Contributing Authors: David A. Ross, MD, PhD
Overview: For the past sixty years, virtually all pharmacological treatments of depression have been predicated on a monoaminergic model. This began with the discovery of the antidepressant effects of iproniazid, a monoamine oxidase inhibitor, and continued through the discovery and development of TCA’s, SSRI’s, SNRI’s, and newer medications like bupropion, mirtazapine, and even the second generation antipsychotics. Though this approach has been effective in some regards (our treatments are vastly superior to what they were pre-1950!) it is clear that this model is inadequate.
The present session is designed to introduce residents to alternative neurobiological models for thinking about depression. We present three articles illustrating different psychopharmacological approaches, each connecting to a different neurotransmitter system and a different biological model. We would emphasize: there are many different approaches for thinking about the neurobiology of depression. The same session could just as easily be conducted using studies focusing on alternative psychopharmacological approaches, circadian rhythms, exercise, deep brain stimulation (DBS), repetitive transcranial magnetic stimulation (rTMS), etc. We do not suggest that the three articles we have chosen are necessarily the “best” glimpse into the neurobiology of depression. Rather, we view them as excellent catalysts for a discussion about the limitations of our current methods and, critically, about the ways in which ongoing translational research may transform the future of patient care.
Author Affiliations: Dr. Ross is an Associate Program Director and Assistant Professor of Psychiatry at Yale School of Medicine. The National Neuroscience Curriculum Initiative is a collaborative effort with AADPRT and the American Psychiatric Association (APA) Council on Medical Education and Lifelong Learning and receives support from the NIH (R25 MH10107602S1) ©National Neuroscience Curriculum Initiative
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I ran this session with a group of residents from all 4 PG years. It worked very well. I actually added a fourth article on rTMS so there were 4 groups going on. This extended the session to be a bit longer than an hour. In retrospect, this made the session slightly less interactive (since residents were thus personally involved in only 25% instead of 33% of the whole module). Next time I do it, I might cut out the ketamine article (since it is kind of old news by now) and use the rTMS instead, so that there would still only be 3 groups.
New Targets for rTMS in Depression: A Review of Convergent Evidence (Downar and Daskalakis, Brain Stimulation, 2012)