The pathophysiology of
mood disorders involves several genetic and social predisposing factors, as well as a dysregulated response to a chronic stressor, i.e.
chronic pain. Our present view that depression involves a dysfunction of the monoaminergic system is a result of important clinical and preclinical observations over the past 40 years. In fact, current pharmacological treatment for depression is based on the use of drugs that act mainly by enhancing brain
serotonin and
noradrenaline neurotransmission by the blockade of the active reuptake mechanism for these
neurotransmitters. However, a substantial number of patients do not respond adequately to
antidepressant drugs. In view of this, there is an intense search to identify novel targets (receptors) for
antidepressant therapy.
Opioid peptides and their receptors are potential candidates for the development of novel
antidepressant treatment. In this context, endogenous
opioid peptides are co-expressed in brain areas known to play a major role in
affective disorders and in the action of
antidepressant drugs. The actions of endogenous
opioids and
opiates are mediated by three receptor subtypes (mu, delta and kappa), which are coupled to different intracellular effector systems. Also,
antidepressants which increase the availability of
noradrenaline and
serotonin through the inhibition of the reuptake of both monoamines lead to the enhancement of the
opioid pathway.
Tricyclic antidepressants show an
analgesic effect in neuropathic and inflammatory
pain that is blocked by the
opioid antagonist naloxone. A compilation of the most significant studies will illustrate the actual and potential value of the
opioid system for clinical research and drug development.