Overview of the pharmacological properties and therapeutic efficacy of phospholipid liposomes (Liposom Forte (R)) in patients with depressive disorders

Major depression is a disorder that impairs mood, emotional behavior and various physical functions, such as sleep and appetite. Quality of life is very poor and occasionally is not worth living. The etiology of depression is multifactorial and still largely unknown; however, there is evidence that a relationship between genetic, environmental/behavioral stress and epigenetic factors plays a central role. The pathophysiology of depressive disorders is mainly correlated with a failure of the fine interplay between monoaminergic neuronal systems (5-HT, NE and DA). Elevated glucocorticoid and glutamate level, as a result of a chronic stress, causes a reduction of neurogenesis, dendritic complexity and synaptic connectivity in the hippocampus and prefrontal cortex, involving proinflammatory cytokines too and contributing in turn to depression and stress related disorders. Current treatment with tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, or serotonin and norepinephrine reuptake inhibitors has some limitations. Therefore, to enhance treatment efficacy and tolerability, clinicians have become increasingly interested in pharmaceutical compounds chemically different from the "classical antidepressants". In this respect particularly interesting seems the use of phospholipid liposomes (PL-Liposom Forte (R)). This review summarizes the experimental and clinical data leading to the use of natural phospholipids as therapeutic agents in depression. Experimentally phospholipids stimulate the monoaminergic systems and markedly reduce the negative effect of chronic stress on neuronal plasticity, corticosterone secretion and, in a model of neuroinflammation, antagonize the pro-inflammatory cytokines release. The results of the clinical studies performed with PL show that this treatment is well tolerated and effective in ameliorating the symptomatology of patients with different degree of depressed mood. In conclusion on the base of both experimental and clinical data, we propose the use of PL as add-on to ameliorate antidepressant treatment or even using such drugs as monotherapy.