New insights into the pathogenesis and pathophysiology of depression

There is now considerable neurobiological evidence on the pathogenesis and pathophysiology of depression. Nevertheless the underlying pathophysiology is far from fully elucidated. Norepinephrine and serotonin deficit hypotheses have been known for quite a long time. Other theories also claim a dysfunction of the dopaminergic and GABA-ergic system in depression, an altered expression of neuropeptides (e.g. of substance P), and neuroimmunologic and neuroendocrinologic mechanisms such as an overdrive of the hypothalamic-pituitary adrenal system. The neurotrophin hypothesis suggests that decreased production of neurotrophic factors and impaired neurogenesis are crucial for the pathophysiology of depression. These upcoming pathophysiological concepts have also initiated novel treatment approaches whose clinical utility still has to be demonstrated.