Despite the revolution in recent decades regarding monoamine involvement in the management of major depressive disorder (MDD), the biological mechanisms underlying this psychiatric disorder are still poorly understood. Currently available treatments require long time courses to establish antidepressant response and a significant percentage of people are refractory to single drug or combination drug treatment. These issues, and recent findings demonstrating the involvement of synaptic plasticity in the pathophysiological mechanisms of MDD, are encouraging researchers to explore the molecular mechanisms underlying psychiatric disease in more depth. The discovery of the rapid antidepressant effect exerted by glutamatergic and cholinergic agents highlights the mammalian target of rapamycin (mTOR) pathway as a critical pathway that contributes to the efficacy of these pharmacological agents in clinical and pre-clinical research. The mTOR pathway is a downstream intracellular signal that transmits information after the direct activation of α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate (AMPA) and neurotrophic factor receptors. Activation of these receptors is hypothesized to be one of the major axes involved in the synthesis of synaptogenic proteins underlying synaptic plasticity and critical to both the rapid and delayed effects exerted by classic antidepressants. This review focuses on the involvement of mTOR in the pathophysiology of depression and on molecular mechanisms involved in the activity of emerging and classic antidepressant agents.
IntroductionIn 2004 depression ranked third among non-fatal disease global disability burden and is expected to attain first place by 2030 [1]. Major depressive disorder (MDD) is a serious and recurrent disorder, linked to diminished quality of life, increased morbidity, increased mortality and economic burden [2,3]. The pathogenesis of depression and mechanisms of action of current antidepressant drugs are not yet clear [4]. Although the activity of common antidepressant drugs involves acutely the monoaminergic system, the therapeutic effect occurs only after chronic treatment and appears to be under poorly understood changes in cellular biochemical mechanisms. Evidence indicates that neurotrophic and neurogenic factors mediate neural adaptations involved in the late therapeutic responses after chronic treatment with classical antidepressants [5][6][7].Recent research has provided emerging theories on the pathophysiology of depression and possible mechanisms of action of antidepressants that consider the neurobiological British Journal of Clinical Pharmacology