What is Depression?
Depression is a very common and very serious mental illness that negatively impacts the way you feel, decisions you make, how you think, and how you behave. Depression can cause a sense of sadness, exhaustion, and lack of interest in life or things you once enjoyed. It is among the most common disabling clinical diagnoses in the world. Living with depression can lead to an individual developing other emotional and physical issues. Depression can have severe impacts on quality of life.
How Common is Depression?
The American Psychiatric Association estimates that 1 out of every 15 adults will experience depression this year. The World Health Organization claims that 17.1% of all adults will experience depression at some point during their lifetime [1]. Globally, it is estimated that depression affects 340 million people, and is affecting 18 million people in the United States alone at any given moment. Depression can develop at any point in a person’s life, but a common age of onset is during teenage years and early 20’s. It tends to disproportionately impact women more than men.
What Causes Depression?
It is difficult to identify a specific cause of depression, but best summarized, depression is caused by poor regulation of specific pathways involved in mood and motivation within the brain. Several factors should be assessed at the onset of depression, ranging from genetic vulnerability, medication changes, brain trauma and other traumatic life events. Often people hear that the cause is due to “too little of this chemical and too much of that chemical” within their brain. This is an oversimplification and does disservice to the individual living with depression. Many intricately designed pathways transmitting a handful of neurotransmitters need to be working well and in harmony in order for us to not be depressed. There are many points throughout these various pathways where dysfunction can occur and create depression.
What are the Symptoms of Depression?
Depression is more than a feeling of sadness or grief. Grief may come in waves, while depression is a consistent sadness and oppressed mood. Depression also brings on a decrease in interest in activities you once enjoyed, changes in appetite, changes in sleep patterns or increased sleep disturbances, fatigue, slowing of movements and speech patterns, difficulty concentrating or maintaining focus on a task for a long period of time, a sense of self-loathing, a sense of worthlessness, ongoing feelings of guilt, and thoughts of death or suicide.
What are the Consequences of Depression?
Early-onset major depression has been associated with a number of important clinical consequences, beyond the fundamental observation of an increased likelihood of future episodes as mentioned above. Two recent reports of clinical trial outcomes have identified some of these consequences. In a comparison of patients with early-onset (i.e., before age 21-22 years of age) and late-onset (i.e., after age 21-22 years) depression, it was observed that patients in the early-onset depression group tended to have a longer index first episode, sharply higher rates of recurrence, higher overall rates of comorbid personality disorders, lifetime substance use disorders, and a longer hospitalization (9,10). Further, there was a more extensive family history of mood disorders in the early-onset patient group, lower educational attainment and lower annual earnings (12%–18%) for women (1).
What Happens to the Brain with Depression?
A study from May 2020 assessed the complex and various abnormalities that can occur to cause depression. It compiled data from the published literature, looking specifically at neuroimaging studies on subjects with major depressive disorder (MDD). The study identified several key structural abnormalities, as well as functional abnormalities, of very diverse brain regions that are located in different areas of the brain but it singled out one specific region within the left hippocampus as demonstrating abnormality consistently across all studies.
Identification of consistent abnormality within the subgenual anterior cingulate cortex in this meta-analysis is a potentially important finding for depression research. The subgenual cingulate has been widely implicated in major depression as a regulator of mood (8-12), in the processing of emotional stimuli (13–15), and as a target for network-based treatments such as deep brain stimulation and a downstream target for transcranial magnetic stimulation (16, 17).
The left hippocampus was also identified in this study. Decreased hippocampal volume has been observed in neuroimaging studies of major depression over the past 20 years (18). Hypotheses of major depression-related decline in hippocampal volume posit that the hippocampus may be affected by stress (19) and may contribute to the cognitive challenges (20) and recollection memory deficiencies (21, 22) often present in individuals with major depression. The hippocampus has also been implicated in major depression through disrupted hippocampal connectivity effects on self-referential activity in major depression (23), and conjoint reductions in gray matter density and activation during working memory tasks have been demonstrated in patients with major depression (24).
Regions of the right amygdala and right putamen were also identified in this study. The amygdala has demonstrated aberrant activation in patients with major depression compared with healthy control subjects (25). The amygdala was also found to demonstrate reliable volume differences in unmedicated patients with major depression relative to control subjects in a meta-analysis of 13 individual neuroimaging studies (26). The putamen, although its potential role is less well established in major depression, has also demonstrated volumetric and shape abnormalities in untreated first-episode major depression (27).
Studies performed using transcranial magnetic stimulation have also demonstrated a clear asymmetry between left and right frontal cortices when compared to non-depressed subjects. The left frontal cortex of depressed patients was less excitable, or reduced in function, compared to the right, suggesting important asymmetries that should be taken into consideration when tailoring therapy for a depressed patient.
To summarize, neuroimaging studies have documented aberrant structure, function, and connectivity in brain regions that correspond to aspects of emotion and emotional regulation that become deficient in MDD. Specifically, investigators have reported structural anomalies in MDD in the amygdala and hippocampus, and functional abnormalities in the subgenual anterior cingulate cortex, dorsolateral prefrontal cortex, amygdala, and ventral striatum.
There is also a typical pattern of asymmetry of function in the hemispheres of the brain, usually meaning the left frontal cortex is firing less frequently and intensely than the right frontal cortex in patients suffering with MDD. There is growing recognition that depressed individuals are characterized by abnormalities in the anatomical and functional connections among these brain regions.
How is Depression Usually Treated?
Depression is often treated through the use of medications, usually anti-depressants, and psychotherapy, oftentimes simultaneously. Different types of brain stimulation, including electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS), are sometimes advised for cases that are non-responsive to other therapy options. Exercise has been shown to be an effective treatment for clinical depression, as well (7).
How is the NeuroRescue Program Different?
One of the main things your brain does, and maybe even the primary thing, is help you determine where you are in the world. Your brain uses inputs from your inner ear to figure out where your head is in relation to gravity and how it is moving. It uses inputs from your muscles and joints to figure out where your body is in relation to your head and what your body is doing. It uses inputs from your eyes to figure out where your body is in relation to the visual environment.
Your brain needs to put all of that together to make sense of where the world is, and where you are in relation to the world. It needs to be able to localize you effectively in the environment, in order for you to be able to respond to the environment properly.
When your brain is experiencing dysfunction that presents as depression, we regularly see abnormalities to pathways that involve the eyes (28, 29), the inner ear, muscles and joints, among many others. At a foundational level a failure of integration exists between various parts of the brain and these regions involved in depression are also involved in movements of the eyes, the vestibular system, and proprioceptive feedback from muscles and joints.
This is why many patients fail to fully resolve their depression with medication management, psychotherapy and exercise, even when all done simultaneously. While all of these therapies can help with problems in the individual systems, none of them take the comprehensive NeuroRescue Program approach to address all of the systems involved in your specific depression.
How Does the NeuroRescue Program Work?
We design your unique NeuroRescue Program to be among the most comprehensive diagnostic and therapeutic protocols available today. We create individual NeuroRescue Programs based on a comprehensive analysis of every relevant neurological system and pathway, using gold-standard, cutting edge neurodiagnostic technologies and examination procedures and state-of-the-art therapies.
We begin with your Discovery Day, wherein we perform a comprehensive history of not only your condition, but your life on a timeline. This allows us to dive deeply into your case and see all of the factors that led to where you are now. It helps us uncover hidden problems and associated conditions that may be making it difficult for you to move your recovery forward.
Our examination allows us to identify the areas and pathways of your brain that have been impacted prior to your depression and by your depression. We begin by precisely quantifying the function of your visual, vestibular, and proprioceptive systems through computerized analysis of your eye movements, your inner ear reflexes, and your balance in a host of different sensory conditions.
We employ technologies including Videooculography and Saccadometry to measure several classes of eye movements. We use Video Head Impulse Testing to measure the function of your inner ear, and Computerized Dynamic Posturography to assess your balance in different sensory conditions.
We use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and perception of vertical in a virtual reality environment.
We combine all of this with a comprehensive physical and neurological examination of your sensory, motor, autonomic, and cognitive systems. We review any relevant laboratory testing, radiological imaging, and prior neurodiagnostic testing, and integrate that information with our findings.
We use this information to identify which parts of your brain are working properly, which systems are struggling, and the precise point at which your systems fatigue.
We can then design a NeuroRescue Program that is unique and specific to your brain, and yours alone. It will be various electrical modalities proven to be beneficial to improving depression (30), As mentioned above, repetitive transcranial magnetic stimulation is a very successful therapy for treating refractory depression (31). It may include specific types of eye exercises to activate deficient brain regions involved in depression (32). It may include vestibular therapy to activate brainstem centers that produce neurotransmitters vital in regulating emotions (33) It may involve using lasers and LED devices for photobiomodulation, which has been shown to be very helpful in treating depression (34).
It may also involve exercises to integrate visual, vestibular, and proprioceptive systems simultaneously, an approach that has been shown to be effective in a host of neuropsychiatric conditions (35). It may even involve performing exercises in a virtual reality environment, shown to be a promising therapy for managing symptoms of depression (36).
Your NeuroRescue Program works to rejuvenate and reintegrate the damaged neurons and pathways in your brain. It works to improve energy, endurance, and functional capacity within your fragile systems.
We use our technologies and procedures to not only see what we need to address, but also when it is time to stop and let you rest. We address your impaired neurological function from multiple angles of therapy, and provide metabolic support to improve neurological recovery.
While we cannot bring back neurons that have been lost, your NeuroRescue Program allows us to take the pathways that remain and maximize their efficiency and endurance. And by focusing on the integration of systems, we can do more than just get pathways working better, we can get them working together again. This gives us our best opportunity to get your depression under control, and return you to living a healthy, vibrant, and fulfilling life.
Your Next Best Step:
Living with depression is extraordinarily challenging, but there is hope for recovery and freedom from this condition.
To see if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.
And remember, it’s never too late to start getting better.
References:
2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294300/
3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294408/
4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456260/
5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563769/
6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571509/
7. https://www.webmd.com/depression/guide/depression-treatment-options#1
8. https://pubmed.ncbi.nlm.nih.gov/9126739/
9. https://pubmed.ncbi.nlm.nih.gov/18704495/
10. https://pubmed.ncbi.nlm.nih.gov/21145043/
11. https://pubmed.ncbi.nlm.nih.gov/15110034/
12. https://pubmed.ncbi.nlm.nih.gov/10327898/
13. https://pubmed.ncbi.nlm.nih.gov/16237317/
14. https://pubmed.ncbi.nlm.nih.gov/27013105/
15. https://pubmed.ncbi.nlm.nih.gov/29867204/
16. https://pubmed.ncbi.nlm.nih.gov/15748841/
17. https://pubmed.ncbi.nlm.nih.gov/20160213/
18. https://pubmed.ncbi.nlm.nih.gov/8632988/
19. https://pubmed.ncbi.nlm.nih.gov/20661246/
20. https://pubmed.ncbi.nlm.nih.gov/28652752/
21. https://pubmed.ncbi.nlm.nih.gov/11866320/
22. https://pubmed.ncbi.nlm.nih.gov/26441703/
23. https://pubmed.ncbi.nlm.nih.gov/22418737/
24. https://pubmed.ncbi.nlm.nih.gov/25066663/
25. https://pubmed.ncbi.nlm.nih.gov/21041614/
26. https://pubmed.ncbi.nlm.nih.gov/18504424/
27. https://pubmed.ncbi.nlm.nih.gov/27749245/
28. https://pubmed.ncbi.nlm.nih.gov/28638208/
29. https://pubmed.ncbi.nlm.nih.gov/24072973/
30. https://pubmed.ncbi.nlm.nih.gov/29459836/
31. https://pubmed.ncbi.nlm.nih.gov/29415152/
32. https://pubmed.ncbi.nlm.nih.gov/16914221/
33. https://pubmed.ncbi.nlm.nih.gov/30292730/
34. https://pubmed.ncbi.nlm.nih.gov/31819453/
