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Knowledge is Necessity

Depression may well be the most complex illness in the universe, as well as one of the most deadly.

"Like the Germans at D-Day, we are forced to contend with far too many things all at once."

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 Biological Warfare - Stress etc and Depression

Two of the most common misconceptions about depression is that it is all in the mind, and is nothing more than a low mood or a bad case of the blues.

One may as well declare an El Nino or La Nina a mild warm front. Depression amounts to a full-scale attack on everything that holds body and mind in place, leaving in its wake a trail of wreckage and destruction that points to nothing less than a biological hurricane raging through every process we associate with human activity:

Circadian rhythms are thrown out of whack, along with psychomotor function, appetite, and cognition. Bodily functions are disrupted, resulting in fatigue, poor sleep, lack of concentration, and loss of motivation, and more.

All this is laid out in a paper presented to the American Psychiatric Association's annual meeting in May 2000 by Jerrold Rosenbaum MD. What he didn't add was depression's linkage to heart disease, bone marrow loss, asthma, diabetes, and a host of other ills. That aside, Dr Rosenbaum makes a compelling case for the biological basis of the disorder:

For starters, decreased levels of serotonin (5HT)have been linked to major depression, along with serotonin metabolites (5HIAA) in brain tissue, decreased levels of serotonin metabolites in cerebrospinal fluid (CSF 5HIAA), and high concentrations of "corticotropin releasing factor" (CRF) and decreased CRF receptor binding sites.

The article also mentions "catecholamine," which is a reference to the neurotransmitters epinephrine, norepinephrine, and dopamine.

No, you will not be asked to memorize all that. The point of this exercise is to illustrate the biological complexity of depression. To continue:

MRI findings of depressed patients demonstrate reduced hippocampal volume in the brain, as well as bilaterally reduced amygala core volume. (Both hippocampus and amygdala are associated with the brain's limbic system. Until a short time ago, it was assumed the hippocampus had nothing to do with the regulation of mood.) Blood flow studies have also correlated amygdala activity with depression severity. Magnetic resonance spectroscopy studies have found low cortical GABA concentrations. (GABA is a neurotransmitter that dampens neuron activity.) Meanwhile, PET scans point to a reciprocal relationship between decreased cortical functioning and increased paralimbic functioning, suggesting that depression involves the disruption of "an interactive network of corticolimbic pathways critical to the integrated regulation of mood and the associated motor, cognitive, and somatic [ie bodily] behaviors."

We're not through:

New research implicates corticotropin-releasing factor (CRF), considered to be both a stress hormone and a neurotransmitter, in depression. According to the author, "CRF activity is associated with sleep and appetite disturbances, decreased libido, and psychomotor changes."

As if all that is not enough, we are told that depression hardly operates in a vacuum. For example, stress can affect the production of new neurons, which may account for decreased hippocampal volume in people with depression.

Until very recently, it was assumed that the brain could not manufacture new neurons (neurogenesis). Now, according to an article in The American Scientist: "Controlling neurogenesis in the adult brain might have a significant impact on the treatment of mental illness."

Depending on the state of your own depression as you are reading this, you are free to interpret this information optimistically or pessimistically. On one hand, we are learning more every day, which is bound to result in more effective treatments. On the other, the sheer complexity of what we are up against seems to militate against a simple effective solution to depression. Like the Germans at D-Day, we are forced to contend with far too many things all at once, coming at us in full strength with far too much force.

Paradoxically, we can draw some comfort from the fact that it takes nature's best series of shots to bring us down, and we can even assume some measure of pride in surviving.

But any personal victory, we know, is hollow, for any minute of any day we are all too aware the other shoe may drop, and next time we might not be so lucky. Nature, after all, has far too many weapons at its disposal.

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