A BSTRACTDue to the complexity of the disease, several hypotheses exist to explain the etiology of depression. The monoamine theory of depression suggests that disruptions in the sero tonergic and noradrenergic systems result in depressive symptoms. Therefore, the serotonin transporter (SERT) has become a pharmacological target for treating these symptoms. This review will discuss what is known about the molecular interactions of antidepressants with SERT. The effects of antidepressants on SERT regulation and expression in addition to the receptors that may be involved in mediating these effects will be addressed. Specifically, how changes to SERT expression following chronic antidepressant treatment may contribute to the therapeutic benefi ts of antidepressants will be discussed. Furthermore, the effects of SERT gene polymorphisms on antidepressant effi cacy will be examined. Finally, a brief overview of other hypotheses of depression will be addressed as well as factors that must be considered for future antidepressant development.
K EYWORDS:SSRIs , antidepressant , serotonin transporter , depression , reuptake
MONOAMINE THEORY OF DEPRESSIONFunctional defi ciencies in serotonin (5-hydroytryptamine, 5-HT) and norepinephrine (NE) have been implicated in the pathophysiology of depressive syndromes, and restoring the normal function of 5-HT-and NE-associated signaling pathway has been the target of antidepressants. Restoration of monoamine defi ciencies to normal levels as a therapeutic strategy is based on the monoamine hypothesis of depression. 1 The oldest antidepressants, the monoamine oxidase inhibitors (MAOIs), increase synaptic levels of 5-HT and NE by inhibiting the enzymatic degradation of these neurotransmitters. The tricyclic antidepressants (TCAs), as well as newer selective 5-HT reuptake inhibitors (SSRIs) and 5-HT/ NE reuptake inhibitors (SNRIs), all increase synaptic levels of 5-HT or NE by inhibiting reuptake via the 5-HT transporter (SERT) or NE transporter (NET), respectively. Emerging evidence indicates that the monoamine hypothesis of 5-HT and NE modulation fails to explain the whole mechanism of antidepressants. Other hypotheses, including the cytokine hypothesis of depression, the hypothalamic-pituitary-thyroid hypothesis of depression, as well as the role of brain-derived neurotrophic factor and cyclic AMP response element binding protein will be considered later in this review.