Major depressive disorder (MDD) is estimated to impose maximum debilitating effectson the society by 2030, with its critical effects on health, functioning, quality of life and concomitanthigh levels of morbidity and mortality. Yet, the disease is inadequately understood, diagnosedand treated. Moreover, with the recent drastic rise in the pace of life, stress has materialized as oneof the most potent environmental factors for depression. In this scenario, it is important to understandthe modern pathogenetic hypotheses and mechanisms, and possibly try to shift from the traditionalapproaches in depression therapy. These include the elaboration of pathophysiologicalchanges in heterogeneous systems such as genetic, epigenetic, serotonergic, noradrenergic, gammaaminobutyricacid, glutamatergic and endocannabinoid systems, neurotrophic factors, HPA axis,immune system as well as cellular stress mechanisms. These components interact with each other ina complex matrix and further elucidation of their mechanism and cascade pathways are needed.This might aid in the identification of MDD subtypes as well as the development of sophisticatedbiomarkers. Further, characterization might also aid in developing multitargeted therapies that holdmuch promise as compared to the conventional monoamine based treatment. New candidate pharmacons,refined psychotherapeutic modalities, advanced neuro-surgical and imaging techniques aswell as the implementation of pharmacokinetic, pharmacogenetic prescribing guidelines constitutethe emerging expanses of MDD treatment.
Athira Kaipuzha Venu, Bandopadhyay, S., Samudrala, P. Kumar, V.G.M. Naidu, Mangala Lahkar, and Chakravarty, S., “An Overview of the Heterogeneity of Major Depressive Disorder: Current Knowledge and Future Prospective”, Current Neuropharmacology, vol. 18, no. 3, 2020.