Major depressive disorder (MDD) is a devastating neuropsychiatric disorder encompassing a wide range of cognitive and emotional dysfunctions. The prevalence of MDD is expected to continue its growth to become the second leading cause of disease burden (after HIV) by 2030. Despite an extensive research effort, the exact etiology of MDD remains elusive and the diagnostics uncertain. Moreover, a marked inter-individual variability is observed in the vulnerability to develop depression, as well as in response to antidepressant treatment, for nearly 50% of patients. Although a genetic component accounts for some cases of MDD, it is now clearly established that MDD results from strong gene and environment interactions. Such interactions could be mediated by epigenetic mechanisms, defined as chromatin and DNA modifications that alter gene expression without changing the DNA structure itself. Some epigenetic mechanisms have recently emerged as particularly relevant molecular substrates, promoting vulnerability or resilience to the development of depressive-like symptoms. Although the role of brainderived neurotrophic factor (BDNF) in the pathophysiology of MDD remains unclear, its modulation of the efficacy of antidepressants is clearly established. Therefore, in this review, we focus on the epigenetic mechanisms regulating the expression of BDNF in humans and in animal models of depression, and discuss their role in individual differences in vulnerability to depression and response to antidepressant drugs.
KEY WORDS: BDNF, Epigenetics, Individual differences
IntroductionMajor depressive disorder (MDD) is a common debilitating disorder (Bromet et al., 2011) affecting many aspects of the patient's life and family. In addition to its high comorbidity with other neuropsychiatric conditions and increased rate of suicide, depression has a variety of socioeconomic consequences, including low education, unstable employment, reduced work performance and marital dysfunction (Kessler and Bromet, 2013). In 2000, the economic costs of depression in the United States alone were estimated at $83.1 billion, encompassing direct medical costs, suicide-related mortality costs, as well as indirect workplace costs (Greenberg et al., 2003). Moreover, the prevalence of depressive disorders is expected to continue its growth and become by the year 2030 the second leading cause of disease burden among the World Health Organization member states (Mathers and Loncar, 2006). Despite extensive research efforts in past decades, the etiology of REVIEW Department of Biomedical Sciences, Neuroscience Program, Florida State University, Tallahassee, FL 32306, USA.*Author for correspondence (mohamed.kabbaj@med.fsu.edu) depression remains elusive, its diagnosis uncertain and the pharmacotherapy inefficient. Indeed, the antidepressants currently used, which target the monoaminergic pathways, require weeks to months of treatment and exhibit very poor or no response in nearly 50% of patients (Magni et al., 2013;Trivedi et al., 2006;Warden et al., 20...