That's despite the fact that many such patients have no mood disorder they're not sad, but suffer from anxiety, fatigue, insomnia, or a tendency to obsess about the whole business. And third, the improvement in translation of neuroscientific insights to aid and advance clinical practice and research.Ībout one American in five receives a diagnosis of major depression over the course of a lifetime. Second, the continued search for potentially overlooked pathophysiological factors, especially outside the immediate boundaries of the brain. We argue that future developments may rely on three important lines of enquiry: first, the development of an integrated neuroscientific model of depression and its treatment in which different levels of description can be mechanistically linked, and in which distinct pathophysiological trajectories leading to depressive symptomatology can be identified. We then turn our attention to the future and discuss where the field might be moving in the years to come. In doing so, we cover neurochemical, neuroendocrine, immunological, functional and structural anatomical, and cognitive levels of description. In this article, we first turn to the past and briefly review what neuroscientific investigations have taught us so far about depression. Keywords: depression, melancholia, history, mood disorder, classification of mental disorders, antidepressantsĭepression is a common and debilitating mental health condition whose underlying aetiology and pathophysiology is still relatively poorly understood. Consumption of antidepressants have continued to rise year after year, and the World Health Organization notes depression as the leading cause of disability worldwide.Īt present, internationally recognized systems of classification favor a single category for depressive illness (alongside a circular mood disorder, bipolar I and II), but this view is challenged by clinicians and researchers who argue for the reinstatement of melancholia as a separate and distinct mood disorder with marked somatic and psychotic features. Following the publication of DSM-III in 1980 and the introduction of SSRIs a few years later, major depressive disorder became ubiquitous. In the early 20th century, melancholia gradually fell out of use as a diagnostic term with the introduction of manic-depressive insanity and unipolar depression. Melancholia was reconfigured in 19th-century medicine from traditional melancholy madness into a modern mood disorder. Current treatments for depression include selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), and lifestyle changes however, more severe forms of the disorder can require other medication, sometimes in combination with electroconvulsive therapy (ECT).ĭisagreement persists over how to define and classify depression, in part due to its ambivalent relationship to melancholia, which has existed as a medical concept in different forms since antiquity. Research suggests a link between depressed mood and monoamine depletion, elevated cortisol, and inflammation, but existing laboratory evidence is inconclusive. Depression is defined in diagnostic literature as a mood disorder characterized by depressed mood, loss of interest or pleasure in activities, significant changes in weight, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, difficulty concentrating, and suicidal ideation and/or attempts.
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