The Biology Of Depression: How To Treat It Depends On Your Brain
Nobel Prize winner Eric R. Kandel has a fascinating article in The New York Times, noting how depressed people's brains vary:
Helen Mayberg, at Emory University, and other scientists used brain-scanning techniques to identify several components of this circuit, two of which are particularly important.One is Area 25 (the subcallosal cingulate region), which mediates our unconscious and motor responses to emotional stress; the other is the right anterior insula, a region where self-awareness and interpersonal experience come together.
These two regions connect to the hypothalamus, which plays a role in basic functions like sleep, appetite and libido, and to three other important regions of the brain: the amygdala, which evaluates emotional salience; the hippocampus, which is concerned with memory; and the prefrontal cortex, which is the seat of executive function and self-esteem. All of these regions can be disturbed in depressive illnesses.
In a recent study of people with depression, Professor Mayberg gave each person one of two types of treatment: cognitive behavioral therapy, a form of psychotherapy that trains people to view their feelings in more positive terms, or an antidepressant medication. She found that people who started with below-average baseline activity in the right anterior insula responded well to cognitive behavioral therapy, but not to the antidepressant. People with above-average activity responded to the antidepressant, but not to cognitive behavioral therapy. Thus, Professor Mayberg found that she could predict a depressed person's response to specific treatments from the baseline activity in the right anterior insula.
These results show us four very important things about the biology of mental disorders. First, the neural circuits disturbed by psychiatric disorders are likely to be very complex.
Second, we can identify specific, measurable markers of a mental disorder, and those biomarkers can predict the outcome of two different treatments: psychotherapy and medication.
Third, psychotherapy is a biological treatment, a brain therapy. It produces lasting, detectable physical changes in our brain, much as learning does.
And fourth, the effects of psychotherapy can be studied empirically. Aaron Beck, who pioneered the use of cognitive behavioral therapy, long insisted that psychotherapy has an empirical basis, that it is a science. Other forms of psychotherapy have been slower to move in this direction, in part because a number of psychotherapists believed that human behavior is too difficult to study in scientific terms.
Here's George A. Eby on a little-explored apparent cure for some forms of depression. I found this through yet another excellent post by psychiatrist Emily Deans. More from her here at Psychology Today.
Apparently chewing gum may be helpful for mild depression:
http://www.confectionerynews.com/R-D/Chewing-gum-may-help-the-mildly-depressed-say-researchers
snoopy at September 8, 2013 12:15 PM
Thanks for sharing this. I only read the excerpt and it was so fascinating. I look forward to reading the more at the links.
I struggled with depression for most of my life before I was able to seek treatment. It was on your recommendation, Amy, that I specifically looked for a cognitive behavioral therapist, and I cannot begin to quantify how it has changed my life and the way that I think.
LL at September 8, 2013 12:45 PM
This can open a few avenues of discussion, at least. I know of a woman who has some disorder approximating diabetes in presentation, in that irritability, then sedation occurs, with hunger - yet blood sugar remains in normal ranges.
I grin widely when you do this, Amy. It speaks to your skills in grasping many more things than a simple "Dear Abby" clone would ever realize!
Radwaste at September 8, 2013 1:17 PM
Amy Alkon
https://www.advicegoddess.com/archives/2013/09/the-biology-of.html#comment-3898878">comment from LLIt was on your recommendation, Amy, that I specifically looked for a cognitive behavioral therapist, and I cannot begin to quantify how it has changed my life and the way that I think.
LL, thank you so much for telling me that. Means so much to me.
A friend struggling with depression is now trying the magnesium. I'm hoping it works.
I take only magnesium, 5,000 iu of D, vitamin K, and coconut oil caps. Everything else I get through food. I eat a lot of fat (meat and butter) and kale and green beans and Omega 3 butter and eggs.
Amy Alkon
at September 8, 2013 2:01 PM
Anti-depressants make me MORE depressed over the long run. If I didn't have a good doctor she would just up the dose. I'm more depressed so I need more of an anti-depressant right?
Nope...I need a mood stabilizer.
It is crucial you have a doctor that figures out what kind of depression you have. They give these out like candies too which is not good.
Ppen at September 9, 2013 5:59 AM
Amy Alkon
https://www.advicegoddess.com/archives/2013/09/the-biology-of.html#comment-3900696">comment from PpenI told a psychologist I met at a party about how two shrinks, who'd barely spent any time with me, prescribed me: 1. Haldol and 2. Depakote.
I needed neither and knew better than to take them.
Go to a fibromyalgia doctor and he's likely to find that you have fibromyalgia. Even if you have nothing of the sort.
Amy Alkon
at September 9, 2013 6:05 AM
Amy if you want to hear a bad shrink story.
My friend disclosed to her shrink she was raped and the shrink kept asking her if she was a lesbian because she didn't show any interest in being around men.
Ppen at September 9, 2013 6:32 AM
Amy Alkon
https://www.advicegoddess.com/archives/2013/09/the-biology-of.html#comment-3900771">comment from PpenWow. Horrible.
I am so lucky to have the shrink I have now. He is wise, great on science, compassionate, and very smart. It was his intervention -- because I could trust him enough to be honest with him that Ritalin wasn't working -- that got me on the Adderall that does work.
He also understands that I don't need to be treated like a crazy person. I like seeing him because he's interesting and if he weren't my shrink, he'd be in my circle of friends.
Amy Alkon
at September 9, 2013 6:36 AM
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