Novel treatment possibilities in depression and schizophrenia

In medicine, there are two main methods of improving the healthcare provided: seeking new treatment procedures and perfecting(optimizing) the existing ones. Optimization of treatment includes not only practical tools such as therapeutic drug monitoring,but also implementation of general trends in the clinical practice. In depression, treatment-resistance to antidepressive pharmacotherapyrepresents one of the most important clinical challenges. Switch to monotherapy with new multimodal/multifunctionalantidepressants and augmentation with new atypical antipsychotics (aripiprazole and brexpiprazole) may be promising options.Further, current evidence supports utility and safety of adjunctive treatment of nutraceuticals. Novel approaches being studiedinclude ketamine and opioids. Recent advances in technology and emerging knowledge about dysfunctional brain circuits andneuroplasticity have led to the development of different new neuromodulation techniques usually used as add-on therapy. Antipsychoticsare still the cornerstone of the current treatment of schizophrenia. Two new partial dopamine agonists, brexpiprazoleand cariprazine, are now available in addition to aripiprazole. Although the mechanisms of action are similar, the two agents differin terms of their pharmacodynamic profiles. New treatment options not yet available include cannabidiol, glutamate modulatorsand nicotine receptors agonists. These strategie might improve also negative symptoms and cognitive dysfunction.

Keywords: optimization of treatment, multimodal/multifunctional antidepressants, partial dopamine agonists, glutamate modulators,
nicotine receptors agonists