As the neurobiological understanding of depression matures, it is increasingly clear that a “simple” monoamine hypothesis of depression is inadequate. Future research will help clarify the role of the check details monoamines in depression within the context of a larger genetic-neurochemical-neuroanatomical-environmental framework. Although discussed separately, it should Inhibitors,research,lifescience,medical be recognized that the 5-HT, NE,

and DA systems interact to modulate neural function. For example, 5-HT neurons have synapses on locus ceruleus cells and NE neurons innervate cells in the raphe nuclei. Further, it is clear that the monoamines operate within a larger neurochemical-neuroanatomical system. As discussed below, several brain regions have been implicated in depression, including the hippocampus. In animal models, chronic treatment with antidepressants increases the rate of neurogenesis within the hippocampus,61 Inhibitors,research,lifescience,medical suggesting that site-specific action of these medications may be important. Gene-environment studies suggest that genetic determinants of monoamine function such as SERT polymorphisms determine the degree to which environmental stressors affect one’s vulnerability to depression. Future studies of the monoamines in depression will focus on a number of areas. Better delineation

of the interactions within the monoamine systems will help clarify the specific role of each Inhibitors,research,lifescience,medical system in the pathophysiology of depression. Prior studies Inhibitors,research,lifescience,medical suggest that some patients respond well to medications that selectively modulate 5-HT function, others respond to medications that affect 5-HT and NE function, while still

others appear to require modulation of all three monoamine systems (eg, via MAOIs). Several pharmaceutical companies are developing “triple” reuptake inhibitors which inhibit reuptake of all three monoamines.62,63 Studies exploring the interactions between the monoamine systems and other neurotransmitter/neuromodulatory Inhibitors,research,lifescience,medical systems (eg, CRF, neurokinins, glutamate, and GABA – discussed in more detail below) will help develop realistic, integrated neurochemical models of depression. Functional imaging studies combined with neurochemical challenge will help clarify the anatomical specificity of monoaminergic dysfunction in depression. For example, PET imaging can be combined with monoamine depletion strategies to investigate the functional neuroanatomy crotamiton of depressive relapse with decreased monoamines.64-66 Development of radioligands for various monoamine receptors and transporters will help identify in which brain regions and to what degree these systems are abnormal in patients with depression. Genetic studies will also be more informative by incorporating imaging approaches. To date, at least two studies have suggested that 5-HTTLPR polymorphisms affect the structure, function, and functional connectivity of brain regions implicated in the pathophysiology of depresson.