2017, Number 5
Rev Fac Med UNAM 2017; 60 (5)
Pharmacological treatment of depression: current and future directions
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Major depressive disorder represents one of the main causes
of disability worldwide. Its neurobiology is complex, involving
genetic, molecular, neurophysiological and psychosocial factors.
Treatment options include psychotherapy, psychotropic
medication, electroconvulsive therapy, and transcranial and
deep magnetic stimulation. Currently available medication
will only achieve modest response and remission rates. Current
antidepressants have the common characteristic of regulating
the monoaminergic neurotransmission systems (serotonin,
noradrenaline, dopamine), regardless of their different mechanisms
of action, and share similar efficacy. The choice of
the antidepressant must be individualized and based on the
symptomatic characteristics of the depressive episode, comorbidities,
side effects, pharmacological interactions, and
availability. For this reason, practitioners must be deeply familiar with the pharmacological profiles of the antidepressants.
Recent advances in research on the neurobiology of
depression have involved the glutamatergic system as a contributor.
Also, the discovery of the antidepressant effects of
ketamine, a glutamatergic NMDA receptor antagonist, has
opened the doors to the development of strategies directed
to new therapeutic targets
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