[Monoamine's role in depression and possible consequences for the clinical management of the core symptoms of major depression]

Abstract

Major depression (MD) in a complex disorder, resulting from multidimensional pathogenetic factors. Its phenomenology is characterized by emotional, behavioural, cognitive, and physical symptoms. Recent advances in neuropharmacology and neuroimaging are clarifying the role of putative brain circuits in regulating mood. In this context, it appears that a relationship between the three monoamine neurotransmitters (i.e., serotonin, norepinephrine, and dopamine) and different malfunctioning neural circuits mediating specific clinical domains in MD does exist. Therefore, these symptoms may be targeted by using antidepressants that enhance monoaminergic transmission within the hypothetically brain structures involved. This, in turn, would improve the effectiveness of the treatment. It has been suggested, mostly on empirical evidence, that some dual-acting drugs, by extensively targeting both "core" and "associated" symptoms of MD, may offer some advantages, when compared with more selective antidepressants, in terms of clinical remission and improvement of patient's quality of life.