Review from JAMA Psychiatry — The Role of Dopamine in the Pathophysiology of Depression

Major depressive disorder (MDD) is a highly prevalent, disabling, and costly illness.^1-3 For a patient presenting with MDD, an antidepressant medication or evidence-based psychotherapy is currently recommended as first-line treatment.^4-7 However, fewer than 40% of patients achieve remission with initial treatment,^8,9 and choosing the “wrong” initial treatment has significant individual and societal costs due to continued distress, risk of suicide, loss of productivity, and wasted resources associated with 2 to 3 months of an ineffective treatment.^10,11 Given the public health consequences of inadequately treated depression, a clinical or biological marker to guide initial treatment selection for MDD could have major health and economic impact.¹²

Anxiety, obsessive-compulsive, and posttraumatic stress disorders constitute the most prevalent group of mental disorders, collectively affecting up to 30% of individuals at some point in their lives.¹ These conditions contribute significantly to the global burden of disease and disability-adjusted life-years.²