During an informative presentation at Psych Congress 2023 (September 6-10, 2023; Nashville, TN), Michael Thase, MD, discussed the worldwide prevalence of depression and reviewed the development of antidepressant medications throughout history.
Depression is a major public health concern, leading to underperformance, disability, and suicide. Fortunately, there are several antidepressant medications available today to treat patients dealing with depression. Through the years, these medications have evolved to offer improved tolerance, safety, and ease of use.
Beginning in the 1950s, the first effective classes of antidepressants were monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs). However, the need for improvements in the tolerability of side effects, the time to onset of action, and drug specificity led to the next generation of antidepressants, the selective serotonin uptake inhibitors (SSRIs), in the early to mid-1980s. SSRIs offered greater convenience, better tolerability, and comparable efficacy to earlier antidepressants. In the late 1980s, second-generation antidepressants—namely bupropion, a norepinephrine-dopamine reuptake inhibitor (NDRI)—hit the market. NDRIs showed comparable efficacy to SSRIs, while offering the lowest risk of sexual side effects, weight gain, and daytime sedation. Finally, serotonin and norepinephrine reuptake inhibitors (SNRIs) were developed in the mid-1990s to early 2000s. SNRIs showed a positive dose-response relationship, and some show superior efficacy over SSRIs in moderate-to-severe depression.
Through the research and development of new antidepressant medications, three key strategies have emerged to improve the delivery of care to patients: measurement-based care (MBC), collaborative care, and shared decision-making. These overlapping strategies focus on assessing and monitoring symptoms and side effects in a timely manner, and an improper balance of these two aspects should indicate a need for treatment reevaluation. Applying these strategies can provide a valuable complement to available pharmacotherapeutics that can help to optimize patient care.
While an impressive number of antidepressant medications are currently available, Dr Thase advised that health care providers should always pursue the latest advancements in patient care. Evaluating emergent applications in practice serves to drive the field forward, leading to more promising approaches to treatment in the future.
“My own belief is that the US portion of the pharmaceutical industry is the best hope right now,” said Dr Thase. “[There are] newer, more effective, better-tolerated medications for patients, and I think [patients] deserve to get the best advice they can get.”
Thase, M. Foundations in psychopharmacology: focus on antidepressants. Presented at: Psych Congress; September 6-10, 2023; Nashville, TN.