PSYCHOPHARMACOLOGY: HISTORY AND FUTURE PROSPECTS

Abstract

The article analyzes and summarizes the historical stages of psychopharmacology development, current trends, and future prospects. The aim of the study is to analyze historical trends, current mechanisms of action, and promising areas of psychopharmacology, assessing the efficacy, safety, and pharmacogenetic approaches. Methodology. During the course of the work, an analysis of current scientific literature was conducted and the evolutionary development from the monoaminergic paradigm of the mid-20th century to multimodal approaches covering glutamatergic, GABAergic, muscarinic, and neurosteroidal systems was traced. During the work, the methods of analysis, synthesis, and generalization were used. Scientific novelty. The clinical efficacy and safety of modern drugs such as esketamine, zurenolon, and xanomel-tropisone combinations, which demonstrate a rapid onset of action and an improved tolerability profile compared to traditional SSRIs/ SNRIs, were analyzed. It was noted that they require further evaluation of long-term efficacy and cost-effectiveness. An oral course of zurenolon has been shown to result in a statistically and clinically significant reduction in postpartum depression symptoms, with a good tolerability profile within a 14-day treatment period. However, data on remission stability after 30–45 days are limited, which affects economic indicators such as the need for repeat courses/higher levels of expenditure. With regard to LAI antipsychotics, symptomatic and functional benefits have been confirmed, correlating with better adherence. At the same time, data indicate metabolic burden and an increased risk of developing metabolic syndrome in individuals with schizophrenia, bipolar disorder, and depression. The problems of therapeutic resistance, side effects, and insufficient personalization of treatment are outlined. Particular attention is paid to the role of pharmacogenetic markers (CYP2D6, CYP2C19, SLC6A4, HTR2A) in the selection of therapy, the prospects for the use of digital biomarkers, machine learning, and artificial intelligence for predicting therapeutic response. Conclusions. It has been shown that the effectiveness of most modern drugs remains moderate (OR 1.3–2.1), which emphasizes the need to integrate biomarkers, pharmacogenetics, and pharmacoeconomic analysis in the creation of personalized treatment models. The psychopharmacology of the future is defined by the synergy of biomedical, genetic, and digital approaches aimed not only at reducing symptoms but also at restoring cognitive and emotional functioning.