Summary And Conclusions

In the past 50 years a multitude of effective and safe treatments for mood disorders have been successfully introduced into the clinic. Conditions that once required long-term hospitalization for many patients are now routinely treated on an outpatient basis, and people suffering from mood disorders are more often than not able to lead relatively normal lives. Given the economic and social impact of these conditions, it is essential to improve diagnosis and provide consistent access to treatment.

During this period, the focus of psychiatric research was on understanding the role of monoamine systems in the pathophysiology of mental illnesses. These efforts were greatly influenced by the discovery of the CNS DA deficiency in patients suffering from Parkinson's disease (Ehringer and Hornykiewicz, 1960) and the remarkable therapeutic effects of l-DOPA treatment (Cotzias et al., 1967). The discovery of a DA deficiency in Parkinson's disease led psychiatric investigators to hope that the pathophysiology of mental disorders would be discovered by understanding the pharmacology of our treatments. The research of the past 30 years suggests that new, more complex models are in order. We have begun to understand that mood disorders are not simply the result of a deficiency on monoamine neurotransmitters and that we have to better understand the anatomy and function of brain circuits regulating emotion and cognition as well as the molecular events that modulate the function and viability of these circuits. As the pathophysiology of mood disorders becomes elucidated, future efforts will target disease pathophysiology, leading to more rapidly acting and effective treatments.

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