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How Does Depression Affect the Brain?
Jules Washington
If you have symptoms of depression, it's natural to wonder what's going on in your body. The good news is that researchers have now answered two crucial questions: how does depression affect the brain, and what chemical imbalance causes depression? These discoveries can help you on your journey toward recovery.
How Does Depression Affect the Brain?
Brain cells talk to one another through chemical messengers (also called neurotransmitters) that are released from one cell and passed to the next. Depression is not caused by an imbalance in a single chemical and it's not simply a matter of one chemical being too high or too low. Instead, when someone has depression, we see changes in the normal
function and effect of neurotransmitters.
Now, how do these chemical changes cause depression? Take a moment and imagine you're at the airport waiting for a flight connection. Picture the busy, bustling scene around you—hundreds of people all taking different journeys through the same interconnected system. Your brain is like the nation's airport network system. If there are
major delays at an airport hub , these have larger effects throughout the rest of the airport network. That is just how it is for depression. Neurotransmitters interact with the brain's "flight paths," or nerve connections, and if one isn't operating properly, it may cause issues elsewhere.
The brain's physical structures (all those airport buildings) are also crucial. Some people who experience depression have subtle differences in these structures. We do not yet know why these variations occur—whether being depressed possibly causes these structural changes, or if the brain changes themselves cause depression.
It's important to remember that depression is not only about what happens within your brain; your life outside of it matters, too. Depression goes beyond those flight paths and those airport buildings. Several factors can interact with one another to trigger depression, including one's genetic blueprint and stress levels, as well as some medications. General health plays a role, too. For example, chronic pain can trigger or increase the chance of depression.
How Do Brain Changes Manifest as Depression Symptoms?
The system mainly implicated in depression is the limbic system. This is a set of structures concerned with emotions and memory, all underpinned by the hard work of those neurotransmitters.
Here are some of the major structures that appear to show subtle differences in some people with depression:
- The hippocampus is associated with emotions and memory storage. It's susceptible to the effects of stress hormones, such as cortisol. If you experience long-term high levels of stress, that can increase your cortisol levels, which, in turn, affects the growth of nerve cells within the hippocampus. This may explain why many people with depression report memory and concentration difficulties. Numerous studies have shown that changes in the hippocampus can be reversed with depression treatment.
- The hippocampus influences the functioning of the prefrontal cortex , the region toward the front of your brain. This region helps with decision-making, attention, and social behavior. Brain scans show minor and reversible changes in the prefrontal cortex. This could account for troubles with attention and decision-making seen in some with depression.
- The
amygdala
is a structure deep within the brain that is associated with certain emotions, such as sorrow, fear, anger, and pleasure. Activity in the amygdala is higher when someone experiences depression. Like the hippocampus, it is sensitive to consistently high levels of cortisol. This increased activity in the amygdala could influence sleep patterns; up to 90 percent of people with depression report insomnia.
What Does This Mean for Treatment?
There are two promising and constructive messages to take from this evolving science.
Firstly, these brain changes are reversible—they can be remedied. Some depression treatments might even trigger the growth of
new nerve cells and strengthen novel connections between cells.
Secondly, our understanding of the brain's biology has helped researchers design targeted and effective depression treatments. This knowledge could deliver treatments to you with a dedicated approach that suits you best.
What Treatments Address Chemical and Connectivity Issues?
Knowing which brain connections are affected has helped to unravel some of the mysteries of depression. Now, it is driving game-changing treatment options.
Transcranial magnetic stimulation (TMS) is a
non-invasive and non-drug form of brain stimulation that goes far beyond correcting one chemical imbalance or one disrupted network connection. Instead, it addresses the complex brain changes of depression—those neurotransmitter and connectivity issues discussed earlier.
TMS applies highly focused magnetic pulses to brain regions that are crucial in the regulation of mood. Those focused magnetic pulses result in activation of the nerves in that area of the brain, which when given over time, can correct imbalances in function. Research supports its ability to form new connections between nerve cells affected by depression, including those within the
hippocampus . It can help to relieve some, or even all, depression symptoms in many patients.
Understanding the science of depression has taken years, and there is still much more to learn. But in our quest to answer those vital questions—how does depression affect the brain, and what chemical imbalance causes depression—we have uncovered tailored treatments that acknowledge everyone's unique experiences.
This personalized knowledge can empower you to finally navigate your way toward recovery. Just like those airport hubs with their temporary flight delays, there are ways to get back on track once again.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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