The psychobiology of stress, depression, adjustment disorders and resilience

Figures & data

Table 1. Critical elements of human resilience (Dennis Charney, MD, Dean, Icahn School of Medicine at Mount Sinai, New York, NY, Psychiatric Grand Rounds January 2009).

Character strengths and virtues Altruism Optimism Moral compass/a code of honour Faith/spirituality Humor Role models Social supports Facing fear/out of one’s comfort zone A life’s mission Training (in all its forms)

Table 2. Neurochemical response patterns to acute stress (Dennis Charney, MD, Dean, Icahn School of Medicine at Mount Sinai, New York, NY, Psychiatric Grand Rounds January 2009).

	Key functional interactions	Resilience	Psychopathology
Cortisol	Increases amygdala CRH Increases hypothalamic CRH	Stress induced increase constrained by negative feedback via GR and MR receptors	Unconstrained release leads to hypercortisolemia, depression, hypertension, osteoporosis, insulin resistance, coronary vascular disease. Over constrained release leads to hypercortisolemia – seen in some PTSD patients
DHEA	Antiglucocorticoid actions	High DHEA cortisol ratio may have preventive effects regarding PTSD and depression	Low DHEA response to stress may predispose to PTSD and depression and effects of hypercortisolemia
CRH	CRH-receptor-1 anxiogenic CRH-receptor-2 anxiolytic Increases cortisol and DHEA Activates LC-NE system	Reduced CRH release adaptive changes in CRH-1 and CRH-2 receptors	Persistently increased CRH may predispose to PTSD and major depression, may relate to chronic symptoms of anxiety, fear and anhedonia
Locus coeruleus norepinephrine system	Activates sympathetic nervous system and HPA axis, inhibits parasympathetic outflow, stimulates hypothalamic CRH	Reduced responsiveness of LC-NE system	Unrestrained LC-NE system leads to chronic anxiety, hypervigilance and intrusive memories. Some patients with PTSD, panic disorder and major depression show evidence of heightened LC-NE activity
Neuropeptide Y	NPY reduces CRH related actions at amygdala, NPY reduces LC firing rate	Adaptive increase in amygdala NPY is associated with reduced stress-induced anxiety and depression	Low NPY response to stress associated with increased vulnerability to PTSD and depression
Galanin	Galanin reduces the anxiogenic effects of LC-NE system activation	Adaptive increase in amygdala galanin is associated with reduced stress-induced anxiety and depression	Hypothesized low galanin response to stress associated with increased vulnerability to PTSD and depression
Dopamine	Reciprocal interactions between cortical and subcortical DA systems	Cortical and subcortical DA systems remain in optimal window of activity to preserve functions involving reward and extinction fear	Persistently high levels of prefrontal cortical and low subcortical DA activity associated with cognitive dysfunction and depression. Persistently low levels of prefrontal DA associated with chronic anxiety and fear
Serotonin	High levels of cortisol decrease in 5HT1A receptors	High activity of postsynaptic 5HT1A receptors may facilitate recovery	Low activity of postsynaptic 5HT1A receptors may predispose to anxiety and depression