Biologically and chemically speaking, how depression happens, and how do antidepressants helps in improving the condition?

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Biologically and chemically speaking, how depression happens, and how do antidepressants helps in improving the condition?

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Depression is a combination of psychological and neurogical phenomenon that mostly centers on how the brain assesses negative outcomes.

Your brain relies on a horomone called serotonin to regulate many functions like mood, sleep, appetite, energy, and confidence. One of the ways it does this is essentially by counting the number of positive and negative experiences you have. If you have more negative experiences, it’s an indication that your environment is dangerous, and you aren’t equipped to handle it. The brain increases your levels of vigilance, which is described as having anxiety. The problem with vigilance is its metabolically stressful. It wastes energy and exhausts the brain and body.

The majority of the physical and emotional symptoms of depression stem from this process. The body spends too much time on high alert, becomes exhausted, and suffers from chronically poor mood, appetite, and sleep.

Now, why does this process cause a feedback loop that makes escaping depression difficult? That’s a much more complex question. Essentially, you can imagine that as your current environment becomes increasingly demanding of your attention to avoid danger, you can afford to care less about the future. There’s no point in pursuing a future reward if you ride is going to fall apart before that happens. The degree to which you value the future is somewhat predetermined, somewhat psychosocial developed, and somewhat based on your mood and confidence. As you become depressed, the distance into the future you care gradually shrinks.

Eventually, the amount into the future you care about what happens is zero, or indistinguishable from zero. This is where things like motivation become an issue. The brain does not perceive any value in pursuing activities that will produce a future reward, so it view them as dangerous and expensive wastes of energy that it can’t afford to waste.

In a way, it’s not that depressed people are sad or can’t be happy. The brain loses the desire to be happy, because it’s too preoccupied with percieved environmental dangers to spend energy on them. The problem with depression is that many of the dangers the brain is perceiving are social dangers (which are very real and very dangerous, but they do have some unique properties). Social dangers are hard to resolve because they require conflict and negotiation with the source of these dangers. That’s a daunting and taxing endeavor, and carries the risk of making things worse if you mess it up. Often, people who suffer from depression are poorly equipped to handle the issue causing their suffering and are aware that mishandling it will make things worse so they avoid the situation.

Another way to phrase this is that the person neglects to engage in the sort of intense short term conflict that produces solutions which are effective in the medium to longer term. A correlary to this is that people who are high in trait agreeableness are predisposed to be conflict averse, even to the extent that they struggle to articulate what they want. Women, who tend to be higher in trait agreeableness on average than men, also tend to be higher in trait neuroticism, or, sensitivity to negative effects emotion. When something is upsetting how upset does it make you. In combination, these traits make it very easy to fall into depression, especially in stressful environments with high levels of conflict and high risk outcomes. Depression is highly disproportionately common among young women in intense social environments, especially when the negotiating relationships with high stakes, ie, after becoming vulnerable to having a child.

Therapy and medication are used in combination to counteract the patterns of behavior that contribute to depression. Now, to be clear, depression makes the path out very steep and unpleasant, on top of it being likely that the personality type which falls into depression would find the path out highly unpleasant to begin with; but ultimate depression becomes cyclical due to the actions and choices of the afflicted.

SSRIs and MAOIs are designed to artificially increase serotonin levels. A person with higher serotonin will have more energy and confidence to confront their issues. Essentially, it’s designed to roll back the clock to when the depression wasn’t as deep, and escape was more attainable. It also increases the amount intrinsic reward the patient experiences as a result of small positive interactions. SSRIs especially help the depressed person experience positive emotion in response to their success, like feeling good for cleaning something up or generally improving themselves or their lives. These drugs go a long way towards staving off that last extreme of the depressive cycle where the person has zero motivation. As a consequence, the person can be “functional” and thus have more energy, confidence, and a better position with which to confront their larger issues.

Therapeutically, treatment for depression often focuses on identifying the major threats in the patients environments that cause their anxiety. Then, on developing strategies for addressing these problems. Most often, a large part of this therapy is coming up with a solution that satisfies the patient that it isn’t likely to do more harm than good. This is actually quite difficult because often the patients fears have a decent basis in reality. While their total despair or hopelessness may be am extreme reaction, being worried or afraid to begin with isn’t. The solution is usually for the patient to focus on smaller issues that are more accessible to them to develop their skills and confidence. The most common example is e couraging the patient to exercise increased discipline over their eating, sleeping, and exercise habits. These are ideal choices be abuse not only does it have a massive impact on your overall physical health and energy level, the effects are noticable in the short term as well as the long term, and thus the patient can feel good about their accomplishments as they accomplish them.

Ultimately, curing depression involves the patient overcoming the things which they feel they are unable to confront, and as a consequence have pushed them into taxing and unsustainable coping mechanisms. Curing depression requires breaking the cycle of avoidance. These stressor are usually life defining challenges like your relationship with an intimate partner, or lack thereof. Things like lack of fulfillment from work, or being tyrannized by someone in a position of authority when confronting authority is a skill you didn’t develop in childhood. The moral of the story is that it’s really really hard.

Whooo, I’m not qualified to answer this exactly but I did stumble upon a pretty interesting 60 minutes episode a while back that talked about how antidepressants might not do shit but in fact, the placebo is. It was interesting.

Often Lack / not enough of neurotransmitters, “fixed” by preventing their re-up take (SSRI) not really along term solution however