Maybe the Phrase "It's All In Your Head" Should Really Be "It's All In Your Brain"
"Cartoons and Poems following each article are created and copyrighted by Dr. Ackerman and cannot be copied or reproduced without his permission."
I'm sure that many of my readers who have experienced severe depression have long suspected that it had less to do with bad things happening to them and more because something had gone terribly wrong with the wiring in their brains. Well it's beginning to look like they had the right idea. In an article by Brian Vastag featured in the April 10, 2002 JAMA entitled "Decade of Work Shows Depression Is Physical" the concept that "depression is as physical as diabetes or heart disease" is explored thoroughly and backed convincingly. Some recent findings have been almost startling. For example, work done by Drevets and published in Nature in 1997 claimed that a bout of depression could actually cause certain areas of the brain to shrink nearly 40% in volume. A second article in Nature Medicine followed this work in 2001, which actually pinpointed the cell changes and the resulting effects. The brain sites affected were termed "emotion zones." The volume loss was concentrated in the gray matter where the main cells affected were the glial cells. The apparent reason for the resulting depression seems to be due to connections to other parts of the brain being cropped. In other words, the dendritic cells, which ordinarily link one part of the brain to another, were cut off from their connections. It was described as a sort of "short circuiting" of "an individual's ability to deal with strong negative feelings."
Proof of the dramatic changes taking place in the brain depended on 10 years of imaging research. A transmitter is required in order for nerve cells to communicate with one another. This neurotransmitter is called serotonin. Using PET scans the researchers were able to demonstrate that those structures responsible for communication in patients at the peak of their depression were unable to respond properly to the serotonin. The most important deficiencies were found where one might suspect, "in brain areas critical to emotional stability." These areas include the mesiotemporal cortex where the amygdala and hippocampus are located and the midbrain raphe nucleus. It has been demonstrated that neurons capable of producing serotonin are densely packed in these regions. The salutary effects of current selective serotonin reuptake inhibitor antidepressant drugs on severe depression can readily demonstrate proof of the importance of these facts. Unhappily, these serious physical changes don't just go away. The idea that patients can simply hang on until the problem dissipates appears to be "pie in the sky" thinking. By not treating, it may be that permanent damage to some structures could result.
There is no coincidence in the role played by the amygdala in the creation of a state of depression. Damage to this region is known to result in an inability to recognize whether someone else's face is portraying happiness, sadness, fear or ecstasy. When stimulated electrically the recipient immediately recalls events in life that were charged with emotions. On the other hand normal individuals who notice a fearful or sad face demonstrate a great deal of activity in the amygdala. However depressed individuals push the reaction to extremes, even possibly getting stuck in an overactive state. Symptoms are manifold including inactivity, social withdrawal, decreased motivation, slowed metabolism, inability to sleep at night, and even gastrointestinal problems. Furthermore this excessive state causes an increased activity in the nearby orbital cortex that in normal individuals tends to balance any overactivity of the amygdala and decrease depression. The increase is even greater than in normals. It's as if the area is straining to "suppress the emotional sparks thrown off by the amygdala." Furthermore, this is believed to be true in spite of the fact that the depressed individuals have been found to have shrunken orbital cortexes. The data seem to point to some sort of dysfunction in this region of the brain as a cause of the depression similar to other involved regions where glial cells and dendritic connections are lost. The result is apparently a loss of regulation of emotion that becomes free to express emotion without appropriate control.
Inheritance in those prone to severe depression demonstrates a family background. So far searches for the genes involved have not proven anything, but it's suspected that it may involve a hypersensitivity to certain hormones or other stimuli.
Even Sigmund Freud believed that some forms of depression were "somatic rather than psychogenic affections." How do we put these findings into perspective? After all, even though we can now show that there are distinct changes taking place in the brain of someone with severe depression, there does not yet seem to be any answer as to whether these structural changes come first or whether it's actually severe depression that comes first and then creates in turn the structural changes. My gut reaction would be that the structural changes represent a hereditary tendency to deterioration of the affected regions leading to severe depression under the appropriate negative circumstances
I just can't figure everything out,
I'm so depressed, I want to shout,
The market crashed late yesterday,
Then I found wife and friend rolling in the hay.
But heck this happens all the time,
These things are really no big crime.
After all I never owned any stock,
And since our divorce it's no big shock.
So why do I think only thoughts that depress?
What could be the reason for this mess?
I must go see a psychiatrist without fail,
If my lawyer ever gets me out of jail.
Cartoons and Poems following each article are created and copyrighted by Dr. Ackerman and cannot be copied or reproduced without his permission.
Copyright © 2014 by Marvin Ackerman, M.D.