The brain is different if you have depression, but are these changes caused by the condition or do they precede it? It seems now that depression appears to affect brain structure.
Before looking at this, a few caveats.
Firstly, on the phrase ‘you have depression’. This is labelling and has pluses and minuses. The pluses of diagnosing a condition that can be addressed are obvious when considering the treatment options. One of the minuses is identifying the label as you, per se. No-one is defined by a condition as there is so much more to the person. In defining, or self-defining, it means that many important decisions are pushed through this framing, thereby limiting one’s actual and potential for growth and development. It can become a limiting belief.
Secondly then, this blog discusses depression in a knowingly false way in the light of the first caveat. The points made, we must then pull back and look at the person within the context of their life. Without context, there can be misunderstanding.
Each person has their own unique experiences of what it is like to be themselves
Thirdly, we can consider depression to be a state. Our state is continually changing and updating. Biologically there is a dynamic interplay of systems in the dark that we have no access to other than by inference via our conscious experience: what is it like to be me right now? There is no single state. We are not in the same state continually as this is not compatible with being alive. Our self-assessment of how we are is a narrative, or inner voice. Again this is an inference or guess at what is happening by the brain (see here)
Fourthly, everyone has ups and downs in mood. Frequent downs that string together to create a feel of consistency over days, months and years would clearly need attention. Often there is a reason and this must be clarified. We have some excellent forms of treatment and therapy to help. Medication, therapy, deep listening, encouragement, coaching, purpose, connections and other means exists to support people on their journey to improving their lives.
Fifthly, everyone has their own unique experience. So whilst many of the points made are general, we must acknowledge that each person has their own genes, experiences and contexts.
Depression causing brain changes
That said, there is now evidence that the brain changes appear to be caused by depression. We can add this to knowledge about the role of genes, childhood trauma and poverty upon depression.
The brain will also be changing and updating its processing according to behaviours and experiences; i.e./ learning. Johan Hari argues that people with depression have lost connection with what is important to them in their lives. I agree and believe that this can be a significant part of the problem, but also offers a way forward. There are many similarities here with chronic pain. I listen to people’s stories and so often at the heart of their suffering lies disconnection with what I call the 3 Ps: people, purpose and the planet (getting outside). Conversely, when we focus on how they can reconnect, we see a significant change in their experience of themselves, including pain relief and a different outlook.
Depression and pain often arise together. There may well be a similar underlying biology in inflammation resulting from an on-going state of survival or protection and perceived isolation
Understanding that the brain is always changing helps us to realise our potential and gives great hope. Of course we are more than a brain. We are embodied individuals; ‘the body keeps the score‘ being the title of an excellent book about trauma. Our minds are embodied — our quality of thinking and decision making is grounded in our bodies and our actions create our perceptions. I describe this to the people I work with so that they can gain insight into their experiences and learn to take different perspectives and change gears to move forward. This is part of a coaching approach.
So with the brain changing according to what we are doing, it means that when we withdraw and become less active, certain pathways (white matter) become less efficient. Use it or lose it is a simple way to think about it. For example, how does your body feel when you have been inactive for a while?
Therein lies the challenge. Aside from any medical treatment, which may in some cases be minimal, we must create ways that the person can actively re-engage, and ‘use’ those pathways once more. The brain may have changed due to depression, but which way will we encourage change now? The descriptions of the choices appear to be straight forward yet the experience of depression is grounded in complex biology, prior experiences, genes and circumstance. The key point is that it is possible to carve out a way forward and improve life, but it is not easy. Detail on this is beyond this very brief blog that aims to merely identify some of the key considerations.
Depression is embodied (as is pain). Usually called a mental health condition, this terminology does not encourage the right thinking. It is the person, the whole person, who suffers and hence it is the person that we listen to, encourage, support and treat. The mood in which we find ourselves is not chosen. Instead it emerges involuntarily from context and prior experience. This is the brain’s best guess, based on what we know and what has been before, and change relies on new sensory information updating the predictions — new inferences being made. There is a strong argument that emotions are inferences of physiological needs (read here), but establishing what this may be and what to do can be difficult.
The new findings, brain changes resulting from depression, will need replication. This is the scientific process, and rigour is necessary in the search for fact. Adding to what is already known, we can build a picture that incorporates the key considerations: biology, genes, past experiences, lived experiences, narratives. From here we can design more and more effective ways of helping people to improve their lives. It is a very hopeful time.