Depression and Anxiety Are Not Chemical Imbalances: They Are Disorders of Communication

Does this article change the way that you view depression and anxiety?

Those terms are not emotions, they are not willpower-deficiency, they are not weaknesses.

They are organizational changes.

At DCFN, this is how we have always approached depression and anxiety.

By Dr. David Traster, DC, MS, DACNB

Co-owner, The Neurologic Wellness Institute

Boca Raton • Chicago • Waukesha • Wood Dale

For decades, depression and anxiety were framed as problems of deficiency.

Too little serotonin.

Too much norepinephrine.

Not enough dopamine in the right place.

This story was simple. It was tidy. And it was wrong—or at least profoundly incomplete.

Modern neuroscience tells a different story.

A quieter one.

A more unsettling one.

Depression and anxiety are not primarily diseases of missing chemicals.

They are diseases of miscommunication.

Not failure of neurons—but failure of networks.

Across resting-state and task-based functional MRI, and across diffusion imaging of white matter, the most consistent finding is not damage to one region, but altered connectivity between regions. The brain is still there.

The neurons are still firing. But the conversation between systems has changed.

The brain, in depression and anxiety, is not broken.

It is stuck in a pattern.

The Brain as a Networked Organ

The healthy brain is not organized as isolated parts. It is organized as large-scale networks—ensembles of regions that synchronize their activity depending on what the organism needs to do.

Three of these networks appear again and again in the science of mood and anxiety:

The Default Mode Network—the system that constructs the internal narrative: memory, self-reflection, meaning, identity.

The Salience Network—the system that scans the world and the body for what matters: threat, relevance, urgency, uncertainty.

The Central Executive (Frontoparietal) Network—the system that exerts control: attention, working memory, cognitive flexibility, reappraisal.

In a healthy brain, these networks behave like a skilled orchestra. They take turns leading. They yield when appropriate. They modulate one another.

In depression and anxiety, the orchestra loses its conductor.

Depression: When the Internal World Becomes Too Loud

One of the most consistent findings in major depressive disorder is altered connectivity within the Default Mode Network.

The DMN is not the enemy. It is where we construct autobiographical memory, imagine the future, and make sense of who we are. But when this network becomes over-engaged or improperly regulated, the mind turns inward—and does not return.

This is the neural substrate of rumination.

The brain rehearses the past.

It predicts a future that feels already lost.

It loops.

Imaging studies repeatedly show abnormal coupling between key DMN hubs—particularly medial prefrontal regions and the posterior cingulate/precuneus—in people with depression. The network responsible for the inner narrative becomes dominant, sticky, and difficult to disengage.

At the same time, the systems designed to interrupt that loop begin to weaken.

Loss of Control Is Not a Metaphor

The Central Executive Network—the circuitry involving dorsolateral prefrontal and parietal regions—is responsible for holding information online, shifting attention, and regulating emotion through top-down control.

In depression, connectivity within this network, and between this network and others, is frequently reduced.

This is not just a psychological experience of “feeling overwhelmed.”

It is a measurable reduction in the brain’s capacity to shift states.

The depressed brain does not lack insight.

It lacks leverage.

The Salience Network: The Switch That Stops Switching

Between the DMN and the executive network sits the Salience Network, anchored in the anterior insula and dorsal anterior cingulate.

This system decides what deserves attention—and when the brain should switch from internal focus to external action.

In depression, this switch often malfunctions.

Salience signals bleed into the internal narrative. Threat, loss, and uncertainty are tagged as relevant even when no immediate danger exists. The brain remains internally focused when it should mobilize outward.

Recent high-resolution mapping work adds another layer: in many individuals with depression, the salience system does not just change strength—it changes shape. Network boundaries blur. Frontostriatal salience territories expand. Functional architecture reorganizes.

This is not simply a quieter or louder signal.

It is a different wiring diagram.

Anxiety: When the World (and the Body) Won’t Stand Down

If depression is the brain trapped inside itself, anxiety is the brain unable to stand down from threat.

Across generalized anxiety and related disorders, resting-state studies repeatedly highlight alterations in circuits involved in salience, interoception, and threat monitoring.

The insula—a region that integrates bodily signals—shows altered connectivity with thalamic and cortical regions. The brain amplifies internal sensation. Normal physiological noise becomes meaningful.

Heartbeats feel ominous.

Breath feels insufficient.

Uncertainty feels dangerous.

At the same time, regulatory pathways linking medial prefrontal regions and the anterior cingulate to limbic structures show altered coupling in many anxiety phenotypes. Safety signaling weakens. The brain knows how to generate fear—but struggles to turn it off.

Anxiety, at the network level, is not excess fear.

It is impaired disengagement.

What Changes During Tasks: The Brain Under Load

Resting-state imaging shows us the brain’s default posture.

Task-based imaging shows what happens when the system is stressed.

During emotional processing and regulation tasks, depression consistently reveals a familiar imbalance: limbic systems activate readily, while prefrontal regulatory systems fail to coordinate effectively.

Healthy brains recruit prefrontal-limbic coupling during reappraisal.

Depressed brains often show altered coordination within this same circuitry—not always weaker, not always stronger, but less adaptive.

Cognitive control tasks reveal something similar. Executive systems engage less efficiently. The bandwidth is narrower. Mental effort costs more.

Anxiety tasks reveal a parallel pattern.

When uncertainty or threat is introduced, salience and interoceptive systems activate strongly, while regulatory networks struggle to impose calm.

Again, this is not a lack of intelligence or willpower.

It is a network timing problem.

The White Matter Story: Why Structure Matters

Functional connectivity describes coordination.

White matter tells us how that coordination is physically supported.

Diffusion imaging does not point to a single broken cable.

Instead, it reveals a pattern: fronto-limbic and fronto-thalamic highways show altered microstructure across depression and anxiety.

One tract appears repeatedly: the uncinate fasciculus—the pathway linking orbitofrontal and ventromedial prefrontal regions to the amygdala and anterior temporal lobe. This is a core emotion-regulation highway.

The cingulum bundle, which integrates medial frontal regions with hippocampal and parahippocampal structures, also appears consistently. This tract supports memory-emotion-self integration.

Interhemispheric pathways, particularly in the corpus callosum, are frequently implicated, suggesting altered coordination between hemispheres rather than isolated regional failure.

Broader fronto-striatal-thalamic pathways also show differences, reinforcing the idea that mood and anxiety disorders are disorders of distributed regulation, not local damage.

The Transdiagnostic Truth

When depression and anxiety are examined together, their overlap becomes obvious.

Different symptoms.

Different subjective experiences.

Shared circuitry.

Fronto-limbic regulation pathways.

Salience and interoceptive systems.

Executive control networks that struggle to impose order on emotional noise.

This is why depression and anxiety so often co-occur.

They are different expressions of the same network instability.

What This Means (and What It Does Not)

These findings do not mean brain scans can diagnose depression or anxiety.

They do not mean one pattern fits all.

They do mean something important:

Mood disorders are not character flaws.

They are not moral failures.

They are not simply chemical shortages.

They are states of network organization.

And network states, unlike dead tissue, can change.

The most reproducible targets across research—Default Mode Network dominance, salience network over-engagement, executive network under-coordination, and the white-matter pathways that bind them—are not just explanations.

They are entry points.

Because the brain is not static.

It is plastic.

And communication, once distorted, can be retrained.

This is not optimism.

It is anatomy.

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