{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T12:21:52Z","timestamp":1783340512769,"version":"3.54.6"},"reference-count":164,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>Sigmund Freud developed Drive Theory from clinical observations and proposed that a limited set of basic drives, including hunger, thirst, sleep, sexuality, and attachment, contributes to psychological stability. Modern reinterpretations allow these drives to be discussed alongside neurobiological regulation, including serotonergic and opioidergic signalling, which are relevant to depressive disorders. Selective serotonin reuptake inhibitors remain a common first line pharmacological option, yet treatment response varies, and simplified deficiency accounts are debated in the current literature. Early adversity is a transdiagnostic risk factor for affective disorders and may contribute to a subtype of depression in which attachment disturbance is prominent. In this context, trauma related epigenetic modifications have been reported in genes involved in serotonergic signalling and related pathways. Reduced serotonergic regulation may be linked to diminished \u03b2-endorphin tone, a mechanism discussed in clinical and translational work. Such opioid hypoactivity may also help to frame comorbid behaviours, including overeating and substance use, as short term compensatory attempts rather than independent primary disorders. This manuscript proposes a revised Freudian Drive Theory to describe trauma related depression as a disorder of impaired attachment related motivation with downstream effects on \u03b2-endorphin mediated satisfaction. The model is intended to provide a clinically oriented explanatory model. It generates testable predictions and may help to clarify why pharmacological response differs across trauma related presentations, while emphasizing the complementary role of psychotherapy in addressing attachment difficulties, interpersonal functioning, and emotion regulation.<\/jats:p>","DOI":"10.3389\/fpsyt.2026.1827617","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T12:02:09Z","timestamp":1783339329000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Updated Freudian drive theory: childhood trauma, epigenetics, serotonin and beta endorphin"],"prefix":"10.3389","volume":"17","author":[{"given":"Michael","family":"Kirsch","sequence":"first","affiliation":[{"name":"Medical Faculty of the University of Cologne, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne","place":["Cologne, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"B1","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","year":"2013"},{"key":"B2","doi-asserted-by":"crossref","DOI":"10.9783\/9780812290882","volume-title":"Depression: Causes and Treatment","author":"Beck","year":"2009"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-022-01661-0","article-title":"The serotonin theory of depression: a systematic umbrella review of the evidence","volume":"28","author":"Moncrieff","year":"2023","journal-title":"Mol Psychiatry"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00406-022-01549-8","article-title":"Is the serotonin hypothesis\/theory of depression still relevant? 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