What depression does to the brain

Brain structure alterations in depression: Psychoradiological evidence

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What Does Depression Physically Do to My Brain?

Written by Keri Wiginton

In this Article

  • Brain Size
  • Brain Inflammation
  • Are the Changes Permanent?
  • How to Get Help

Depression is more than feeling down. It may physically change your brain.

This can affect how you think, feel, and act. Experts aren’t sure what causes these changes. They think genetics, stress, and inflammation might play a role.

It’s important to get help for your depression. That’s because repeat episodes seem to damage your brain more and more over time. Early treatment might help you avoid or ease some of the following changes.

Brain Size

There’s some debate about which areas are affected and how much. There’s growing evidence that several parts of the brain shrink in people with depression. Specifically, these areas lose gray matter volume (GMV). That’s tissue with a lot of brain cells. GMV loss seems to be higher in people who have regular or ongoing depression with serious symptoms.

Studies show depression can lower GMV in these areas:

Hippocampus. That part of your brain is important for learning and memory. It connects to other parts of your brain that control emotion and is responsive to stress hormones. That makes it vulnerable to depression.

Prefrontal cortex. This area plays a role in your higher-level thinking and planning.

There’s also evidence these parts of your brain get smaller:

  • Thalamus
  • Caudate nucleus
  • Insula

Results are mixed on how depression affects the amygdala. That’s your fear center. Some studies show it gets smaller. Others found that stress and depression might boost its GMV. The more severe the depression, the higher the GMV.

When these areas don’t work the right way, you might have:

  • Memory problems
  • Trouble thinking clearly
  • Guilt or hopelessness
  • No motivation
  • Sleep or appetite problems
  • Anxiety

You might also move or talk slowly, or overreact to negative emotions.

Brain Inflammation

Experts aren’t sure if depression or inflammation comes first. But people who have a major depressive episode have higher levels of translocator proteins. Those are chemicals linked to brain inflammation. Studies show these proteins are even higher in people who’ve had untreated major depressive disorder for 10 years or longer.

Uncontrolled brain inflammation can:

  • Hurt or kill brain cells
  • Prevent new brain cells from growing
  • Cause thinking problems
  • Speed up brain aging

Are the Changes Permanent?

Scientists are still trying to answer that question. Ongoing depression likely causes long-term changes to the brain, especially in the hippocampus. That might be why depression is so hard to treat in some people. But researchers also found less gray matter volume in people who were diagnosed with lifelong major depressive disorder but hadn’t had depression in years.

While more research is needed, there’s hope that current or new treatments might help reverse or ward off some brain changes.

Here’s what research says about two common depression treatments:

Antidepressants. These work on the chemicals in your brain that control stress and emotions. There’s evidence these drugs can help your brain form new connections and lower inflammation.

Cognitive behavior therapy (CBT). Experts think CBT promotes neuroplasticity. That means you can change your brain in a way that helps your depression.

How to Get Help

Tell your doctor if you have symptoms of depression. They’ll want to rule out other health conditions so they can find you the right treatment. You might need to make some lifestyle changes, take medicine, or talk to a mental health specialist. Some people benefit from a mix of all three.

Some treatments for mild or serious depression include:

  • Talk therapy
  • Antidepressants
  • Short-term use of ketamine
  • Brain stimulation
  • Exercise
  • Meditation
  • Healthy diet change

Suicide is a serious symptom of depression. Get help right away if you’re thinking about hurting yourself. You can reach someone at the National Suicide Prevention Lifeline at 1-800-273-8255. They’re available anytime, day or night.


This diagnosis is often misdiagnosed. Depression is a disease that has many causes and about which we still do not know much.

Sadness, dark thoughts, low self-esteem, loss of interest or inability to enjoy... Depression is not just a blues, but a real illness. It affects all aspects of daily life and is accompanied by an increased risk of suicide. It can lead to the formation of various addictions, as well as heart disease, diabetes or sexual disorders. nine0006

Many factors are involved in the development of depression. Vulnerability factors are at the basis, for example, if a person was a victim of abuse in childhood. The development of depression is usually preceded by the impact of so-called trigger factors. They can be a breakup in a relationship, the death of a loved one, or financial problems.

Apparently, genetic factors also play a certain role, which makes it possible to speak of hereditary predisposition. Chronic illness, smoking, dependence on alcohol or other psychoactive substances, and even an unbalanced diet can also increase the risk of depression. nine0006

322 million

people living with depression in 2017 1

+ 18.4% 2

Less than half of people with depression receive antidepressant medication. 3



In people with depression, the biochemical processes occurring in the brain are disturbed. This disorder can manifest itself as a deficiency or imbalance in the content of one or more types of neurotransmitters - molecules that are released from the terminal part of the neuron (at the synapse) and act as carriers of chemical signals in the brain. Depression disrupts the balance of three neurotransmitters: serotonin, norepinephrine, and dopamine. They are involved in the regulation of mood and behavior, and their function can be restored with the help of antidepressants. nine0006


According to guidelines issued by the World Health Organization and republished by the French health authority (Haute Autorité de Santé) in October 2017, “an episode of depression is characterized by the presence of at least two of the following three main symptoms (see infographic) for two consecutive weeks with a certain degree of severity; they must be different from the patient's previous condition and cause significant distress."

nine0003 Depressive episodes usually resolve after a few weeks or months with treatment or spontaneously. This state is called remission.

If subsequent episodes of depression do not recur, recovery is declared, but this rarely happens. In 50–80% of cases, a new episode occurs within the next 5 years. 6 Depression is considered chronic when certain symptoms persist, sometimes less severely, for at least 2 years. nine0006


Psychotherapy is recommended regardless of the severity of the depression.

Several types of psychotherapy are used, including supportive, cognitive-behavioral, and analytic-based psychotherapy, as well as psychotherapies based on individual, family, and group sessions.

Relatives and friends invariably play a special role in the treatment of the patient. The patient's expression of his suffering and his acceptance of help are of the utmost importance for successful treatment. nine0006

In addition to psychotherapy, the use of drugs, in particular antidepressants, is most often useful or even necessary.

Antidepressants are recommended for moderate to severe episodes of depression.

There are several classes of antidepressants. Most of them target nerve cells that release serotonin, norepinephrine, or dopamine. Their action is realized through various mechanisms through which the concentration of neurotransmitters increases or the nerve circuits damaged due to depression are restored. nine0006

The physician selects the antidepressant that is most appropriate for the patient, based on the patient's symptoms, medical history, past or current conditions and treatment. The effectiveness of antidepressants usually becomes noticeable only after a few weeks.


  • The acute phase (6 to 12 weeks) is needed to overcome the current episode of depression.
  • Consolidation phase (4 to 6 months) aims to reduce the risk of disease recurrence in the short term. nine0072
  • Maintenance phase: After three episodes of depression, treatment can be given for several years to prevent relapse.

In most cases, treatment is carried out on an outpatient basis (at the patient's home) under the regular supervision of a healthcare professional. However, sometimes a patient may require emergency care or an episode of depression may be resistant to traditional medications. In this case, hospitalization may be considered. nine0006


For over 30 years, Servier has provided medical solutions to people who suffer from depression. Recently, the attention of our group has been focused, in particular, on the development of a digital cognitive-behavioral approach.

It combines a cognitive approach, which focuses on correcting the thoughts that keep the patient in a state of emotional decline, and a behavioral approach, which focuses on correcting unacceptable behavior. The goal of therapy is for patients to adopt a new way of thinking and develop optimal behavior. nine0006


  1. Incorporate regular, moderate-intensity physical activity into your daily routine
    Exercise (walking, running, swimming, cycling) at the recommended frequency of 30-40 minutes 5 times a week.
  2. Eat a balanced diet
    A diet rich in fresh fruits and vegetables, fish and seafood, vegetable oils and whole grains. This type of food is high in essential fatty acids, vitamin B12, selenium, zinc, and iron, a lack of which increases the risk of depression. nine0072
  3. Discuss your psychological problems without delay
    Talking to family, friends or a doctor can help prevent a relapse of depression. In addition, there are communities that provide the necessary assistance to those in need

(1) (2) (3) WHO Report: Depression and other common mental disorders 2017 https://www.who.int/mental_health/management/depression/prevalence_global_health_estimates/en/

(4) http://www.info-depression.fr/spip.php?rubrique16

(5) Léon C, Chan Chee C, du Roscoät E, the Baromètre santé 2017 survey group. La depression en France chez les 18-75 ans: résultats du Baromètre santé 2017. Bulletin épidémiologique hebdomadaire. 2018;(32-33):637-44


(6) Website of the French National Inserm Institute for Health and Medical Research, report on depression. nine0006


NEUROPHYSIOLOGY OF DEPRESSION【 Psychological consultation】