Modern approach to treating depression

Depresija, bolest kompleksne etiologije i različitih simptoma, danas je globalni zdravstveni problem i najveći uzrok onesposobljenosti u svijetu. Antidepresivi su raznovrsna skupina lijekova pozitivnog učinka na simptome depresije. Klasifikacijske skupine klasičnih antidepresiva su selektivni inhibitori ponovne pohrane serotonina (SIPPS/SSRI), inhibitori ponovne pohrane serotonina i noradrenalina (SNRI), triciklički antidepresivi (TCA), inhibitori monoaminooksidaze (MAOI), selektivni ihibitori ponovne pohrane noradrenalina, inhibitori ponovne pohrane noradrenalina i dopamina, antagonisti 5-HT2/α2 receptora, dualni serotoninski antidepresivi (DSEA), melatoninsko-serotoninski antidepresivi, noradrenergični i specifični serotoninski antidepresivi (NASSA) te multimodalni antidepresivi. Osim ovih dobro poznatih antidepresiva, veliki značaj imaju nove metode liječenja, osobito za pacijente kod kojih se do sada dostupne metode nisu ili su se tek djelomično pokazale korisnima. Suvremene metode liječenja depresije opisane u ovom radu uključuju primjenu ketamina i esketamina, moždanog neurotrofnog čimbenika (BDNF), mikro-RNA (miRNA), serum i glukokortikoid-regulirane-kinaze 1 (SGK1), hormonske terapije te duboke mozgovne stimulacije (DMS/DBS). Većinom su to farmakološke metode u fazi kliničkih istraživanja s pokazanim velikim potencijalom uspješnog liječenja depresije. To potvrđuju dobri rezultati primjene duboke mozgovne stimulacije te bioloških biljega, mikro-RNA i molekule SKG1. Trenutno se najveći uspjeh od do sada odobrenih metoda liječenja očekuje od farmakološkog liječenja esketaminom.
Depression, a disease of complex etiology and various symptoms, is nowadays a global health problem and the biggest cause of disability in the world. Antidepressants are a group of diverse medications with a positive effect on depression symptoms. Classification groups of traditional antidepressants are selective serotonin reuptake inhibitors (SSRI), selective norepinephrine and serotonin reuptake inhibitors (SNRI), tricyclic antidepressants (TCA), monoamine oxidase inhibitors (MAOI), selective norepinephrine reuptake inhibitors, norepinephrine and dopamine reuptake inhibitors, 5-HT2α receptor antagonists, dual serotonin antidepressants (DSEA), melatonin-serotonin antidepressants, noradrenergic and specific serotonergic antidepressants (NASSA), and multimodal antidepressants. Beside these well-known antidepressants, new treatment approaches have a great significance, especially for patients with treatment resistant depression. Modern approaches to treating depression described in this paper include usage of ketamine and esketamine, brain derived neurotrophic factor (BDNF), micro-RNA (miRNA), serum and glucocorticoid-regulated kinase 1 (SGK1), hormone therapy and deep brain stimulation (DBS). Most of these are clinical trial phased pharmacological treatments with a great potential of a successful depression treatment based on good results of DBS administration and biological markers micro-RNA and SGK1 administration. The biggest success of so far approved treatments is expected from esketamine usage.