Abstract
The neurobiology of emotion regulation is complex and multifactorial. Current models suggest that connections between information processing by the brain and its communications with the mind and body are impaired by chronic stress and the system is dysregulated in Major Depressive Disorder (MDD). Despite the high prevalence of MDD, the condition remains poorly managed with current treatment approaches, which have traditionally been aimed at correcting a single level of dysfunction, notably in neurotransmitters. A substantial proportion of patients who achieve symptomatic improvement with conventional therapy continue to report residual depressive symptoms and/or poor psychosocial functioning. Few clinical trials have been powered to detect changes in measures of functioning, resulting in a lack of evidence-based guidance for clinicians. The present paper reviews the evidence for an integrated, multipronged approach to the management of depression that may involve pharmacotherapy, psychotherapy, Complementary and Alternative Medicine (CAM) approaches such as yoga/meditation, exercise, diet and dietary supplements, and social support groups. The author advocates for the use of a patient-centric approach founded on a strong patientprovider alliance for the management of MDD. A shared decision-making approach should consider the potential role of pharmacotherapy, psychotherapy and CAM, which may enhance symptomatic remission and functional recovery in patients with MDD. These results may be mediated, at least in part, through improved regulation of the Hypothalamic- Pituitary-Adrenal (HPA) axis, and reduced allostatic stress load.
Highlights
The neurobiology of emotion regulation is complex and multifactorial
The Medline (PubMed) database was searched for any combination of the following terms: “major depressive disorder”, “depression”, “psychosocial functioning”, “quality of life”, “patient-centered approach”, “complementary medicine”, “alternative medicine”, “exercise”, “physical activity”, “yoga”, “meditation”, “dietary supplement”, “nutraceuticals”, “omega-3 fatty acids”, “St. John’s wort”, “L-methylfolate”, “social network”, “stress”, “hypothalamic-pituitaryadrenal axis”, “sleep”, and “clinical trial”
Both are associated with dysfunction in areas of the brain associated with information processing, emotion and affect, and may constitute promising targets for treatment of depression
Summary
The neurobiology of emotion regulation is complex and multifactorial. The brain can be conceptualized as the integration centre where information and stimuli from the physical and social world are processed and synthesized, resulting in the expression of emotion, mood and behaviour. This review will attempt to integrate the concepts of the neurobiology of emotion regulation, the consequences of allostatic overload on mental and emotional functioning, and the value of a multidimensional approach to managing the complexity of depression that considers the many realms of a person’s psychosocial functioning and well-being. It will consider the value of a more patient-centric, “functional medicine” approach whereby the underlying causes of disease are addressed using a systems-oriented approach and engaging both the patient and practitioner in a therapeutic partnership. Practitioners of functional medicine aim to understand the origins, prevent, and treat complex chronic diseases, including depression
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