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Medical News & Perspectives |

Decade of Work Shows Depression Is Physical

Brian Vastag
JAMA. 2002;287(14):1787-1788. doi:10.1001/jama.287.14.1787.
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Bethesda, Md—Psychiatrist and brain imaging researcher Wayne C. Drevets, MD, recalls a patient dealing with breast cancer and unrelated episodes of major depression. The woman found it easier to talk about the cancer because, Drevets said, "with the depression there was nothing tangible to point to or explain to people, even herself."

It turns out that there is something tangible. A decade of unusually collaborative research by Drevets and a number of other researchers dramatically illustrates that chronic major depression is as physical as diabetes or heart disease. Dysfunctional metabolism and blood flow in the brain's emotional centers mark two physical manifestations of the mental disorder. Charted with magnetic resonance imaging and positron emission tomography scans, these findings have been replicated in dozens of studies.

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A decade of imaging research points to specific, possibly irreversible, changes in brain structures during and after episodes of major depression. Here, transverse PET scans illustrate a recent finding, that brain structures in individuals at the nadir of depression cannot properly listen to the neurotransmitter serotonin (5-hydroxytryptamine [HT]). A series of scans using a radioactive tracer synthesized at the University of Pittsburgh uncovered marked deficiency in 5-HT type 1A receptor activity in depressed individuals. The most pronounced deficits were seen in brain areas critical to emotional stability, including the mesiotemporal cortex (home of the amygdala and the hippocampus) and the midbrain raphe nucleus, which is densely packed with serotonin-producing neurons (Biol Psychiatry. 1999;46:1375-1387). Current antidepressant drugs, such as selective serotonin reuptake inhibitors, appear to compensate for this effect in depressed individuals. (Photo credit: Wayne C. Drevets, MD)

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