Depression 17 Jul, 2017 LESEZEIT: 1 min

Pharmacological treatment for depression

National Institute for Health and Care Excellence (NICE) Clinical Guidance (CG90)

For people with moderate or severe depression, provide a combination of antidepressant medication and a high-intensity psychological intervention (CBT or IPT)1  

Depression is a clinically heterogeneous disorder, and as such can be treated through several approaches.1

Five classes of antidepressant treatments are available for depression therapy, and all affect the concentrations of one or several of the monoaminergic neurotransmitter systems within the neuron or in the synaptic cleft. However, each class also offers differences in efficacy, tolerability, pharmacodynamics and pharmacokinetics.

Here is a table which provides an overview of the different classes of antidepressant treatments, presented in chronological order of introduction to the clinic:

Table

Multimodal antidepressants broaden our existing clinical spectrum of antidepressants, offering an increased variety of pharmacotherapies for the treatment of depression.7

In recent years, an additional class of antidepressants has emerged with heterogeneous yet specific molecular targets. There are now several drugs in the clinical repertoire which are described as having multimodal modes of action. This means that they exert their therapeutic effects through a combination of targets including ion channels, receptors and neurotransmitter reuptake transporters. This broadens our existing clinical spectrum of antidepressants, offering an increased variety of pharmacotherapies for the treatment of depression.7

References

  1. National Institute for Health and Clinical Excellence 2009. Depression in adults: the treatment and management of depression in adults. CG90.
  2. Fiedorowicz JG, Swartz KL. The role of monoamine oxidase inhibitors in current psychiatric practice. J Psychiatr Pract 2004; 10(4): 239-248.
  3. Zajecka JM, Zajecka AM. A Clinical Overview of Monoamine Oxidase Inhibitors: Pharmacological Profile, Efficacy, Safety/Tolerability, and Strategies for Successful Outcomes in the Management of Major Depressive Disorders. Psychiatric Annals 2014; 44(11): 513.
  4. Gillman PK. Tricyclic antidepressant pharmacology and therapeutic drug interactions updated. Br J Pharmacol 2007; 151(6): 737–748.
  5. Hiemke C, Härtter. S. Pharmacokinetics of selective serotonin reuptake inhibitors. Pharmacol Ther 2000; 85: 11–28.
  6. Hajós M et al. The selective norepinephrine reuptake inhibitor antidepressant Reboxetine: pharmacological and clinical profile. CNS drug reviews 2006; 10(1): 23–44.
  7. Baghai TC et al. Individualised pharmacological treatment of depressive disorders: state of the art and recent developments. J Depress Anxiety 2014; 3(2): 100015.