly increases the risk for numerous negative health outcomes. This review updates the current evidence base for management of depression in cancer, highlighting new research directions based on the inflammatory hypothesis of depression. Research on pharmacotherapy and psychotherapy for depression in cancer has shown mixed efficacy partly because of methodological issues arising from the phenomenology of depression in cancer. After decades of stagnancy, more recent high-quality clinical trials are beginning to provide an evidence base to guide treatment. Inflammatory cytokine-associated depression is a subtype of depression that may have particular relevance in cancer, opening new avenues to explore therapeutic targets and biobehavioral impacts of interventions, which may improve cancer outcomes. The continuum of severity in cancer-related depression is important to consider in management approaches. Choice of treatment should be personalized to the patient and their symptom profile as there is currently insufficient evidence to recommend any particular medication or psychotherapy over another. Psychological interventions should be considered first line for mild-to-moderate depression, and pharmacological treatment added for more severe depression, which can be optimally delivered within a collaborative care model. http://links.lww.com/YCO/A62.

Diagnosis and Pharmacotherapy of Bipolar Depression in Pediatric Patients.

Bipolar depression in youth has a negative effect on numerous domains, including physical and emotional well-being, school and family functioning, friendships, and academic success. Early treatment is crucial, yet diagnosis is difficult. The standard of treatment often requires life-long psychopharmacological management, and most treatments increase risk of adverse effects. Pediatric patients who have at least 1 parent with bipolar disorder are considered to be at higher risk for also developing bipolar depression, although there is currently no clear evidence of efficacious pharmacotherapy for these patients.

What if Depressed and Pregnant?

Depression is the most prevalent mood disorder among pregnant women. Only 50% of women seek intervention during gestation. Untreated during pregnancy, depression can induce obstetric and neonatal complications, most commonly, anhedonia, suboptimal weight gain, suicidal behavior, pre-term birth, and/or spontaneous miscarriage. The babies more often suffer cognitive deficits, low birth weight, and growth delay. The mothers subsequently also experience an increased risk for significant degrees of postpartum depression. Those with relatively milder cases of depression should initially receive psychotherapy. Otherwise, there are many antidepressant medications available for the pharmacotherapy of depression. However, treating pregnant females with depression is a challenge because of potential teratogenic effects caused by many pharmaceuticals. Physicians should know the recommended guidelines for treating depressed women during a time of gestation. It is crucial to identify women suffering from depression during pregnancy, and electing those that warrant pharmacotherapy while picking the best and safest medication is a complex process with paramount significance. Before prescribing an antidepressant drug, explain the advantages and disadvantages of the interventions. Whenever prescribing during these circumstances, more than conventionally close obstetric, emotional, and medication monitoring is to be provided. This would also include an emphasis on diet, exercise, psychotherapy, and avoidance of any non-critical medicinal or other substance exposures.

Pharmacoepidemiological and pharmacoeconomic study of the structure of prescribing antidepressants in anxiety-depressive disorders

Introduction. The problem of choosing antidepressants in the pharmacotherapy of depression remains relevant over the past decades, not only due to the annual steady increase in the number of depressive disorders around the world, but also with the appearance of new drugs of this group on the pharmaceutical market. In addition, the costs of diagnosing and treating anxiety-depressive states are increasing, as is the financial loss associated with the disability of patients due to depression. Thus, it is extremely important to analyze the structure of prescribing antidepressants in anxiety-depressive disorders and the structure of financial costs. Purpose of the study: To conduct a pharmacoepidemiological and pharmacoeconomic analysis of the prescription of antidepressants to patients with neurotic disorders of an anxiety and anxiety-depressive nature (F 41.0 – Panic disorder (episodic paroxysmal anxiety), F 41.2 – Mixed anxiety and depressive disorder, F 45 – Somatoform disorders, F 06.41 – Organic anxiety disorder in connection with cerebral vascular disease (according to ICD-10)) on the basis of the Department of Crisis Conditions of the Clinic of Hematology and Occupational Pathology of the SSMU in 2019-2021 and to reveal the correlation between the structure of costs and the structure of prescribing antidepressants. Materials and methods. The volume of antidepressant prescriptions, taking into account dosages, treatment regimens and treatment outcomes using the method of “Defined daily doses”, was assessed. The structure of financial costs for prescribed drugs was investigated, and an analysis of the demographic data of patients (gender and age), as well as their history of life and illness, was carried out. Results. The carried out pharmacoepidemiological and pharmacoeconomic studies made it possible to determine that there are discrepancies between the structure of prescribing antidepressants and the structure of financial costs. The most commonly prescribed antidepressant was amitriptyline, while it accounted for a very small proportion of the cost. Trazodone incurred the maximum financial costs, and therefore its high cost seriously limited the possibilities of its prescription. Pipofezin, which has great potential for expanding use, ranks second in both the cost structure and the structure of prescriptions. In the course of the study, the features of the drugs that determined the prevalence of their prescription were identified and their advantages and disadvantages were assessed. It was noted that some antidepressants, which could potentially be more effective, turned out to be unavailable to patients due to the high price or absence in the city pharmacies. Conclusion. Based on the study, it can be concluded that it is advisable to conduct a full-scale clinical study in order to determine the pharmacoeconomic effect of pipofezin in comparison with other antidepressants.

Interactions between neuroticism and stressful life events predict response to pharmacotherapy for major depression: A CAN-BIND 1 report.

Exposure to stressful life events and individual differences in the personality trait neuroticism are important risk factors that interact to predict major depressive disorder (MDD). Less is known about their effect on treatment response in depression. Here, we examine whether stressful life events experienced prior to and during treatment interact with neuroticism to predict response to 16-week pharmacotherapy for MDD. Participants included 159 outpatients with MDD who were initially treated with 8weeks of escitalopram. Those who responded to the initial treatment continued on escitalopram monotherapy, whereas non-responders received 8weeks of adjunctive aripiprazole. Personality was assessed using the NEO-Five Factor Inventory, and stressful life events were assessed using the Life Events and Difficulties Schedule, a rigorous contextual interview that includes independent ratings of threatening life events. High baseline neuroticism was associated with a lower likelihood of response when patients experienced one or more negative life events before treatment. Secondary analyses indicated that this effect was specific to neuroticism, and not better accounted for by its self-criticism or negative affect facets. Our results suggest that assessing personality and stressful life events at baseline can help clinicians assess which patients will respond to antidepressant therapy and which may need treatment augmentation.

A prospective study to determine the clinical utility of pharmacogenetic testing of veterans with treatment-resistant depression.

Pharmacotherapies for depression are often ineffective and treatment-resistant depression (TRD) is common across bipolar disorder (BD), major depressive disorder (MDD), and post-traumatic stress disorder (PTSD). Patient genetic information can be used to predict treatment outcomes. Prospective studies indicate that pharmacogenetic (PGX) tests have utility in the treatment of depression. However, few studies have examined the utility of PGX in other diagnoses typified by depression, or in veterans, a cohort with high rates of medical comorbidity, social stress, and suicide. To determine the efficacy of genetically guided pharmacological treatment of TRD. We conducted an 8-week, prospective, multisite, single-blind study in 182 veterans with TRD including patients with BD, MDD, and PTSD. Subjects were randomly assigned to PGX-guided treatment in which the clinician incorporated PGX information into decision-making, or treatment as usual (TAU). Overall, the PGX group improved marginally faster compared to TAU, but the difference was not statistically significant. Secondary analyses revealed that only PTSD patients showed a potential benefit from PGX testing. Patients predicted by PGX testing to have moderate levels of genetic risk showed a significant benefit from the PGX-guided treatment, whereas other risk groups demonstrated no benefit. Clinicians generally found the PGX test was useful, particularly in more depressed patients and/or those with more warnings for significant or serious adverse outcomes. Clinicians more often used the results to select a drug, but only rarely to adjust dosing. The data reveal possible group differences in the utility of PGX testing in veterans with TRD.ClinicalTrials.gov Identifier: NCT04469322.

Individual and common patterns in the order of symptom improvement during outpatient treatment for major depression

BackgroundResearch so far provided few clues on the order in which depressive symptoms typically remit during treatment. This study examined which depressive symptoms improve first, and whether symptoms changed before, simultaneous with, or after the core symptoms of depression (i.e., sad mood, loss of pleasure, and loss of interest). MethodsParticipants were 176 patients with Major Depressive Disorder (MDD) receiving outpatient treatment (a combination of pharmacotherapy and psychological interventions) for depression. Participants filled out the Inventory of Depressive Symptomatology - Self Report (IDS-SR) for 16 to 20 consecutive weeks. For each symptom, the timing of onset of a persistent improvement was determined for each single-subject separately. ResultsWhich symptoms improved first differed markedly across patients. The core depression symptoms improved 1.5 to 2 times more often before (48% - 60%) than after (19% -28%) depressive cognitions (‘view of myself’ and ‘view of the future’), anxiety symptoms (‘feeling irritable’ and ‘feeling anxious / tense’) and vegetative symptoms (‘loss of energy’, ‘slowed down’, and ‘physical energy’). Only improvements in suicidal thoughts were more likely to occur before (46% - 48%) than after (29%) improvements in the depression core symptoms. LimitationsNot all ‘core depression-non-core symptom’ combinations could be tested because some symptoms did not improve in a sufficient number of patients. ConclusionsWhich improvements mark the start of symptom remission differed between patients. Improvements in the core depression symptoms ‘sad mood’, ‘loss of interest’, and ‘loss of pleasure’ were more likely to occur before than after improvements in non-core symptoms.

Epilepsy Associated Depression: An Update on Current Scenario, Suggested Mechanisms, and Opportunities.

Depression is one of the most frequent psychiatric comorbidities associated with epilepsy having a major impact on the patient's quality of life. Several screening tools are available to identify and follow up psychiatric disorders in epilepsy. Out of various psychiatric disorders, people with epilepsy (PWE) are at greater risk of developing depression. This bidirectional relationship further hinders pharmacotherapy of comorbid depression in PWE as some antiepileptic drugs (AEDs) worsen associated depression and coadministration of existing antidepressants (ADs) to alleviate comorbid depression has been reported to worsen seizures. Selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs) are first choice of ADs and are considered safe in PWE, but there are no high-quality evidences. Similar to observations in people with depression, PWE also showed pharmacoresistant to available SSRI/SNRIs, which further complicates the disease prognosis. Randomized double-blind placebo-controlled clinical trials are necessary to report efficacy and safety of available ADs in PWE. We should also move beyond ADs, and therefore, we reviewed common pathological mechanisms such as neuroinflammation, dysregulated hypothalamus pituitary adrenal (HPA) axis, altered neurogenesis, and altered tryptophan metabolism responsible for coexistent relationship of epilepsy and depression. Based on these common pertinent pathways involved in the genesis of epilepsy and depression, we suggested novel targets and therapeutic approaches for safe management of comorbid depression in epilepsy.

The effect of N-acetylcysteine on bipolar depression: a systematic review and meta-analysis of randomized controlled trials.

The current pharmacotherapy of bipolar depression often presents limited efficacy and increased risk for adverse events. N-acetylcysteine (NAC) has been suggested as potentially effective and well-tolerated adjunctive treatment for bipolar disorder (BD). This systematic review and meta-analysis aimed to examine the efficacy of N-acetylcysteine, as an adjunctive therapy, for treating bipolar depression. PubMed, Cochrane Library, Scopus databases, and grey literature were searched for studies retrieval. Randomized controlled trials including patients with a diagnosed bipolar disorder and a current depressive episode were included in the analysis. The measured variables included symptoms, functioning, and quality of life scales. The mean change in Montgomery-Åsberg Depression Rating Scale (MADRS) was set as the primary outcome. A total of five studies were included in the analysis. A significant improvement was not observed from the addition of NAC to standard therapy in symptomatology [MADRS (MD = -3.32; 95% CI = -12.79 to 6.16), Young Mania Rating Scale (MD=-0.7; 95% CI=-2.15 to 0.75), Bipolar Depression Rating Scale (MD=-3.19; 95% CI=-15.48 to 9.1), and Clinical Global Impression for severity (MD=-0.13; 95% CI=-0.33 to 0.08)], functioning, [Global Assessment of Functioning Scale (MD=3.21; 95% CI=-12.55 to 18.97), Social and Occupational Functioning Assessment Scale (MD=0.47; 95% CI=-4.60 to 5.53), or quality of life [Quality of Life Enjoyment and Satisfaction Questionnaire (MD=2.27; 95% CI=-9.13 to 13.67)]. There is no evidence indicating that NAC has beneficial effects as an adjunctive treatment for bipolar depression. Future trials with improved methodological design and efficient sample sizes are required to draw safer conclusions.

Effectiveness of pharmacotherapy for depression after traumatic brain injury in adults: an umbrella review protocol.

The objective of this review is to synthesize systematic reviews of the effectiveness of pharmacotherapy vs any other comparator for the management of post-traumatic brain injury depression in adults. Depression following a traumatic brain injury can have a considerable impact on the life of the individual, their family members, and the health care system. There have been several recent systematic reviews and meta-analyses on pharmacologic treatment for depression caused by post-traumatic brain injury. These reviews differ in conduct, quality, and reporting, and have discordant results and conclusions. Therefore, an umbrella review can provide prescribers with a summary of the evidence. This review will consider systematic reviews of studies of adults 16 years or older who have sustained a traumatic brain injury of any severity at any time in the past, who are receiving pharmacotherapy for depression of any severity in any health care setting. Studies that include the following outcomes will be considered: change in symptoms of depression and occurrence of harms. MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Database of Systematic Reviews, Epistemonikos, and PROSPERO will be searched, as well as Google Scholar, ResearchGate, TRIP Medical Database, and hand searching journals. There will be no restriction on publication date. Only systematic reviews published in English will be considered. Screening of articles, assessment of methodological quality, and data extraction will be performed independently by two reviewers. A Grading of Recommendations, Assessment, Development and Evaluation Summary of Findings will be presented. Data will be summarized in narrative form with supporting tables. PROSPERO CRD42020184915.

Psychometric approach in psychiatry: excess or necessity?

Psychometric approach is historically associated with the formation of psychiatry as a science. Psychometric scales have been used repeatedly to form classifications of mental disorders. Currently, effectiveness of psychometric approach in psychiatry has received evidence-based confirmation in a number of international projects on the pharmacotherapy of depression. A new direction has emerged, called measurement-based care. It has been proven that the use of psychometric scales by 2545% increases the efficiency of diagnostic assessment in psychiatry, improves the interaction between doctor and patient, and improves the organization of psychiatric care. At the same time, a significant number of practicing psychiatrists do not use psychometric scales due to time costs, low validity and difficulties in interpretation. In this regard, modern psychiatry is in dire need of introduction of new psychometric technologies, allowing in a short time to develop economic, valid and accurate psychometric instruments.

Chinese Herbal Medicine for the Treatment of Depression: Effects on the Neuroendocrine-Immune Network.

The neuroimmune and neuroendocrine systems are two critical biological systems in the pathogenesis of depression. Clinical and preclinical studies have demonstrated that the activation of the neuroinflammatory response of the immune system and hyperactivity of the hypothalamus–pituitary–adrenal (HPA) axis of the neuroendocrine system commonly coexist in patients with depression and that these two systems bidirectionally regulate one another through neural, immunological, and humoral intersystem interactions. The neuroendocrine-immune network poses difficulties associated with the development of antidepressant agents directed toward these biological systems for the effective treatment of depression. On the other hand, multidrug and multitarget Chinese Herbal Medicine (CHM) has great potential to assist in the development of novel medications for the systematic pharmacotherapy of depression. In this narrative essay, we conclusively analyze the mechanisms of action of CHM antidepressant constituents and formulas, specifically through the modulation of the neuroendocrine-immune network, by reviewing recent preclinical studies conducted using depressive animal models. Some CHM herbal constituents and formulas are highlighted as examples, and their mechanisms of action at both the molecular and systems levels are discussed. Furthermore, we discuss the crosstalk of these two biological systems and the systems pharmacology approach for understanding the system-wide mechanism of action of CHM on the neuroendocrine-immune network in depression treatment. The holistic, multidrug, and multitarget nature of CHM represents an excellent example of systems medicine in the effective treatment of depression.

Glucocorticoid-induced depression - the role of the dopaminergic system and microRNAs.

Presentation of the role of the dopaminergic system and microRNAs in the development of depression after glucocorticoids (GCs) therapy. GCs are steroid hormones secreted by the adrenal glands, and their synthesis is regulated by the hypothalamic-pituitary- adrenal (HPA) axis. The secretion of GCs (cortisol in humans and corticosterone in rodents) is dependent directly on corticotropin, secreted from the pituitary gland and indirectly on the corticotropin-releasing factor, a hormone released from the paraventricular nuclei of the hypothalamus. Prolonged treatment with GCs disrupts the functions of the HPA axis, impairs the dopaminergic system, suppresses hippocampal neurogenesis and sensitizes the amygdala, leading to an increased susceptibility to depression. This is an important problem because GCs are commonly prescribed for a broad range of medical conditions, including inflammatory and autoimmune disorders. The action of GCs may be at least partially regulated by epigenetic mechanisms (microRNAs), in addition to which microRNAs modulate GCs production and cellular response to GCs. The administration of GCs may lead to changes in dopaminergic system activity (e.g. D2 receptors activity), which significantly contribute to the predisposition to depression. Additionally, GCs therapy may cause changes in the activity of micro-RNAs (e.g. miR-124), which exacerbates symptoms of depression. Searching for specific changes in microRNA expression will provide clinically practical and easily applicable biomarkers of depression risk and new forms of pharmacotherapy in GC-induced depression.

Different molecular targets, one purpose – treatment of depression

Abstract Although vast scientific progress has been made, the current pharmacotherapy of depression is still not fully effective. In adults, depressive disorders are among the most common diseases in industrialized countries, impact upon all aspects of family and working life and significantly disturb social functioning. Moreover, increasingly, they affect children and teenagers. Depressive disorders have a complex etiology. This includes a number of mechanisms that are not yet fully understood. Therefore, the current review concentrates on bringing to the foreground the many molecular areas involved in occurrence of this disease. The work highlights the notion that depression has a complex pharmacology and inevitably requires the adoption of individual pharmacotherapy. This manuscript concentrates on currently used drugs drawn from diverse therapeutic groups and presents new promising targets for the treatment of depression. This is a particularly important issue due to the continuous lack of effective therapy and the constant search for new drugs and molecular targets for its treatment.