Friday, March 11, 2016
Subtypes of Depression
Andrew A. Nierenberg, MD, Massachusetts General Hospital, Alexian Brothers Behavioral Health Hospital for Violence Prevention Clinic/Program and ADHD Clinic
Depression, with its highly variable presentation and “wide network” of psychological, behavioral, and somatic symptoms, always presents a diagnostic and therapeutic challenge. Dr. Nierenberg reviewed symptoms and subtypes of depression across demographic groups and the key contributory role of stress. Depression is highly comorbid, making it complicated to manage. Duration of depressive episodes also is highly variable, with some patients experiencing episodes that last as long as 14 weeks. Stress, in combination with genetic factors, affects the brain by increasing neuronal atrophy and suppressing neurogenesis and the expression of brain-derived neurotrophic factor (BDNF)—potentially putting patients into a “ruminative loop” that resists attempts to “move forward” toward recovery. Antidepressants exert their therapeutic influence in part by blocking suppression of BDNF.
