Editorial: Central & Peripheral Nervous Systems: Antidepressants: clinical and neuropharmacologic considerations relevant to future drug discovery and development

Abstract

Numerous drugs for the treatment of depression are now available or in development. In general, the new drugs are safer than the originally introduced tricyclic antidepressants, but none are substantially more rapidly acting or efficacious than imipramine. On the other hand, several of the newer agents act through novel mechanisms which generally manipulate the serotonin system in some way or another, and provide considerable insight into what is needed to achieve an improved antidepressant response. Recently, considerable attention has been focused on the chronic or neuroadaptive effects of antidepressant therapy as well as the state of the serotonin system in depression. Although the ideal agent has not yet been realised, it appears that we now have the tools in hand to develop such a drug which will have a very quick onset of action and a greater effect on depressive symptoms. Beyond these shorter term considerations, the search for better therapy should turn toward seeking a better understanding of the aetiology of the disease. Future therapeutics should be based on the neurobiological underpinnings of depression, and should act to prevent the development or recurrence of major depression rather than seek simply to alleviate the symptoms.