Stressor-induced NMDAR dysfunction as a unifying hypothesis for the aetiology, pathogenesis and comorbidity of clinical depression.

Typically the monoamine system has been the central focus of neurobiological research into depression and represents the major target of modern antidepressant medications; although the extent to which monoamines such as serotonin play a role in the pathogenesis of depression is still not clear. Recent research advancements have expanded the neurotransmitter-level focus of mood disorders to incorporate intracellular pathways and regional brain circuitry. As such the importance of other systems has emerged including those related to neuroplastic signal transduction and gene transcription cascades within cortico-limbic circuits. Indeed mounting evidence suggests interaction with these pathways is required for the chronic therapeutic effect of current clinical antidepressants. Dysfunction of the glutamatergic system has also emerged as a major pathological feature in depression, and glutamatergic agents have demonstrated rapid and robust antidepressant activity in humans. In particular, the glutamate receptors (AMPAR, NMDAR & mGluR) are intrinsically connected to neuronal efficiency and inefficiency cascades, so their dysfunction may account for alterations to multiple signal transduction pathways in depression. This article presents concepts supporting a NMDA hypothesis of depression, whereby the pathogenesis of depression may arise from stressors inducing excessive NMDAR activity which acts heterogeneously at both cellular and regional levels to disrupt normal neurobiological function and induce the depressive phenotype. In this hypothesis multiple psychological and environmental stressors are united in their capacity to potentiate excessive tonic and phasic NMDAR activation on neurons and glia. Such NMDAR dysfunction may lead to: disruption of glia processes and tripartite signalling; potentiation of extrasynaptic inefficiency/LTD pathways in some regions (e.g. prefrontal cortex & hippocampus); potentiation of synaptic efficiency/LTP pathways in other regions (e.g. amygdala); and regional disruption of cortico-limbic circuits and dopaminergic reward pathways (e.g. nucleus accumbens). This model unites depression with a variety of stressors including glucocorticoids, inflammation, oxidative stress, magnesium deficiency, hyperhomocysteinemia, and bio-energetic dysfunction; and also helps explain comorbidity with other neurological and affective disorders. In particular, a neurometabolic contribution to the aetiology of depressive as well as other neurological and affective disorders is explored.