- Hey, everybody.
Today we're gonna learn
why you may really need antidepressants
and how they actually work in our brains.
We will first get into what depression does to our brain,
and then how antidepressants work to fix that,
and finally, things that we can do today to feel better
in conjunction with our antidepressants.
(relaxed electronic music)
As a therapist, I know that therapy alone
isn't enough for a lot of people.
Sure, it can help to get some tools and techniques
to help us better manage our life.
But if we are drowning in our symptoms,
those tools aren't gonna be very useful.
We need something to help us get our head above water.
And that's where medication comes in.
Study after study proves that it's therapy
in combination with medication
that gives us the best outcome.
Let me repeat that.
Several reputable studies show
that therapy with medication can produce the best outcome
if you are suffering from depression.
But I know that medication can be scary to start.
Some feel that it's really stigmatized
and we don't really know how or why they work.
Let's answer some of those questions
so that we are all more informed
and able to make the best decision for us and our treatment.
And I wanna thank Johnson & Johnson
for sponsoring this video.
(relaxed electronic music)
First, let's talk about what happens
in the brain when we are depressed.
Too often we downplay our mental illnesses
because you can't see the issue.
But the truth is that you can.
Using PET scans, SPECT, and fMRI scans,
we can actually see a depressed brain
has decreased activity in most areas,
except, according to this scan, it looks like,
in the amygdala, the striatum, and the thalamus.
But because I'm a therapist
and my training focuses primarily
on the symptoms of depression,
not the brain structures or activity
during a mental illness,
I have asked my friend an actual neuroscientist,
Dr. Ben Rein, to explain a bit
about what happens in the brain
when we are suffering from depression.
(relaxed electronic music)
- Thanks for having me, Katie.
Let's first talk about what we can see
in brain imaging studies.
First, the amygdala, which is a hub for fear and emotion,
is actually more active in those with depression
when viewing faces that are expressing emotion.
And interestingly, data suggests
that this effect can be reversed by SSRIs.
Now, other studies have shown that certain brain areas
are less active, and in some cases, even reduced in size.
The subgenual anterior cingulate cortex,
which is involved in emotional regulation,
is less active in those with depression
and physically smaller.
We've also seen reductions in volume of the hippocampus,
which is a memory hub that's deep inside here,
and various areas of the frontal cortex,
which is involved in high-level cognition,
social functions, memory, and emotion.
What's really interesting is that SSRIs
have been shown to increase volume of the hippocampus
and several areas of the frontal cortex.
It has also been shown that stimulating the frontal cortex
can reduce depression symptoms.
Now, you may have noticed that I've mentioned SSRIs,
but I haven't said anything about serotonin.
That's because the evidence that serotonin
is the root cause of depression is actually pretty mixed.
We've seen that certain gene mutations
which affect serotonin signaling in the brain
may increase risk for depression.
And those with depression have reduced detectable levels
of serotonin metabolites in their body.
But looking at the brain,
there's surprisingly not super obvious evidence
that serotonin is the problem.
Clearly, we're still figuring this all out.
But what we do know is that in many cases,
drugs that target serotonin
and norepinephrine signaling in the brain,
like SSRIs and SNRIs,
can sometimes improve depression symptoms.
(relaxed electronic music)
- Next, let's jump into how antidepressants work.
Because now we know what happens in the brain
when we are depressed.
So how are these medications supposed to help those issues?
Again, I've asked my good friend Ben to explain to us
how two of the more commonly used antidepressants,
SSRIs and SNRIs, work.
Because just saying that we have a chemical imbalance
and that these medications help with that
isn't enough information for me.
There has to be a better way to explain it.
(relaxed electronic music)
- There is strong evidence that SSRIs,
or selective serotonin reuptake inhibitors,
are effective for treating depression.
But what exactly does
selective serotonin reuptake inhibitor mean?
In the brain, messages are constantly being passed
between cells at little junction called synapses.
At these synapses,
one cell passes a neurotransmitter off to another cell,
and that either increases or decreases this cell's activity.
You can think of it like brain cells
sending each other mail.
The neurotransmitter gets put in the mail,
or released into the synapse.
And then it binds to a receptor on this cell,
like being delivered into the appropriate mailbox.
But as you know, sometimes when we send mail,
it gets returned to this sender.
Well, this can happen in the brain too.
If a neurotransmitter like serotonin
gets released into the synapse
and there are no mailboxes or receptors for it to bind to,
it can get returned to the original cell.
This process is called reuptake.
So selective serotonin reuptake inhibitors
block that process.
When you take an SSRI, that serotonin
that gets sent back to the original cell
basically isn't let in.
So instead, it has to wait in the synapse
for a mailbox to become available on a recipient cell.
Eventually, that serotonin goes happily into a receptor.
So overall, this results in the recipient cell
taking in more serotonin over time.
In summary, SSRIs enhance serotonin signaling
between brain cells.
And SNRIs enhance both serotonin
and norepinephrine signaling between brain cells
in the same way.
So why does boosting serotonin and norepinephrine help?
Well, serotonin is very much involved in mood.
So boosting serotonin can theoretically boost your mood.
But serotonin also increases plasticity in the brain,
meaning it allows brain cells to form new connections
and change their existing connections with other cells,
sort of like creating new mailing routes
or building new mailboxes.
This could explain why, as I mentioned earlier,
SSRIs can increase the volume of certain brain areas,
because it actually causes
new synaptic structures to be built.
Norepinephrine is also involved in mood regulation
and overall increases vigilance and alertness.
So boosting norepinephrine with SNRIs can be very helpful
for certain depression symptoms
like fatigue, sleepiness, and anhedonia.
(relaxed electronic music)
- It's also important to know that antidepressants
do have a boxed warning for increased risk
of suicidal thoughts and behaviors
in pediatric and young adult patients.
It can have sexual side side effects.
And it can cause weight gain.
So make sure that you talk to your doctor
and ask about any and all side effects
so that you are informed
and can make the right treatment decision for you.
I recently had the opportunity
to go to Johnson & Johnson's Museum.
And I didn't realize how long J&J
had been in the mental health field
and how many breakthroughs they are responsible for,
not to mention giving people with mental illness
the option of being treated at home
instead of always being institutionalized,
which used to be the only option.
So while I know we can be reluctant to consider medication,
know that there have been some amazing breakthroughs
in depression treatment over the last five years.
So please talk to your doctor if medication could help you.
(relaxed electronic music)
Third and finally, let's get into what we can do today
to improve our depressive symptoms
once they're at a more manageable state.
Because while medication has its place in our treatment,
we can also do things in our life each and every day
to help us think better and feel better.
As a therapist, I live in this third section.
Because this is where therapy happens.
And with that in mind,
it's important to know that therapy won't work
if we aren't able to participate in it.
Let me repeat that.
Therapy may not work alone
if you are drowning in your symptoms.
Meaning that if we're drowning in our symptoms
and not able to do any of the tips and tools
our therapist is offering,
or maybe we can't even really share much in therapy
because doing that is so overwhelming to our system,
then therapy's not gonna work.
Which is why medication is there and helpful.
And also why it's proven, again,
that therapy plus medication gives us the best result.
But without further ado,
let's get into those to manage daily depression.
(relaxed electronic music)
Number one, check in on your basic needs.
Like, have you eaten a well-balanced meal
in the last three to four hours?
Are you getting enough sleep?
What about your overall health?
Are you taking care of it?
I always use the acronym H.A.L.T. to describe this tip
because it stands for hungry, angry, lonely, and tired.
And by checking in on those things
and taking care of them first,
we make ourselves less vulnerable
to our depressive symptoms.
Moving on to number two.
Pay attention to the negative
or unhelpful thoughts that you're having.
I know you be thinking
it doesn't make sense to pay attention to them.
I mean, wouldn't that make them worse,
or remind me more of those negative thoughts?
Well, actually it's in the not noticing
that we allow these harmful thoughts to hang around
and we accept them as fact.
And they impact our life negatively.
So try to notice them.
And then, you can check to see
if you have any facts to support that thought.
And know other thoughts are not facts.
And number three,
once we have noticed some of our unhelpful thoughts,
we can use bridge statements to help move them
into a less negative place.
Meaning that the goal isn't to make them positive,
just less hurtful.
For example, if my negative thought is,
"I'm so lazy and stupid,"
then the bridge statement could be something like,
(exhales)
"I'm open to the possibility
"that I may not be quite as lazy or stupid as I think."
Or it could be, "Even though I think I'm lazy and stupid."
Still thinking it, right?
"I agree that those thoughts aren't helpful for me."
Now, I know the shift in this is really small.
But trust me, any movement
away from the harmful thought is progress.
And you will start to feel the difference
just after a few days of practicing this.
Number four is to help someone else out.
Depression can keep us stuck in our own upset and pain.
Getting out of our own experience and helping someone else
can not only give us a sense of purpose,
but also connection.
And I've always found
that whether I'm helping out a friend
or volunteering at a local soup kitchen,
I get as much, if not more, out of it
than the person that I'm helping.
It's healing to remember
that we are important or valuable to others.
So go ahead and give it a try.
And my final tip, number five, is to move your body.
No, I didn't say exercise.
I said move.
So can we go out maybe and get our mail?
Maybe take a walk around the block?
Have we try are doing a full-body shake?
Or is stretching more up our alley?
Whatever we can do to get our body moving, do it.
Not only is it good for our body to be in motion,
but it can also help our nervous system
release some of that built-up stress response.
And I know we think of depression
as only being sadness and feeling sleepy,
but we can also feel irritated and stressed out.
Moving helps give those experiences an outlet.
I hope this video helped you get a better understanding
of what depression does in our brain,
how medication treats that,
and ways that we can help ourselves today.
And a huge thank you to Dr. Ben Rein
for sharing his knowledge and expertise with us.
Thank you so much for watching, and I'll see you next time.
(relaxed electronic music)