We're a little crazy, about science!

Sometimes it rains

Brains are wild. I mean we have this misshapen jello blob stuck in our head and it somehow gives us the ability to be aware. We exist and think, feel, reason, all the stuff that makes us who we are. Brains are great, except when they aren’t. Depression is a horrible thing, which lives in the brain. You can’t “just be happy” anymore than someone could just be rich. Obviously when you live with chronic depression you got a dud of a brain. It may have to do with genetics, environmental factors, the way we were raised, or maybe it’s just horrible luck, but out of all the organs we can fix or replace, the brain is not one of them. You’re stuck as you and sometimes that sucks.

I’ve been battling a serious case of depression lately. Worse than usual and it is roughly that time of the year that I go through this process with my brain. While I know it’s coming, there’s not a lot I can do about it besides wait and hope. I don’t like it and wish I could refuse to participate in it, but here we are. Yes, once again talking about my crap brain.

Which I guess is a good reminder to say that depression causes actual, physical, and measurable changes to the brain. I’ve covered all that in this post (here), but the quick and dirty explanation is that your brain eats itself alive. Since we’re on the topic let’s dive into what depression does. The more technical explanation, which I’m quoting directly from the paper I’m linking to, explains it as such:

“Morphological and functional changes have been repeatedly reported in the brain organization of depressed patients. The main modifications demonstrated by structural magnetic resonance imaging (MRI) are a reduction in the gray matter volume within the prefrontal cortex, the hippocampus, and the striatum.”

Neuroplasticity: from MRI to depressive symptoms
DOI: 10.1016/j.euroneuro.2004.09.001

From our understanding of the brain the prefrontal cortex handles all the high level stuff, our will power. it also influences attention, impulse inhibition, prospective memory, and cognitive flexibility. While the picture is probably more complex than this, a gross (and mostly wrong) simplification is that where you live is in the prefrontal cortex. I mean the brain works as a whole. I can’t hand you a CPU and tell you you’re holding the thing that makes a computer a computer, it’s all the parts that come together and work in unison that makes a computer what it is. Same goes for the brain, but we can say undeniably that the CPU and the prefrontal cortex for that matter are important parts to the system as a whole neither the computer or the brain could function without them. In fact the prefrontal cortex changes are probably the most damaging in terms of what we see in depression. A good paper that talks about these changes describe it as such:

“Functional imaging studies, with few exceptions, demonstrate prefrontal lobe hypometabolism in primary and secondary depression, with severity of depression often correlating with the degree of frontal inactivity. These studies imply that dysfunction of the prefrontal cortex, particularly with respect to its role in modulating limbic activity, could conceivably produce many of the symptoms seen in clinical depression.”

Prefrontal cortex dysfunction in clinical depression
DOI: 10.1002/depr.3050020202

The hippocampus is (again from our current and ever evolving understanding of the brain) associated with learning and memory. So you could think of your hippocampus as the thing that helps sort your memories and stores them away for later. It would make sense that learning and memory are tied since you can’t really learn without some sort of memory of the event you’re learning from. The hippocampus also (probably, maybe, sort of) has a role in regulating emotional behavior. This would probably explain its role in depression and why depression causes changes to this part of the brain. A good paper that talks about the effects of depression (briefly in one of the later paragraphs) on the hippocampus reminds us that:

“Though emotional behavior is regulated mainly by amygdala, hippocampus and amygdala both have reciprocal connections, thus can influence each other (latter affects more than former). Since hippocampus has projections to hypothalamus, thus can affect release of adrenocorticotropic hormones. That is why, in patients with atrophied hippocampus, there is rise of cortisol.”

Hippocampus in health and disease: An overview
DOI: 10.4103/0972-2327.104323

Which brings us to the other part of the brain affected by depression, the corpus striatum (striatum for short). Now here’s where depression gets really interesting because (yet again, current understanding of) the striatum is one of the principal components of the basal ganglia, a group of nuclei that have a variety of functions, but are best known for their role in facilitating voluntary movement. Now if that were it you may be very confused why depressed people would have changes in the striatum when they don’t normally have issues with voluntary movement (although speaking as someone who lives with chronic depression, moving does feel like work a lot of the time). However, the striatum is also associated with reward during social behavior. That makes more sense because people who are depressed tend to not want to be around anyone. I once told my therapist I would be perfectly happy living in a cave alone and I still feel that way most days (okay almost all days). Or to quote directly from another paper on the purpose of the striatum

“Activity in the striatum has been hypothesized to integrate actions with rewards. The picture that emerges from this review is that the striatum is a general-purpose subcortical region capable of integrating social information into coding of social action and reward.”

The role of the striatum in social behavior
DOI: 10.3389/fnins.2013.00233

So there are demonstrated changes in the brain and the severity of those changes correlates to the severity of depression. In short, depression is a type of brain damage, or if not damage, a type of disfunction. A good example of damage would be a traumatic brain injury (TBI), which I have! So to anyone who has told a person to “just be happy” or to “get over it” I say, with all love and respect, go fuck yourselves. Seriously, you wouldn’t tell someone with a serious spinal cord injury to get over it and start walking again, or maybe you would, I’ve known some seriously inconsiderate jackasses. Conversely if you have said that in the past and didn’t know any better, well now you do and have no excuses.

Thankfully there are medications to treat depression, that’s the good news. The bad news is that the malformed jello ball in your head is unique to you, like spinal cord injury or TBI, or any sort of injury, it’s incredibly personal and what work’s for you may not be the same as what works for someone else. In fact the sad truth is that a lot of medications that are used to treat depression can actually make it worse and there’s no test that can be done beforehand to see what medicine works, it’s all luck of the draw or as I like to put it, medication roulette.

Treating depression is hard because we don’t fully understand the mechanisms behind it or why some people have depression and others do not. We don’t even exactly understand why certain medications help, we have theories and data that support ideas, but a lot of them are very vague explanations and not the nice firm science that would probably help make medication selection easier if we knew how the brain worked better.

Of course the alternative is to wait until we understand the brain well enough to treat depression, but that could be 10 years, it could be 100 years, it could be never. We may never understand the brain well enough to have a way to personalize treatment and guarantee it will work before you try it. That would be an awful way to live since that helps absolutely no one now and there are some great successes with medication, so if you’re someone who needs treatment don’t be afraid to try a few different types of medicine to find the one that works best for you.

However, there are people like me out there who have tried basically every medication there is to treat depression (and some that treat things similar to depression) with no result. Treatment resistant depression is a very real and very shitty thing. Those of us unfortunate souls stuck on that boat have no real option to treat depression outside of the vague therapies available, or possible future medications that are in the pipeline.

For people like me, we’re stuck riding it out and trying to survive. It’s exhausting on the best of days and downright torture on the worst. I’ve talked about the constant feeling like I should just kill myself (which I talk about here) and get it over with and the constant depression definitely plays a role in that feeling (or could be the cause of it all together).

Society isn’t kind for people like me, who have to put in serious effort just to get out of bed. I need to eat and live, so I need to have an income. That adds stress and creates more work to do, so it’s a vicious cycle that wears on a person. This time of year is particularly rough because it’s an anniversary (the bad kind, the trauma kind), so for the next few months I just have to keep my head down and once I make it out the otherside.. well it won’t be better exactly, it just won’t be quite as heavy. In any case, I don’t get control over it, just like I have no control over the rain. Hence the title for today’s post.

So that’s the story for the day. Be kind to your brain, especially if you’ve got a good one, or at least one that isn’t so broken.

But enough about us, what about you?

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