I find it helpful to explain how a change in brain chemicals can alter how they feel physically. This kind of explanation helps them think about depression as a physiological condition that is expressed in psychological and physical symptoms.
Brain changes that occur during depression are similar to those observed in cases of chronic stress. Alterations in the amount and activity of chemical messengers such as serotonin occur in different brain regions, and levels of stress hormones like cortisol and adrenalin are elevated.
Levels of other chemicals such as dopamine and acetylcholine also change. The altered balance of these chemicals may explain depression symptoms reflected in appetite, sleep, thinking, and mood.
Previous research has shown that chronic stress can lower brain levels of serotonin, which is associated with a greater risk of suicide. Some individuals have a genetic predisposition for lower serotonin levels, which could explain the tendency for depression to run in some families.
Brain scans of patients with severe depression indicate reduced metabolism and blood flow to the frontal areas that control cognition (thinking).
Conversely, the scans show high blood flow and metabolism in the deep brain structures that control emotion and behavior.
We know that neural activity in the amygdala — an emotional control center in the brain’s temporal lobe — increases when a person becomes depressed.
The hippocampus, which is located next to and works closely with the amygdala, is the area that processes memory. In some depressed people, the hippocampus is smaller than normal. This may explain why depressed people focus on sad or disturbing memories.
The thalamus, a structure deep inside the brain, receives sensory information and relays it to the brain’s outer rim (cortex), which controls behavior, movement, thinking, and concentration. In some depressions, abnormalities are seen in the thalamus.
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