Depression

It seems probable that the more severe forms of depressive illness are associated with chemical changes in certain parts or pathways of the brain. These changes may he different in the various forms of depression. Whether or not these chemical changes are the cause of depression, rather than one of its consequences, is not known.

In unipolar depression, the changes may include alterations in the number or sensitivity of nerve cell receptors for particular neurotransmitters (chemical messengers) - in particular receptors for 5-hydroxytryptamine (5-HT, also known as serotonin), noradrenaline and dopamine. 5-HT is involved in the regulation of impulses, and has a role in maintaining normal patterns of appetite, sleep and sexual activity: abnormalities in 5-HT pathways might lead to the disturbance of sleep, increased anxiety and irritability and loss of sexual interest that are seen in many people with depression. Noradrenaline is involved in regulating mood and energy, and possibly has a role in social interactions : changes in noradrenaline may lead to the tiredness, loss of enthusiasm and social withdrawal, often seen in depression. Finally, dopamine probably has a role in gaining pleasure, and changes here could lead to the sense of being unable to get enjoyment from usually pleasurable activities. Abnormalities in dopamine may be especially important in patients with bipolar depression.

In people with more severe forms of depression, changes in all three of these neurotransmitters may be important. It seems likely that other messengers are also involved. Also there is some evidence that changes within the brain are linked to changes in the levels of some hormones in the bloodstream.

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