A new chapter in the history of depression

摘要

Once thought of as a disturbance of the humors, then as the result of anger turned inward, we now recognize that major depression is a brain disorder that is highly responsive to both somatic and psychological/behavioral interventions. For decades, a small group of investigators in the latter half of the 20th century focused specifically on the relationship of depression to disturbances of the circadian system, but they were clearly in the minority, overshadowed by those working on theories of neurotransmission and endocrine disturbances. Finally, we have arrived at a new chapter in our understanding of depressive illness that, while recognizing the importance of this earlier work, also acknowledges the importance of circadian factors and how their disturbance relates to the various dimensions of depression. In this volume, we present a series of papers focused on this new understanding of depression. Courtet and Olie begin the discussion with an overview of the circadian dimension and how it relates to severity of depression. Racagni and Tardito then present a beautifully reasoned argument for the critical synergy between melatoninergic receptor agonism and serotoninergic receptor antagonism in achieving antide-pressant response. The paper by Fossati focuses on the emerging neuroscience of emotion, in particular on the brain regions responsible for the emotion processing so critical to mood disorders. Lam provides a review of what is known about the time course and trajectory of antide-pressant treatments, with a particular focus on early onset of symptomatic improvement, losifescu then addresses the critical role of functioning as a marker of deterioration and improvement in psychiatric illness and how mood may interact with cognition and psychosocial functioning to determine overall levels of impairment.