Depression: Not Just a Top–Down Phenomenon

Abstract

Depression is the second leading cause of disability worldwide with prevalence ranging from 2.5 to 20 % of the population dependent on the country. It can present as a single condition, but often it is co-morbid with chronic diseases. Medical professionals commonly treat depression as a neurotransmitter imbalance; yet, many effects ascribed to antidepressant medication, such as selective serotonin reuptake inhibitors, have also been explained by the placebo effect in patients with mild to moderate depression. Largely ignored research indicates that depression is caused by highly complex interactions of neuroendocrine and inflammatory mechanisms. In addition, culture/stigma, access to mental health services, and social instability play significant roles in perpetuating HPA and inflammatory pathways to maintain the disease and treatment resistance. The presented evidence highlights the need to appreciate depression through a multi-disciplinary lens to properly treat it and successfully reduce the debilitating effects on quality of life, co-morbidity and mortality, especially from suicide.