engleski

Do we need new therapeutic strategies for depression?

Depression is a relatively common condition, with a chronic and recurrent course and it is frequently associated with functional impairment. The morbidity and mortality associated with depression can be prevented with the correct treatment. But there are some problems in connection with successful treatment. Depression is still under-diagnosed and under-treated. Between 30 and 60% of depression cases are not detected by the general clinician in primary care units. When depressed patients are diagnosed and treated, up to 60% of depressed patients do not respond completely to antidepressants (ADs) and up to 30% do not respond at all. Also, there is no definition of an adequate treatment and depressed patients are presented with histories of varying degrees of treatment adequacy. In addition, there are no universally accepted definitions of treatment - resistant depression (TRD) and we have situation that adequate treatment well as TRD definition varied widely over the years. The development of new treatments for depression is leading by the fact that with currently available antidepressants, many patients could not achieved full remission and that treatment - resistant depression occurs frequently in clinical practice. Therefore, there is the clear need for better therapies, but recent efforts to develop novel antidepressants have been relatively unsuccessful. Why is that so? There are several reasons for this situation. The heterogeneity of depression indicates several different mechanisms underlying their etiology and pathophysiology. Both psychiatric and somatic comorbidities contribute to nonresponse and treatment resistance. Depression has been associated with impaired monoamine neurotransmission, disturbed circadian rhythms, disturbed HPA axis, chronic, low grade inflammation, abnormal allelic forms of receptors and resulted in disrupted neuronal circuits. Broader approaches to understanding pathophysiology of depression suggest that we need next generation of antidepressants with probably not only monoaminergic mechanisms of action. In order to give our depressed patients better treatment, we also suggest better research co- operation between basic and clinical neuroscience in the development of novel concepts of treatment.

new strategies ; antidepressants ; treatment ; depression

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