Literature Review on Pathogenesis and Treatment of Depression

ABSTRACT

Background: Among various psychiatric disorders, depression is one of the most frequently encountered intoday’s world. Depression confers a significant risk of recurrence in the subsequent years following the firstepisode. In order to deal this disorder, it is crucial to comprehend the pathogenesis and properly implement theavailable management options. Objectives: We intend to explore the pathogenesis and patho-physiology ofdepression and highlight the available methods to treat and manage this psychiatric disorder including bothpharmacotherapy and psychotherapy. Methods: A review of relevant articles published from 1988 till date inEnglish language was done using the electronic databases of PubMed, Pico and, Google Scholar with presetkeywords. Conclusion: Depression is a highly prevalent psychiatric disorder that requires a multidimensionalapproach. The pathogenesis of depression comprises of 30-40% genetic contribution and about 60-70%environmental factors. Environmental factors include stressful life events at any point in an individual’s lifetimeand alter the stress response by the hypothalamic-pituitary-adrenal axis. The patho-physiology of depressioninvolves altered brain structure and function in addition to modified levels of neurotransmitters. Serotonin andits precursor tryptophan are decreased in the brain in depression in addition to various changes incatecholamines i.e. dopamine and norepinephrine. The treatment of depression is recommended by acombination of psychotherapy and pharmacotherapy which has higher efficacy than either therapy alone. Thepreferred forms of psychotherapy include interpersonal psychotherapy and cognitive behavioral therapy. Themost commonly used pharmacotherapy include SSRIs, which are the most efficacious and tolerableantidepressants while other second generation antidepressants such as SNRI, TCA and MOA inhibitors,mirtazapine and trazodone are chosen on the basis of patient preference, cost, comorbidities and side effectprofile.