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For today’s “How Do You Move Beyond Blue?” post, I have published a comprehensive update of some fascinating studies that will lead to more effective treatments for depression and other mood disorders. This valuable summary by Karen Swartz was printed in the Fall 2007 Issue of The Johns Hopkins Depression and Anxiety Bulletin.
Dr. Swartz (above left) is one of the physicians at Johns Hopkins who evaluated me in March of 2006. She is Director of Clinical Programs at the Johns Hopkins Mood Disorders Center and Assistant Professor of Psychiatry at the Johns Hopkins University of Medicine. She is also Co-Director of the Women’s Mood Disorders Clinic (with Dr. Jennifer Payne, above right), founder of the Adolescent Depression Awareness Program, and an attending psychiatrist at Johns Hopkins with extensive clinical experience in mood disorders, anxiety disorders, and eating disorders. In other words, she knows her stuff, inside and out, and I am SO lucky to have found her and Dr. Smith.
I’ve made a few remarks in brackets (as always).
What happens within the brain when a person is depressed? Our concept of the anatomy and physiology of mood has rapidly shifted over the past decade, thanks to work in brain imaging and molecular medicine.
In the 1990s, several lines of research began turning our view of mood disorders upside down. Taken chronologically, the first step was research showing that neurogenesis—the birth of new brain cells—can continue throughout life. The second breakthrough was evidence that depression is associated with a loss of volume in parts of the brain.
Most of us remember being told at some point that we are born with all the brain cells we’ll ever have. But we now know that the process of neurogenesis is an ongoing one, with new brain cells being born even as old brain cells die off. Researchers have discovered, however, that depression appears to inhibit this birth of new brain cells.
And that may help explain the second line of research: why people who’ve had depression are likelier to have a smaller hippocampus—a part of the brain that plays a role in emotion and is associated with memory and learning. The more severe and long-lasting the depression, the greater the loss of brain volume. This process of brain atrophy also affects the brain’s frontal lobes (specifically, the prefrontal cortex), which are involved in regulating the emotional centers of the brain.
The good news is that most of the volume loss seems to be related to cell shrinkage rather than outright cell death, and thus can potentially be reversed. Genetic studies have also found that a subgroup of people are more susceptible to this process of brain atrophy.
Brain atrophy is only part of the depression story, however. In August, researchers at the University of Wisconsin-Madison reported the results of one of the first studies to use brain imaging to look at the brain circuits involved in emotional control in patients with depression. They found that the brains of people with clinical depression react very differently than those of healthy people when trying to cope with negative situations.
In the study, published in “The Journal of Neuroscience,” brain imaging revealed a breakdown in normal patterns of emotional processing that impairs the ability of depressed people to suppress negative emotional states. Efforts by depressed patients to suppress their feelings when viewing emotionally negative images increased activity in several brain areas, including the amygdala, known to play a role in generating emotion. [Reread that last sentence. Fascinating. And why “mind over mood” attempts can sometimes sabotage recovery.]
Mood disorders are believed to originate in the limbic system—the brain’s emotional center. This region includes all the structures mentioned so far—the hippocampus, prefrontal cortex, and amygdala—among others. Identifying the specific areas and circuits in the brain associated with mood disorders is one of the most pressing issues in psychiatric research today.
“It’s normal for people to have negative emotions in certain circumstances,” says lead study author Tom Johnstone, Ph.D., of the University of Wisconsin. “One of the features of major depression is not that people have negative reactions to negative situations; it’s that they can’t pull themselves out of those negative emotional moods. They seem to have a deficit in their ability to be able to regulate their emotions—to come back down to baseline after a negative experience.”
To evaluate this deficit, Dr. Johnstone and his colleagues monitored the brain activity of 21 adults diagnosed with major depressive disorder and 18 healthy subjects of comparable ages. Participants were asked to view a series of emotionally positive and negative images and then indicate their reaction to each one. Four seconds after the presentation of each picture, participants were asked either to increase their emotional response (for example, imagining a loved one experiencing what was depicted in the image), to decrease it (for instance, imagining the situation was acted out rather than real or envisioning a more positive outcome), or simply to continue watching the image.
During the test, a functional magnetic resonance imaging (fMRI) scanner detected changes in brain activity. Johnstone and his colleagues also recorded levels of emotional excitement by measuring pupil dilation.
In both healthy and depressed participants, efforts to reframe the content of what they were seeing increased brain regulatory activity in the prefrontal cortex. This was expected. The big difference was observed in the activity levels of the emotional response centers, including the amygdala.
In non-depressed participants, high levels of regulatory activity were associated with low levels of activity in the amygdala. In other words, the healthy subjects’ efforts to reduce their emotional responses were successful.
But in depressed participants, high levels of activity in the amygdala and other emotional response centers persisted despite intense activity in the regulatory regions. What’s more, the difference between healthy and depressed participants was even more pronounced the harder the participants tried. [Reread that sentence, too. Whenever you feel like you are failing at cognitive work, of thinking yourself to health, READ THAT SENTENCE.]
One possible explanation is that depressed people have a broken link between the brain regions, such that regulatory centers fail to send dampening signals to emotional centers.
Or perhaps depressed patients get stuck ruminating on negative thoughts. “When they try to engage in regulation of their negative responses, they just think more about the emotional content of the images. Instead of turning down their emotional responses, they turn them up.” [That paragraph is somewhat consoling to me, too, when I’m too hard on myself.]
Cognitive therapy, in which the patient and therapist focus on breaking negative thought patterns, uses mental strategies similar to those used in this study, suggesting that it might not be the best treatment for those patients whose mental efforts only increase their emotional responses. For these patients, other therapeutic approaches may be more beneficial. Perhaps, in the future, doctors will use measurements of activity in the amygdala to predict the effectiveness of treatments for depression such as cognitive therapy.
Of course emotional regulation underlies many psychiatric disorders, not just depression, and identifying and understanding the brain circuits involved will enable scientists to target these circuits with more refined treatments.
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Previous Posts
Therapy Thursday: Sweat
posted 6:01:57am Feb. 09, 2012 | read full post »
Scrupulosity: What It Is and Why It's Dangerous
posted 6:17:35am Feb. 07, 2012 | read full post »
The Treasures of Darkness
posted 6:06:40am Feb. 06, 2012 | read full post »
On Groundhog Day: 12 Winter Depression Busters
posted 6:30:47am Feb. 02, 2012 | read full post »
6 Ways to Stay Resilient in Stress
posted 6:00:24am Jan. 31, 2012 | read full post » |
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Therese J. Borchard writes the daily blog, Beyond Blue, on Beliefnet and is a regular contributor to the award-winning blog, World of Psychology, on Psych Central. Therese is the author of Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes and The Pocket Therapist: An Emotional Survival Kit. Subscribe to Beyond Blue, visit her website, or follow her on Twitter @thereseborchard.
Meet others on the journey in
Therese’s community group
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Therese J. Borchard writes the daily blog, Beyond Blue, on Beliefnet and is a regular contributor to the award-winning blog, World of Psychology, on Psych Central. Therese is the author of Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes and The Pocket Therapist: An Emotional Survival Kit. Subscribe to Beyond Blue, visit her website, or follow her on Twitter @thereseborchard.
posted January 7, 2008 at 12:00 pm
Hi ALL,
I really hate to dump this on ALL of you, so early in the year, but A. Frenda Meine,(who I like to think/hope is the Holy Spirit, but then with bi/multi polar, you never know !) has been dumping on me since the beginning of the year, so too bad! Bear in mind that I don’t “no” crap about anything (or is that know ?) but I do claim to be the worlds greatest conspiracy theorist (the government should hire me, dammit !)This is my theory as relayed to me through A. Frenda Meine (I don’t take credit or blame for anything…yeah, right !)
We now have surrounding us, 24 hours a day, seven days a week, 365 days a year (discounting leap year, of course) electronic vibration/signal/polution. There is TV, Radio, Cell Phones, Vid Games, etc,etc,etc (not to mention all kinds of other radio activity) The human body was not designed to take that kind of bombardment. And it gets worse everyday! This could very well account for all of this dis-ease, dis-order and screwed up polarity in this world. On top of all that, the scientific prediction is “The Poles shall shift 15 degrees, and shall also reverse” . . . The Bible states in Revelation “The Earth shall be shaken in its orbit”
Here’s one that will scare the crap out of ALL of you living in the Metropolitan Area. I just learned from a retired cop friend of mine (not to be confused with A. Frenda Meine) that a friend of his went to help during the 911/ WTC incident. His is now very sick and apparently the government is studying everybody from that area, to see what their sickness was caused by. It appears that he did not have a mask during his volunteer work there., and he is now coughing up human flesh and bone remains . . .Guess what, on a average day, there is over 10 million people in that city, and none of them had masks on ! (except the Michael Jackson types, if you catch my drift !) Oh Yeah, all of that so called pollution had been blown westward, especially into NJ. On top of that, they built this cool observation bridge one “Ground Zero” so touriss from all over thw world can get a good sniff of mass pain!
Now let’s go back to long-time-ago India. It appears the was a high epidemic of Leprosy, and they discovered that it was cause by the burning of bodies on funeral pyres, since the poor people , could not afford to bury they relatives in a proper fashion. (guess what, they also inhaled burned body parts) . . . Now let me take you all the Way back to ancient Rome and their conquests. I don’t know how many of you know this, but the Romans also burned all the dead bodies (because they were not about to waste a lot of labor in burying them) and the place they burned them was in Gahanna, the town dump “It would be better to be cast in Gahanna . . . , etc,etc” (now perceived as Hell) . . . (guess what more breathing dead bodies, more leprosy !)
And finally (whew !) “CrudeOil” is fossilized fuel! . . .BINGO ! Expect to have a very serious outbreak of leprosy in this country (and I don’t even want to think what our government is going to do about it, but you can be sure it will cost trillions . . . what’s after trillions ? (if you catch my drift !) Hey! How else will the prophesies be fulfilled . . soon the Messiah !
LUV 2 ALL
WIZDUMB
Too quick to be stupid
posted January 7, 2008 at 12:34 pm
Hey ! Did you notice, they got a picture of me in the upper right hand corner ! They shortened my name to just DUMM, but that’s OK, it’s nive to be finally recognized !
LUV 2 ALL
WIZDUMB
too quick to be stupid
posted January 7, 2008 at 12:38 pm
Interesting stuff — but the footnotes made the story, Therese.
That, and your own (and thank G-d) lifesaving connection to one of the authors.
posted January 7, 2008 at 4:32 pm
This is a fantastic article (of course)!
Thank you
posted January 7, 2008 at 4:47 pm
One more thing, on the ad about Energy Hog, there is a lot of tips to conserve energy, and a whole lot of vid games for kids. (of course I just had to go to the kids site !)
LUV 2 ALL
WIZDUMB
just another pig in the poke
posted January 7, 2008 at 5:03 pm
Wow – now I know why I cannot reason my way out of anxiety and depression. Thinking makes it worse! And as person who tries to put mind over matter, it shows me that I am only making myself worse. Great insight and thank you for sharing it with all of us.
posted January 7, 2008 at 11:25 pm
“Depression Can Be Treated, Depression Can Be Defeated”
“Happiness Is Cool. Happiness RULES”
Just as there is a part of our brain that controls our heart rate, body temperature, and breathing, there is a part that controls our moods and emotions. Some people require medication to help control their blood-sugar level. Some people require medication to help regulate their moods and emotions. Our bodies don’t always function perfectly every hour of every day. That’s why we need science and medicine to live better, more productive lives. Society will accept a malfunctioning pancreas or kidney more than it will accept a malfunctioning brain. It accepts that we don’t have full control over some organs, but not the brain. It’s time that common sense became more common in this world. My best hours are spent with my “Sane Circle of Friends”. Some are near, some far away. I can always count on them to lift me up and allow me to live in a better world.
WiseSteven
posted January 8, 2008 at 1:44 am
while i agree that depression can be treated and defeated, it’s good to see that doctors are at leastBEGINNING to discover the phyiological components that make some of less successful in the struggles against it. As a diabetic, no one has EVER told me to “keep a stiff upper lip” or “pull myself up by my bootstraps” since everyone pretty much “gets” that there is a physiological deficiency. Yet my depressions frequently ellicit those types of comments, along with that most-dreaded platitude,’but you have so much to be thankful for!” Thank you, therese, for once again alerting us to the cotting edge research. It provides (for Me at least) another tool for my toolbox which I can take out and display when family and friends are gibing me one of their “I’m only saying this for your own good” speeches. My late father used to proclaim that all I really needed was “a good, swift kick in the butt!” and I’d be fine. I still hold out hope that depression bipolar disorder, and other mood disorders will get their due within my lifetime, and knowing about this kind of research olnly strengthens that dream. How nice it would be not to have to hide anymore, huh?
posted January 8, 2008 at 11:53 pm
**As a diabetic, no one has EVER told me to “keep a stiff upper lip” or “pull myself up by my bootstraps” since everyone pretty much “gets” that there is a physiological deficiency.**
Funny, Margaret, that’s what my severely (really life-threatening) Type I diabetic sister tells me about my condition routinely.
I’ve had two suicide attempts. Whose condition is life-threatening and whose isn’t? We’re pretty even-stevens, as far as I’m concerned.
(And I literally cannot imagine battling two such difficult diseases at the same time … you’re quite amazing just to do so, Margaret.)
posted January 9, 2008 at 5:11 am
WOW…for the past decade I have had much treatment (medications) and
therapy. It’s been worse than a lost decade. So many folks trying so hard to help…and mostly I was just worse and worse and worse. I try
to follow the latest research regarding depression/bipolar, but missed this work. Years of trying so hard to get out of the pit…
beating myself up over and over again when I fail…and I usually fail.
Therese…thank you so much for posting this to your blog. Thank you,
thank you, thank you. Thank you for the information you provide. I
am going to let myself off the hook…what a relief that will be.
Nancy (the seashell one)
posted January 9, 2008 at 9:57 am
It’s just good to know this is’nt my fault. My brain is malfunctional. That’s a good oneliner. Thank God I can find humuor when I need it most. ” Dear God…Draw me a picture, show me the line. I’m only human, You are divine. Throw me a rope, I’m at the end of mine. You’re my best hope, my spiritual vine. I needed some peace in the aftershock. I threw down a fleece and you sent me a flock!”
posted January 9, 2008 at 1:26 pm
I like what you said Lynn about “my brain is malfunctioning”. I have to remember to use that line when my brain wires get crossed and short circuit (open mouth insert foot kind of stuff).
I definitely have suffered from the “negative depression” and it still likes to head butt me but with my “self-esteem file” suggested by Therese, my support group of AA and knowing “my brain is malfunctioning” I only need to start telling my AA friends what kind of thinking my brain is doing (they know me better then myself,my other friends and family) they have my head back on straight fairly quickly.
Hugs,
Nancy a.k.a. sixlittlekitties
posted January 9, 2008 at 4:41 pm
Hello there,Betty here. I have been cursed with mental and emotional problems, and I am a Bi-Polar. I blame mine on the complete Thyroidechtemy I had at age 25. I had a huge goiter, and had been treated incorrectly for 5 years, a quack doctor!!!!
The thyroid gland controls so much in the body that most people don’t even think about it.
My theory of how my life long adult depression feels. It’s like my life id going by me,but I am not in it.
I just found this blog. How wonderful to find a site that shares simikar feelings, and also has interesting and helpful articles to learn from.
The best thing anyone can do to make a deeply depressed or suicidal person feel better is, just chatting with them about nothing, or anything, and ofcourse not bringing up any mention of their depression. I am always so lonely and don’t have anyone to talk to, that when I do have someone to talk with, like my councelor at my mental health clinic, I always feel so much better when I leave there.
Talking is such a great release for the mind and body, for me personally.
All people just want to be noticed by someone that they are ALIVE, and that someone in the world CARES whether they live or die.
In my suicidal thoughts, which ofcourse I have been told are distorted thinking at the time. I convince myself that all my kids hate me, no one on earth cares if I live or die, and they would never miss me if I hung myself anyway
About Britney Spears, The person who wrote, There but by the grace of God go I”. I say that all the time, and it is so true. Britney does need help, but she needs to be treated like a normal human being, and have the media stop hounding her every mood. No mother really wants their kids taken away. I hope she can find a good mental health person to talk to, she would be able to afford the best help she can find. She is an extremelyfrazzled state right now. Get better soon Britney.
posted January 18, 2008 at 8:47 pm
I’m so behind on my BB reading. I’m so glad I didn’t skip this one. Very recently I was wondering if it was just me who had a hard time getting out of a negative mood. I did consciously decide, that night, to not have that negative event turn into a negative mood lasting a week or more. It is a relief to read that it may not all just be ‘in my head’.
posted January 29, 2008 at 4:57 pm
Do NOT recommend the mood disorder center
posted March 5, 2008 at 7:11 am
Hello, of course I came to visit your site and thanks for letting me know about it.
I just read this post and wanted to say it is full of number one resources. Some I am familiar with. For those who don’t know these other sites they are in for a treat as there is a lot to learn there.
posted July 21, 2008 at 7:24 am
Dr. Payne should not interface with patients as she should remain as a researcher only. Very destructive as a clinician.
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