Greg Mattingly, MD, on Unmet Needs in the Treatment of Depression

In this video, Greg Mattingly, MD, discusses needs that remain unmet in the treatment of depression. Dr. Mattingly is Associate Clinical Professor, Washington University, St. Louis, Missouri, principal investigator in clinical trials for Midwest Research Group and founding partner of St. Charles Psychiatric Associates, St. Charles, Missouri.


The depression landscape still has a lot of unmet needs. Each and every day, I think every clinician across the country goes out to their waiting room and finds patients whose depressions may be partially better, but still probably partially there. We know that depression right now is one of the top causes of disability in the United States and around the world.

The good news, bad news is...The good news is, we have many more treatment options than we did 20 years ago. The bad news is, disability rates have not improved. We know that our patients with depression continue to struggle, they miss days of work, they have difficulties as a parent. They have difficulties in their daily life despite our treatment options.

Some of the biggest unmet needs include number one, antidepressants that have higher rates of remission, not just response. Getting people all the way better, not partially better, so, remission being the goal.

Another unmet need is speed of onset. We know that many of our antidepressants take weeks to months to start working, and for a lot of my patients, weeks to months can feel like a lifetime.

Imagine a mom who's struggling to take care of her kids, a dad who's struggling to make it to work, a university student who's afraid to go in and take his finals because his brain is locked in a fog that's caused by depression. Faster onset is another one of our bigger unmet needs.

We also know that our current mechanisms of action for the last 30, 40 years have focused on the monoamines—serotonin, norepinephrine, dopamine. We hadn't really had a revolutionary breakthrough until just the last few years.

Medicines that have a different mechanism of action, this new group of medicines we call fast‑acting antidepressants that can stimulate the glutamate GABA intersection, medicines that increase resilience to depression. They increase our ability to fight off the next episode of depression.

Now, we're looking at whole new generation of antidepressants that we may take on an as‑needed basis, where we treat an episode of depression in the same way we treat an antibiotic for an infection.

Higher remission, faster onset, new mechanism of action, I think those are some of the unmet needs when we talk about the world of depression.