Vol 7 n°3 - Pharmacology
in mood disorders
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epressive disorders
are common, recurrent,
chronic, and
require treatment. Major depressive disor-
der
can occur across the entire life cycle and is the most
common
of the severe psychiatric illnesses. In the USA,
the
lifetime prevalence was 16.2% (32.6-35.1 million
adults)
and the 12-month prevalence was 6.6% (13.1-
14.2 million adults) in a recent survey. 1
World Health Organization’s Global Burden of Disease
Report ,2
of
disease burden worldwide in 1990.The World Health
Organization
predicts that by 2020, major depression will
become
the second leading cause of worldwide disease
burden, surpassed
only by ischemic heart disease. In this
review, we
will focus on major depressive disorder,
although we will also briefly discuss bipolar depression.
The cardinal feature of major depression is persistent
depressed mood or pervasive loss of interest or pleasure
for a minimum of 2 weeks, accompanied by a series
of
somatic and cognitive changes (Table I) . In
assessing the
core components of depression, it
is important to note that
the
psychological and biological symptoms are accompa-
nied
by negative thought content, cognitive dysfunction,
and
suicidal ideation. These components follow
the
American Psychiatric Association Diagnostic and Statisti-
cal Manual of Mental Disorders (DSM-IV) nosology for
mood disorders, but recently there has been considerable
interest in assessing not only current symptoms, but
also
“softer” or spectrum
features, which may present lifetime
signs of particular mood or mood-related spectra. 3,4
such persistent features may relate
to levels of functional
impairment during
episodes of depression more directly
than
current symptoms. Such assessment strategies raise
the
need for assessment of dimensional approaches to
S t a t e
o f t h e a r t
The
pharmacological management of
Depressive disorders are common, recurrent,
and chronic,
and
require treatment. A review of the symptom picture
and
current drug targets demonstrates the need for accu-
rate
assessment of depression severity, including suicidal-
ity.
The initial focus of treatment is rapid resolution of
symptoms
during an acute phase, followed by continua-
tion.
Maintenance treatment is indicated if the risk of
recurrence
is high. The range of available medications is
considerable
and the benefit/risk ratio is acceptable.
Depression is diagnosable across the
life span and treat-
able
at every age (although recent disagreement
has
arisen
with regard to young patients). Comorbidity, both
psychiatric
and medical, need to be assessed, as does the
possible
presence of two subtypes of depression (psychotic
and
bipolar) often requiring different interventions. It is
expected
that the next generation of antidepressants
would
be associated with more specific disease and out-
Dialogues Clin Neurosci. 2005;7:191-205.
Keywords:
depression; selective serotonin reuptake inhibitor; comorbidity; neurotransmitter;
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