BRAIN-SEROTONIN AND THE MECHANISM OF ACTION OF SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI)

The role of serotonin (5-HT) in the human central nervous system and i ts involvement in a variety of physiological and behavioral functions are summarized. The main items of the 5-HT hypothesis of depression, a nd the role of 5-HT in the pathophysiology and treatment of this mood disorder are considered. The main pathogenetic hypotheses and drug tre atment of depression are also briefly reviewed. New data on the admini stration of selective 5-HT re-uptake inhibitors (SSRI) and their mecha nisms of action are discussed. Their relative safety, and the lack of cognitive impairments associated with their use are in favor of their utilization in the treatment of older patients. However, it is emphasi zed that evidence-based treatment strategies of depression in the elde rly patients have not yet been identified and this lack of scientific evidence might be associated with the problem of under-diagnosis and u nder-treatment in the daily medical practice. Finally, the recent guid elines of pharmacological treatment strategies of depression in the el derly people are reported, emphasizing the specific issues in treating older patients, such as the bio-availability, the pharmacokinetic cha nges, the excretion rates of medicines, etc., which all need to be con isdered when planning treatment of depression.