[Stress and depression-a neurobiological perspective]

Depression is a common and often very debilitating disease causing a high number of years lost to disability worldwide. Mortality rates are high due to suicide and depression-associated somatic disorders, which seem to have a bidirectional connection. Depression is considered to be stress associated. Adverse life events such as losses, interpersonal conflicts, financial issues, unemployment, and loneliness are often found in the patient history. Also childhood maltreatment is a known risk factor. Chronic stress can cause maladaptive changes in different neurobiological systems and may contribute to the development of depression. Relevant changes have been described in the stress-response and immune systems of persons with depression and those with childhood trauma or abuse. Psychotherapy and antidepressants are both effective, and current treatment guidelines recommend their combination in severe depressive episodes.