Cns Spectrums
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There are several investigational drugs in development for the treatment of depression. Some of the novel antidepressants in development target monoaminergic neurotransmission in accordance with the "monoamine hypothesis of depression." However, the current conceptualization of antidepressant actions is that it is the downstream effects on protein synthesis and neuroplasticity that account for therapeutic efficacy, rather than the immediate effects on synaptic monoamine levels. Thus, a number of novel agents in development directly target components of this "neuroplasticity hypothesis of depression," including hypothetically overactive glutamatergic neurotransmission and dysfunctional hypothalamic-pituitary-adrenal (HPA) axis functioning.
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Ketamine induces rapid-onset and short-duration improvement in depressive and suicidal symptoms in both treatment-resistant unipolar depression and bipolar depression, and also reduces chronic pain after short intravenous infusions. In order to develop long-acting oral agents with the same clinical effects, the pharmacologic mechanism of action must be understood, and the leading hypotheses are discussed here.
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Alzheimer's disease (AD) is an urgent public health challenge that is rapidly approaching epidemic proportions. New therapies that defer or prevent the onset, delay the decline, or improve the symptoms are urgently needed. All phase 3 drug development programs for disease-modifying agents have failed thus far. ⋯ Early translational research is complemented by later stage translational approaches regarding how best to use evidence to impact clinical practice and to assess the influence of new treatments on the public health. Funding of translational research is evolving with an increased emphasis on academic and NIH involvement in drug development. Translational neuroscience provides a framework for advancing development of new therapies for AD patients.
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Risk for post-traumatic stress disorder (PTSD) varies in part due to the nature of the traumatic event involved. Both injury and return from combat pose high risk of PTSD symptoms. How different injuries may predispose towards PTSD is less well understood. ⋯ These results suggest that service members with blunt or combination injuries merit particular attention when screening for PTSD.