Therefore, achieving a state of symptomatic remission must be a treatment goal of utmost clinical importance. Targeting both serotonin and norepinephrine in those neuronal circuits

that mediate somatic symptoms is the most widely employed strategy to reduce painful and nonpainful somatic symptoms in depression.90 In comparison with selective serotonin reuptake inhibitors, learn more antidepressants with a dual action on both the serotonin and norepinephrine system were significantly superior in alleviating these somatic symptoms and achieving full symptomatic remission of depression. This may be a promising approach, even to treating chronic pain conditions, eg, fibromyalgia, without prevailing Inhibitors,research,lifescience,medical depressive symptoms.153,154 This seems to have been well established In clinical trials with venlafaxlne,155-159 duloxetlne,160-163 mllnaclpran,164 or mlrtazaplne.165 In order to Improve distressing symptoms of fatigue, Inhibitors,research,lifescience,medical the use of psychostimulants, modafinil, bupropion, or selective norepinephrine reuptake inhibitors such as reboxetine or atomoxetine may be recommended.166 As a rule, psychopharmacological efforts to Inhibitors,research,lifescience,medical treat severe states of depression or states of depression

with prominent somatic symptoms effectively must be guided by a perspective of a longer duration than usual. Higher dosages of a selected antidepressant have to be used very often. Sometimes shifts within or between pharmacological classes of antidepressants or an augmentation with, eg, lithium

or tri-iodthyronine, are necessary to arrive at the desired aim. From a pragmatic standpoint, clinically rational algorithms may favorably guide this endeavor.167 Finally, it must be Inhibitors,research,lifescience,medical stressed that a reasonable combination of pharmacological and psychotherapeutic approaches can improve the treatment results in Inhibitors,research,lifescience,medical many depressed patients.168,169
Depression is an incapacitating disorder with a lifetime prevalence of 16%,1 with a female-to-male ratio of about 5:2. Research is beginning to allow us to fully grasp the complexity of factors- personal, genetic, biological, societal, and environmental – which are involved. Several Bcl-2 activation efficient treatments and strategies exist, among which antidepressant drugs are a main choice. Although the criteria for choosing the best strategy remain empirical – there is some indication that the efficacy of antidepressants is comparable between and within classes – most patients are best treated with a combination of antidepressants and psychotherapy, modulated according to the course of their illness.2 Schematically, one may categorize the treatment of depression into three phases: acute, continuation, and maintenance.3,4 As summarized in Table I, each phase is defined by specific aims and strategies. Some aspects remain under discussion, especially those concerning the appropriate duration of long-term treatment.