[Advances in the molecular treatment of depression].
OBJECTIVE
The objective of this study is to survey present and future antidepressant drug therapy based on the progress made in the field of biotechnology.


METHODS
The simplistic and mistaken view that one single system of neurotransmission is altered in depression and that there is, therefore, just one single treatment has changed. Molecular biology and Genetics have enabled us to determine other possible chemical alterations in the brain, beyond the sole participation of the monoaminergic modulation systems, which is the classical hypothesis. In this paper we describe the evidence for the relations between depression and the therapeutic effect the classical antidepressants have on: 1. The peptidergic system of the corticotropin-releasing hormone, cortisol and the functional state of its receptors; 2. Intracellular signalling systems such as cAMP on transcription factors like CREB and neurotrophins; 3. The immune system and cytosines; 4. Glutamate transmission; and 5. The neuropeptidergic system of substance P, neuroactive steroids and the neuroglia. This has allowed other biochemical hypotheses about depression and the possibility of new treatments to be put forward.


CONCLUSIONS
We are still not certain about the exact cause or the processes that determine mental illnesses such as depression or how improvements are achieved with the antidepressants we currently have available. Nevertheless, biotechnology is expected to be a great help in advancing towards a better understanding of the interrelations between the nervous, immune and endocrine systems, with their intracellular cascades and final outcomes in genetic expression and protein function, in depression. This will enable more efficient, more selective and faster-acting drugs to be developed and, in the future and with the help of psychogenomics, even make it possible to produce tailor-made medication for each patient.
Páez
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Facultad de Medicina, Universidad de los Andes, Mérida, Venezuela. pacap@ing.ula.ve
Hernández
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Baptista
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D000928:Antidepressive Agents / Q000627:therapeutic use*; D015306:Biogenic Monoamines / Q000378:metabolism; D003346:Corticotropin-Releasing Hormone / Q000378:metabolism; D000242:Cyclic AMP / Q000378:metabolism; D017362:Cyclic AMP Response Element-Binding Protein; D016207:Cytokines / Q000276:immunology / Q000378:metabolism; D003863:Depression / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology*; D006801:Humans; D009446:Neurobiology; D017470:Receptors, Glutamate / Q000378:metabolism; D011987:Receptors, Steroid / Q000378:metabolism; D015290:Second Messenger Systems / Q000502:physiology
D000928:Antidepressive Agents; D015306:Biogenic Monoamines; D017362:Cyclic AMP Response Element-Binding Protein; D016207:Cytokines; D017470:Receptors, Glutamate; D011987:Receptors, Steroid; D003346:Corticotropin-Releasing Hormone; D000242:Cyclic AMP