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Clinical and Biochemical Manifestations of Depression: Relation to the Neurobiology of Stress
Open accessAbstract
Major depressive disorder (MDD) is a chronic, recurrent, and severe psychiatric disorder with high mortality and medical comorbidities. Stress-related pathways have been directly involved in the pathophysiology and treatment of MDD. The present paper provides an overview on the stress system as a model to understand key pathophysiological paradigms in MDD. These mechanisms involve behavioral, cognitive, and systemic manifestations and are also associated with the mechanisms of action of effective antidepressants. Aspects such as depression subtypes, inflammation, insulin resistance, oxidative stress, and prothrombotic states in critical brain circuits and periphery are critically appraised. Finally, new strategies for approaching treatment-resistant major depression and potential adverse effects associated with this complex and intricate network are highlighted. The authors used PubMed as the database for this review. Each author extracted relevant data and assessed the methodological quality of each study.
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“Hypercortisolism is one of the relevant mechanisms involved in response to stress and is present in many people with MDD and in animals subjected to stress in the laboratory.”
From Stress and serum cortisol levels in major depressive disorder: a cross-sectional study (2020) · cites this paper as [9]
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“Chronic stress throughout life involves several biological changes, which are underlying MDD in many patients and in laboratory animals [4],[6],[9].”
From Stress and serum cortisol levels in major depressive disorder: a cross-sectional study (2020) · cites this paper as [9]
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“Insulin resistance and inflammation can cause anxiety [47]”
From The Effect of Anxiety and Nutritional Habits on the Body Distortion of Athletes. (2025) · cites this paper as [47]
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“Experiential avoidance seeks to control the way or frequency of aversive private experiences [37] and has been associated with anxiety [38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54].”
From The Effect of Anxiety and Nutritional Habits on the Body Distortion of Athletes. (2025) · cites this paper as [47]
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“At the same time, depression favors prothrombotic status, inflammation and oxidative stress, mechanisms that in the context of SARS-CoV-2 infection induce a severe evolution, with a high risk of death [151].”
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“Patients with melancholic depression, a subtype based on symptoms, were thought to respond better to TCAs than atypical patients (hence the name) (20, 27, 31, 32), but other researchers could not replicate this finding (33–36).”
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“This is mediated by physiological responses to stress: exposure to a highly arousing, negative event activates stress responses governed by the hypothalamic-pituitary-adrenal (HPA) axis [33, 34].”
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Crossmodal Audiovisual Emotional Integration in Depression: An Event-Related Potential Study
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“The interaction between emotion and group was not significant, F(2, 80) = 1.”
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Obesity and Depression: Shared Pathophysiology and Translational Implications
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The Effect of Anxiety and Nutritional Habits on the Body Distortion of Athletes.
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“Insulin resistance and inflammation can cause anxiety [47], and whole grains decrease inflammatory biomarkers [48] and influence the postprandial glucose metabolism [49–51], which could affect insulin sensitivity.”
Winter is coming: Seasonality and the acoustic startle reflex
Armbruster, D., Brocke, B., & Strobel, A. (2016) · Physiology & Behavior · doi:10.1016/j.physbeh.2016.11.038 · Cited by 7
“melancholic depression have been argued to be caused by different dysregulations in a number of interlinked neurobiological systems [12].”
BackgroundChildhood depression and oxidative stress
Miniksar, D. Y., & Göçmen, A. Y. (2022) · The Egyptian Journal of Neurology Psychiatry and Neurosurgery · doi:10.1186/s41983-022-00518-1 · Cited by 7
Psychiatric Illness Is Common in Elderly Fracture Patients
Gitajn, I., Titus, A., Mastrangelo, S., Ali, S., Sparks, M. B., & Jevsevar, D. (2019) · Journal of Orthopaedics and Trauma · doi:10.1097/bot.0000000000001371 · Cited by 5
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“symptoms of depression, anxiety and several other psychological illnesses (9,10).”
BackgroundSharma, A., Gugulothu, D. B., Virmani, T., Sharma, A., Kumar, G., Singh, K., Jain, D., Bhuia, M. S., Chowdhury, R., Ahammed, N. T., et al. (2025) · Journal of Nutrition and Metabolism · doi:10.1155/jnme/2275526 · Cited by 5
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Depression Detection via User Behavior and Tweets
Ji, N., Bouazizi, M., & Ohtsuki, T. O. (2023) · Globecom · doi:10.1109/globecom54140.2023.10437866 · Cited by 4
“Depression seriously affects the normal life of patients [1] and nearly 15% of patients with depression choose to commit suicide [2].”
BackgroundEffects of brain estrogen receptor on depression and its mechanism of action
Wen, Y., Gao, K., Tong, G., Meng, X., Pan, M., Wang, Y., Meng, D., Zheng, Y., & Yue, G.-X. (2024) · Guidelines and Standards of Chinese Medicine · doi:10.1097/gscm.0000000000000026 · Cited by 4
“Considerable research indicated that NE level in the peripheral plasma of depression patients is apparently higher than in normal people [10,11] , which is possibly due to the suppression of peripheral NE by central nervous NE.”
Escudero, G. E., Martini, N., Jori, K., Jori, N., Maresca, N. R., Laino, C. H., Naso, L. G., Williams, P. A. M., & Ferrer, E. G. (2016) · Journal of Enzyme Inhibition and Medicinal Chemistry · doi:10.3109/14756366.2016.1160900 · Cited by 4
A genetic marker of risk in HIV-infected individuals with a history of hazardous drinking
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The Role of Stress and Glucocorticoids in Pathogeny of Age-Related Neuropsychiatric Disorders
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“In addition, depressive illness is age-related, being more frequent in the intermediate age categories [10].”
Pharmacological management of treatment resistant depression: a clinical review
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A circuit-based framework for depression: Reshaping the pathological attractor
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A DISFAGIA NO ENVELHECIMENTO ASSOCIADA A DESNUTRIÇÃO E DESENCADEAMENTO DE TRANSTORNOS MENTAIS
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Modulating Neuroplasticity: Lessons Learned from Antidepressants and Emerging Novel Therapeutics
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The Neurochemistry of Stress: the Chemistry of the Stress Response and Stress Vulnerability
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Allostatic load in major depressive disorder: An in-patient clinical study
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“In parallel, CORT—the end product of HPA axis acti-vation—has been widely studied as a biomarker of stress-related psychopathology [27].”
Huang, J., Zhang, Y., Zhou, D., Li, X., Li, H., Lian, B., Cai, W., Cao, L., Liu, J., Xu, F., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120880 · Cited by 2
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“This preliminarily confirms that MDD is a complex psychiatric disorder with a highly heterogeneous pathophysiology [61, 62].”
Narra, B., Lakshmi, N. R. A., Ramasamy, N., Kaviprawin, M., Jyrwa, S., Awadhiya, O., Khan, F., Padhi, B. K., & Gandhi, A. P. (2026) · Indian Journal of Psychiatry · doi:10.4103/indianjpsychiatry_467_25 · Cited by 3
“[68] elucidated this mechanism, linking chronic hypercortisolemia in depression to increased adiposity and impaired glucose homeostasis.”
Prevalence and determinants of depression in patients with epilepsy during the COVID-19 pandemic
Sehlo, M. G., Mohamed, W. S., Youssef, U. M., Lotfi, S. E., & El-deen, G. M. S. (2022) · Middle East Current Psychiatry · doi:10.1186/s43045-022-00190-4 · Cited by 2
“(serotonin and norepinephrine) [8], and anatomical abnormalities (prefrontal cortex and paralimbic structures) [9], also the social burden of the epilepsy itself on the patients.”
BackgroundDepression and poor sleep: neglected prevalent issues among adult epileptic patients
Fathy, S. E., AbdAllah, A., El-Maghawry, H. A., Ali, L. I., & Helal, R. Y. (2024) · Middle East Current Psychiatry · doi:10.1186/s43045-024-00391-z · Cited by 2
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Metadata
- Authors
- Gold, P. W., Machado-Vieira, R., & Pavlatou, M. G.
- Affiliations
- National Institutes of Health (US)
- National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, MD 20892, USA
- Corresponding author
- Gold, Phillip W.
- ORCID
- Pavlatou, Maria G.
- Venue
- Neural Plasticity
- Publisher
- Hindawi Limited
- Published
- 2015
- Volume
- 2015
- Pages
- 1-11
- ISSN
- 1687-5443 (ISSN-L)
- 2090-5904
- PMC
- PMC4387963
- OpenAlex
- W2055457894
- Cited by
- 259
- References
- 53
- Citations by year
- 2026: 12 · 2025: 12 · 2024: 15 · 2023: 17 · 2022: 17 · 2021: 26 · 2020: 24 · 2019: 24 · 2018: 27 · 2017: 29 · 2016: 20 · 2015: 6
- FWCI
- 3.43
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Neural Plasticity (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
- Keywords
- major depressive disorder, stress system, neurobiology of stress, depression pathophysiology, antidepressant mechanism, depression subtypes, inflammation, insulin resistance, oxidative stress, hypercoagulability, treatment-resistant depression, antidepressant side effects
- MeSH terms
- Animals, Brain, Depressive Disorder, Homeostasis, Humans, Inflammation, Neuronal Plasticity, Stress, Physiological, Stress, Psychological, Oxidative Stress, Neurogenesis
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