Depression is not imagination »Marlena’s first aid kit» SciLogs

Depression is often difficult to understand for outsiders. Affected people find it difficult to explain what is happening to them. What really goes on in the brain, and why depression is about more than just a little sadness.

Harald Grohn * enters the doctor’s room. He looks around uncertainly. I can see his thoughts in his head. It took him a long time to come here. To a psychiatrist. Psychiatrists. He thinks what many of my patients think. Am i here? Why can’t I do it myself? His whole attitude expresses what he confesses to me in the conversation: shame and guilt mixed with nervousness. He wouldn’t be here if his wife hadn’t talked him into it.

Harald Grohn suffers from severe depression. It started two months ago. He couldn’t sleep properly at first. He spent his evenings and nights thinking. His company was on the verge of bankruptcy. How should he tell his employees this? He couldn’t eat a lot because of the pressure. He has already lost over 5 kg. And then his dog, whom he loved above all else, died. Heavy blow. too much for him.

But Harald had forbidden himself to mourn. First, it was necessary to save the company. But no matter how he twisted and twisted it, he couldn’t see the exit. Then, a week ago, thoughts started. He thinks everything would be easier if he just wasn’t there anymore. When his wife accidentally found a farewell letter on her bedside table, she immediately drove him to the clinic. She tells me that she was completely shocked by her husband’s reaction.

Harald hasn’t been with the company for the past two weeks. He just lay in bed staring at the wall. He didn’t even want to talk to his best friend. And he no longer touched the sauerbraten that he otherwise cheerfully devoured every Sunday. He asks: what is wrong with him? How it’s possible?

Depression is about more than just a little sadness

Depression is often difficult to understand for outsiders. The causes of symptoms are rarely obvious. Anyone with a broken foot can expect compassion from those around him because of the pain and difficulty walking. Everyone is injured and knows the inconvenience it can cause – even if it’s just a little toe. On the other hand, anyone who lies in bed for weeks completely depressed, even though apparently having no physical limitations, tends to be misunderstood.

Many patients often ask themselves, “What’s wrong with me? Why can’t I pull myself together? Why am I so lethargic and exhausted? ” They look for the causes of their gloomy mood, but often there is no obvious stimulus, as in the case of Harald Grohn.

Stress levels in affected individuals and their families are extremely high. This is because depression can affect many areas – experience, thinking, behavior, and the body. It can completely change your life. Common symptoms include severe depression, no drive, and no joy. He no longer deals with former interests and hobbies. Due to exhaustion, affected people often avoid all social interaction, withdraw from friends, suffer from insomnia, and feel guilty and worthless. In extreme cases, suicidal thoughts may also occur.

The triggers are varied

Depression triggers can vary from person to person. Genetics play a role, as do traumatic experiences, chronic stress, and other health factors. It should be noted that depression is not imaginary! In fact, changes are taking place in the brain which mean that it cannot process feelings properly.

Just as people with diabetes have improper use of sugar by their bodies, people with depression suffer from metabolic disorders in the brain. The tricky part: While diabetes has been well-researched, it’s not yet fully understood exactly what happens with depression.

Various explanations are possible. The best known and oldest theory is the so-called monoamine deficiency hypothesis. It believes that when you are depressed, your brain does not have enough messenger substances such as serotonin and norepinephrine. Our nerve cells (neurons) need these messenger substances – also known as neurotransmitters – to communicate with each other.

When you are depressed, communication is disrupted

This can be imagined as if different neurons are constantly putting letters (ie messenger substances) into mail in order to exchange information. The postman is a break between nerve endings, medically known as a “synapse”. There, the letter is delivered to the mailbox (receptor) of the next nerve cell.

Normally this communication is fluid in our nerve cells. However, when you’re depressed, some parts of this complex process can get confusing. For example, if the receiving neuron’s mailbox is blocked (the receptor does not work), the letter is not sent correctly (problems with the cell’s transmitter production) or it is delivered (the nerve cells are excessively sensitive or resistant to the messenger substances).

Since there is not only one but different messenger substances that can be affected, the symptoms of those affected vary – depending on the disrupted signal pathway. Antidepressants are used for treatment. Drugs aimed at increasing the concentration of messenger substances in the synaptic cleft again, that is, putting more letters into circulation.

Not everyone benefits from antidepressant treatment

Problem: Not everyone with depression benefits from antidepressant treatment. Sometimes it takes weeks for an effect to be noticed at all, although the messenger substances return to normal levels shortly after ingestion. And not every depressed person suffers from a lack of these neurotransmitters in the brain. For some time, therefore, there have been doubts about the monoamine deficiency hypothesis. This explanatory approach alone is not sufficient to understand the development of depression.

There are currently many studies exploring other possible theories. Recent findings indicate that a lack of growth hormones can lead to the death of certain nerve cells in an area of ​​the brain called the hippocampus in the context of depression.

Named for its seahorse shape, this part of the brain is involved in our memory and in controlling our emotions. Connections to other regions of the brain enable emotional evaluation of memories and new information. If there are disturbances in this area, the feelings can no longer be properly processed.

Chronic stress and inflammation play a role

Some studies also link depression to chronic stress. Depressed people often suffer from elevated cortisol levels. Cortisol has many functions that our body needs to adapt to acute stressful situations. For example, it serves to mobilize energy reserves or to temporarily weaken our immune system. If it is chronically elevated, various kinds of disorders can occur, for example in metabolism, the immune system, the circulatory system and memory.

Scientists have been able to show that the sustained release of stress factors such as cortisol can also slow down the growth of nerve cells in the brain. Following a traumatic experience, the feedback mechanism that would normally be used to reduce stress factors in the body is disrupted. In this way, it was possible to establish a relationship between the traumatic experiences and the development of depression.

Animal studies have shown that chronic inflammation in the body can also affect the brain. Special immune cells, called microglia, can be over-activated by inflammatory factors and lead to the death of nerve cells in the brain via complex signal chains. This creates a vicious cycle that leads to depression.

However, it should not be forgotten that some physical illnesses can also cause depressive symptoms. Therefore, before making a diagnosis, it is always necessary to rule out diseases such as hypothyroidism, inflammatory bowel diseases, brain tumors, various dementias, heart diseases, and immunological or viral diseases.

More research is needed

Unraveling the exact causes of depression remains complex and requires much more research. So far, good arguments for and against each theory have been found. It is very likely that there is not a single trigger, but many factors that can vary from person to person and cause depression only through interactions.

The main difficulty in studying depression is sampling. One can look into the brains of living people only to a limited extent. Most of the knowledge comes from animal studies or only through indirect observations such as the administration of a specific drug and subsequent analysis of the effects with questionnaires. Brain scans, such as PET or fMRI scans, can be used to measure the activity of specific areas of the brain from the outside. However, the anatomy of the brain can only be properly studied in the deceased, but then the neurons no longer communicate with each other.

For this reason, many scientists have long been looking for alternative ways to look inside the brain. It is also expected to find new therapeutic options, such as the ability to electrically stimulate certain nerve areas to influence their activity.

For people suffering from depression such as Harald Grohn, an important finding remains that his depression is not just about imagination or willpower, but a disease that can be proven. Thanks to the combination of psychotherapeutic and therapeutic approaches, he has a good chance to enjoy his wife’s sauerbraten again, full of joy in life.

* Name changed

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4664582/

https://onlinelibrary.wiley.com/doi/abs/10.1034/j.1600-0447.108.s418.19.x

https://www.amboss.com/de/wissen/unipolare-depression/

https://www.sciencedirect.com/science/article/abs/pii/S0166223615001769

https://www.health.harvard.edu/mind-and-mood/co- causes-depression

https://www.mpg.de/4752810/Antidepressive_Treatment

Intensive course in psychiatry and psychotherapy – K. Lieb, S. Frauenknecht, ed. IX

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