Multi-target strategies for the improved treatment of depressive states: Conceptual foundations and neuronal substrates, drug discovery and therapeutic application

Pharmacol Ther. 2006 May;110(2):135-370. doi: 10.1016/j.pharmthera.2005.11.006. Epub 2006 Mar 7.

Abstract

Major depression is a debilitating and recurrent disorder with a substantial lifetime risk and a high social cost. Depressed patients generally display co-morbid symptoms, and depression frequently accompanies other serious disorders. Currently available drugs display limited efficacy and a pronounced delay to onset of action, and all provoke distressing side effects. Cloning of the human genome has fuelled expectations that symptomatic treatment may soon become more rapid and effective, and that depressive states may ultimately be "prevented" or "cured". In pursuing these objectives, in particular for genome-derived, non-monoaminergic targets, "specificity" of drug actions is often emphasized. That is, priority is afforded to agents that interact exclusively with a single site hypothesized as critically involved in the pathogenesis and/or control of depression. Certain highly selective drugs may prove effective, and they remain indispensable in the experimental (and clinical) evaluation of the significance of novel mechanisms. However, by analogy to other multifactorial disorders, "multi-target" agents may be better adapted to the improved treatment of depressive states. Support for this contention is garnered from a broad palette of observations, ranging from mechanisms of action of adjunctive drug combinations and electroconvulsive therapy to "network theory" analysis of the etiology and management of depressive states. The review also outlines opportunities to be exploited, and challenges to be addressed, in the discovery and characterization of drugs recognizing multiple targets. Finally, a diversity of multi-target strategies is proposed for the more efficacious and rapid control of core and co-morbid symptoms of depression, together with improved tolerance relative to currently available agents.

Publication types

  • Review

MeSH terms

  • Adrenergic Uptake Inhibitors / adverse effects
  • Adrenergic Uptake Inhibitors / therapeutic use*
  • Animals
  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / classification
  • Antidepressive Agents / therapeutic use*
  • Brain / drug effects*
  • Brain / metabolism
  • Bupropion / pharmacology
  • Bupropion / therapeutic use
  • Clinical Trials as Topic
  • Cyclohexanols / adverse effects
  • Cyclohexanols / therapeutic use
  • Depressive Disorder, Major / drug therapy*
  • Depressive Disorder, Major / etiology
  • Depressive Disorder, Major / metabolism
  • Dopamine / metabolism
  • Dopamine Uptake Inhibitors / adverse effects
  • Dopamine Uptake Inhibitors / therapeutic use
  • Drug Delivery Systems*
  • Drug Design
  • Drug Therapy, Combination
  • Humans
  • Morpholines / adverse effects
  • Morpholines / therapeutic use
  • Nerve Net / drug effects
  • Nerve Net / metabolism
  • Neurons / drug effects
  • Neurons / metabolism
  • Norepinephrine / metabolism
  • Reboxetine
  • Selective Serotonin Reuptake Inhibitors / adverse effects
  • Selective Serotonin Reuptake Inhibitors / therapeutic use*
  • Serotonin / metabolism
  • Venlafaxine Hydrochloride

Substances

  • Adrenergic Uptake Inhibitors
  • Antidepressive Agents
  • Cyclohexanols
  • Dopamine Uptake Inhibitors
  • Morpholines
  • Serotonin Uptake Inhibitors
  • Bupropion
  • Serotonin
  • Venlafaxine Hydrochloride
  • Reboxetine
  • Dopamine
  • Norepinephrine