16-year-old Lynda showed up to a hospital after having thoughts of wrapping a telephone cord around her neck and hanging herself. Suicidal thoughts are common for Lynda, and when she has them, she often attempts to cut herself. Lynda reported difficulty sleeping, decreased energy, irritability, appetite changes and feelings of worthlessness: five of the symptoms that must be present to diagnose a major depressive disorder.
Lynda falls into the 3.2 million adolescents aged 12 to 17 in the United States that had at least one major depressive episode in 2017. That’s 13.3% of said age group.
Depression is on the rise among teens; the odds of adolescents experiencing the condition rose 37 percent between 2005 and 2014. Because of these alarming numbers, it’s important for teens and adults alike to understand what truly occurs at the core of depression: the brain.
As most of us likely know, depression (also called major depressive disorder) is a long term, relapsing condition associated with high levels of disability and mortality. Depression can radically change the way you perceive and interact with the world, having symptoms like the feelings of worthlessness and irritability that Lynda experienced.
You may have heard the common phrase that depression is simply a “chemical imbalance in the brain.” A more accurate definition of depression is, however, much more complex. An imbalance of brain chemicals are a factor in depression, but in reality, there are likely multiple factors at play in the brain, including genetics, side-effects of medications, chronic diseases and stressful life events.
Depression can’t be explained by one simple answer when there are thousands of reactions occurring in the brain at any given moment that may reflect different aspects of the condition. However, brain changes that often result from untreated depression are somewhat more resolvable. These tend to fall into two categories: structural changes in the brain and neurotransmitter (chemical messenger) alterations.
Dilara Yüksel, a researcher from the Department of Psychiatry and Psychotherapy at Phillips-University at Marburg, Germany, found that patients with major depressive disorder show reductions in the amount of gray matter (brain tissue that processes information) in regions of the brain comprising the limbic system, which is associated with emotion and motivation.
Additionally, a large-scale study on depression by the ENIGMA Major Depressive Disorder Working Group proposes similar evidence of thinning gray matter in regions responsible for decision-making, self-awareness, emotion and memory. This makes sense considering that the symptoms of depression can include risky behavior, feelings of sadness and hopelessness and trouble remembering details. The ENIGMA group also noted that the loss of brain area seemed to be most drastic in depressed adolescents, which could be due to the vulnerability of the teen brain to mental illnesses like depression.
Major depressive disorder, especially in teens, often consists of significant stress. The body releases the hormone cortisol in response to stress, so in depression, excessive amounts of cortisol are sent to the brain. These elevated cortisol levels can slow the production of new neurons (nerve cells) and shrink neurons located in brain regions associated with memory and personal control, leading to long-term problems with memory and consistency of emotion. High cortisol levels can also interfere with the regulation of the amygdala, the brain region associated with fear and pleasure, and cause problems in sleep patterns.
Untreated individuals with depression also appear to have fewer receptors in their brain for “feel-good” neurotransmitters that boost mood, according to the University of Michigan Health System. Shortages were most prevalent in serotonin and opioid receptors, which bring feelings of well-being and happiness.
Although an exact cause of depression is difficult to pinpoint, we do know about the structural and receptor changes characteristic of a depressed brain. And for as long as depression rates remain high among teens, we will need to continue discussing what occurs at the heart of the condition: changes in the brain. Hopefully, then, we will be better equipped to help teens like Lynda who are struggling with depression.
Seek the advice of a mental health professional or other qualified health providers if you are concerned with your mental health. If you’re having suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) to talk to a skilled, trained counselor at a crisis center in your area at any time. If you are located outside the United States, call your local emergency line immediately.
Featured image via Pixabay.
