New developments hold promise for the increasing number of depression sufferers. Currently, about fourteen new medications for the treatment of depression are in the pipeline.

Researchers do not know if all depression is caused by precisely the same factors.  Different types of depression may exist and different medications are used in the attempt to treat them.  Much effort has been devoted to understanding how these medications work, as well as into searching for alternatives.  The 1950s brought new developments for those with this debilitating illness.  MAO inhibitors and tricyclics introduced means to manage depression but not without limitations, dietary restrictions and side effects.  In the late 1980s, a new class of medications called selective serotonin re-uptake inhibitors (SSRIs) were introduced.  With their selective targeting of a particular brain chemical, serotonin, SSRIs offered depression sufferers relief from symptoms with fewer side effects and no dietary restrictions.

Recent accounts of the approval process for new medications suggest a short or quick process.  The reality is that a medication takes between seven and fifteen years to get from lab to patient.   Each potential medication for FDA approval first has to go through several stages or phases of testing before even having its application submitted.  Early research, including preclinical testing, requires years of collecting and analyzing data from laboratory and animal studies.   The three phases of clinical trials begin with tests on healthy individuals to determine general safety and dosage and finish with trials of the medication on one thousand to three thousand patient-volunteers to confirm effectiveness and monitor long term effects.   An application is then submitted to the FDA seeking its approval.  The final approval process takes about a year and a half.   The Pharmaceutical Research and Manufacturers of America state, by this point, the average company has spent five hundred million dollars.  FDA approval rate is one in ten of those compounds which enter Phase I testing are approved. There are medications at almost all stages of development now which hold promise for depression.

Researchers are exploring the role a brain chemical called substance P may play in depression.  Initially, much research was focused on blocking substance P in an effort to relieve chronic pain.  While that sis not work, it may hold promise for depression sufferers.  Several companies are researching the possibilities.  Preliminary results of one such compound will be published in a September issue of Science.  If effective, substance P blockers will represent a different class of antidepressant medication.

SSRIs were considered an important development because they specifically targeted serotonin in the brain.  Research indicates that another neurotransmitter, norepinephrine, may also play a role in depression.  A new medication, reboxetine, represents another new class: selective norepinephrine reuptake inhibitors. A recent study suggests it may have more of an effect on drive and motivation rather than mood regulation.  Pharmacia & Upjohn has submitted an application for its approval to the FDA and it is presently being reviewed but has not yet been approved.

Developments for the treatment of depression are not limited to pharmacologic intervention.
Repetitive transcranial magnetic stimulation (rTMS)  is showing some promising results.  A magnetic field, produced by a stimulating coil, introduces a small electrical current in the cerebralcortex. Many studies are investigating the possibility of an antidepressant effect being produced by passing this coil close to the patient's head over a small interval of time.  Preliminary results suggest rTMS deserves further investigation.  It is, unfortunately, not a side effect free treatment.  Even if proven effective, it will still be some time before patients will be scheduling appointments for  rTMS.

Work continues toward a better understanding of depressive illness.  Thousands still go untreated each year or experience little relief from currently available options.  Hopefully, current and future research will result in doing better than the 80 percent of individuals who are successfully managing this illness now.