If you read my article: ‘The Truth About Anxiety’, you will be familiar with this series; I attempt to raise awareness of mental health conditions, educate and challenge stigmatisation. Despite the fact that depression effects approximately 300 million people around the world, there is still some confusion surrounding its nature. Today we will hopefully put that confusion to bed. We will largely focus on a neurobiological account of depression, however if you’d like to read into more explanations of depression, click this link. Anyway, let’s get started.
Understanding Depression
Before we can discuss how depression works, we must first look at what depression actually is. There are many answers to this question, however, we’ll start with how it differs from everyday experiences. Many of us have our down days; wrongly, depression is often associated with just feeling sad, however, it is much more. Depression can be distinguished from sadness as depression tends to persist for much longer periods of time and, much like anxiety, depression is diagnosed when it interferes with a person’s everyday life. It has been suggested, that those with depression perceive the world differently. For example, Faith Orchard and others found that depressed participants exhibited a negative interpretation bias. This meant that they were more likely to interpret situations negatively, compared to those without depression. However, don’t think that those with depression have any control over this (they don’t).
As with any mental health condition, the symptoms of depression can vary between individuals; no two people will experience depression in exactly the same way. The DSM (a manual created for healthcare professionals to use for diagnosis), suggests that in order to ‘fit the criteria’ for depression, you must experience one of the two core symptoms, namely:Â
Depressed mood
Diminished interest/pleasure in the majority of activities. The ‘majority of activities’ does not include avoiding skydiving due to your persistent fear of heights; these are activities from which you once gained joy but can no longer bring yourself to take part in.
Symptoms of depression can also include inability to sleep/oversleeping, fatigue and feelings of worthlessness. However, this isn’t an exhaustive list. Because of the nature of the core symptoms, many who suffer from depression withdraw from situations which would usually promote pleasure. This means that the routine activities which once felt easy, like meeting up with friends or family, can now prove a massive challenge. If you do know someone with depression who is demonstrating withdrawal behaviour, try to see it from their point of view. Imagine being so low that you struggle to get out of bed in the morning (a very cliché comparison, but a very real one for some); often avoidance may feel like the only option. Having said this, as with anxiety, withdrawal only serves as a negative reinforcement that avoidance will solve the problem, which unfortunately it doesn’t. Common treatments for depression include CBT (a type of therapy we encountered previously), Interpersonal therapy (IPT), which focuses on your relationship with others, and the most widely known, antidepressant medication, which we will look at later.
Depression and the Brain:
There are many causes of depression; the most common belief is that it results from a chemical imbalance, but this doesn’t capture its complexity. So, let’s break it down a bit. There are three main areas of the brain which are often associated with depression: the hippocampus, the prefrontal cortex, and the amygdala.Â
Let’s start with the hippocampus. The role of the hippocampus is to store memories and regulate hormone production. Today, we’re interested in the hormone cortisol (although this isn’t the only chemical which may cause depressive symptoms). Those with depression experience elevated levels of cortisol. Too much of this hormone can stunt production of new neurons (usually our brain is in constant production of neural pathways, so we are able to maintain the things we know and build on the things we don’t). If this doesn’t take place, this can cause the hippocampus to shrink! This partially explains why some of those depression experience memory problems.
The prefrontal cortex is responsible for making decisions, forming memories, and regulating emotions. With an excess of cortisol, the prefrontal cortex also begins to shrink. As this causes problems in emotion regulation, this could partially account for the persistent and intense low mood which is often experienced in depression.
Heightened levels of cortisol can also impact the amygdala. The amygdala controls emotional responses. Unlike the hippocampus and the prefrontal cortex, the amygdala expands with cortisol over-production. An overlarge amygdala can cause problems with sleep and irregular hormone release. This is because the brain usually produces more cortisol in the morning and less at night, however, in those with depression, cortisol levels are always elevated. This might be why many people with depression experience irregular sleep cycles.
Can Medication Alter the Brain?
With CBT and IPT, medication is one of the most commonly used treatments for depression. However, whilst many have heard of it, they do not know how it works. But can medication affect how your brain works? In short, yes! Let’s take a look at how. It is suggested that by balancing out chemical variance, we can reduce shrinkage of brain areas and therefore decrease symptoms. But how do they work? There are many different types of antidepressants and there is no one type which will work for everyone. Today we’ll focus on the most common anti-depressant, Citalopram (another one of those unpronounceable names that you passively accept from your doctor). Citalopram is a selective serotonin reuptake inhibitor (SSRI) (wordy, I know!). These target a chemical called serotonin which contributes to feelings of happiness and well-being. SSRI’s prevent the reabsorption of serotonin back into the neuron, causing longer lasting effects. In short, by keeping the ‘happiness hormone’ around for longer, we can begin to improve one of the core symptoms of depression, low mood. So, yes medication can alter the brain, but don’t worry, this doesn’t mean that it is hardwiring you into some robot; sometimes our hormones just need a helping hand!
Debunking Stigmas
Let’s take a look at what depression is not, through a few common misconceptions:
If you’re depressed, medication will fix it. For starters, there is no ‘fixing’ depression. Whilst some treatments may improve symptoms, this does not mean it is gone forever, think of it more as dormant. At the same time, medication isn’t the answer to everything; the use of antidepressants is only recommended for those with moderate or severe depression. Antidepressants do not work for everyone and sometimes they can have side effects. Therapies such as CBT or IPT can be the better option for some people. If you know someone with depression, try not to be a know it all; it really depends on the individual.
People with depression should just snap out of it. If they could, they would! As we discussed above, it is believed that those with depression can have a fundamentally different view of the world, often due to ‘chemical imbalances’ in the brain. So, it’s really not that simple!
Depression is caused by going through a tough time. Although significant negative life events can increase the likelihood of depression, it isn’t a simple case of cause and effect (like most things in Psychology). Depression is most likely caused by a combination of factors and it shouldn’t be oversimplified.
Those with depression are just weak and lazy. A big no! It’s hard to believe that some people actually think this. Depression can happen to anyone and those with depression are not any less strong. If the person is withdrawing, some wrongly see this as laziness, however, hopefully after reading this, you will now understand that this is not a reflection of the person, but a symptom of their mental health condition.
I hope after reading this article, you will have a better idea of what depression is and what it is not. If you are suffering with depression, or know someone who is, I have included some links below that you might find useful. Don’t forget to subscribe on my homepage to keep up to date. Happy learning!
Those suffering with depression:
A good self-help book for those with minor depression: Overcoming Depression: A Self-Help Guide Using Cognitive Behavioural Techniques (3rd Edition) by Gilbert, P (2009).
Friends or family: