Additional Antidepressant Pharmacotherapies According to a Neural Network

Abstract

Major depression, a frequent psychiatric disease, is associated with neurotransmitter alterations in the midbrain, hypothalamus and hippocampus. Deficiency of postsynaptic excitatory neurotransmitters such as dopamine, noradrenaline and serotonin and a surplus of presynaptic inhibitory neurotransmitters such as GABA and glutamate (mainly a postsynaptic excitatory and partly a presynaptic inhibitory neurotransmitter), can be found in the involved brain regions. However, neuropeptide alterations (galanin, neuropeptide Y, substance P) also play an important role in its pathogenesis. A neural network is described, including the alterations of neuroactive substances at specific subreceptors. Currently, major depression is treated with monoamine reuptake inhibitors. An additional therapeutic option could be the administration of antagonists of presynaptic inhibitory neurotransmitters or the administration of agonists/antagonists of neuropeptides.

Three Cases of Major Depression: Different Pharmacological Antidepressant Options

“…SSRI's (e.g., citalopram) have a good antidepressant effect and in the case report 1 they successfully treated the transient depressive symptoms. Adverse effects such as arrhythmias, hypotension, increased intraocular pressure and constipation should be controlled [7]. Doxepin, a tricyclic antidepressant drug, inhibits the reuptake of serotonin and noradrenaline and in the case report 2 it fails to improve severe depressive symptoms.…”

“…Adverse effects are decreased blood pressure, constipation, increased intraocular pressure, weight gain and decreased sexual activity [7]. In the case report 1, the transient depressive symptoms were improved after administration of citalopram.…”

“…Through this mechanism of action, depressive symptoms are improved. Antidepressant drugs have different mechanisms of action, improve the depressive symptoms to a different extent and exert different adverse effects [7].…”

“…In the case report 2, it improves partly the severe depressive symptoms. The adverse effects of venlafaxine are changes in the E.C.G., hypo/ hyper-tension, increased intraocular pressure, weight gain or loss and insomnia [7].…”

“…Bupropion may not be administered in patients with manic or psychotic symptoms, because it can induce dopamine hyperactivity and thus worsen manic or psychotic symptoms [6]. Adverse effects are changes in the E.C.G., hypertension, insomnia, increased intraocular pressure and weight loss [7]. The patient in the case report 3 showed an increased blood pressure (treated with ramipril) and partly insomnia [2].…”