The Truth About Depression: Medication May Not Always Be the Simple Fix
August 14, 2020
Depression is a complex and far-reaching mental illness. It doesn’t discriminate by age, gender identity, or social status. It can be chronic or temporary, severe or mild, and it often is combined with other mental illnesses like anxiety.
Thankfully, the modern world has several options for treatments. The tricky bit is finding what works, and the answers may surprise you:
- What medicine is supposed to do for depression
- How can we tell if its working (the waiting game)
- What other non-traditional treatments might work?
Whether you’re currently suffering from depression and struggling with treatments, or if you’re someone who is part of a support network for a depression sufferer, this article may give you some understanding and hope.
How depressed brains work and how meds are supposed to fix it
There are several challenges in treating depression. One of the biggest is that the medical community still doesn’t really know exactly what causes it, partially because they don’t fully understand how the brain itself works.
What does the brain have to do with emotions, such as depression? Everything, science says.
The thing about clinical depression is that it’s a constant state with many-faceted symptoms and causes. See, the brain regulates everything in your body-- both voluntary and involuntary responses. This includes emotional reactions and regulation, through certain parts of the brain. Many of these brain sections are believed to be involved in depression in various ways.
One way is through the physical brain itself. For example, the hippocampus is the part of the brain that helps process long-term memory and the amygdala is the part of the brain where big emotions (like terror and pleasure) live. The interplay between all bits and pieces of the brain work through nerve cells and neural pathways. The hippocampus tends to be smaller in some depressed patients, and the amygdala is overactive-- therefore the interplay between a more domineering amygdala on a smaller hippocampus may lead to a loss in nerve cell growth in the hippocampus.
The thalamus is another part of the brain that scientists believe may play a part in some types of depression, most notably bipolar disorder. It’s job is to take in sensory information and relay it like a customer service agent to correct part of the cerebral cortex for processing. When it doesn’t work right, thinking, behavioral reactions, and learning go haywire, as does the ability to link sensations with pleasant/unpleasant feelings. It’s this latter bit that is thought to affect bipolar disorder.
So really, clinically depressed brains cannot process and regulate mood within an acceptable or normal range. Therefore, the goal of treating depression-- especially with medicine-- is to get the brain to do just that. Mood regulation and processing happens with nerve cell communication, which in depressed brains, is thought to be glitchy.
Nerve cells communicate via neurons, which are like loose braids or looped highways running around the brain connecting its different parts to each other. A combination of electrical and chemical signals travel through the neurons and carry communication between and within them. The chemical signals are called neurotransmitters, and boosting them seems to help decrease depression or depression symptoms. Why?
Because these chemical signals are either suppressed or overactive in depressed brains, which, depending on which is happening, either halts the transmission or extends it to other neurons. Too much or not enough is never a good thing, and the brain can’t regulate emotions.
There are several other factors that can cause depression, such as genetics and major life stressors or traumas. But in general, that imbalance in the brain is there. And that’s what the medicines treat-- or so science has indicated.
Traditional medicines such as antidepressants increase the neurotransmitters in the brain, which may help compensate for any that are being stunted or overextended in the neurons. There are several different kinds of neurotransmitters that science has shown probably play a role in depression. You’re probably already familiar with serotonin and dopamine, but there are others that affect learning, blood pressure, anxiety levels and excitement levels.
How can we tell if medicine will work?
Traditional medicines work for most depressed patients. However, for about 30% of depressed patients, antidepressants and the like do not work. It takes weeks of trial and error to find this out, as drugs such as antidepressants generally need about 8 weeks-- that’s two months, minimum-- to prove effective or not. That’s two months-- again, minimum-- that the patient isn’t being effectively treated and healed.
This process of trial and error alone is very hard on the emotional and mental health of depressed patients. It can give them a sense of helplessness, that there is something “wrong” with them, and a sense of hopelessness. Patients can feel like they are one giant mad scientist experiment.
There is hope, however. Stanford University is conducting a promising study, where an AI correctly predicts which patients will successfully be treated with traditional medicines-- and which won’t-- based upon an electroencephalogram. The work is published in Nature Biotechnology, and shines a huge light on a future where eight-week trials could be reserved for those whose brains show they might respond to antidepressants or even nonexistent.
Stanford’s AI experiment used theories from neuroscience, clinical science, and biotechnology along with a machine-learning algorithm, which it then used to analyze the data from the electroencephalogram. The study included 309 participants, and the AI correctly predicted each patient’s response to antidepressants based on their alpha brainwaves. Alpha waves affect the prefrontal cortex, which is where the mood regulating neurotransmitters are produced. Patients who had more “lively” prefrontal cortexes were predicted to respond better to the antidepressants than those whose prefrontal cortexes were less active.
This method of prediction has proven to be more effective so far than the current methods of diagnosis, as it uses less subjective data.
What else is out there to try besides meds?
The other use for Stanford's AI experiment is that it may eventually be able to be tweaked so that it could suggest which alternative treatments may be more effective for each individual patient. Right now, that’s a dream. But at least the technology is developing for that dream to become a reality.
So what other methods may be used to treat depression?
There are some natural alternatives, such as St. John’s Wort. Many people for whom traditional medicines have not worked have found relief from depression symptoms using this herb. It is very popular in Europe for treating mild to moderate depression, often with fewer side effects. However, even natural products have their side effects-- St. John’s Wort increases photosensitivity, and may decrease the effectiveness of other medicines. And it cannot be combined with antidepressants as a booster, because the combination of the two can cause a toxic and life-threatening over-production of serotonin.
Other natural methods include increasing Omega-3 fatty acids, which are heart-healthy. Scientists have long known that heart disease often leads to depression, though the relationship between the two may not be clear-cut. DHEA is a hormone our bodies naturally make that seems to have a positive effect on treating depression. However, loads more research is needed.
Transcranial Magnetic Stimulation
Transcranial magnetic stimulation (TMS) is an alternative to antidepressants that is based on some pretty science. This treatment is noninvasive, and uses magnetic fields to stimulate those all-important nerve cells. As we discussed earlier, when nerve cells are either under- or over-saturated by brain chemicals, they don’t work right. The brain may even reduce their production.
TMS uses a magnetic coil placed against the patient’s forehead, where the region of the brain that regulates mood control is located. It painlessly delivers magnetic pulses to this area, which in turns stimulates those nerve cells into working better. Thus, depression symptoms are relieved and the patient can then focus on healing with a therapist.
It is crucial to note that no treatment for clinical depression is fully effective without a therapist. The role this particular treatment plays helps patients to learn healthy coping techniques, recognize symptoms, and further assess and regulate mood and emotional reactions. In cases where the depression is linked to trauma, the psychotherapy can also help the patient deal with the cause of the depression and heal from it. It also helps patients learn to deal with everyday life when depressive episodes occur, and may help identify when they are severe enough to warrant hospitalization.
Advances in modern medicine have given us a wide variety of treatments for when antidepressants don’t work. And as Stanford has proved, the use of AI may help scientists to develop better tools for individual diagnoses and treatment planning.
So what is the truth about depression?
Depression is a mental illness that is highly complex, but it is very treatable. Traditional medicines may not always work, but alternatives like TMS are available and effective.
And one day in the future, technology will help your doctor choose which method will be most effective for you.