Literature Review on Pathogenesis and Treatment of Depression

Ibrahim Abdullah , Tyseer H.A. Hassan , Abdulaziz S.Alhudaif , Mousa A. Bahkali , Safiah B.Aleid , Maryam M. AlSunbul , Fahad O. B. Alharbi , Mohammed A.I. Almalki , Zainab M.A. Alhajji

Abstract

Background: Among various psychiatric disorders, depression is one of the most frequently encountered in today’s world. Depression confers a significant risk of recurrence in the subsequent years following the first episode. In order to deal this disorder, it is crucial to comprehend the pathogenesis and properly implement the available management options. Objectives: We intend to explore the pathogenesis and patho-physiology of depression and highlight the available methods to treat and manage this psychiatric disorder including both pharmacotherapy and psychotherapy. Methods: A review of relevant articles published from 1988 till date in English language was done using the electronic databases of PubMed, Pico and, Google Scholar with preset keywords. Conclusion: Depression is a highly prevalent psychiatric disorder that requires a multidimensional approach. 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 lifetime and alter the stress response by the hypothalamic-pituitary-adrenal axis. The patho-physiology of depression involves altered brain structure and function in addition to modified levels of neurotransmitters. Serotonin and its precursor tryptophan are decreased in the brain in depression in addition to various changes in catecholamines i.e. dopamine and norepinephrine. The treatment of depression is recommended by a combination of psychotherapy and pharmacotherapy which has higher efficacy than either therapy alone. The preferred forms of psychotherapy include interpersonal psychotherapy and cognitive behavioral therapy. The most commonly used pharmacotherapy include SSRIs, which are the most efficacious and tolerable antidepressants 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 effect profile.