This Is Your Brain On Stress and Depression. Any Questions?

Remember those “brain on drugs” commercials? I think it’s about time for a discussion of your brain on stress.

Chronic Stress and Your Brain

While trying to understand how dopamine works in depression and whether there’s any useful research on anhedonia reversal (little to none), I learned that the chronic stress I experienced throughout childhood and to this day (thanks BIGlaw) has been destroying my brain. Through processes as of yet unproven and partially unknown, the brain of the chronically stressed experiences significant malfunction over time in the hippocampus (atrophy), amygdala and neuron production, which are related to anxiety, mood disorders and memory problems. The same malfunctions are observed in patients experiencing chronic depression.

If you’re one of those depressed people who has responded positively to antidepressants and/or exercise — even if not completely — then maybe the research that I’ve been reading lately will be helpful to you too.

How Do SSRIs Work?

It turns out the popular theory of SSRIs — that they essentially keep serotonin accessible in the brain longer to keep you calmer and happier — was largely debunked nearly 10 years ago. Instead, SSRIs may actually be helping the brain to heal itself, create new neurons and stop, and even reverse, atrophy of the hippocampus by helping the body create more of a protein called brain-derived neurotrophic factor (BDNF). That’s why it takes weeks to improve after you start an SSRI, rather than days (despite increased serotonin availability within hours).

What Does This Mean?

Why does this matter? Because the research also suggests that there are many ways to halt and even reverse this atrophy! It appears voluntary exercise, calorie restriction, intellectual stimulation, cumin, antidepressants and electroconvulsive therapy could all work to increase BDNF expression in the brain. Am I crazy for thinking that it’s about time I start working out daily, going on a calorie restricted diet made up of 30% Indian food and reading more interesting books?

The important thing to note here is that the jury is still out. It is not clear whether this is a cause-effect relationship or simply a random correlation. Further, it is certainly clear that too much calorie restriction, for instance, can actually lead to lethargy and depressed mood, orthorexia and other unhealthy food relationships. But in my n=1 experience, I do feel better when I exercise nearly daily, limit my food intake so that I’m never stuffed/eat when actually hungry and do work that stimulates my brain. I have had rather positive experiences with intermittent fasting as well. And look, I will take any excuse to eat Indian food. (Pass the naan!)

What Else Can We Do?

But there is something else. Something that’s potentially more important for mental health over the long haul. If the cause of these troubles is chronic stress — which I’m still struggling to manage — then the highest long-term priority of those suffering from depression should probably be to learn and utilize better coping strategies. Learning to both minimize stress where possible, and process it and expel it from the body in effective ways may be protective against future depressive episodes.

Maybe stress management and increased BDNF production are the keys to recovering from depression now and helping to prevent its recurrence — for good.

What’s My Motivation?!

Anhedonia. Defined as the inability to feel pleasure. Personally, a more precise definition is the inability to stop thinking that everything I do is boring and stupid. It’s a pervasive lack of motivation, knowing that even accomplishing a goal won’t be rewarding or fulfilling in the slightest.

I took up knitting, baking, coloring and jewelry-making a few months ago. I got halfway through a scarf, made some lovely drop earrings, completed a couple of pictures and made (and ate) more cookies than is healthy. I was so proud of myself. When I attempt to pick up my needles now I am repulsed by how bored I am almost immediately. I hate them and don’t want to do it. I immediately want to throw the needles down because I’m so angry at them for not making me happy anymore.

Losing motivation is devastating. You don’t know what is wrong with you. Why nothing seems worth doing. Nothing is fulfilling and you hate others for asking you to do stupid, pointless things and not understanding how stupid and pointless those things are. When I get like this I become terrified of what will become of me. I was always a good student, curious and hardworking, unbelievably responsible, a teen with myriad passions and dreams and when I was “on” I was one of the most organized, neat, planned, forward-thinking people I knew. I’m the person people always picked to be the coordinator and plan events in college and law school. I was thorough. I took care of my entire family when my mom was sick. Details? I had ’em covered.

Lately, the anhedonia has taken over with a vengeance. Funny that something that deprives me of the ability to give a damn or feel passion is such a strong, pulsing, growing force. I work up the will to start the laundry, but that’s all the steam I’ve got so I lay down and leave it sitting in the washer. I used to be a neat freak. Now I vacuum once a month. Who am I?

So my new experiment is to completely forget about doing things for pleasure, or waiting for motivation. It’s a fake it ’til you make it game. I’m going to make a list of things that I have to do everyday regardless of whether I feel like it. And just do them. I imagine worst case is that I become even more angry and bored, but at least my life keeps moving forward.

But maybe best case, is it helps me get better. Some achievement sparks something — however small — in me and gives me what I need to keep moving forward.

What do you think? Have you struggled with anhedonia? What have you done to overcome it? Exercise? Medication? Therapy? Just waiting it out? Can I fake it ’til I make it?

What’s It All For?

While struggling with depression, my low days always involve the most misery-making of questions: What’s my motivation? Why am I doing this? What meaning or purpose does any of this have? Why even bother? If it’s not one existential crisis with me, it’s another.

Unfortunately, I don’t have answers. When I am most depressed, I binge on cookies, TV and sleep and do anything not to face these questions. For reasons I cannot articulate, asking these questions and realizing I lack an answer (or worse, that the answer is “there is no reason”) causes me spiritual and physical pain.

When I am well I don’t ask these questions. When I am well, I think less and do more. I get outside of my mind and into the world around me.

When I am not well, doing things that distract me from these questions (even binging on TV) makes me feel better. There is some variation in the quality and lasting result when it comes to distractions from the crisis. Teaching an English class or following my weight lifting routine make me feel better immediately and often continue to help my mood for hours afterward. With TV binges, as soon as the episode ends and the laughter subsides it’s as if the bubble bursts violently and the pain returns. So maybe I should do more engaging things when I am feeling low — to the extent that I can get myself to do them.

My partner has repeatedly suggested I alter my worldview: there is no meaning, but that is OK. I am not ready to commit to that yet. It does have some appeal. Maybe I will find peace when I accept that life lacks intrinsic meaning. That it only has whatever meaning I assign to it. As it stands I experience excruciating pain when I ask the question and then feel that maybe there is meaning for others or even meaning for myself that is as of yet undiscovered by me.

What do you think? Does life have intrinsic meaning? Can we find it or assign meaning on our own? Or does simply accepting the lack of meaning liberate us?

I’m Back!

Hey y’all.  I’m back!

It’s been almost a year since my last post. I can’t believe it! I had to take a break as my anxiety and depression were not well managed and I was downward spiraling something fierce. But I’ve made significant adjustments to my treatment plan and my anxiety is about 85% under control. We’re still working on my depression. That’s more stubborn.

Over the past year I’ve made a lot of progress and experienced significant growth. I’ve become far more accepting of myself. I am not built for a 50-60 hour work week for starters. It’s nearly impossible to get well in this kind of environment. Although doing work that doesn’t go against my values is better than doing work that is in constant conflict with them, I know that I went to law school for a reason and I want to do work that aligns with my values. So as a fourth year associate, I’m planning my exit.

I have had a wonderful experience here at my second firm. I work with great people.  I enjoy a lot of the work and I’ve learned a ton. But I want to do more. My work takes from me, but it never gives back. It isn’t fulfilling. I have come across some slightly non-traditional positions that I think would align far better with my strengths and interests and have started sending out applications. Fear not: my JD will not go to waste. The work will still involve engaging with the law. Cross your fingers for me!

Now that I’m feeling better, I’ve decided to restart the blog because writing is a significant outlet for me and quite frankly I love it.  Even if no one reads it (but hopefully, someone will) it’s good therapy. 🙂

Beautiful Darkness

It was dark. Lonely. Quiet. Beautiful…

I remember the days of my darkest depression in law school fondly.  It sounds strange, I know.

There was no pretense. I was free.  I was shrouded in complete darkness.  I didn’t need to hide as I was protected under the cover of night.  Nothing mattered to me at all. I couldn’t be bothered to get up and get dressed.  I was probably barely even eating, although I really don’t remember.  I just remember the feelings.

I remember the darkness. It tried to overtake me — beckoned me ever further into its depths. I felt the darkness throughout my body. That weird metallic taste in my mouth. The nausea always churning in my stomach.  The headache if I stayed awake too long. The backache if I laid down all day.

Even more clearly I remember that feeling of being past broken. My heart cracked open. The whites were running free. The yolk soon to follow. Anything could bring me to tears.  To swallow those tears would have been to ingest poison.  I needed to liberate them. Unleashing them somehow set me free.

To do well in college and escape familial dysfunction I had made myself rigid.  I had become ashamed of my internal struggles and what I deemed emotional imbalance (i.e., a spectrum of feelings). I threw away all of my journals. ALL OF THEM.  I wanted to bury the evidence if I could.  I needed everything to be perfect. I was inflexible and in ways insufferable.  But I was superwoman. I could have it all. My roommates commented that they’d never seen anyone vacuum so often.  Long before joining a law firm I was scheduling and recording my activities down to 15 minute increments.  If it could be done, I was going to do it.

“As long as I kept moving, my grief streamed out behind me… So I just didn’t stop.” (The Poisonwood Bible, Barbara Kingsolver)  I didn’t want to feel anything.  I didn’t want to be distracted.  I couldn’t risk my emotion bringing me to ruin.  My feelings couldn’t be trusted. So I buried them.

Funny thing about a burial though. The thing doesn’t cease to exist. Ghosts of emotions past start rising up from the places where they’ve been buried in secret and they haunt your life. They will not be ignored for always.

I’ve been told that depression is the absence of feeling. The absence of tears. Something darker still.  If that’s true, maybe what I experienced was not depression at all, but rather grief. So many denials of self over time.  So many funerals for the innumerable times I chose to please the other at the expense of my values, my self-respect and my dignity.

Under the cover of darkness, lit by the moonlight, everything seemed more beautiful.  Even the parts that hurt, just to be reminded that they were there was magnificent. While walking down the street I stopped, leaned over and pressed my nose to a flower and was in rapture.

The gift of my depression was to give the hidden, muted parts a voice and to remove from me all power to turn away.

The darkness lit up the path that brought me back to life.