Wrestling with depression can feel like crawling through mud, fog, and flamingos. It has taught me the value of kindness toward oneself, and that the brain is a complex and mysterious work of nature. With an understanding of its biology, depression can be manageable and even remedied.
This essay is not about the emotional wound of depression or the spiritual significance of kindness but about the biological basis of a complex condition. Depression involves a constellation of factors and its symptoms and treatment protocols depend on the individual.
Types of depression
In general, there are 2 types of depression: bipolar depression (includes manic highs and lows) and major depression (or unipolar as characterized by only the lows).
According to World Health Organization (WHO), major depression affects 5% of the population. That is, if you attended a 100-person wedding, 5 people there are struggling with depression, hopefully that’s not including the bride or groom or it would be a boring wedding, or would it?
Symptoms
The clinical symptoms of major depression include things like prolonged grief, low threshold for crying, anhedonia (inability to enjoy things such as food, sex, social outings), and vegetative symptoms that feel like flatness. A person with depression may experience any combination of these symptoms.
Hormones
The hormones of a depressed brain are notably different in the release of dopamine, serotonin (the target of SSRI’s), and norepinephrine. Because of that, the chemical pathways for sleep, appetite, and cognitive function are disrupted.
20% of people with major depression have low thyroid hormone, which regulates metabolism. there are cases where thyroid medication can relieve depressive symptoms. I’m planning to look into this for myself.
Genes
There is also a genetic factor. The gene 5HTTLPR codes for serotonin activation and studies show that a person with this gene is significantly more susceptible to depression.
Experience of pain
What’s interesting is that a depressed person can be hyper-sensitive to pain, be it physical or emotional as the two neural pathways are closely interlinked. This is why in a depressed state sometimes anger can amplify due to over-sensitivity to the underlying hurt.
Drugs
Selective Serotonin Reuptake Inhibitors (SSRI) medication such as Prozac and Zoloft support the optimal use of existing serotonin in the brain. While SSRI’s provide a balancing function, there are many side effects such as gastrointestinal issues, sexual dysfunction, and emotional blunting.
Though SSRI’s have been used since the 1980’s, studies have shown that they actually don’t work 1/3 of the time. Still, they can have some or significant effects in 2/3 of cases. It is recommended to run a thorough analysis of the individual case before committing to a methodical use of SSRI’s.
Omega-3
Studies show that Omega-3 fatty acids, specifically EPA’s, can provide relief from depression so much that it matches the effects of SSRI’s. 1000mg to 2000mg is a recommended daily protocol for optimal use.
Exercise
2hrs+ of exercise (specifically zone 2 cardio) per week is a recommended protocol for it activates dopamine, serotonin, and norepinephrine.
Creatine
Studies show that Creatine Monohydrate can enhance serotonin uptake and improve forebrain function. A 5g/day protocol is recommended.
Pleasure is not joy
Given that depression represents an imbalance of dopamine levels, it is recommended to avoid over-seeking pleasures so the pain-pleasure balance is not further disrupted. Dopamine is the molecule of more – craving, motivation, and drive. When we overwhelm the pleasure system, we run the risk of anhedonia, the inability to feel joy (yes pleasure and joy are different).
These findings I gathered from multiple sources including The Huberman Podcast, hosted by Stanford Neuroscientist Andrew Huberman.
Arya Salehi helps individuals be their best in their work and relationships.
Author of Panic in the Soup and host of the Bee Now podcast, Arya is a seasoned coach and facilitator. You can catch him cycling on dirt trails at sunset in Roseville, California.