Recent Progress in Pharmacological and Non-Pharmacological Treatment Options of Major Depression

Abstract

In spite of recent progress in the pharmacotherapy of depression major issues are still unresolved. These include the non-response rate of approximately 30% to conventional antidepressant pharmacotherapy, side effects of available antidepressants and the latency of several weeks until clinical improvement. The only non-pharmacological biological treatment options available so far which exert more rapid antidepressant efficacy are electroconvulsive therapy and, as an augmentation strategy, sleep deprivation. Current pharmacological treatments aim to enhance serotonergic and/or noradrenergic neurotransmission. In spite of emerging knowledge, the crucial mechanisms underlying both non-pharmacological treatments, which are responsible for antidepressant efficacy, are not yet clear so far. In the meantime several new pharmacological principles are under investigation with regard to their putative antidepressant potency. These include 5-HT1A receptor agonists, tachykinin receptor antagonists and various interventions within the hypothalamic-pituitary-adrenal system. While there is evidence for antidepressant properties of these new treatments in animal studies, in case series, in open studies and to some degree also in placebo controlled studies, no definite proof for the antidepressant efficacy of these new pharmacological strategies according to the requirements for evaluation of antidepressant drugs has been furnished so far. In contrast, for the established non-pharmacological treatment strategies including bright light therapy the clinical efficacy has been proven at least in subgroups of depression, but more knowledge of the main mechanisms underlying their antidepressant efficacy is still necessary. In addition new non-pharmacological treatments like repetitive transcranial magnetic stimulation, magnetic seizure therapy and Vagus nerve stimulation are currently under development. Nevertheless, a follow-up of both the new pharmacological strategies and non-pharmacological treatment options is of major importance to provide even better strategies for the clinical management of depression, which also is of great socio-economic impact.

The influence of concomitant antidepressant medication on safety, tolerability and clinical effectiveness of electroconvulsive therapy

“…Moreover, new treatment principles are in progress to be established (Baghai et al 2006). Nevertheless, electroconvulsive therapy is still one of the best tolerated and most effective biological treatments of depressive disorders.…”

Biomimetic screening of class B G protein-coupled receptors

“…Although the effectiveness of antidepressants is significant for patients with severe forms of depression, it is minimal for those with mild or moderate forms of the disease (Kirsch 2009;Kirsch 2010). It is estimated that greater than 40 % of the patients treated with an antidepressant do not show any response (Baghai et al 2006;Ruhe et al 2006). Moreover, the mechanisms of action of antidepressants are not fully understood.…”

The effect of body–mind relaxation meditation induction on major depressive disorder: A resting-state fMRI study

“…In spite of the development of new and effective medications for depression, as many as 30% to 50% of patients do not respond to medication treatment (Baghai et al, 2006). Furthermore, medications may induce unwanted side effects that can impair patients' quality of life (Kupfer et al, 2012).…”