On SAGE Insight: The Role of Chronic Stress in Anxious Depression

From Chronic Stress

Depression is a major public health crisis and can be caused by many different factors, including stress. Though healthy in small amounts, chronic and unpredictable stress can lead to problems with thoughts and feelings. Prolonged difficulty with thoughts and feelings, including low self-worth, unrelenting feelings of guilt/shame, and the inability to enjoy things that are otherwise pleasurable, are all hallmarks of the syndrome of depression.

Like fever, depression may be the result of a variety of underlying causes. Unlike fever, depression can present with different symptoms across the spectrum: some people have difficulty getting out of bed in the morning, others have difficulty interacting with family, friends, and colleagues, and some think about killing themselves. Because of this heterogeneity, categorization of depression subtypes is incredibly important, and is an area of active research for the National Institute of Mental Health (NIMH). Therapy and medication can be helpful, but the process to find the right treatment often involves “trial and error.” Not all people respond to treatments in the same way, which can be burdensome to people struggling with this illness. Through understanding of the underlying biology of different types of depression, we hope this will help doctors to choose the “right” medication earlier, which will certainly result in improved patient outcomes.

In this review we used the NIMH recommended categorization scheme, called the Research Domain Criteria for psychological constructs (RDoC), to explore the way chronic stress—or, in RDoC terms, sustained threat—can lead to one subtype of depression called anxious depression. We examined current research, which details changes in molecules, cells, neurocircuitry, physiology, and behavior in response to sustained threat, and evaluated the role these alterations may play in the development of anxious depression. We hope that dissecting the symptoms of depression in a way that allows comparison across the spectrum of pathology will lead to more specific and effective treatments for this devastating illness.

By –

Rachel Ross, MD, PhD, is an Instructor in Psychiatry at Harvard Medical School
Twitter @rossenator









Dawn Ionescu, MD is a Director of Neuroscience Clinical Development at Janssen Research & Development, LLC. At the time of initial publication, Dr. Ionescu was an Assistant Professor in Psychiatry at Harvard Medical SchoolEmail: dionesc@its.jnj.c






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Article details
The Role of Chronic Stress in Anxious Depression
Rachel A. Ross, Simmie L. Foster, Dawn F. Ionescu
DOI: 10.1177/2470547016689472
First Published February 17, 2017
From Chronic Stress






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