What can recent research tell us about how to treat depression?

In 2010 the Journal of the American Medical Association (JAMA)  made head-line news when it published research which concluded that whilst anti-depressants were effective in helping those with severe depression, they were no better than a placebo in treating mild to moderate depression.

Anti-depressants such as SSRIs (Serotonin Re-uptake Inhibitors) are widely used to raise the level of serotonin in the brain and this, in turn, is thought to alleviate the symptoms of depression. However, only about half the patients who take SSRIs appear to be helped by them, and then it takes at least three weeks for any effects to be felt.

So the following questions were asked* - if increasing the amount of serotonin in the brain was the answer to depression, why didn't these SSRIs help everyone who took them?  And if a lack of serotonin in the brain was the reason we get depressed, why wouldn't the pills work immediately?

One possible answer was thought to be that, in cases of mild to moderate depression, it was the placebo effect that was really helping patients not the SSRIs.

But that can’t be the whole story, as anyone who has suffered from depression - however mild - will tell you. It also doesn’t explain why the pills take three weeks to become effective in the case of severe depression.

The neurogenic hypothesis of depression suggests that the reason SSRIs work for severe depression is that in these cases the drugs promote the growth of new neurons - and it takes three weeks, because that's how long it takes for the brain to start making new neurons and creating new neural pathways.

This neurogenic hypothesis challenges the old neurotransmitter (serotonin is a neurotransmitter) explanation. In the new explanation, it is the creation of new neural pathways which ultimately frees people from the grips of depression and also explains why depression is so intractable for those who have it and can't seem to shake it off. Old patterns of behavior (i.e., pre-existing neural pathways) get reinforced in depressed people in the same way that new patterns of behaviour get formed: with repetition. Whilst old behaviours go over old ground - again and again and again - new behaviours, on the other hand, create new neural pathways and it is these that can help forge a path out of depression. Cells that fire together wire together.

We are what we repeatedly do; happiness, then, is not an act but a habit.

with apologies to Aristotle

The ability of the brain to forge new neural pathways is what is known as neuroplasticity . To illustrate plasticity, imagine making an impression of a coin in a lump of clay. In order for the impression of the coin to appear in the clay, changes must occur in the clay -  the shape of the clay changes as the coin is pressed into the clay. Similarly, the neural circuitry in the brain must reorganize in response to new experience or sensory stimulation - it’s a physical process - grey matter can actually shrink or thicken; neural connections can be forged and refined or weakened and severed .  

Brains are designed to change. It's what allows us to cope with the ever-changing world around us. So anything that restricts our brains ability to change would be a major hindrance to personal growth and our own survival. And it turns out that one of the things that inhibits the growth of new neurons in the brain is stress. In effect, chronic stress limits neuroplasticity in the brain. And as a result, unrelenting stress can have a major impact on our mental health and influence a whole host of psychological disorders including depression. But in order to benefit from our brain's ability to change, the depressed person must force him or herself to do new things and participate in new activities every day.

Charles Darwin (1809-1882) knew this a long time ago when he wrote:

"My mind has changed during the last twenty or thirty years... Now for many years I cannot endure to read a line of poetry… I have also almost lost any taste for pictures or music… My mind seems to have become a kind of machine for grinding general laws out of large collections of facts...

If I had to live my life again I would have made a rule to read some poetry and listen to some music at least once every week… The loss of these tastes is a loss of happiness, and may possibly be injurious to the intellect, and more probably to the moral character, by enfeebling the emotional part of our nature."

We seem only now to have caught up with him.

So what can we do to help ourselves?

Just as we create flexibility in our bodies by stretching physically, so too we can create flexibility in our minds by stretching mentally. Every day we have the opportunity to exercise our flexibility. We can do this in small ways such as taking a different route home from work or changing the ways we do routine tasks – just doing things differently. On a larger scale, we can learn a new language or learn to play an instrument. Doing unique, random, different, and sometimes ridiculous things is a good way to exercise the mind and promote new ways of thinking about the world around us as well as alleviating any symptoms of depression by markedly refusing to reinforce negative experiences by forging alternative pathways. 

“A mind that is stretched by a new experience can never go back to its old dimensions.”

Oliver Wendell Holmes (1841-1935)

As those of you who took part know, we have recently undertaken a Happiness Habits Experiment to see whether repeating between one and six simple activities that are correlated with well-being, daily, for three weeks, raised people’s happiness levels and became embedded as habits. We’ve had very positive results and will be bringing you the full report in a few days time. Watch this space.

* see Jim Porters blog for more

**I am not in any way suggesting that people who are on anti-depressants should come off them except under the guidance of their doctor - what I am suggesting is that there are alternatives which can compliment drug treatment and that should certainly be considered as a first option in cases of mild and moderate depression before resorting to drug treatment. 


Posted by Annabel