The Architectural Turn in Depression Why Network Topology Will Redefine CNS Strategy
By Denis Katz, MD, MHA Founder, Salience Clinical For decades, psychiatry has framed major depressive disorder (MDD) as a disorder of chemistry, an imbalance of serotonin, norepinephrine, or dopamine. That model produced meaningful therapeutic advances, yet it has not consistently delivered durable remission for a substantial proportion of patients. Roughly one-third remain treatment resistant, and among responders, relapse is common. Incremental modulation of synaptic signaling alone appears to have reached a ceiling in its ability to transform long-term outcomes at scale. The next shift in neuropsychiatry will not be chemical. It will be architectural. By “architectural,” we mean the topology, coupling, and switching behavior of large-scale brain networks that shape how information is processed. From neurotransmitters to networks Advances in high-resolution functional MRI, multimodal imaging, and computational modeling over the past decade have transformed our unde...