Depression as a neuroendocrine disease: Key pathways and clinical manifestations. (IMAGE)
Caption
Depression as a neuroendocrine disease: Key pathways and clinical manifestations. This comprehensive diagram maps the critical interconnections between brain structure, neuroendocrine systems, and clinical manifestations in depression, with bold text emphasizing major components and their relationships. The pathways demonstrate how structural brain changes, neuroendocrine dysfunction, and inflammatory responses collectively contribute to both psychological symptoms and physical health impacts. Color coding represents distinct system components: light purple indicates brain structure changes and neural circuits, including prefrontal cortex regions and limbic structures; light red shows neuroendocrine system components, including CRH, glucocorticoids, and HPA axis activity; light green represents inflammatory pathways and immune responses, including cytokines and microglial activation; light orange depicts clinical manifestations including behavioral, cognitive, and mood symptoms; and light pink indicates physical health impacts including effects on lifespan, osteoporosis, diabetes, and coronary disease. The diagram shows how brain structure changes (particularly in the prefrontal cortex, hippocampus, and amygdala) interact with neuroendocrine disruptions, notably in the CRH system and glucocorticoid signaling. These systems form bidirectional relationships, as seen in the CRH-norepinephrine feedback loop. The inflammatory response system is activated by and influences these neuroendocrine changes. Together, these biological alterations underlie the clinical manifestations of depression, including both psychological symptoms (mood changes, anhedonia, anxiety) and physical health impacts. Key pathways highlight how glucocorticoids damage hippocampal tissue, the central role of CRH in activating both norepinephrine and inflammatory responses, multiple biological systems converging to produce clinical manifestations, and the direct connection between clinical symptoms and physical health outcomes. This integrative model emphasizes depression as a systemic disorder affecting both brain and body, with multiple interacting pathways contributing to its clinical presentation and health consequences.
Credit
Philip W. Gold
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License
CC BY-NC-ND