Therapy Analysis - Depression
Depression and affective disorders
Depression is a complex and often misunderstood disease, coming as it does in many guises, ranging from bipolar disorder to major depressive disorder, dysthymia and post-natal depression. It is estimated that between 5 and 10% of the population suffers from some degree of depression at any one time. More worryingly, depressed individuals may become suicidal – research by the charity the Samaritans suggests that for those with severe depression, the lifetime risk of suicide can be as high as 6%, compared to 1.3% in the general population.
The aetiology of these debilitating and distressing mood disorders is not fully understood. Despite many years of intensive research, there are still so many unanswered questions. Are these disorders related and therefore part of a spectrum of disturbances in central neurotransmission? Or are they, in fact, distinct disorders arising from individual sets of genetic factors that present with similar symptoms? Why do antidepressants work for some individuals and not for others? The answers to these questions could potentially pave the way to solutions for those patients with treatment-resistant depression.
It is widely acknowledged that there is a genetic element to many of these illnesses. For example, 25% of cases of major depression are thought to be familial, although the related genes have yet to be identified. It therefore makes sense to assess individuals on a case-by-case basis to determine the nature of genetic influence of their illness and prescribe appropriately.
There has been some success in bringing new antidepressants in existing classes to the market, but how far have drugs with novel mechanisms of action progressed? The current understanding of depressive disease is based on the known mechanism of action of serendipitously-discovered drugs. So antidepressants with novel pharmacologies, if they work, would not only be good news for those suffering from treatment-resistant depression, but could also cast new light on the illness itself. Elucidating any genetic element would also be a significant break-through, as a 'one size fits all' approach may not be the most effective way of treating depression.
