Introduction: Monoamine Strategy vs Non-monoamine Strategy

In this debate moderated by Dr Charles Raison, watch as Dr Vladimir Maletic and Dr Greg Mattingly present their arguments for the optimal treatment approach for Major Depressive Disorder (MDD). Dr Maletic provides evidence in support of the non-monoamine strategy, while Dr Mattingly emphasizes the monoamine approach.

Dr Charles Raison: Hi, I'm Dr Charles Raison. Welcome to Great Debates in Psychiatry, brought to you by Psych Congress Network. In this series of debates, we're going to discuss the best approach to treating major depressive disorder, and we're going to compare and contrast the monoamine strategy versus non-monoamine strategy.
Now, before we begin, I got to tell you, I'm so excited for this debate. Joining us today are two close colleagues of mine, folks that I hugely admire for their amazing breadth of knowledge in all things psychiatric, but especially in the topic that we're going to cover today.

Now, so Dr Maletic will support the side of arguing for non-monoamine strategies in the treatment of depression. And Dr Mattingly will take the side of monoamine therapy and monoamine strategies. Now, of course, we're going to hear truths and important support for both sides of the argument, but it really is interesting to try to break it up this way because this is a central question in the treatment of mood disorders. How do we optimally address these issues from a neurobiological perspective? And of course, modulating monoamines has been at the core of what biologic psychiatry has done for 50 years, and these agents have saved millions of lives. They are very effective for some people. But, on the other hand, they certainly have limitations. And the idea that a simple monoamine deficiency, for example, which was an early idea as a cause for depression, is clearly not right. It's much more complex than that. And one of the complexities, or one of the interesting things that has arisen in recent years is the realization that other neurotransmitter systems, other networks in the brain can be profitably addressed by pharmacologic strategies, that there are really potentially remarkable non-monoamine strategies that hold great promise. So thinking about how these two different strategies interact with each other is really of direct clinical relevance.