Heal Your Brain

Exploring the new neuropsychiatry.

Depression and Anxiety Disorders Damage Your Brain, Especially When Untreated

Untreated mental disorders cause shrinkage of key brain areas

Key Concepts: 2) Damage from Disorders

The second thing that has become clear from New Neuropsychiatry research is that psychiatric disorders are bad for your brain.  Study after study show that clinical depression and anxiety disorders-not to mention severe conditions like schizophrenia and bipolar disorder and drug abuse-cause measurable changes in key areas of the brain. 

This isn't just an abstract issue, either: it is a serious and meaningful issue for people who have mood and anxiety disorders.  Take depression as an example: common symptoms include mood changes (obviously) but also difficulty with cognitive functioning-trouble remembering things, difficulty making decisions, planning, setting priorities, and taking action.  These are symptoms that every therapist, psychiatrist, and other medical doctor see on a daily basis in people with depression.  Brain imaging studies using MRI scanning show that these common day-to-day depression symptoms are associated with abnormalities in specific areas of the brain, including the hippocampus (the memory center), the anterior cingulate (the brain's conflict-resolution area), and the prefrontal cortex (involved with planning and executing activities). 

Recently, German researcher Thomas Frodl did an important study looking at the brains of people with depression and comparing them to people without depression.  When he first looked at them, depressed people had abnormalities in several brain areas in comparison to healthy (non-depressed) people, specifically in the hippocampus, cingulate, and prefrontal cortex.  Frodl then followed both the depressed and non-depressed people for three years, and showed continued decrease in those brain areas in people with depression, in the dorsomedial prefrontal cortex, anterior cingulate, hippocampus, dorsolateral prefrontal cortex, and orbitofrontal cortex:  "these reductions were found in patients with major depression but not in [healthy] controls."

This seems pretty depressing itself, but it's important to keep in mind the first principle of New Neuropsychiatry, that the brain retains plasticity throughout life.  And as I will discuss in principle 3, the Importance of Remission, over time, treatment can protect from ongoing brain injury. In Frodl's words, "It is likely that an early start of treatment with antidepressants and psychotherapy may prevent neuroplastic changes that, in turn, worsen the clinical course." 

Another interesting area of New Neuropsychiatry research looks at behaviors and thought patterns.  One very common symptom of depression is 'rumination'-a tendency for depressed people to spend a lot of time thinking about how miserable they are.  There are different definitions of ruminations, for instance, "repetitively thinking about the causes, consequences, and symptoms of one's negative affect" (Nolen Hokstema?) or "repetitive thinking about sadness, and circumstances related to one's sadness."  People who are depressed have a tendency to spend hours ruminating, and may justify the time spent ruminating as "trying to sort things out," or to solve their problems. Yet research shows that rumination actually interferes with problem-solving, and makes one's mood worse rather than better.  Most likely time spent ruminating increases activity of the brain's fear system, the amygdala, and increases avoidant behavior-making it less likely that a person will get pleasure from life and have a chance of emerging from depression.

Such was the case with  "Kenneth," whose case I discuss in Heal Your Brain.  A widower in his late 60s, Kenneth had low-level depression for over 30 years that became severe after the death of his wife.  He became a hermit, avoiding friends and relatives, and spent many hours obsessing and ruminating about how terrible his life was.  A major part of his treatment was involved in getting Kenneth to stop obsessing, to get out of his easy-chair and to get him involved in other behaviors-including volunteer work, and spending time with his children and their families. Stop ruminating! I would tell him. Do something that gives you pleasure!  Eventually, months into treatment, Kenneth was able to interrupt his tendency to ruminate and to choose more pleasureable activities-and to get a sense of enjoyment and pleasure in daily life for the first time in decades.

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David J. Hellerstein, M.D., is a Professor of Clinical Psychiatry at Columbia University's College of Physicians and Surgeons in New York City. more...

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