Major depressive disorder | Nature Reviews Disease Primers

Major depressive disorder (MDD) is a debilitating disease that is characterized by depressed mood, diminished interests, impaired cognitive ... Skiptomaincontent Thankyouforvisitingnature.com.YouareusingabrowserversionwithlimitedsupportforCSS.Toobtain thebestexperience,werecommendyouuseamoreuptodatebrowser(orturnoffcompatibilitymodein InternetExplorer).Inthemeantime,toensurecontinuedsupport,wearedisplayingthesitewithoutstyles andJavaScript. Advertisement nature naturereviewsdiseaseprimers primers article Subjects DepressionNeurologicaldisordersPsychiatricdisorders AbstractMajordepressivedisorder(MDD)isadebilitatingdiseasethatischaracterizedbydepressedmood,diminishedinterests,impairedcognitivefunctionandvegetativesymptoms,suchasdisturbedsleeporappetite.MDDoccursabouttwiceasofteninwomenthanitdoesinmenandaffectsoneinsixadultsintheirlifetime.TheaetiologyofMDDismultifactorialanditsheritabilityisestimatedtobeapproximately35%.Inaddition,environmentalfactors,suchassexual,physicaloremotionalabuseduringchildhood,arestronglyassociatedwiththeriskofdevelopingMDD.Noestablishedmechanismcanexplainallaspectsofthedisease.However,MDDisassociatedwithalterationsinregionalbrainvolumes,particularlythehippocampus,andwithfunctionalchangesinbraincircuits,suchasthecognitivecontrolnetworkandtheaffective–saliencenetwork.Furthermore,disturbancesinthemainneurobiologicalstress-responsivesystems,includingthehypothalamic–pituitary–adrenalaxisandtheimmunesystem,occurinMDD.Managementprimarilycomprisespsychotherapyandpharmacologicaltreatment.Fortreatment-resistantpatientswhohavenotrespondedtoseveralaugmentationorcombinationtreatmentattempts,electroconvulsivetherapyisthetreatmentwiththebestempiricalevidence.InthisPrimer,weprovideanoverviewofthecurrentevidenceofMDD,includingitsepidemiology,aetiology,pathophysiology,diagnosisandtreatment. Thisisapreviewofsubscriptioncontent Accessoptions Accessthroughyourinstitution Changeinstitution Buyorsubscribe SubscribetoJournalGetfulljournalaccessfor1year55,14€only55,14€perissueSubscribeAllpricesareNETprices.VATwillbeaddedlaterinthecheckout.Taxcalculationwillbefinalisedduringcheckout.BuyarticleGettimelimitedorfullarticleaccessonReadCube.$32.00BuyAllpricesareNETprices. Additionalaccessoptions: Login Learnaboutinstitutionalsubscriptions Figure1:Average12-monthprevalenceofMDD.Figure2:ThesomaticconsequencesofMDD.Figure3:BiologicalsystemsinvolvedinthepathophysiologyofMDD.Figure4:Modelofgene–environmentinteractionsthatleadtoMDD.Figure5:StructuralbrainalterationsinMDD.Figure6:Stepped-caremodelinthemanagementofMDD.Figure7:Themechanismsofactionofantidepressantdrugs. 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DownloadreferencesAuthorinformationAuthorsandAffiliationsDepartmentofPsychiatryandPsychotherapy,CharitéUniversityMedicalCenter,CampusBenjaminFranklin,Hindenburgdamm30,Berlin,12203,GermanyChristianOtte & StefanM.GoldInstituteofNeuroimmunologyandMultipleSclerosis(INIMS),UniversityMedicalCenterHamburg-Eppendorf,Hamburg,GermanyStefanM.GoldDepartmentofPsychiatry,VUUniversityMedicalCenter,Amsterdam,TheNetherlandsBrendaW.PenninxInstituteofPsychiatry,PsychologyandNeuroscience,King'sCollegeLondon,London,UKCarmineM.ParianteDepartmentofPsychiatryandBehaviouralSciences,StanfordUniversitySchoolofMedicine,PaloAlto,California,USAAmitEtkin & AlanF.SchatzbergDepartmentofPsychiatry,MassachusettsGeneralHospital,Boston,Massachusetts,USAMaurizioFavaDepartmentofPreventiveMedicine,FeinbergSchoolofMedicine,NorthwesternUniversity,Chicago,Illinois,USADavidC.MohrAuthorsChristianOtteViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarStefanM.GoldViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarBrendaW.PenninxViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarCarmineM.ParianteViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarAmitEtkinViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarMaurizioFavaViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarDavidC.MohrViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarAlanF.SchatzbergViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarContributionsIntroduction(C.O.);Epidemiology(B.W.P.);Mechanisms/pathophysiology(C.O.,S.M.G.,B.W.P.,C.M.P.andA.E.);Diagnosis,screeningandprevention(A.F.S.);Management(M.F.andD.C.M.);Qualityoflife(S.M.G.);Outlook(C.O.andA.F.S.);OverviewofthePrimer(C.O.).CorrespondingauthorCorrespondenceto ChristianOtte.Ethicsdeclarations Competinginterests C.O.hasreceivedhonorariaforlecturesfromLundbeckandServierandformembershipinascientificadvisoryboardfromLundbeckandNeuraxpharm.S.M.G.hasreceivedhonorariafromNovartisandtravelreimbursementsfromNovartis,MerckSeronoandBiogenIdecandhasreceivedin-kindresearchsupportforconductingclinicaltrialsfromGAIAAG,acommercialdeveloperandvendorofhealthcaremanagementandeHealthinterventions.B.W.P.hasreceivedresearchfundingfromJansenResearchandissupportedbyaVICIgrantfromtheDutchScientificOrganization.C.M.P.wassupportedbytheNationalInstituteforHealthResearchMentalHealthBiomedicalResearchCentreinMentalHealthatSouthLondon,MaudsleyNHSFoundationTrustandKing'sCollegeLondon,thegrants‘Persistentfatigueinducedbyinterferon-α:ANewImmunologicalModelforChronicFatigueSyndrome’(MR/J002739/1),and‘Immuno-psychiatry:aconsortiumtotesttheopportunityforimmunotherapeuticsinpsychiatry’(MR/L014815/1)fromtheMedicalResearchCouncil(UK),researchfundingfromtheMedicalResearchCouncil(UK)andtheWellcomeTrustforresearchondepressionandinflammationaspartoftwolargeconsortiathatalsoincludeJohnson&Johnson,GSK,LundbeckandPfizer,andresearchfundingfromJohnson&Johnsonaspartofaprogrammeofresearchondepressionandinflammation.Inaddition,C.M.P.hasreceivedaspeaker'sfeefromLundbeck.A.E.hasreceivedresearchfundingfromBrainResource,Inc.andhonorariaforconsultingfromOtsuka,AcadiaandTakeda.M.F.reportsthefollowingresearchsupport:AbbotLaboratories;Alkermes,Inc.;AmericanCyanamid;AspectMedicalSystems;AstraZeneca;AvanirPharmaceuticals;BioResearch;BrainCellsInc.;Bristol-MyersSquibb;CeNeRxBioPharma;Cephalon;Cerecor;Clintara,LLC;Covance;Covidien;EliLillyandCompany;EnVivoPharmaceuticals,Inc.;EuthymicsBioscience,Inc.;ForestPharmaceuticals,Inc.;FORUMPharmaceuticals;GanedenBiotech,Inc.;GlaxoSmithKline;HarvardClinicalResearchInstitute;Hoffman-LaRoche;IconClinicalResearch;i3Innovus/Ingenix;JanssenR&D,LLC;JedFoundation;Johnson&JohnsonPharmaceuticalResearch&Development;LichtwerPharmaGmbH;LorexPharmaceuticals;LundbeckInc.;MedAvante;MethylationSciencesInc.;NationalAllianceforResearchonSchizophrenia&Depression(NARSAD);NationalCenterforComplementaryandAlternativeMedicine(NCCAM);NationalCoordinatingCenterforIntegratedMedicine(NiiCM);NationalInstituteofDrugAbuse(NIDA);NationalInstituteofMentalHealth(NIMH);Neuralstem,Inc.;NovartisAG;OrganonPharmaceuticals;PamLab,LLC.;PfizerInc.;Pharmacia-Upjohn;PharmaceuticalResearchAssociates.,Inc.;Pharmavite®LLC;PharmoRxTherapeutics;Photothera;ReckittBenckiser;RochePharmaceuticals;RCTLogic,LLC(formerlyClinicalTrialsSolutions,LLC);Sanofi-AventisUSLLC;Shire;SolvayPharmaceuticals,Inc.;StanleyMedicalResearchInstitute(SMRI);Synthelabo;TakedaPharmaceuticals;TalMedical;Wyeth-AyerstLaboratories;AdvisoryBoard/Consultant:AbbottLaboratories;Acadia;AffectisPharmaceuticalsAG;Alkermes,Inc.;AmarinPharmaInc.;AspectMedicalSystems;AuspexPharmaceuticals;AvanirPharmaceuticals;AXSOMETherapeutics;BayerAG;BestPracticeProjectManagement,Inc.;BiogenandBioMarinPhar.D.C.M.hasreceivedhonorariaforlecturesandformembershipinascientificadvisoryboardfromOtsuka.A.F.S.has,since2015,servedasaconsultantforAlkermes,Cervel,Clintara,ForumPharmaceuticals,McKinseyandCompany,MyriadGenetics,Neurontics,Naurex,OneCarbon,Pfizer,Takeda,SunovionandX-HaleandasaspeakerforPfizer;heholdsequityinAmnestix,Cervel,Corcept(co-founder),Delpor,GileadIncyte,Merck,Neurocrine,SeattleGenetics,TitanandX-Hale;andheislistedasaninventoronpharmacogeneticandantiglucocorticoidusepatentsonpredictionofantidepressantresponse. 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NatRevDisPrimers2,16065(2016).https://doi.org/10.1038/nrdp.2016.65DownloadcitationPublished:15September2016DOI:https://doi.org/10.1038/nrdp.2016.65SharethisarticleAnyoneyousharethefollowinglinkwithwillbeabletoreadthiscontent:GetshareablelinkSorry,ashareablelinkisnotcurrentlyavailableforthisarticle.Copytoclipboard ProvidedbytheSpringerNatureSharedItcontent-sharinginitiative Furtherreading Aberrantfunctionalconnectivityininsularsubregionsinsomaticdepression:aresting-statefMRIstudy RuiYan JiTingGeng QingLu BMCPsychiatry(2022) Anovel4immune-relatedgenesasdiagnosticmarkersandcorrelatedwithimmuneinfiltratesinmajordepressivedisorder LinnaNing ZhouYang DandongDeng BMCImmunology(2022) AnoveljointindexbasedonperipheralbloodCD4+/CD8+Tcellratio,albuminlevel,andmonocytecounttodeterminetheseverityofmajordepressivedisorder DechunZhou HongfengYu WeiChen BMCPsychiatry(2022) RNA-seqbasedtranscriptomeanalysisofethanolextractofsaffronprotectiveeffectagainstcorticosterone-inducedPC12cellinjury XiChen TingYang ZhijieMa BMCComplementaryMedicineandTherapies(2022) Evaluationofinflammatoryandmetabolicimpairmentsregardingdepressiondimensions:acasecontrolstudy YoumnaSabri NohaAbdelsalam MiddleEastCurrentPsychiatry(2022) Accessthroughyourinstitution Changeinstitution Buyorsubscribe AssociatedContent Majordepressivedisorder NatureReviewsDiseasePrimers PrimeView 15Sept2016 Advertisement Explorecontent Primers&PrimeViews News&Comment Videos Collections FollowusonFacebook FollowusonTwitter Subscribe Signupforalerts RSSfeed Aboutthejournal AboutPrimeViews Aims&Scope JournalInformation AbouttheEditors Editorialinputandchecks EditorialValuesStatement JournalMetrics Animations Contact Editorialpolicies Publishwithus ForAuthors ForReferees Submitmanuscript Search Searcharticlesbysubject,keywordorauthor Showresultsfrom Alljournals Thisjournal Search Advancedsearch Quicklinks Explorearticlesbysubject Findajob Guidetoauthors Editorialpolicies Closebanner Close SignupfortheNatureBriefingnewsletter—whatmattersinscience,freetoyourinboxdaily. 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