De­pres­sion and the in­jured brain

The Covington News - - Health - Kir­ven Week­ley

Prozac, the an­tide­pres­sant, is one of the most suc­cess­ful drugs in his­tory. It has been pre­scribed to more than 54 mil­lion peo­ple world­wide and has re­lieved mas­sive amount of emo­tional pain and suf­fer­ing. It ini­ti­ated an in­dus­try of med­i­ca­tions that fo­cus on in­creas­ing the amounts of sero­tonin in the brain. Sero­tonin is a neu­ro­trans­mit­ter, a chem­i­cal in the brain that is as­so­ci­ated with mood. It was de­ter­mined that de­pres­sion was a re­sult of in­suf­fi­cient amounts of sero­tonin. Sad­ness be­came a chem­i­cal is­sue. Hap­pi­ness was just a mat­ter of pro­vid­ing the brain with what it lacked.

The only prob­lem is that this the­ory is grossly in­ad­e­quate to ex­plain Prozac’s ef­forts. Re­cent re­search has demon­strated that low­er­ing sero­tonin does not make a per­son more de­pressed, or less de­pressed, nor does it make a de­pressed per­son more de­pressed. So what, ex­actly, does Prozac do?

Ac­cord­ing to Jonah Lehrer in the Bos­ton Globe, new re­search has of­fered a novel the­ory of de­pres­sion. Pub­li­ca­tions in prom­i­nent sci­en­tific jour­nals have in­di­cated that it is not a lack of sero­tonin that causes de­pres­sion, but that the brain is at­ro­phy­ing and dy­ing. Prozac, and sim­i­lar med­i­ca­tions, ba­si­cally heal th­ese in­jured neu­rons and re­store them to full, healthy func­tion­ing.

“The best way to think about de­pres­sion is as a mild neu­rode­gen­er­a­tive dis­or­der,” said Ron­ald Du­man, a pro­fes­sor of psy­chi­a­try and phar­ma­col­ogy at Yale. “Your brain cells at­ro­phy, just like in other dis­eases (such as Alzheimer’s and Parkin­son’s). The only dif­fer­ence with de­pres­sion is that it’s re­versible. The brain can re­cover.”

This new the­ory is caus­ing rad­i­cal shifts in the sci­ence of the brain. It is shift­ing fo­cus from symp­tom ori­ented explanations of emo­tional states to un­der­stand­ing the bi­o­log­i­cal, anatom­i­cal un­der­pin­nings of mood. With the ad­vent of brain scan­ners and DNA mi­croar­rays, some sci­en­tists are re­cat­e­go­riz­ing men­tal health dis­or­ders in a man­ner that pa­tients are not di­ag­nosed ex­clu­sively on their most ob­vi­ous symp­toms.

Re­search has shown

that chronic stress dam­ages the brain by de­plet­ing the pro­teins that nour­ish and in­vig­o­rate neu­rons. Ac­cord­ing to Du­man, “The men­tal ill­ness oc­curs when th­ese stress mech­a­nisms in the brain spi­ral out of con­trol.” This causes the brain to stop func­tion­ing, ex­cept for the most crit­i­cal func­tions. Neu­rons seem to stop grow­ing and cre­at­ing new cells.

We don’t want to think of de­pres­sion as a re­sult of dy­ing brain cells, pre­fer­ring to think of it as an al­tered emo­tional state. But the term “de­pres­sion” is likely to be mis­lead­ing and con­ceals the fun­da­men­tal na­ture of the process. Sci­en­tists are beginning to pay more at­ten­tion to the ne­glected, “veg­e­ta­tive” signs of de­pres­sion, such as dis­tur­bances in sleep, ap­petite, smell and taste, in ad­di­tion to prob­lems with learn­ing and e mem­ory. Lehrer states, “Like the par­a­lyz­ing sad­ness, which re­mains the most ob­vi­ous man­i­fes­ta­tion of the men­tal ill­ness, th­ese symp­toms are also byprod­ucts of a brain that’s lit­er­ally with­er­ing away.”

Eero Cas­tren is a neu­ro­sci­en­tist at the Uni­ver­sity of Helsinki, who states, “It’s much more than just an in­abil­ity to ex­pe­ri­ence plea­sure.” While an­tide­pres­sants help brain cells re­cover their vigor and form new con­nec­tions, pa­tients must still work to ce­ment th­ese con­nec­tions in place, per­haps with ther­apy. In this man­ner an­tide­pres­sants are like an­abolic steroids, which in­crease mus­cle mass only when sub­jects also go to the gym. Cas­tren states, “if you just sit on your couch, then steroids aren’t go­ing to be very ef­fec­tive. An­tide­pres­sants are the same way: if you want the drug to work for you, then you have to work for the drug.” This may ex­plain the pre­dom­i­nant sci­en­tific ev­i­dence that the best treat­ment for many forms of de­pres­sion is a com­bi­na­tion of psy­chother­apy and med­i­ca­tion. It has been shown re­peat­edly to be the su­pe­rior form of treat­ment over an­tide­pres­sant med­i­ca­tion alone.

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