https://www.quantamagazine.org/the-cause-of-depression-is-probably-not-what-you-think-20230126/?

The Cause of #Depression Is Probably Not What You Think

..."Increasingly, some scientists are pushing to reframe “depression” as an umbrella term for a suite of related conditions, much as oncologists now think of “cancer” as referring to a legion of distinct but similar malignancies. And just as each cancer needs to be prevented or treated in ways relevant to its origin, treatments for depression may need to be tailored to the individual.

If there are different types of depression, they may present similar symptoms — such as fatigue, apathy, appetite changes, suicidal thoughts, and insomnia or oversleeping — but they might emerge from completely different mixes of environmental and biological factors. Chemical imbalances, genes, brain structure and inflammation could all play a role to varying degrees. “In five or 10 years, we won’t be talking about depression as a unitary thing,” Sen said.

To treat depression effectively, medical researchers may therefore need to develop a nuanced understanding of the ways it can arise. Nemeroff expects that someday the gold standard for care won’t be just one treatment — it will be a set of diagnostic tools that can determine the best therapeutic approach to an individual patient’s depression, be it cognitive behavioral therapy, lifestyle changes, neuromodulation, avoiding genetic triggers, talk therapy, medication or some combination thereof.

That prediction may frustrate some physicians and drug developers, since it’s much easier to prescribe a one-size-fits-all solution. But “appreciating the true, real complexity of depression takes us down a path that is ultimately going to be most impactful,” Krystal said. In the past, he said, clinical psychiatrists were like explorers who landed on a tiny unknown island, set up camp, and got comfortable. “And then we discovered that there’s this whole, enormous continent.”