Antidepressive therapy - current developments

Since the development of the first tricyclic antidepressants and monoaminoxidase-inhibitors in the 50s of the last century much more approaches of pharmacological treatment of depression have been developed. After the first generation of antidepressants a second generation was established with the selective serotonin reuptake-inhibitors about twenty years ago. In the following years treatments were developed which provided also selective action, but combine serotonergic, nor-adrenergic and dopaminergic transmission - with the exception of reboxetin, which is acting selectively on noradrenergic transmission. In spite of these multiple approaches the percentage of patients who experience insufficient response to treatment is relatively high. Looking for possibilities of antidepressant treatment more options were investigated in the past years. Metabolites of the established substances are investigated and strategies of augmentation, for instance with atypical antipsychotics, but also compounds targeting melatonergic mechanisms or cortisol secretion are of interest. In this article we provide a summary of current developments.