Everything I Know (Almost)

What I know about my depression. Well, let me talk to you frankly as a friend, let me assume that you are reading this either because you are searching for answers about your own condition or that you know someone you want to help in some way. I’ll do my best to explain things as clearly as I can, they way I know it. I’m not going to waffle… if it’s written here you can be sure there is a good reason for including it. But I’ll also keep it short, so expect to do some more digging after you’ve read this.

The science bit
Serotonin is a chemical messenger in the brain that has a really diverse range of functions, including the control of appetite, sleep, memory and mood. This magic chemical is made in the brain. Mild or severe depression is going to arise if there isn’t enough serotonin being released in the brain. Because of the wide range of functions that serotonin has, a deficiency in serotonin is probably going to affect appetite, sleep and memory too, amongst other things.

So if serotonin is so crucial when it comes to our moods… the next lead for anyone wanting to beat depression is… how can I get my brain to produce more serotonin? You’ll generally come across three ways to stimulate the brain to release serotonin naturally: Bright sunlight exposure; Exercise; and through diet.

Exercise and bright sunlight
Both these have a positive effect on serotonin levels. This is why when you first present to your GP with the symptoms of depression, they will often recommend getting out and about… staying active… taking an invigorating walk. That’s because this sort of activity will benefit you both in terms of sunlight exposure and exercise. A few catches here, for one it isn’t possible to measure serotonin levels directly so that is always going to generate some debate around research in this area. Secondly, depression is characterised by low mood, fatigue, negative feelings and thoughts, changes in eating and sleeping patterns. So patients who are given the advice of ‘take a brisk walk’ won’t necessarily be receptive to the suggestion or ‘feel’ they have the capacity to do so. This is where friends and family can be so helpful at these early stages, because they can provide the additional push and companionship needed to overcome the mental hurdles and engage with some outdoor physical activity. If you’re with depression what you think you can do and what you are actually physically capable of are two different things… but the mind is a very powerful thing.

Diet
Tricky one because if you search the internet you’ll find lots of advice out there suggesting that serotonin levels can be affected by eating certain foods like bananas, pineapple, plums, turkey and milk… all of which contain an amino acid called typtophan. Without getting to geeky, this amino acid is the building block used by the brain to make serotonin… so it makes perfect sense to eat foods containing this stuff doesn’t it? On the other hand the evidence out there suggests that our bodies are not that great at transporting typtophan from the food we eat, through our blood system to our brain. So the idea that eating certain foods will increase serotonin levels is regarded as ‘bad science’. This is not the whole story… and this isn’t the time or place to go into the whole story… but know that there is more to know and that this is an area where the science is developing.

Mood
There is one more way of raising serotonin levels. You see in the same way that serotonin affects mood… mood also seems to affect serotonin; it’s a two way thing. If it is possible to have a light hearted conversation with friends, share a funny joke or anecdote or read a funny story… that will stimulate serotonin release! Again, there is a catch. As depression takes hold a prevalent symptom is withdrawal… so it starts to become harder to talk to and see friends and family. Confidence starts to go too, making this even more difficult. Not to mention all the negative thinking and low self esteem, all of which makes suffers feel like bad company. Again, this is where friends and family can be so helpful, because through their persistence and determination they can help make sure sufferers don’t cut themselves off, and offer light hearted companionship.

The effect mood has on serotonin is the reason why depression can be treated through therapy. Therapy can help the sufferer to distinguish between thoughts ‘I’m useless’ and feelings ‘sad’. This critical distinction allows the sufferer to recognise that whilst feelings cannot be helped, thoughts… even the ones that pop into our heads automatically, can be managed. And if they are managed well, we can stop negative thoughts from adversely affecting our mood. Learning how to managing thoughts to this end is called cognitive behaviour therapy or CBT.

So what about medication?
Well serotonin is released naturally and is reabsorbed naturally too. If there isn’t enough sloshing about we now understand that there will be problems. The popular anti-depressants of the day work simply by preventing serotonin from being reabsorbed so quickly. ‘Happy Pills’. Absolutely not… they don’t make you happy…and in fact the sufferer is still going to have to do something to release serotonin in the first place. What these anti depressant will do is keep the serotonin in play once it’s released so that as more is released you can build on it. This is why sufferers prescribed these medications may still find it hard getting started each day… starting with low serotonin levels and having to build on them as the day goes on.

Remember too that serotonin affects a range of functions, appetite, sleep, memory and mood to name a few. So anti-depressants that affect serotonin availability will likely also affect eating habits, weight, sleep patterns, concentration, levels of aggression etc. All these things need to be monitored and understanding the changes that are occurring will help you to decide if this is the right medication for you. Again, this is where friends and family can help, as they are well placed to be supportive about changes (e.g. being sensitive about changes in weight) and help to spot changes in behaviour.

My depression came out of nowhere.
So if all this is down to chemicals in the brain… what caused the depression in the first place. Why did the levels of serotonin dip? Well, whilst it is safe to say that there is no single reason why people suffer from depression, it is also equally true to say that there is a reason. Sufferers may not see it that way, after all this is something that can creep up on you almost unnoticed until one day the routine of daily life is disrupted. It can seem to come out of nowhere. But it did come from somewhere… no matter how difficult that is to believe sometimes. Do you need to explore where the depression came from, what triggered it? That depends. For some it might be a single episode, triggered by set of circumstances and it may cause more harm than good to look deeper out of sheer curiosity. If on the other hand you are someone who relapses, who experiences several episodes of depression, it is probably worth getting under the skin of it and exploring its origins. Working with a therapist will help you to identify the early signs that show you things are not as healthy as they could be. A therapist will also help you to understand some of the experiences that may have led to some unhealthy ideas you have about yourself and how these unhealthy ideas become prevalent when they are triggered by certain circumstances. Most importantly, a therapist can hep you learn the strategies that will help you to manage your unhelpful thoughts, and maintain healthy living patterns so that you keep yourself well.

It all sounds so much simpler than it feels. The challenge of overcoming long term depression is a difficult one… not least because of the journey it takes you on through events you might rather forget, and unhealthy thoughts about yourself that you’d rather not admit to, and behaviours that you’ll find hard to break. Through it all you’ll need courage, determination, belief in yourself and a will to get better. Expect set backs, expect a long journey. As with any long journey, its about the journey and not so much the destination. Pack carefully… you’ll need the support of others and they’ll need to know how they can support you. Giving them this to read would be a good start.

If you would like a more in depth and scientific understanding of depression I can highly recommend the following You Tube film, which has a running time of about an hour and features Robert Sapolsky giving a lecture on the subject at Stanford Universtity: Stanford's Sapolsky on Depression in the US (Full Lecture)
With thanks to Running Circles for introducing me to this film.