Bioenergetics for depression: Something different for depression

摘要

At those times when I slow down enough to reflect on the current state of psychiatry and my own clinical experiences since I completed residency 20 years ago, I am struck by how much we have learned yet how relatively little we have advanced. Although we have a number of new medications and therapies, most of these are from the same general drug classes or psychotherapy models that I used in residency, e.g., dopamine antagonists for psychosis or cognitive-behavioral therapy for anxiety. Most of these were based on serendipitous discoveries. Consequently, the management of major depression remains little changed over the last two decades (1); the general approach is still to increase the concentration of monoamines serotonin and norepinephrine in the synapse, generally through reuptake inhibition (even though the initial increases seem to have little to do with the eventual antidepressant response), and then add some cognitive-behavioral or other evidenced-based therapy to try to improve outcome.