I have a couple of things to discuss and yes, they are related to depression! This new-to-me information really made me think and reevaluate my attitude towards “excessive” prescribing of antidepressants.

First, depression and stress can cause physical, sometimes irreversible problems in the body. The most disturbing are the structural changes in the brain that researchers are finding through imaging studies. Here are some highlights:

Your prefrontal cortex (PFC) is divided into two sides, each with different functions. The left side is associated with creating positive feelings and inhibiting negative ones. MRIs show reduced blood flow to that side of the PFC in depressed patients and it is measurably smaller. It is also responsible for turning off the amygdala. When the left PFC is not activated, the amygdala runs unchecked.

The amygdala tells us how negatively we see an event and can control the severity of depression by its output. The longer it stays active, the worse we think things are. It too will become smaller from recurrent depression.

The hippocampus is associated with learning and memory. It shrinks in people and animals under repeated stress. Prolonged stress (and depression) kills cells in the hippocampus and starts a decline in cognitive abilities.

The brain has plasticity, meaning it’s able to change its actual structure/shape and grow new neurons. This is what allows us to continue to learn and create new memories. Atrophy of the brain structures mentioned above is seen in people with long term depression. However, it may be possible to prevent these effects with early treatment. Treatment has also been shown to stimulate the growth of new neurons.

The second area of information that was new to me is the idea that depression is all in the body, not the head. Bruce Charlton is a research psychiatrist in England. He claims that depression is a completely physical disorder, one that is misread by the brain. Sickness or pain is interpreted as sadness. Lack of energy, loss of pleasure in activities, poor memory and the inability to concentrate are all the body’s way of conserving energy when it isn’t well. “Major depressive disorder,” he says, “is sickness behavior inappropriately activated and sustained….Antidepressants do not make people happy. Their effect on mood is no more remarkable than the fact that it is easier to be happy without a headache.” (As quoted in Psychology Today article by Morano).

This actually makes sense. My NP told me recently that antidepressants help fibromyalgia, chronic fatigue and other painful diseases. So here’s a crazy thought: maybe the reason antidepressants are so overprescribed in this country is because we’re treating all sorts of things with those magic pills. Is it all mental or all physical? Does it matter? Relief is good and returning to a functional life is great. Keeping your brain from withering away is also pretty cool.

So what’s the point? We should really eliminate stress whenever possible and find healthy, effective ways to deal with the stuff that isn’t going away. That’s common sense. Exercise is your friend! (It’s been shown to stimulate the same regenerative pathways as antidepressants).  I think it’s important to get the word out that antidepressants can do more than just cheer you up. If you or someone you know is suffering from recurrent depression or a painful, chronic condition, you might want to do some research and then talk to your doctor. Don’t try to tough it out for too long. Early treatment of depression could prevent your brain from shrinking. That’s worth thinking about.

Here’s a highly educational video clip about the structures of the brain:

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