The New Mind-Body Science of Depression by Vladimir Maletic

Author:Vladimir Maletic
Language: eng
Format: epub
Publisher: W. W. Norton & Company

CHAPTER 8

Functional and Structural Brain Changes in Depression

When discussing changes in brain function or structure that are characteristic of depression, we face the same challenge as a painter staring at an empty canvas pondering how to accurately depict the flight of a bird. First he has to choose which bird he wishes to paint. Although it is not an easy choice, the form and color of the bird need to match his overall idea and the sensibility of the painting. The task in front of us is infinitely more complex. Accumulated scientific data suggest that the diagnosis of major depressive disorder (MDD) does not reflect a single biological entity. Therefore, we are making a choice among a multitude of depressions—which one is the most representative? The limitations of language will require that we speak of MDD as if it is a single entity, but in truth any statement we make in discussing this topic is by necessity reductionistic, probabilistic, and relative. Painting is not a dynamic medium; therefore, the flight of a bird on the canvas will be a frozen frame, an offering to be elaborated by our imagination. Like the flight of a bird, depression is not a static phenomenon but, rather, a dynamic struggle between the pathophysiological processes of the disease state and the healing homeostatic activities each individual brain and body bring to this painful condition. Gender, age, personality organization, resilience factors, wellness practices, and the existential context, as well as the presence of medical and psychiatric comorbidities, all have a role in continuously defining the activity patterns and structural brain changes that occur in depressed individuals. Because of these complexities, what we see when we examine MDD will be to a large extent influenced by our choice of the window of observation.

Our emotional reality appears to be actively construed rather than passively experienced.1 Indeed, an individual’s emotional experience of the world is a synthetic process, perpetually infusing perceived elements of internal and external reality, assigning them meaning and merging them with the flow of ongoing mental activity. This process of fusion is an elaborative one—the quality of “incoming” emotions can dramatically alter the priorities of our current mental state and activate a repertoire of adaptive responses. Think for a moment about the last time when you were running late for an important meeting. Much to your relief, that morning the traffic was flowing well and it looked like you were going to make it to the meeting after all. But then a mile before your exit you saw flashing red and blue lights in the rearview mirror, accompanied by a shrill siren. This simple sensory experience and the associated emotions are likely to evoke a somatic response, such as a wave of nausea. With this feeling comes a radical rearrangement of your priorities. The converse is also true. In the midst of a depressive episode, although one is sharing a meal and a glass of wine with good friends, there may be an unbridgeable gap of emotional distance.

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