New Directions in Psychiatry

By Dr. Anthony Levitt

For decades, researchers and clinicians have been pre-occupied with the notion of depression resulting from a “chemical imbalance” in the central nervous system. This is an appealingly simple explanation that clinicians and patients and families alike seem to understand and accept. And, it is still possible that major depression may be the result of some complex chemical imbalance. But theories have slowly moved towards a slightly different understanding of what biological mechanism might underlie depression – and this shift has opened a remarkable array of potential treatments and the hope for possible “cures” for depression.

The two biggest shifts have been our understanding of a concept called “neuro-plasticity” and a realization that alterations of “brain circuitry” might be important in depression. Neuro-plasticity refers to the capacity of cells in the brain to react and adjust to stress, injury, and other challenges that occur from a variety of sources. Brain circuitry refers to pathways (essentially electrical pathways) that exist within the brain that connect various brain structures for very specific purposes. For example, there are circuits required for movement, circuits required for complex emotional experiences, and circuits required for sensations and other functions such as balance. More and more evidence is mounting that suggests depression may be a state in which the brain is unable to adapt; in other words, it has lost its neuro-plasticity. Similarly, evidence is accumulating that depression is a disturbance in critical brain pathways or electrical circuits.

The implications of these findings are that direct treatments can enhance brain plasticity or correct failing or misfiring circuits. And, these treatments may not just reduce the symptoms of depression but may, indeed, prevent depression from returning. These treatments include such things as Deep Brain Stimulation, Trans Cranial Magnetic Stimulation, as well as surgical and other micro lesions. The next 10 years will see an explosion in these direct brain treatment models that may either replace or at least enhance current pharmacotherapy or medication treatment. These new discoveries are the most hope-inspiring developments in the field of depression treatment that we have seen in more than 50 years!

Dr. Anthony LevittDr. Levitt is Chief of the Hurvitz Brain Science Program, and Medical Director of the Family Navigation Project at Sunnybrook Health Sciences Centre, and Professor of Psychiatry at the University of Toronto. He specializes in the management of treatment resistant depression and bipolar disorder, and is a strong advocate for enhancing patient and family access to, and navigation of, the mental health system.

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