Antidepressants + Psychotherapy = Healing in the Brain

Did you know childhood trauma can causes massive changes in the hippocampus, shrinking it so that new, long-term explicit memories cannot form? (The hippocampus is crucial for organizing our short and long term memory.)

Did you know that a traumatized person’s hippocampus is 18% smaller than that of a depressed adult without childhood trauma.

Now here’s an amazing fact: Until very recently doctors and scientists thought that if the brain was broken, you could not fix it. Now we know that as people recover from depression, their memories return, and research suggests that new neurons (or brain cells) are created in the brain stem and hippocampi can grow back!

Brain scientists suspect a stress hormone called “glucocorticoid” kills cells in the hippocampus so it cannot make the synaptic connections in the neural networks that make learning and explicit long-term memory possible (see below for explanation of explicit memory.)

Studies on baby animals taken from their mothers show that a gene turns on the switch for glucocorticoid production. It gets turned on and stays on. Studies on adult survivors of childhood abuse also show signs of glucocorticoid supersensitivity.

We are now begining to understand that depression, high stress, and childhood trauma all release glucocorticoids, which kill hippocampus cells.

The shrunken hippocampus in survivors of trauma is an important discovery. It helps us understand why counselors watch their clients struggle to find explicit memories of their childhood.

So much for the bad news. Now here’s the good news:

1). Antidepressant medications (SSRI’s) increase the number of stem cells that become new neurons in the hippocampus.
2). Counseling helps change the chemical makeup of the brain.

This was a complex subject so let me summarize: Many believe the brain can heal itself. Counseling and Antidepressants can actually cause neurogenesis (new cell growth) in the hippocampus.

 

*Implicit memory in a two-year old is the kind of memory where we learn some procedure or group of automatic actions where words are not required. They are usually unconscious. Explicit memory, or declarative memory, connects specific facts and events. It begins to develop when a child is almost two years old. It is the type of memory that connects facts and events. It is supported by language)

*Material taken from The Brain That Changes Itself by Norman Doige, M.D.

Antidepressant Medications

Free photo from Morguefile.com

There are several categories of antidepressant medications that are unique and target different brain chemicals (serotonin or norepinephrine or both). Some antidepressant medicaitons simultaneously treat anxiety.

SSRIs (Selective serotonin reuptake inhibitors) – medications like Prozac, Zoloft, and Paxil.

A second category includes drugs like Wellbutrin and Effexor

The third category is old antidepressants that are still considered effective but have more side effects:

A. Tricyclics such as Anafranil and Tofranil

B. MAO inhibitors such as Nardil and Parnate

A full 60 – 70% percent of depressed patients improve after trying one type of antidepressant, but it takes three to six weeks to achieve a full response. If one medication does not work, most patients find success by their second try.

Some patients do not respond well and/or have terrible side-effects to any medications.

Prozac is believed to work by increasing serotonin in the brain. Side effects can include nausea, insomnia, and nervousness at the beginning of treatment. It can block the effectiveness of other medications.

Wellbutrin affects the levels of norepinephrine and dopamine (not serotonin) so it is likely to affect a different type of patient than the one taking Prozac. Common side effects include insomnia, anxiety, tremor, and headache. On the positive side, it has few sexual side effects. In fact, some patients report a pro-sexual side effect.

Effexor works in an entirely different way from all the other drugs in its class. It raises levels of serotonin when taken in low doses and elevates norepinephrine at higher doses. Studies show that Effexor is more effective than other drugs on severely depressed patients.

If a patient is successfully taking antidepressants it is recommended he stay on them from four to nine months and be weaned off slowly (according to doctor’s instruction) or else the rebound depression rate could be worse than it was initially.

Depression is real!

I have heard countless stories of people who are spiritually abused by those who tell others they are not trusting God or that they don’t have enough faith.

This is wrong.

Many people cannot begin to address their emotional pain until they begin experiencing relief from serious depression.

Everyone is different. Some need psychotherapy, others need medication, and many benefit from both, at least for a time.

Some people use St. John’s wort (made from a fragrant yellow flower) to treat mild depression. Large, well-controlled studies found that it was no more effective than a placebo. It can have dangerous interactions with other medications and its potency and preparation are not well regulated.

*I am not giving medical advice. Anyone starting a drug treatment therapy should always consult a doctor. Thanks to Sonja Lyubomisky  and her book The How of Happiness.