An Update on the Pathophysiology of Major Depression: Neurophysiology for Clinicians

Abstract

Work from the last decade has resulted in exciting findings regarding brain changes associated with depression as cutting edge neuroscience has been brought to bear on the pathophysiology of major depression and other psychiatric illnesses. Here we review a current model that links stress, depression and antidepressant effect to cellular and molecular changes in the hippocampus, one of several brain regions implicated in the pathophysiology of depression. There are emerging classes of medication that do not appear to directly modulate monoamines (serotonin, norepinephrine or dopamine) but have antidepressant effects. It is currently unknown whether these medications will have neurobiological effects similar to those discussed below. Therefore instead of referring to antidepressant medication generally, the discussion refers to monoamine modulating antidepressant medications (MMAMs) which primarily include the serotonin reuptake inhibitors, noradrenaline reuptake inhibitors and monoamine oxidase inhibitors.