Often Times Young People

People, often young people, throw the word “depression” around when faced with even the slightest of inconveniences. I can attest to this, as I have caught myself doing the same thing. When asked what depression really is, I was left aimlessly pondering, only to come to the realization that I do not actually know the answer to this question. Many assume that depression is simply the product of an overactive imagination, and across the globe, people of a variety of cultures agree with this statement.

Through this paper, I will talk about all of the different intricacies that surround depression, influences, and causes, in hopes of combatting the stigma that surrounds the disorder.

Depression has both physical and mental symptoms. Physical factors can be, but are not limited to, fatigue, excessive hunger, or loss of appetite resulting in weight gain or weight loss. Mental factors include anxiety, mood swings, loss of interest in activities, lack of concentration, and thoughts of suicide among others. It is important to remember that everything is rooted in the brain and it controls everything the body does, which includes both mental and physical processes. With this in mind, does it not make sense that depression has something to do with some imperfection that exists in the brain? Recently, scientists have been applying this same logic to spearhead new experiments and studies, in hopes of finding a common imperfection that could be considered the cause of depression. Previously, it was accepted that depression was due to some type of chemical imbalance in the brain, but this hypothesis is increasingly being challenged with every passing day. The chemical imbalance hypothesis is not necessarily incorrect but it is not necessarily correct either.

“The general idea is that a deficiency of certain neurotransmitters (chemical messengers) at synapses, or tiny gaps, between neurons interferes with the transmission of nerve impulses, causing or contributing to depression” (Arkowitz and Lilienfeld). Serotonin is “…produced in the intestines and the brain” ( James and Wilson) and since “Serotonin cannot cross the blood-brain barrier…any serotonin that is used inside the brain must be produced inside the brain” (James and Wilson). The serotonin that exists within the brain “…impacts levels of mood, anxiety, and happiness” (James and Wilson).

Over the years, intense feelings of sadness have been made synonymous with depression so researchers and scientists took to finding a way to combat that sadness in order to find a cure. The result, antidepressants in the form of SSRIs or selective serotonin reuptake inhibitors. “SSRIs are called selective because they seem to primarily affect serotonin, not other neurotransmitters” ("Selective Serotonin Reuptake Inhibitors (SSRIs)”). Some of the more common SSRIs or antidepressants include Fluoxetine (Prozac), Sertraline (Zoloft), and Escitalopram (Lexapro). These medications “…block the reabsorption (reuptake) of serotonin in the brain, making more serotonin available” (“Selective Serotonin Reuptake Inhibitors (SSRIs)”). For some patients, these medications do help lessen and sometimes even temporarily get rid of the symptoms of depression, but SSRIs cannot be considered a cure.
Think about this: when someone has a migraine, they might take Ibuprofen, which is isobutylphenylpropionic acid. Their migraine goes away, or their symptoms lessen in intensity. Just because the symptoms went away or were lessened does not mean that the person who took the Ibuprofen is lacking isobutylphenylpropionic acid in their body. This same logic can be applied to antidepressants. Antidepressants cannot necessarily be considered drugs because they are not addictive; however, patients can and may become physically dependent on them. Antidepressants are nothing more than a quick fix and, for this reason, along with many others, scientists and researchers have begun to move past the chemical imbalance hypothesis. This is a hypothesis that was a result of old-century thinking and has been accepted "uncritically" (Arkowitz and Lilienfeld) for over fifty years.

As mentioned previously in this paper, everything is rooted in the brain. Researchers have also utilized this crucial piece of information in their search for a cure for depression. They have begun to look at all the individual brain structures in hopes of finding any information that might lead to a possible cure. With the use of different types of brain imaging technologies, such as positron emission tomography (PET), single-photon emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI) (Harvard Health Publishing), discoveries are being made that have never been possible before.

These different imaging machines have revealed that "certain brain areas differ in size between depressed and mentally healthy individuals" (Arkowitz and Lilienfeld). A common conclusion that continues to be reached by scientists and researchers is that areas of the brain that have anything to do with emotion or processes involving emotion seem to be different in size when compared to the brain of a person considered to be "normal". Some areas of the brain that are affected by depression are the amygdala, hippocampus, prefrontal cortex, and the thalamus. A recent fMRI study released in The Journal of Neuroscience researched "24 women who had a history of depression. On average, the hippocampus was 9% to 13% smaller in depressed women compared with those who were not depressed" (Harvard Health Publishing).

The hippocampus is "an interior brain region involved in emotional memory" (Arkowitz and Lilienfeld). Emotional memory refers to experiences that might have elicited intense feelings of happiness, anger, or fear. The amygdala is a region of the brain responsible for analyzing the emotional significance behind certain events and stimuli. The limbic system is "primarily responsible for our emotional life" (Boeree) and the formation and processing of memories. As parts of the limbic system, both the amygdala and the hippocampus work together. For example, when a child gets bitten by a dog, they go through the rest of their life being wary of dogs. The caution exhibited in the example shows the hippocampus and the amygdala at work. The amygdala is stimulated when one remembers emotionally filled memories, like the fear of getting bitten by a dog.
The hippocampus registers a feeling of fear when seeing a dog again and activates the caution that a child exhibits around dogs for the rest of their lives. These same systems are firing and stimulated during trauma and sometimes even after. The thalamus is on the receiving end of most sensory information and then sends it to the corresponding parts of the cerebral cortex. The different parts of the cerebral cortex are responsible for various "high-level" functions such as movement, thinking, learning, and behavioral reactions. However, what happens chemically during trauma that contributes to depression?

Depression often becomes more prominent after an individual has experienced trauma. Trauma "can be defined as a psychological, emotional response to an event or an experience that is deeply distressing or disturbing" (Rosen). During a traumatic event or situation, two major chemical reactions occur. These happen in order to help the individual process and cope with the situation as it unfolds. One "is the acute secretion of the cortisol stress hormone" (Dan Siegel). The other is "the acute secretion of high levels of adrenaline" (Dan Siegel). These reactions, in normal amounts, are not harmful to the body or the brain. However, if they happen excessively they can leave the body and brain vulnerable to neurotoxicity.

Excessive exposure to the chemical cortisol can be toxic to neurons in the brain because it can lead to a decrease in activity in the hippocampus. "Excessive exposure to adrenaline can decrease the encoding needed for implicit memory" (Dan Siegel). "The normal human brain undergoes changes in structure and function across the lifespan — from early childhood to late life"(Bremner). This is why chemical reactions are even more dangerous to children and young adults whose brains are still growing. The regions of a developing brain are establishing and enhancing synaptic connections. Excessive exposure to the chemical cortisol may destroy these synapses.

Synaptic connections are essential to memory. Without these connections, people would not be able to learn and make other connections within the brain, essentially leaving everyone "empty". This is why people who have experienced traumatic events have trouble focusing and have difficulty in learning and retaining information after experiencing traumatic stressors. The stress response is the most common after-effect of trauma.

This stress response involves the prefrontal cortex, the amygdala, and the hippocampus. Subsequent stressors or triggers prolong and rekindle the two potentially neurotoxic chemical reactions involving cortisol and adrenaline, in turn triggering norepinephrine responses. "Norepinephrine constricts blood vessels, raising blood pressure, and triggers anxiety" (Harvard Health Publishing). These subsequent stressors release stress hormones that impair "the growth of nerve cells in this part of the brain (hippocampus)" (Harvard Health Publishing). Therefore, they are restricting the efficiency of the brain's capability to encode and retrieve implicit or unconscious/automatic memories. Stress greatly influences depression, "when biology and stressful life situations (trauma) come together, depression is a result" (Harvard Health Publishing).
By itself, stress is accompanied by its own set of unique chemical reactions. Similar to the chemical reactions that occur during and after trauma, if the reactions that accompany stress are short-lived, then they are not harmful to the body. However, if they happen for longer periods of time, then they become toxic to the body too. "Stress can be defined as an automatic physical response to any stimulus that requires you to adjust to change," according to Harvard Health Publishing. The initial signal begins in the hypothalamus, a part of the brain that "plays an important role in the nervous system as well as in the endocrine system," cites Mandal. The hypothalamus is responsible for the body's emotional responses, circadian rhythm, temperature, intake of food and water, etc. The hypothalamus sends a signal to the pituitary gland, which then releases the hormones that trigger the autonomic nervous system, associated with the "fight or flight" response. When all of the aforementioned systems are constantly overfilling at high rates and intervals, the brain eventually gives in and is unable to continue functioning at its normal rate. As a result, depression begins to take root and eventually takes hold as a permanent result of all the stress on the brain and its functions.

With all of the revelations and logic that are finally being brought to light on the global stage, how is it that some cannot believe in what simply is? As mentioned previously in this paper, many cultures find mental illness, more specifically depression, to be taboo. One may argue that it is because depression is not a real disorder but rather a lie, concocted by the weak-minded, that people who claim to have depression must simply “get over it.” Yet, when one has a physical ailment, one seeks medical attention, so why is this not the same when it comes to a mental ailment? There is actual physical and tangible evidence proving the existence of depression within people; its presence has never been doubted by the scientific community as a whole. Now, with the help of new-age imaging technology like PET and MRI machines, there is yet another form of tangible evidence that helps researchers, scientists, and communities worldwide understand the disease and its very real complexity.

A chemical explanation has even taken root, one that is more extensive and complex than the previously accepted chemical imbalance theory. This involves the explanations of the chemical reactions that occur during trauma, as explained earlier in this paper. It has become clear that cultures and communities harbor doubt towards not only depression but also any mental disorder, not because of a lack of evidence but solely because of fear. The fear of the unknown and things that seem too complex to interpret results in a fear of being too incompetent to grasp the facts. However, scientists start their studies without knowing about their subjects, and this is often how new discoveries begin.
When you live in a world that changes every day and waits for no one, it is important to remember that patience and understanding are virtues. Nothing is certain and nothing will ever be certain, and that is just a fact of life that will never change. However, humans can change. Yes, it is not easy and happens seldom, but they can. Science involves making discoveries and adapting to the world and the species that reside in it. The new waves of research and research methods are designed to help humankind understand themselves. To understand one is to understand all. So I leave you with this question for your curious mind to ponder: will you make the effort to understand one?

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