Deep Brain Stimulation And Depression: How Does It Work
In the previous blog posts, Deep Brain Stimulation was introduced, then the history of psychosurgery leading up to the treatment of depression was traced. In this post, we will cover some of the neurological theories as to why it is an effective treatment. We will begin with the prevailing theories behind the treatment of depression with DBS, then move on to explore some more novel ideas.
This images shows changes in oxygen and other metabolic usage in different areas of the brain following chronic DBS treatment
The most commonly targeted area of the brain in DBS for depression is the Subcallosal Cingulate Gyrus , which has been known to be heavily involved in mood regulation. Early studies showed that both successful pharmacotherapy and psychotherapy lead to reductions of activity in this area. Lozano et al furthered these studies by showing decreases in activity in the orbital and medial prefrontal cortices and insula, as well as increases in the parietal lobe, mid and posterior cingulate gyri. Most importantly, their study showed increases of activity in white matter immediately next to the electrodes. The discovery of a wide range of affected locations, as well as the activity in connective tracts, became a key step in establishing the treatment of depression as the treatment of a network.
This image shows the dual-loop system. Regions in brown are the fast inner loop, and blue regions are part of the slower outer loop.
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How Does Your Brain Change From Depression
What does depression do to the brain? Unfortunately, this question isnt easily answered, because the effects of depression on the brain can be quite complex. Whats more, they continue to be studied, since we dont understand everything there is to know about the relationship between our brains and depression. Even though researchers have more to learn about the cause, effect, and correlation between the brain and depression, they have been able to establish a foundational understanding of how depression affects the brain.
In short, depression is broadly associated with brain inflammation. But we dont yet know if depression causes brain inflammation, or if its the opposite that the inflammation is causing depression.
Researchers have been able to determine that depression directly impacts multiple areas of the brain, most of which are affected by a loss of gray matter volume . Gray matter is a type of brain material thats dense with cells and needed for strong brain activity.
What Is The Role Of Genetics In Depression
The inheritance of risk for depression is considered, at best, polygeneticthat is, a number of unknown genes each contributes a tiny risk under certain environmental conditions. None of them makes depression inevitable. The baseline risk of depression in the population is 10 percent having a first-degree relative with depression doubles or triples an individuals risk, to 20 to 30 percent over the course of a lifetime.
There are many non-genetic factors that contribute to risk of onset of major depression, and there are some inherited factors as well. To make matters a bit more complex, some non-genetic factors, including certain kinds of adverse childhood experiencesuch as repeated child abuse or neglectcan have a lasting impact on the function of genes to increase the risk of depression later on.
Variation of one gene associated with the serotonin system has been most linked to depression susceptibilityit is thought to moderate the impact of stressful life eventsbut the evidence has been disappointing. Life experience and lifestyle factors are believed to play more significant roles in depression risk.
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How Depression Affects The Body
There are, of course, mental symptoms of depression, such as feeling sad or down. Anhedonia, the inability to feel pleasure in things that usually bring joy, is also common.
Some people have one of those two symptoms, but some people dont, Areán says.
In fact, many depression symptoms are felt not in the mind but in the body.
Physical depression symptoms can be polar opposites depending on the person. Hypersomnia, or excessive sleepiness, is common, as is insomnia. Appetite can also be affected, either by not having one or by overeating or eating without thinking. Some people feel a complete lack of energy or motivation others feel restless or on edge.
One aspect to depression that is not in the diagnostic criteria is that it can make you feel sick, achy and tired all the time. Its not that youre being lazy, its that you dont have energy and your brain and muscles feel tired. That makes it challenging because the thing you need to do is the thing you dont feel like doing, so you have to push yourself, Areán says.
How someones symptoms manifest can depend on their age, too. Children and teens are more likely to be restless or irritable, whereas older adults may have things like stomach problems and insomnia.
What Does Depression Look Like In The Brain
Gray matter in the brain is a brain tissue composed of cell bodies and nerve cells. People with depression have been shown to have thick gray matter in the parts of the brain involved in self-awareness and emotions . This anomaly may contribute to the problems that people with depression have in these areas.
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What Is The Biochemical Basis Of Depression
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
There are several theories about what causes depression. The condition most likely results from a complex interplay of individual factors, but one of the most widely accepted explanations cites abnormal brain chemistry.
Sometimes, people with depression relate the condition back to a specific factor, such as a traumatic event in their life. However, it’s not uncommon for people who are depressed to be confused about the cause. They may even feel as though they don’t have “a reason” to be depressed.
In these cases, learning about the theories of what causes depression can be helpful. Here’s an overview of what is known about how chemical imbalances in the brain may influence depression.
Treatment Technology: Brain Chemistry And Depression
How does depression affect the brain? Research continues to reveal answers, and Deep TMS takes advantage of the most current knowledge about brain connectivity and plasticity. These treatments may give symptom relief when depression has not been responsive to other treatments. As the brain is better understood, technology will continue to have a vital role in the evolution of depression assessment.
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Why Does A Major Depressive Disorder Change Your Brain
When you suffer from depression, your brain is physically changed. Research by the National Institutes of Health shows that you lose gray matter volume when you suffer from depression. This loss is caused by parts of your brain shrinking due to the hormone cortisol impeding the growth of your brain cells.
The more serious depression a person suffers, the more GMV they lose. Since GMV contains most of your neurons or nerve cells, slowed growth means that your cognitive capabilities are at risk of impairment.
How Does Depression Work In The Brain
Living with depression can feel like youre adrift in the ocean with no life vest and no rescue boat in sight. Like powerful waves hitting your face and controlling your every move, depression can feel commanding, terrifying and without end.
For those dealing with a substance use disorder, self-medicating to manage feelings of depression can sometimes seem like a viable way of coping with symptoms. While alcohol or drug use can provide short-term relief from depression, it consistently leads to severe substance addiction and even greater ongoing emotional issues. Understanding how depression affects you can help you find ways to manage it and recover from substance abuse.
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Brain Chemicals And Depression
Researchers have suggested that for some people, having too little of certain substances in the brain could contribute to depression. Restoring the balance of brain chemicals could help alleviate symptomswhich is where the different classes of antidepressant medications may come in.
Even with the help of medications that balance specific neurotransmitters in the brain, depression is a highly complex condition to treat. What proves to be an effective treatment for one person with depression may not work for someone else. Even something that has worked well for someone in the past may become less effective over time, or even stop working, for reasons researchers are still trying to understand.
Researchers continue to try to understand the mechanisms of depression, including brain chemicals, in hopes of finding explanations for these complexities and developing more effective treatments. Depression is a multi-faceted condition, but having an awareness of brain chemistry can be useful for medical and mental health professionals, researchers, and many people who have depression.
Depression Discussion Guide
What Does Brain Imaging Look At In Depression
Some types of brain imaging, such as CT scans and magnetic resonance imaging , take static pictures of the brain to determine whether any specific structures are larger or smaller than normal in depressed patients. Positron emission tomography scans and functional magnetic resonance imaging look at the brain in action, to see whether and where there are problems in the way the brain processes specific types of information.
In fMRI studies, normal controls and depressed patents are typically given some task to perform in the scanner. For example, subjects may be asked to look at a series of pictures, some of them with emotionally disturbing content, to see how the brain handles negative stimuli. The brain scanners measure blood flow or metabolic activity, based on the concentration of agents earlier injected into the bloodstream. Comparison of hot spots and dead spots of activity between controls and depressed patients highlight areas of the brain that malfunction in response to challenging stimuli.
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How Is Depression Treated
Depression is among the most treatable of mental disorders. Between 80% and 90% percent of people with depression eventually respond well to treatment. Almost all patients gain some relief from their symptoms.
Before a diagnosis or treatment, a health professional should conduct a thorough diagnostic evaluation, including an interview and a physical examination. In some cases, a blood test might be done to make sure the depression is not due to a medical condition like a thyroid problem or a vitamin deficiency . The evaluation will identify specific symptoms and explore medical and family histories as well as cultural and environmental factors with the goal of arriving at a diagnosis and planning a course of action.
Can Genes For Depression Be Modified
Scientists know that the expression and function of many genes can be altered without doing the near-impossiblemaking any changes to the gene structure itself. Such changes are known as epigenetic modifications. Some life experiences can create vulnerability to depression through epigenetic changes. For example, in rat pups, lack of maternal care can permanently reset the sensitivity of receptors to stress hormones. If their mothers fail to lick and groom them, they grow up to display an exaggerated response to stress hormones and develop depression-like behavior in response to stress.
But there are also ways to strategically induce epigenetic changes to reverse symptoms of depression. For example, the nutritional supplement SAM-e, a synthetic version of a compound found in the body, contains a substance that chemically augments the activation and deactivation of genes. Some studies show it is effective against symptoms of depression.
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Depression Is Different From Sadness Or Grief/bereavement
The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such situations. Those experiencing loss often might describe themselves as being depressed.
But being sad is not the same as having depression. The grieving process is natural and unique to each individual and shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from usual activities. They are also different in important ways:
- In grief, painful feelings come in waves, often intermixed with positive memories of the deceased. In major depression, mood and/or interest are decreased for most of two weeks.
- In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness and self-loathing are common.
- In grief, thoughts of death may surface when thinking of or fantasizing about joining the deceased loved one. In major depression, thoughts are focused on ending ones life due to feeling worthless or undeserving of living or being unable to cope with the pain of depression.
Grief and depression can co-exist For some people, the death of a loved one, losing a job or being a victim of a physical assault or a major disaster can lead to depression. When grief and depression co-occur, the grief is more severe and lasts longer than grief without depression.
How Does Nerve Cell Communication Go Awry In Depression
Where once researchers and clinicians focused on the role of neurotransmitters such as serotonin in depression, they now know that neurotransmitters are only one part of a much larger story of how nerve cells function in circuits to relay messages from one part of the brain to another. In fact, many experts see depression as a nerve circuit disorder, marked by a power failure in the brains wiring, affecting communication between one area of the brain and another.
The nerve cell connections between the amygdala and the prefrontal cortex are sometimes called the depression circuit depression results when emotion-laden signals from the amygdala overpower the ability of the PFC to regulate the signals. The prolonged or excessive release of stress hormones can lead to a failure of activation of key nodes in neural networks or impair the strength of signals between them, especially when processing emotion-related or reward stimuli.
Its important that depression is now seen as a nerve circuit disorder, because that influences the search for effective treatments.
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The Biology Of Depression
Depression makes deep inroads on biology to bring about the many symptoms of depression, from sleep disruption and an inability to experience pleasure to lack of motivation and feelings of guilt. Many factors influence how a person reacts to stressful events, whether an individual gets depressed, and how the disorder manifests. These include genetic inheritance, life experience, temperament, personality traits, social supports, and beliefs.
Still, exactly how biological changes give rise to depressive symptoms is not well understood. Because of its complexityand because the disorder contributes so much to human sufferingthe biology of depression is a major subject of ongoing research.
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Susceptibility To Physical Health Issues And Illness
Stress hormones make your heart beat faster as if youre constantly in danger. Because your heart isnt meant to beat at high speeds for extended periods, this could lead to a life-threatening heart illness in the future.
Depression also impacts your digestive systems health, especially if you binge eat or take antidepressant medications. If you rapidly gain weight during a depressive episode, youre more likely to develop diseases closely tied to obesity, like diabetes. Conversely, depression may also cause someone to lose their appetite for food and experience rapid weight loss, which can be equally harmful to the body.
Some people may use drugs or alcohol as a way to deal with their symptoms of depression, leading to substance use disorders. In some cases, this substance abuse issue can develop into life-threatening addictions.
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When To See A Doctor
Depression with CD can interfere with your ability to function normally and may cause disruptions to your life. See your doctor if you suspect you have CD caused by depression to avoid worsening symptoms.
Your doctor may ask targeted questions about your cognitive abilities to determine the severity of your symptoms. Theres currently no test or scale to diagnose CD symptoms in depression.
You may feel forgetful, slowed, or inattentive if you have depression. These cognitive symptoms may be signs of CD, or brain fog, a common symptom of depression. You should discuss these symptoms with your doctor to determine a treatment plan.
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Early Childhood Depression Alters Brain Development
The brains of children who suffer clinical depression as preschoolers develop abnormally, compared with the brains of preschoolers unaffected by the disorder, according to new research at Washington University School of Medicine in St. Louis.
Their gray matter tissue that connects brain cells and carries signals between those cells and is involved in seeing, hearing, memory, decision-making and emotion is lower in volume and thinner in the cortex, a part of the brain important in the processing of emotions.
The new study is published Dec. 16 in JAMA Psychiatry.
What is noteworthy about these findings is that we are able to see how a life experience such as an episode of depression can change the brains anatomy, said first author Joan L. Luby, MD, whose research established that children as young as 3 can experience depression. Traditionally, we have thought about the brain as an organ that develops in a predetermined way, but our research is showing that actual experience including negative moods, exposure to poverty, and a lack of parental support and nurturing have a material impact on brain growth and development.
The findings may help explain why children and others who are depressed have difficulty regulating their moods and emotions. The research builds on earlier work by Lubys group that detailed other differences in the brains of depressed children.
Luby said that is the main challenge facing those who treat kids with depression.
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