by Carissa Weber
Every time a depression medication commercial comes on TV I can’t help but think about the 264 million people worldwide that struggle with depression (which is close to 6% of the world’s population, or 1 in 15 adults to put it into scale) each day. That is a pretty big number! What breaks my heart even worse, is the idea that this number could actually be higher because of how many people minimize the impact of their depression.
Depression comes in many forms and can impact everybody (although women are twice as likely to suffer from symptoms of depression than men are). Why is depression something so hard to talk about? So many of my clients shared that it’s harder to talk about depression than it is anxiety because everyone just assumes “you’ll get over it” or “you’re just sad.” In this post, we will talk about how depression works in the brain, some of the scary statistics that happen when we don’t take care of our depression, and what to do if you fear you are one of those scary statistics.
First off, let’s talk about the brain. If you recall from my first post, The Brain and Mental Health: The Breakdown (Literally and Figuratively), you may remember the breakdown of the limbic system and the role it has in mental health. Unlike anxiety, depression has many sources in our brain. Many people think depression is simply caused by a chemical imbalance. Well, that’s not true. According to Harvard health publishing (which is connected to the Harvard school of medicine), depression is defined as, “faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems.” There is a lot of factors playing in to depression! No wonder why it is easy to feel overwhelmed! The diagnostic Bible therapists use, the DSM-5, defines depression as this:
- Feeling sad or having a depressed mood
- Loss of interest or pleasure in activities once enjoyed
- Changes in appetite — weight loss or gain unrelated to dieting
- Trouble sleeping or sleeping too much
- Loss of energy or increased fatigue
- Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable by others)
- Feeling worthless or guilty
- Difficulty thinking, concentrating or making decisions
- Thoughts of death or suicide
If you have a minimum of five of the above criteria for longer than a two week period, your therapist and/or Dr. would like to talk to you more about your depressive symptoms.
Through imaging studies, scientists have been able to identify that darn amygdala and the rest of the limbic system (hippocampus, hypothalamus, and thalamus), all play a major role in depression. Despite feeling sluggish, unmotivated, and uninspired, that darn amygdala is working overtime (here I bet you thought I was going to say the amygdala wasn’t working at all!). You got it right, that darn amygdala is working overtime and sending messages all over the brain about why it is sad, overwhelmed, or saying those negative things about ourselves.
That darn amygdala is spending so much time turning every little sensory message into an emotional response, it hardly has time to let the prefrontal cortex in to say “do we really need to feel like this over all the peanut butter being gone?” Over time, the prefrontal cortex starts to loose its ability to assist in problem-solving, impulse control and identifying facts to support that darn amygdala’s emotional responses. Have you ever felt so unmotivated you couldn’t get out of bed? Some of that is because your prefrontal cortex has lost the ability to challenge what that darn amygdala and the thalamus are doing.
Interestingly enough, people who suffer from depression have a larger than average thalamus. Why is that? A study completed by the researchers at Southwestern Medical School showed that the thalamus is sending more and more emotional messages from the amygdala around the brain.
While the thalamus is pumping the brain full of emotional messages, it is also allowing the neurotransmitter, serotonin, to just hang out in the synaptic gap. What does this mean? This means serotonin, as well as dopamine and endorphins, are not dispersing around the brain, which is keeping you feeling sluggish, unmotivated, and just down. Scientists and researchers are still uncertain about what causes the brain to not move these feel good neurotransmitters around, but based on how anti-depressants work (which will be covered at a later time), getting serotonin and other feel-good neurotransmitters moving decreases the feelings of depression.
As we discussed in the post, Fight-Flight-Freeze: The Ultimate Coping skill and What Anxiety Really is: A Map to Distress, the hippocampus seems to slow down and shrink as that darn amygdala continues to say how stressed the brain is (you can thank that steady stream of adrenaline, noradrenaline, and cortisol for your shrinking hippocampus). One study showed the hippocampus shrank almost 16% in study participants with depression (MacQueen GM, Yucel K, Taylor VH, Macdonald K, Joffe RBiol, 2008). This same study also showed a smaller hippocampus is also a sign that depression could relapse (or come back) in the future.
One thing to keep in mind is the genetic factor with depression. Many people don’t realize we have a gene responsible for depression. Science has found 4 promising genes (12a, 12q23, 15q, and 18q) that seem to correspond with depression, serotonin receptors, and serotonin production (isn’t that fascinating?) (Lohoff, 2010). Couple this with a genetic predisposition to a smaller hippocampus, adrenal gland issues (also genetic), and you may be at risk for hereditary depression.
Now that we have covered the biological reasons depression happens in the brain, we have to consider things outside of our body that contribute to depression. It is pretty common knowledge that chronic stress is a factor in developing depression. This stress can come from multiple areas: work, home, school, friends, family, substance use, chronic medical conditions, and even financial reasons.
Did you know that diet could even be considered a factor in developing depression? Just like we discussed in Neurotransmitters: The Language of the Brain, serotonin develops out of tryptophan, which is an amino acid found in food we eat. If we are not getting enough food in our brain may not be able to move serotonin around like our brain needs. Are you busy binging on comfort carbs? Notice the last green thing you ate was a gummy worm? The lack of a BALANCED DIET could increase the chances of developing depression. Some of the foods you could eat to help increase the production of serotonin include (but not limited to) the following:
- Fish (especially salmon)
- Dairy products (milk, yogurt, cheese)
- Pumpkin Seeds
- Soy products
When you look at this list above, you may notice these foods are also high in protien, iron, and vitamin B. Not only do these carry the tryptophan for us, they also help our limbic system improve our memory, focus, and connections between the prefrontal cortex and that darn amygdala. Now, rumor has it that carbs can help boost tryptophan and promote serotonin production. Carbs do this by releasing insulin into our body. the insulin helps reabsorb all the good things, leaving the tryptophan in your body for a longer period of time. Could this be why you crave pizza when you’re down in the dumps? Perhaps.
One of the toughest symptoms to challenge with depression is the lack of motivation. Many of you may even know all the skills in the world to help improve your depression, but if the motivation isn’t there to use them, the depression stays like that heavy cloud over your head. One way to gain motivation is through the use of a skill called behavioral activation.
Behavioral activation looks at the cycle depression plays in the brain (loud amygdala, quiet prefrontal cortex, no serotonin to use, all put together to create the “blahs”) and gentally coearses your darn amygdala to put its energy to good use. Just like other coping skills, behavioral activation uses the body’s natural reward system (endorphins, dopamine, and serotonin) to activate the prefrontal cortex and naturally tell that darn amygdala to “shut up.”
Coping Skills Alert
To use behavioral activation, we first have to have a good understanding of those external and internal triggers we talked about in What Anxiety Really is: A Map to Distress. Remember that journaling exercise we talked about? That is part of behavioral activation! By identifying the trigger that sets off the depression, the emotion that came from the trigger, and what you ultimately did (good or bad) when you experienced that emotion, you are providing your prefrontal cortex with objective facts to help the hippocampus form a memory of what you would like to change.
Once you have tracked your mood and identified the cycle of your depression, you can now start to set small goals (specifically goals surrounding changes in your behavior) That the chances of a positive outcome versus an increase in depression. These goals come from what you value the most in life, What brings us pleasure in life, and lastly, help us develop a new skill.
Although it may take some brainpower, it is good to explore your value system. Not only does it help improve self-esteem, but it also helps prepare your brain to release serotonin! Think about what you hold near and dear to you. Take a look at the list below and take a moment to rank how important these things are to you ( one being the highest value of course):
- family relationships
- physical health
- mental health
- friends/social life
- career choice
- work ethic
- hobbies/leisure activites
- personal growth
- role in your community
That is a lot to think about! As we think about our values, it helps us make a realistic goal as to what we would like to change when our depression cycle becomes active. Value we can that identify the activities that naturally give us pleasure (A.K.A. release the feel-good neurotransmitters). In activities that include our value system, serotonin flows naturally. What does that mean for our depression? The symptoms of our depression slowly decrease! Bonus points if you can participate in this pleasurable activity for longer than 20 minutes a day. Why? It allows your prefrontal cortex and that darn amygdala to start to open up its communication channels. By practicing a leisure activity on a regular basis, you are promoting brain health, hippocampus healing, and telling that darn amygdala to shut up!
The next part of behavioral activation, is mastery. This is where we take the skills that release the feel good neurotransmitters, and develop them into a sense of accomplishment. If you recall from Neurotransmitters: The Language of the Brain, accomplishing a task naturally releases serotonin into the brain.
The last step of behavioral activation includes setting SMART goals. This takes those pleasurable/leisure skills, values, and mastery skills and turns them into doable goals that you can schedule. SMART goals is an acronym for:
- S – Specific: make the goal specific
- M – Measurable: identify when you have achieved this goal
- A- Attainable: Make sure the goal is actually possible
- R- Realistic: Developing the goal to be within your abilities
- T – Trackable: track the progress to your goal and celebrate that progress!
Even though these are self-explanatory, it is important to remind ourselves if we don’t set specific and realistic goals we can actually achieve, we are setting ourselves up for failure. That’s right, self-sabotaging comes in the form of unrealistic goals.
Now how long does behavioral activation take to see the benefits? Well, you can feel it pretty quick (when you allow yourself to see ALL the emotions from the activity). On average, it takes 10 minutes a day for about about 60 days (give or take a few) to make behavioral activation your new pattern and rewire the connection between your prefrontal cortex and that darn amygdala. In short, keep practicing!!!
Thank you so much for taking time to invest in your mental health and learning about the cycle of depression. I would like to challenge you to try behavioral activation. Even if it is just as an experiment, take time to evaluate your value system, identify things that (used to) bring you joy, and schedule a time to participate in something you know you are passionate about. Journal how it made you feel for a week or so. In the next post, we are going to go over some more coping skills known as cognitive behavioral therapy.
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- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
- Cowen, P. J., & Browning, M. (2015). What has serotonin to do with depression?. World psychiatry : official journal of the World Psychiatric Association (WPA), 14(2), 158–160. https://doi.org/10.1002/wps.20229. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/
- Ferri, J., Eisendrath, S. J., Fryer, S. L., Gillung, E., Roach, B. J., & Mathalon, D. H. (2017). Blunted amygdala activity is associated with depression severity in treatment-resistant depression. Cognitive, affective & behavioral neuroscience, 17(6), 1221–1231. https://doi.org/10.3758/s13415-017-0544-6. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5728990/
- Harvard Health Publishing (2009, 2019). What Causes Depression? Retrieved from https://www.health.harvard.edu/mind-and-mood/what-causes-depression
- Lohoff F. W. (2010). Overview of the genetics of major depressive disorder. Current psychiatry reports, 12(6), 539–546. https://doi.org/10.1007/s11920-010-0150-6. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3077049/
- MacQueen GM, Yucel K, Taylor VH, Macdonald K, Joffe RBiol Psychiatry. (2008) Posterior hippocampal volumes are associated with remission rates in patients with major depressive disorder. Biol Psychiatry. 2008;64(10):880–883. Retrieved from https://pubmed.ncbi.nlm.nih.gov/18722590/
- Pandya, M., Altinay, M., Malone, D. A., Jr, & Anand, A. (2012). Where in the brain is depression?. Current psychiatry reports, 14(6), 634–642. https://doi.org/10.1007/s11920-012-0322-7. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3619732/#R26
- Tinsley, Grant and Gotter, Anna (2021). What Is Tryptophan? Retrieved from https://www.healthline.com/health/tryptophan
- University of Michigan (date unknown). Behavioral Activation. Retrieved from https://medicine.umich.edu/sites/default/files/content/downloads/Behavioral-Activation-for-Depression.pdf
- UT SOUTHWESTERN MEDICAL CENTER (2004). Severe Depression Associated with Greater Number of Nerve Cells in Thalamus Region of Brain. Retrieved from https://www.eurekalert.org/pub_releases/2004-07/uots-sda063004.php#:~:text=1%2DJul%2D2004-,Severe%20depression%20associated%20with%20greater%20number%20of,in%20thalamus%20region%20of%20brain&text=Southwestern%20Medical%20Center-,Individuals%20who%20suffer%20from%20severe%20depression%20have%20more%20nerve%20cells,Center%20at%20Dallas%20have%20found.
- World Health Organization (2020). Depression. Retrieved from https://www.who.int/news-room/fact-sheets/detail/depression