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Major depressive disorder: mechanism-based prescribing for personalized medicine

Authors Saltiel P, Silvershein D, Lapolla T

Received 26 August 2014

Accepted for publication 12 December 2014

Published 31 March 2015 Volume 2015:11 Pages 875—888

DOI https://doi.org/10.2147/NDT.S73261

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 5

Editor who approved publication: Dr Roger Pinder

Philip F Saltiel,1 Daniel I Silvershein2

1Department of Psychiatry, New York University School of Medicine/Langone Medical Center New York University Behavioral Health Programs, New York University Pearl Barlow Center for Memory Evaluation and Treatment, New York, NY, USA; 2Department of Medicine, New York University School of Medicine/Langone Medical Center, New York, NY, USA

Abstract: Individual patients with depression present with unique symptom clusters – before, during, and even after treatment. The prevalence of persistent, unresolved symptoms and their contribution to patient functioning and disease progression emphasize the importance of finding the right treatment choice at the onset and the utility of switching medications based on suboptimal responses. Our primary goal as clinicians is to improve patient function and quality of life. In fact, feelings of well-being and the return to premorbid levels of functioning are frequently rated by patients as being more important than symptom relief. However, functional improvements often lag behind resolution of mood, attributed in large part to persistent and functionally impairing symptoms – namely, fatigue, sleep/wake disturbance, and cognitive dysfunction. Thus, patient outcomes can be optimized by deconstructing each patient’s depressive profile to its component symptoms and specifically targeting those domains that differentially limit patient function. This article will provide an evidence-based framework within which clinicians may tailor pharmacotherapy to patient symptomatology for improved treatment outcomes.

Keywords: MDD, tailored pharmacotherapy, patient-specific profile, individualized pharmacotherapy


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