[Indications for new antidepressants with reference to ICD-10: a waggish question or the future of psychiatry?].
The biological psychiatry's postulate is that depression is related to a lack of balance between the dopaminergic, noradrenergic and serotonergic monoaminergic neurotransmitters systems. These systems are related to cortico-striatal-thalamo-cortical circuits, involving the association and limbic prefrontal cortex and the basal ganglia (caudate nucleus, putamen, nucleus accumbens, globus pallidus). The pharmacology of depression recently grows rich from "new" antidepressive agents, having selective monoaminergic activity: Selective Serotonin presynaptic Reuptake Inhibition ("SSRIs"), selective Reversible Inhibition of the Monoamine oxidase A ("RIMAs"), selective dopaminergic or noradrenergic agents. The last International Classification of mental and behavioural Disorders proposed by the World Health Organisation: the ICD-10, proposes a "new" classification of the depressive disorders based on atheoric "practical" diagnostic criteria. These criteria are unrelated to neurobiochemical, neuroanatomical or neurophysiological data. Reviewing the diagnostic criteria of depressive disorders proposed by the ICD-10 in relation to the neuroanatomic structures subtending the monoaminergic theory of the depressions, the author attempts to answer to the question: is the "new" pharmacology of the depressions that constitute the "new" antidepressants blind or correlable to the "new" nosology of the depressive disorders proposed by the ICD-10? Finally, indications in first intention of the "new" antidepressive agents for each depressive disorder defined by the ICD-10 are proposed.
De Smet
Y
Y
Hôpital Neuropsychiatrique de l'Etat, Unité de Neuropsychiatrie Gériatrique, Grand-Duché de Luxembourg.
D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001921:Brain / Q000187:drug effects / Q000503:physiopathology; D003866:Depressive Disorder / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D018377:Neurotransmitter Agents / Q000502:physiology; D011379:Prognosis; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*
D000928:Antidepressive Agents; D018377:Neurotransmitter Agents