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.
DEPRESSION IS THE MAIN CAUSE OF DISABILITY IN THE WORLD
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
GREAT UNDERSTANDING OF THE CAUSES OF DEPRESSION
DISTURBANCES IN THE OPERATION OF THE SYSTEM OF NEURO-MEDIATORS
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
SYMPTOMS
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
TREATMENTS
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.
TWO PHASES OF TREATMENT (THREE IN THE EVENT OF RECURRENCE):
- 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
THE ROLE OF SERVIER
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
RECURRENCE PREVENTION MEASURES
- 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.
- 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 - 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
https://www.santepubliquefrance.fr/content/download/119666/file/152124_2018-32-33-1.pdf
(6) Website of the French National Inserm Institute for Health and Medical Research, report on depression. nine0006
https://www.inserm.fr/information-en-sante/dossiers-information/depression
NEUROPHYSIOLOGY OF DEPRESSION【 Psychological consultation】
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Depression is not just sadness or melancholy lasting several days, and not just fatigue. Temporarily giving up after failure is normal. Grieving after the loss of a loved one or the loss of a meaningful relationship is normal.
This is not depression, but a normal reaction to difficult circumstances. Clinical depression is a painful condition. Clinical depression is manifested by persistently depressed mood, fatigue, apathy, as well as frequent disturbances in sleep and appetite. The mood can be depressed for several weeks and even months, sometimes for no apparent reason. Fatigue in depression does not go away with rest. The lack of energy can be so strong that it is difficult to perform simple everyday tasks. Cleaning the house or cooking becomes a feat. A therapist can help you understand your condition and understand the difference between fatigue and the depressive or anxious emotions you are experiencing. A therapist can help if you find it difficult to do your daily activities or if you feel overwhelmed. nine0092 In depression, a downward spiral occurs, which is expressed in the fact that the manifestations of depression themselves reinforce the continued existence of depression. For example, on Saturday you are invited to a party, and you think: “something I don’t want to go, and, most likely, it won’t be fun there,” and you decide not to go.
Instead, you, say, lie on the couch for a long time, leafing through the Internet. The next day you sleep for a long time, and when you wake up, you feel overwhelmed. No one calls and you feel lonely, or think that no one is interested in you, or stress other people. These thoughts spoil the mood, and even more so, I don’t want to communicate with anyone. It's not about communicating or not communicating. As a result, such thoughts and feelings lead to the fact that a person stops thinking and doing, even what brings him pleasure. And good mood becomes less. Thus, this downward spiral causes the brain to switch to a negative perception of various situations, and this helps to stabilize the state of depression. nine0092 The therapist can help the person reverse this downward spiral and turn it into an upward spiral. For example, if you don’t even go to a party, but call a friend and talk or meet him in a cafe. This little effort can help you enjoy socializing in a more comfortable environment.
And it is logical that then it is harder to convince yourself of your own loneliness and uselessness. The less sad thoughts appear, the less the mood deteriorates. And most importantly, with the help of simple actions, a small contribution was made to feeling more comfortable. nine0006
In depression, not only do negative emotions predominate, but it is also difficult to feel positive emotions. Joy and satisfaction can be difficult to feel, even when a person understands that he should be happy, but he does not feel joy. A psychotherapist can help a person formulate the goals of psychotherapy, one of which is
"I want to feel joy." People, convinced that nothing brings them pleasure, stop looking for pleasant activities. And it is difficult for them to get positive emotions. For example, a person loves to draw and has been drawing as a hobby for some time. Then he stopped drawing, because as a result of a negative assessment of situations, he set high standards for drawings and underestimated the drawing process itself.
Thus, the negative sensations take away the beneficial action, and the absence of pleasant activities exacerbates the negative sensation. Considering the situation in a downward spiral is useful, as there are real physiological causes and consequences of the described psychological complexities. nine0092 In clinical depression, the brain works differently than in a healthy state. With depression, the biochemical and physiological processes in the human brain change. In recent decades, changes in the physiology of the brain and the relationship of these changes with the psychological state of a person have been actively studied. Modern research sheds light not only on the formation of individual manifestations of depression, but also on the impact of various treatments on manifestations of depression. The main treatments for depression are antidepressant medication and psychotherapy. nine0092 Several groups of antidepressants are used to treat depression . Serotonin reuptake inhibitors (SSRIs) are usually prescribed for the first episode of depression.
Second-line drugs include tricyclic antidepressants. Effective types of antidepressants are those developed after 2000, such as serotonin and norepinephrine reuptake inhibitors. Dopamine derivatives and melatonin agonists are often used. Antidepressants help increase energy levels, activity, and improve sleep. Dependence does not develop from antidepressants. With the correct use of antidepressants and the correct termination of their use, the withdrawal syndrome does not develop. Antidepressants are prescribed and stopped under the supervision of a doctor. nine0092 Neurophysiological studies show that the main areas involved in the development of depression are the cerebral cortex, the hippocampus and the amygdala. The cerebral cortex is the most "smart" part of the brain, which is responsible for the analysis of information, complex mental operations such as writing and reading. In depression, a reduced amount of gray matter was found in the cerebral cortex, especially in the frontal (frontal) zone.
This part of the brain is responsible for “must”, for volitional purposeful activity. Also, the frontal cortex is responsible for the interaction between the cortex and subcortical structures. A decrease in the amount of gray matter in the frontal cortex can be manifested by the fact that it becomes difficult for a person to concentrate and consciously remember information. When depressed, it can be difficult to do mental work or study. For example, preparing a report at work can seem like such a big task that it is completely unclear how to approach it. When a person does start writing this report, the work goes worse and slower than expected. In this case, it is easy to give up, stop writing it, which can lead to trouble. In this case, the negative spiral of depression is triggered by the accumulation of problems. With the help of a psychotherapist, a person can reverse this spiral. Discuss that it is useful not to scold yourself for the speed of the work, to appreciate what was nevertheless done.
This allows you not to give up. That is, to do the work in small steps, regularly investing effort. nine0092 Such changes are accompanied by a steady concentration on any negative information, and may be a manifestation of depression. A reduced amount of gray matter in the cerebral cortex also affects thinking, for example, it can manifest itself as a tendency to negatively evaluate any neutral information (Rude et al., 2002), as well as to more easily recall negative information. Cognitive techniques are used as part of cognitive-behavioral therapy to deal with these changes, which occur due to a decrease in the amount of gray matter in the cerebral cortex. They are aimed at identifying specific assessments of situations or thoughts, and testing them for bias, with the subsequent restructuring of these assessments. nine0092 When considering subcortical structures, the area that most often undergoes changes is the hippocampus, or seahorse (Arnone et al., 2013). It is believed that long-term and biographical memory is concentrated in the hippocampus.
The hippocampus can be compared to a flash drive that contains the story that we tell ourselves about ourselves. It is from this story that we derive deep-seated beliefs about ourselves and about the world. Memories recorded in the hippocampus determine emotional responses to situations that resemble these memories. The hippocampus also plays a role in emotional regulation, specifically in processing emotions, and in responding to positive stimuli. Aboulia, or lack of pleasure in activities that previously brought joy, and lack of motivation for these activities may be associated with a violation of the neurophysiology of the hippocampus. nine0092 Techniques for gaining new emotional experience are used to work with a person's deep beliefs about himself and the world. These techniques are based on the fact that for our brain, in terms of emotional experience, reality and imagination are not so different. To help a person get a new emotional experience, the technique of transcription, or rewriting, is used.
This technique involves searching for a memory, more often a childhood one, in which a negative emotional experience was received. After that, the situation in this memory is imagined not as it developed in reality, but as the person would like at the time of rewriting. Gradually, individual memories are "rewritten", and the person receives a new emotional experience. nine0092 Recent studies have shown that the network of nerve cells that is responsible for reward in people with clinical depression is characterized by reduced activation in the limbic part of the brain and increased activation of cells in the cerebral cortex. As a result, a person suffering from depression, analytically, intellectually understands that he can rejoice, but it can be difficult for him to feel joy. Also, intellectually, he can find arguments why it is not worth rejoicing, and emotional sensation cannot balance this argument (Zhang, Chang, Guo, Zhang, & Wang, 2013). nine0092 These features can be balanced using behavioral techniques as part of CBT.
Behavioral techniques help increase the number of enjoyable activities. They allow you to first consciously and systematically monitor the improvement in mood during these activities. This process then becomes automatic and helps reduce depressed mood. These techniques help to use the situation that develops during depression, i.e. when the cerebral cortex is activated strongly, and the limbic (emotional) zone of the brain is activated weakly, to improve the human condition. The cortex, with systematic planning and monitoring of positive activities, fixes how much the mood has improved, and whether there is a feeling of satisfaction, and not how much there is nothing to be happy about. To restore balance between the cortex and the limbic system of the brain, and to improve emotional regulation, the mindfulness technique (or as it is also called mindfulness) is used. Elements of mindfulness practices are used in the course of cognitive behavioral therapy. nine0092 Neuroimaging of the physiology of the brain using functional magnetic resonance imaging (MRI) revealed increased activation of the amygdala in people who suffer from depression compared to people who do not suffer from depression.
Amygdala can be compared to an antivirus on a computer. It gives a signal when the brain evaluates any stimulus as a threat. Increased amygdala activity is manifested by a tendency to increased anxiety and avoidance behaviors that are perceived as dangerous, which can limit a person's freedom of action. If depression is accompanied by anxiety, there are behavioral techniques specific to dealing with anxiety disorder. nine0092 Not only structural changes in the brain are responsible for the development and maintenance of depression, but also changes in the biochemistry of the brain, for example, anhedonia (the inability to feel pleasure) is associated with disturbances in the dopamine signaling system. Dopamine can be considered the central biochemical mechanism of habit formation. It is dopamine that gives signals that I did it “well”, you can rejoice and feel satisfaction. These cues influence decision-making related to evaluating the balance of effort and the result of actions, as well as the ability to form responses to rewards (Cohen, Najolia, Kim, & Dinzeo, 2012).
The disruption of dopamine signaling makes it hard for the brain to pass off chemical goodies for previously pleasurable or adaptive behaviors. nine0092 Scientific evidence shows that clinical depression is accompanied by structural, physiological and chemical changes in the brain. These changes are the basis of manifestations of depression. Any high-quality psychotherapy for depression, and in particular, cognitive-behavioral psychotherapy, does not consist only in “talking”, but has certain approaches and techniques with which it can change the functioning of the brain. Psychotherapy, as well as drug treatment, helps improve the state of the brain in clinical depression. nine0006
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