The traditional way we approached the cause and treatment of depression is to see it as a chemical imbalance. That is you have in sufficient amounts of the neurotransmitters serotonin, norepinephrine and dopamine and low levels of these brain chemicals are what is causing your depression. We treat the depression by replenishing these chemicals using medications that help your brain cells or neurons either produce more of the chemicals or stop the chemicals from being broken down after they are produced so that they hang around a little longer. This is the concept behind the SSRIs or serotonin reuptake inhibitors.
Now we see that the reason the neurotransmitters are low is because of disrupted neural circuits in the brain. It’s related to the concept of neuroplasticity. In this case with depression, you get negative neuroplasticity. In this video, I discuss how neuroplasticity (or the lack of it) contributes to depression. We have a long way to go and getting depression to resolve with medication and using medications that have minimal side effects. This new way of conceptualizing depression has an impact on the new medications that are being developed and the psychotherapies we use to treat depression.
Videos Referenced in this video
Treatment Resistant Depression https://youtu.be/2z5krS51pNg
André RB, Lopes M, Fregni F. A systematic review and meta-analysis of clinical studies on major depression and BDNF levels: implications for the role of neuroplasticity in depression, Int. Journal of Neuropsychopharmacology (2008), 11, 1169–1180.
Serafini G. Neuroplasticity and major depression, the role of modern antidepressant drugs. World J Psychiatry. 2012;2(3):49-57.
Duman CH, Duman RS. Spine synapse remodeling in the pathophysiology and treatment of depression. Neurosci Lett. 2015;601:20-9.
Kang HJ, Voleti B, Hajszan T, et al. Decreased expression of synapse-related genes and loss of synapses in major depressive disorder. Nat Med. 2012;18(9):1413-7.
Rush AJ, et al. Acute and Longer-Term Outcomes in Depressed Outpatients Requiring One or Several Treatment Steps: A STAR*D Report Am J Psychiatry. 2006;163:1905-1917.
Yang CC, Barrós-Loscertales A, Pinazo D, et al. State and training effects of mindfulness meditation on brain networks reflect neuronal mechanisms of its antidepressant effect. Neural Plast. 2016;2016:9504642.
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