Only a few innovations have been made in recent decades with regard to psychiatric, and particularly antidepressant, drugs (Insel et al., 2006) (Figure 1). This conundrum reflects, at least partly, the lack of understanding of the disease biology. This poses a challenge not only to inventive drug development, but also to clinical practice, which faces remission rates of 30 per cent and less in patients given state-of-the-art pharmacological treatment for major depressive disorders (Trivedi et al., 2006). The situation is further aggravated by the exclusive current use of clinically based diagnostic criteria for major depression, which some critics view as ‘a pseudo-category, effectively homogenizing multiple expressions of depression’ (Parker, 2004).
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