What is the view of modern psychiatry on depression?

Theodore A. Henderson, MD
Adolescent Medicine
When the new DSM-V (the diagnostic manual for Psychiatry) came out, thought leaders in Psychiatry, Neuroscience, and brain research questioned the very validity of psychiatric diagnoses. For example, Dr. Tom Insel, Director of the National Institutes of Mental Health, has announced that he believes the DSM system is broken and that federal agency will no longer be funding research based only on DSM diagnostic criteria. Similarly, Nassir Ghaemi, MD has stated, "we have a huge amount of neurobiology research now to conclude that the 20th century neurotransmitter theories of psychopharmacology basically are false." Now, more than ever, it is important to look at psychiatric illnesses with new eyes. We need to utilize neuroimaging, genetic testing, immunological testing, laboratory studies and a thorough understanding of the neurobiological basis of disease.

Basically, depression is no longer about "a chemical imbalance". It's not about a serotonin deficiency. Rather, depression results from a a variety of causes. Depression may involve interplay between genetic vulnerability, nutritional deficits, and environmental stressors. But depression can also develop after traumatic brain injury. Symptoms of depression can be caused by viral infections. I reported on this in a recent paper in Advances in Mind-Body Medicine. The immune system can release factors that cause depression. Symptoms of depression can also be driven by anxiety and no amount of antidepressant will fix the depression until the anxiety is controlled. These are just some of the kinds of depression that I find in my clinic for treatment-resistant depression.

Depression causes the loss of synapses (the connections between brain cells), dendrites (the tree-like branches of brain cells), and brain cells themselves. Research has shown that the hippocampus (a part of the limbis system or emotional brain) gets smaller in depression. Thus, it is important to repair the damage of depression. Antidepressants can help this a little. Even psychotherapy alone can result in regrowth in the size of the hippocampus. But the most powerful agent for brain repair at this point in history is intravenous ketamine therapy. Ketamine powerfully induces the production of a brain growth factor which helps repair the brain injury caused by depression. This is one of the most exciting areas in depression treatment.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.