Depression just hits different. It goes beyond everyday emotions and seeps into life and relationships by altering the brain’s structure and chemical output.
But it’s not a dooming diagnosis. As they say, “The more you know… ” Depression’s brain changes can be walked back with certain treatments as you’ll learn below.
Some people may experience mild depression only once in their lives, while others have several severe episodes over their lifetime.
This more serious, long-lasting, and intense form of depression is known as major depressive disorder (MDD). It’s also referred to as depressive disorder or clinical depression to distinguish it from depressive episodes that can occur sometimes as a result of life events, such as grieving.
The symptoms of MDD can significantly interfere with daily tasks, mood and behavior, and instincts like sleep and appetite.
To be diagnosed with MDD, you have to experience five or more of the following symptoms at least once per day over the course of 2 weeks:
- unwavering feelings of sadness and hopelessness
- lack of interest in doing most activities, especially those you once enjoyed
- decrease or increase in appetite
- extreme weight loss or weight gain
- sleeping too much or too little
- restlessness
- fatigue
- excessive or unwanted feelings of guilt or worthlessness
- difficulty making decisions, thinking, and concentrating
- multiple thoughts of death or suicide
- suicide attempt(s)
Researchers don’t know exactly why some people develop MDD, but they believe the following factors may play a role:
- Stress. A stressful life event such as divorce or death of a loved one can trigger the onset of MDD.
- Hormone imbalances. Changes in the balance of hormones may trigger MDD in certain people, especially during menopause or during and after pregnancy.
- Biochemical reactions. Chemicals in the brains of people with MDD seem to function differently than those in the brains of others without the disorder.
- Genetics. It appears that people with a family history of MDD are more likely to develop the disorder than others.
A note about genetic predisposition
“____ disorder just runs in my family.”
As said before, our genetics can contain certain risk factors for developing some health or mental disorders — but factors aren’t necessarily a guarantee.
Epigenetics is the study of inherited nuances (risk factors) in your DNA that may or may not alter your actual DNA sequence. That means whatever predispositions run in your family can remain latent within you or can even be potentially reversible.
Your diet can create chemical reactions in your DNA that may mute the expression of certain genes.
Read about: DNA Methylation: Can Your Diet Reduce Your Risk of Disease?
Three parts of the brain that appear to play a role in MDD include the hippocampus, amygdala, and prefrontal cortex.
Depression and memories in the hippocampus
The hippocampus is located near the center of the brain. It stores memories and manages the production of a hormone released during physical and mental stress called cortisol. Depression is a physical and mental stressor.
Problems can occur when excessive amounts of cortisol are sent to the brain due to a stressor or a chemical imbalance in the body.
People with MDD have long-term exposure to higher cortisol levels and so experience slower production of new brain cells as well as shrinkage of the existing brain cells in the hippocampus. This can lead to memory problems.
Depression and decision-making in the prefrontal cortex
The prefrontal cortex (PFC) is located in the very front of the brain. It’s responsible for regulating emotions, making decisions, and forming memories.
This part of the brain isn’t fully formed until age 25, which is why some say young adults are prone to making questionable decisions.
According to researchers with the Biological Psychiatry Journal, when the body produces too much cortisol, the PFC appears to shrink.
Depression and your emotions in the amygdala
The amygdala is the part of the brain that helps deliver emotional responses, such as pleasure and fear. In people with MDD, the amygdala becomes enlarged and more hyperactive as a result of constant exposure to excessive levels of cortisol.
An enlarged and hyperactive amygdala, along with abnormal activity in other parts of the brain, can result in unusual sleep patterns, the disruption of prior activities, and those unwanted emotions discussed above.
It can also cause the body to release irregular amounts of hormones and other chemicals, leading to more complications.
Depression and stress hormone cortisol
Harvard medical researchers studied how sustained high cortisol levels may play the biggest role in changing the physical composition and chemical activities of the brain, in many cases triggering the onset of MDD.
Normally, cortisol levels are highest in the morning and decrease at night, think of it as wave cycles: high tide and low tide. In people with MDD, however, cortisol levels are always elevated, even at night.
So we know what depression can do to your brain and how. Now, on to managing depression so you can get back to day-to-day life.
Balancing the amount of cortisol and other chemicals in the brain can help repair any shrinkage of the hippocampus and treat the memory problems it may cause. Balancing the body’s chemical levels can also assist in minimizing symptoms of MDD.
Three major hormones, which all also double as chemical messengers called neurotransmitters, have a role to play in mood. As such, many pharmaceuticals target these hormones to regulate your mood.
| Serotonin | This hormone is a liaison between brain cells and nervous system. It communicates feelings of satisfaction. |
|---|---|
| Dopamine | This hormone is known for pleasure and reward communications in the brain. It’s also responsible for some motor functions. |
| Norepinephrine | Also known as noradrenaline, this hormone communicates the body’s response to stress and steers concentration. |
Prescriptions for depression
There are a handful of common medications that can help manage depression’s side effects on the brain by helping to realign its chemical ratios — specifically mood-messenger hormones.
A note on Rx
Some medications used to manage depression are also approved by the Food and Drug Administration (FDA) for treatment of non-depression-related conditions. These conditions include everything from seizures to premenstrual disorders.
Selective serotonin uptake inhibitors (SSRIs)
These drugs can help alleviate symptoms of MDD by boosting the levels of serotonin in the brain.
Drugs in the SSRI category include:
- fluoxetine (Prozac)
- paroxetine (Paxil)
- escitalopram oxalate (Lexapro)
- sertraline (Zoloft)
- citalopram (Celexa)
Serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants
When used together, serotonin and norepinephrine can relieve MDD symptoms by supplementing their deficiencies in the brain. These chemicals help boost mood and energy levels, among other functions.
Tricyclic antidepressants (TCAs) are so named because they mimic neurotransmitters in the brain in both function and a three-component structure.
Examples of SNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor XR).
Some familiar TCAs include:
- imipramine (Tofranil)
- nortriptyline (Pamelor)
- trimipramine (Surmontil)
Norepinephrine-dopamine reuptake inhibitors (NDRIs)
These medications help people managing MDD by increasing levels of the chemicals norepinephrine and dopamine in the brain.
The basic idea is that by blocking these neurotransmitters from going back into brain cells, the system can increase the queue of active pleasure (dopamine) and concentration (norepinephrine) hormones available for use elsewhere.
Bupropion (Wellbutrin) is an example of an NDR.
Monoamine oxidase inhibitors (MAOIs)
MAOIs help ease symptoms of MDD by increasing the amount of norepinephrine, serotonin, and dopamine in the brain. They can also improve brain cell communication.
Atypical antidepressants
Some depression treatment medications are part other drug families. For example:
- tranquilizers
- mood stabilizers
- antipsychotics
They mainly block hyperactive brain cell communication in order to relax the mind.
Atypical medications include mirtazapine (Remeron) and trazodone (Oleptro).
Procedures for depression
Besides medications, certain noninvasive outpatient procedures are believed to help manage MDD symptoms. These include:
- Electroconvulsive therapy (ECT). This procedure involves passing electrical currents through the brain to boost communication between brain cells. The ECT concept is similar to the idea that small frequent meals boost the metabolism.
- Transcranial magnetic stimulation (TMS). This procedure involves sending electrical pulses into the brain cells that regulate mood. It could be said the TMS approach is akin to eating lifestyles designed to activate specific responses in the body.
Researchers also believe that psychotherapy can alter brain structure and help relieve MDD symptoms. Specifically, psychotherapy appears to strengthen the prefrontal cortex.
Natural remedies to manage depression
If you’re sensitive to medications or would like to try additional treatments, take heart. There are also ways to boost brain health and help manage MDD naturally:
- eating healthful foods and staying physically active, which stimulates and fortifies brain cells and their communication
- sleeping well consistently, which helps grow and repair brain cells
- avoiding alcohol and non-FDA-approved drugs, which can destroy brain cells
- taking supplements (if your treatment team recommends them), which may help boost serotonin in your system or restore deficiencies of other brain chemicals linked with depression
You might remember from grade school science that Newton’s Third Law went something like this: “For every action, there is an equal and opposite reaction.” We’ve just explored how depression hits different inside the brain — and what you can do medically and naturally to hit back.
You and your doctor can treat your depression with mindfulness, knowledge, and the appropriate resources.