Depression has a reach that shows no favourites and no limits. It has no eye for age, gender, culture or anything else that might separate us into easily conquered groups. It is a human condition, and as humans, we all have the potential to be touched by it in some way. If we are not directly dealing with depression, then chances are we will be indirectly affected by watching someone we love struggle against it. 

There is so much research happening in the area of depression and as a result, the way we understand it is changing shape dramatically. The old ways of thinking about depression are being challenged (finally!). This is giving way to new hope for more effective treatments and a more accurate, less stigmatised understanding of what depression is, where it comes from and what it means.

Dealing with Depression: What you need to know.

Here is what you need to know about depression. They are new insights that will have a lofty influence over the way depression is understood, perceived and treated:

1. Depression is an illness of the entire body, not just the mind.

   Depression is a systemic illness that affects the whole body, not just the mind. This may be why people with depression are more likely to be diagnosed with cancer and cardiovascular disease. Depression is linked to oxidative stress in the body. This is a process in which the body over-produces free radicals and is unable to get rid of them from the body. The free radicals cause damage to critical parts of cells, undermining their ability to function effectively and potentially causing those cells to die. The overproduction of free radicals can be triggered by stress, environmental pollutants, alcohol, tobacco, food and the body’s natural immune response (inflammation).   

2. Chronic inflammation in the bloodstream can fuel depression.

   Among people with depression, concentrations of two markers of inflammation, (CRP and IL-6) are elevated by up to 50%. Stress is one of the main contributors to inflammation. A high-fat diet or high body mass are also culprits. Inflammation is usually a sign that the body is trying to fight some sort of pathogen. This is what healthy bodies are meant to do, but in some people, the systemic inflammation is persistent. It is widely accepted that this inflammation is behind all physical and mental illness. Research has also found that depression caused by chronic inflammation is resistant to traditional therapy methods, but that it can be relieved with activities such as yoga, meditation, and exercise.

3. Inflammation increases glutamate in the brain, creating a vulnerability to depression. 

   People with depression who show signs of systemic inflammation have elevated levels of glutamate in certain areas of the brain. Glutamate is used by brain cells to communicate but when levels become too high, it can become toxic to brain cells and glia, the cells that support brain health. Researchers think this may be one of the ways inflammation harms the brain and increases the risk of depression. High levels of glutamate in these areas of the brain are associated with anhedonia, (the inability to experience pleasure) and slow motor function (also associated with depression). Inflammation in this study was determined by a blood test for C-reactive protein (CRP). 

4. Exercise helps to protect the brain against depression.

   Exercise restores the levels of two important neurotransmitters, glutamate and GABA, to healthy levels. Exercise seems to go a long way towards repairing the damage that is done by inflammation. The research was conducted using exercise sessions of between 8 and 20 minutes. The effects of the exercise in the week following the session.

5. Early life stress is a major risk factor for later depression.

   Adults who were abused or neglected as children are almost twice as likely to experience depression. The increased risk is associated with greater sensitivity of brain circuits involved in processing threat and fuelling the stress response. Research suggests that exposure to neglect or abuse reduces activity the part of the brain (the ventral striatum) that processes rewarding experiences. This is likely to affect the capacity to experience enthusiasm, pleasure or other positive emotions.

6. A depressed brain shows a different response to stress.

   In a study involving mice, scientists found vast differences in the brain activity of helpless mice and resilient mice. (Mice are not used because someone thinks they’re cute, but because the mouse model of depression is biologically similar to human depression.) The brains of helpless mice were remarkably similar in many ways. They showed an overall reduction in brain activity, particularly in areas that would affect their ability to deal with stress. These areas of reduced activity included the parts of the brain that are critical for organising thoughts and action, processing emotion, motivation, defensive behaviour, coping with stress, and learning and memory.

7. Genes are NOT destiny. The environment can alter a genetic predisposition to depression.

   Still with tiny rodents – a study with rats has shown that the environment can alter a genetic vulnerability to depression. When rats that were genetically bred to be depressed received a type of ‘rat psychotherapy’, they showed significantly less depressive behaviour. Their blood biomarkers for depression also changed to non-depressed levels. The ‘psychotherapy’ involved putting the rats in an enriched environment that had space, toys to chew on, places to hide and climb, and opportunities to socialise with other mice.

   ‘If someone has a strong history of depression in her family and is afraid she or her future children will develop depression, our study is reassuring. It suggests that even with a high predisposition for depression, psychotherapy or behavioral activation can alleviate it’. Eva Redei, lead study investigator, professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. 

8. Nature? Nurture? Well actually, it’s both.

   The greatest influence on the development of depression is neither genes nor environment, but the interaction between the two. Several genes have been associated with depression, particularly those that affect serotonin, the neurochemical that acts as to regulate mood. A genetic variation (allele) found in the serotonin transporter seems to influence the way a person responds to stress. Those with the ‘S’ (short) allele were more likely to develop depression than those with the ‘L’ (long) allele when they were exposed to the same type and amount of stressors. This research suggests that those with the ‘L’ allele can adapt more effectively to their environment. Those with the ‘S’ allele appear to have a brain that is less able to adapt to adversity. 

9. Depression increases risk for cardiovascular disease but …

   Depression is a known risk factor for stroke, heart attack, and death, but treating depression significantly reduces the risk to non-depressed levels. It is unclear which comes first – the depression or the heart disease. Heart disease may increase the risk of depression, or depression may inflame the risk factors associated heart problems, such as high blood pressure, high cholesterol, diabetes or lack of exercise.

10. Meditation and exercise. The power couple.

     When done together, meditation and aerobic exercise reduce depressive symptoms by 40%. The combination  seems to help people with depression to be less overwhelmed or influenced by negative thoughts. The study involved 30 minutes of focused attention meditation, followed by 30 minutes of aerobic exercise. Meditation and exercise are a powerful combo and they seem to work on a number of levels:

    •  they promote the growth and preservation of brain cells, which is critical for mental health. The slowing down of brain cell growth, or the reduction of brain cells can lead to all sorts of mental health problems, including depression;

    •  they nurture the development of new cognitive skills that get rid of the negative filter;

    •  they reduce the influence of past memories in fuelling depression. 

11. Affectionate mothering can protect a newborn from the potential effects of maternal depression.

    Mothers with depressive symptoms who were more responsive to her baby’s signals, and who engaged in more gentle, affectionate touching during face to face play, had babies who showed less physiological evidence of stress. The research suggests that by interacting sensitively with their babies, mothers who have symptoms of depression may be ‘turning on’ certain genes that help infants manage stress in healthy ways.

12. A depressed brain shows a disconnection between brain regions that process emotion.

    Brain scans of young adults showed that in those who had experienced more than one episode of depression, the amygdala (involved in detecting emotion) is disconnected from the rest of the brain’s emotional network. Researchers suggest this may interfere with how accurately emotions are processed. This disconnection is likely to be the reason that people with depression are more likely to experience neutral information as negative.

13. Burnout and depression overlap.

    In research looking at the overlap between burnout and depression, 1,386 people were categorised as either having burnout or not. 85% of people who were identified as having burnout also met the criteria for depression. In contrast, only 1% of people who did not have burnout met the criteria for depression. People with burnout were about three times as likely to have a history of depression, and almost four times as likely to be currently taking antidepressants. 

14. Social media use increases likelihood of depression.

    The more time young adults spend on social media, the greater their risk of depression. The association between social media use and depression is linear, meaning the risk of depression increases with time spent on social media. The reasons for this are unclear, but the researchers have a few theories:

•  people who are already depressed may be turning to social media to find comfort;

•  the images on social media are highly idealised and may lead to feelings of inadequacy, envy, and cause distorted comparisons. 

•  social media can be a big dirty time hog (come on, you know it’s true), causing people to feel as though they have wasted valuable time;

•  social media use could be feeding an internet addiction, a psychiatric condition that can fuel depressive symptoms

•  the impact of cyber-bullies and other not-so-nice interactions.

And finally …

Depression is more than thoughts and feelings. It’s more than a sad mind or a body that doesn’t feel the way it used to. After settling for decades on the idea that depression is because of broken thinking or a chemical deficiency in the brain, research is now moving forward and showing us that depression is an illness of the body, most probably initiated by genetics and environment. Because of this, we are in a better position than ever to understand depression. With this expanded understanding comes the greater promise of new treatments and management strategies for a happier, richer life, free from the constraints of depression.

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