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. Author manuscript; available in PMC: 2020 Mar 15.
Published in final edited form as: Biol Psychiatry. 2018 Oct 10;85(6):443–453. doi: 10.1016/j.biopsych.2018.09.031

Figure 1. The Role of Chronic Stress and Neurotoxic Processes on Brain Volumetric Reductions and MDD Illness Progression.

Figure 1.

Chronic life stress can trigger the initial development of medial prefrontal cortex (mPFC) and hippocampal volume reductions. However, these reductions are neither necessary nor sufficient to produce a major depressive episode. On the other hand, stress also initiates a set of neurotoxic processes (hypothalamic pituitary adrenal (HPA) axis dysregulation, inflammation, neurotransmitter disturbances) that interact and may drive the development of a more chronic type of MDD marked by further reductions in hippocampal and mPFC volume reductions.