Cited by 550Stress Responses and CortisolTreatment of Major DepressionNeurotransmitter Receptor Influence on Behavior

The DOI matches its Crossref record; 148 of the 151 references it cites were found in a registry or an index; none of the 199 sources its claims cite is checked for support yet.

The Impact of Stress and Major Depressive Disorder on Hippocampal and Medial Prefrontal Cortex Morphology

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Abstract

Volumetric reductions in the hippocampus and medial prefrontal cortex (mPFC) are among the most well-documented neural abnormalities in major depressive disorder (MDD). Hippocampal and mPFC structural reductions have been specifically tied to MDD illness progression markers, including greater number of major depressive episodes (MDEs), longer illness duration, and nonremission/treatment resistance. Chronic stress plays a critical role in the development of hippocampal and mPFC deficits, with some studies suggesting that these deficits occur irrespective of MDE occurrence. However, preclinical and human research also points to other stress-mediated neurotoxic processes, including enhanced inflammation and neurotransmitter disturbances, which may require the presence of an MDE and contribute to further brain structural decline as the illness advances. Specifically, hypothalamic-pituitary-adrenal axis dysfunction, enhanced inflammation and oxidative stress, and neurotransmitter abnormalities (e.g., serotonin, glutamate, gamma-aminobutyric acid) likely interact to facilitate illness progression in MDD. Congruent with stress sensitization models of MDD, with each consecutive MDE it may take lower levels of stress to trigger these neurotoxic pathways, leading to more pronounced brain volumetric reductions. Given that stress and MDD have overlapping and distinct influences on neurobiological pathways implicated in hippocampal and mPFC structural decline, further work is needed to clarify which precise mechanisms ultimately contribute to MDD development and maintenance.

Overview

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Registry

Crossref · 10.1016/j.biopsych.2018.09.031

Cites

148 of 148 references verified0 citation errors · 0 not checkable

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  • It may state two separate claims as one. 30
  • Probably not a substantial claim. 4
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  • The paper relies on this without support.

    Findings from animal models of stress and depression can be generalized to human major depressive disorder neurobiology.

    “Animal models have established that prolonged stress can lead to HPA axis hyperreactivity and depressive behaviors along with hippocampal and mPFC abnormalities (68,69).”
  • The paper relies on this without support.

    Hippocampal and medial prefrontal cortex volume reductions measured by MRI reflect cellular damage or atrophy relevant to major depressive disorder.

    “Volumetric reductions in the hippocampus and medial prefrontal cortex (mPFC) are among the most well documented neural abnormalities in major depressive disorder (MDD).”
  • The paper relies on this without support.

    Peripheral and central measures of inflammation, oxidative stress, cortisol, and neurotransmitters index the same brain processes relevant to hippocampal and medial prefrontal cortex structure.

    “higher levels of peripheral pro-inflammatory cytokines, greater expression of inflammation-related genes, and reduced expression of neuroprotective genes, have all been associated with greater hippocampal volume decline and mPFC thinning in MDD (95–97).”
  • The paper relies on this without support.

    The stress sensitization and stress autonomy models apply to structural brain changes, not only to the onset of major depressive episodes.

    “Two classes of stress-related models, the stress sensitization and stress autonomy models, have been proposed to explain how relationships between stress and depression change as a function of illness course (50).”
  • The paper relies on this without support.

    The proposed indoleamine 2,3-dioxygenase-kynurenine pathway operates in humans with major depressive disorder as described.

    “One possible common pathway involves chronic stress triggering HPA axis dysfunction and enhanced production of cell-mediated immune cytokines, which activate indoleamine 2,3-dioxygenase (IDO;68).”
  • The paper relies on this without support.

    Major depressive disorder illness progression markers such as episode count, illness duration, and treatment resistance reflect a common progressive disease process.

    “they have been consistently associated with markers of a progressive course of MDD characterized by more recurrent episodes/relapses (3,19–25), longer illness duration (24,26–30), and non-remission/treatment resistance (28,31–38).”
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Metadata

Authors
Belleau, E. L., Treadway, M. T., & Pizzagalli, D. A.
Affiliations
  • Harvard University (US)
  • Emory University (US)
Corresponding author
Pizzagalli, Diego A.
Venue
Biological Psychiatry
Publisher
Elsevier BV
Published
2019-03
Volume
85
Issue
6
Pages
443-453
ISSN
0006-3223 (ISSN-L)
OpenAlex
W2895959992
Cited by
550
References
151
Citations by year
2026: 67 · 2025: 94 · 2024: 83 · 2023: 85 · 2022: 89 · 2021: 70 · 2020: 41 · 2019: 20
FWCI
3.68
Type
journal article
Language
en
Open access
Locations
  • Biological Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Harvard Medical School
  • McLean Hospital
  • Klingenstein Third Generation Foundation
Topics
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
Keywords
major depressive disorder, chronic stress, hippocampal volume, medial prefrontal cortex, brain structure, hippocampal atrophy, disease progression, major depressive episode, treatment resistance, hypothalamic-pituitary-adrenal axis, neuroinflammation, oxidative stress, neurotransmitter abnormalities, stress sensitization, structural neuroplasticity
MeSH terms
Animals, Depressive Disorder, Major, Major Depressive Disorder, Hippocampus, Humans, Stress, Psychological, Prefrontal Cortex

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