The Neuropsychology of Depression

In his recently released autobiography, Ian Thorpe describes how he has suffered from depression most of his life. Like many young Australians with depression, the 30-year old revealed that he kept the illness behind closed doors to the point that not even his family and close friends were aware of his battle with the mental illness, and rather than seeking professional help he would instead often turn to alcohol. He recalls in his book periods of low mood that would often last a month, during which he contemplated suicide.

Depression is not uncommon in young Australians, with approximately 160 000 individuals between the ages of 16 to 24 years of age living with the mental illness. Like Thorpe, a high percentage of sufferers experience suicide ideation and such individuals are at increased risk of completing suicide.

Depression is mainly known for its affect on mood. A lesser known fact is that sufferers also exhibit a number of neuropsychological impairments. Research has shown that individuals with depression have poorer episodic memory and slower psychomotor speed. In addition, those with depression exhibit difficulties with problem-solving, planning and mental flexibility.

The range of cognitive impairments seen in individuals with depression is the consequent of several biological changes in the brain. One of the most widely researched biological dysfunction concerns a deficiency in Serotonin, an important neurotransmitter that is known to mediate memory and learning. Brain MRI studies have shown that, relative to healthy controls, individuals with depression have decreased activity in the frontal lobe, an areas of the brain important for problem-solving, planning and mental flexibility. In addition, research has shown that depressed people exhibit abnormal activity in the amygdala, an area important for processing emotional aspects of information.

Thorpe described that after years of suffering with depression he finally consulted with his doctor who prescribed medication “but little in the way of explanation”. Ironically, he noted that this consultation isolated him further as he felt he "now had a secret and no one to share it with.”

While most antidepressant medications are thought to improve symptoms of depression by correcting deficiencies in Serotonin, they are not affective in addressing the important psychological component of the mental illness, namely negative and maladaptive thinking-patterns. This is usually addressed by supplementing antidepressants with some form of cognitive therapy. Interestingly, there is some preliminary evidence to suggest that cognitive therapies may in themselves alter neural circuitry and normalise abnormal amygdala and frontal activity. Whether these changes lead to corresponding neuropsychological improvements, however, is yet to be determined.

New evidence regarding ECT

Mention ECT (Electroconvulsive therapy) to most people and they are likely to imagine a scene out of One Flew Over the Cuckoo's Nest with a patient being involuntarily strapped to a table and given a painful electric shock.

However, ECT is actually a humane and effective treatment for patients with mood disorders like severe depression, particularly in cases when alternative treatments have been ineffective.

Current techniques involve first anaesthestising the patient and then electrically inducing a seizure.

Whilst it has been used successfully in clinical practice for 70 years, until now it has not been well understood how or why it works. Prof Ian Reid and his team from the University of Aberdeen in Scotland found that ECT changes the way different parts of the brain communicate. By comparing the brains of people before and after the treatment using brain imaging they showed that ECT reduces the strength of overactive connections between parts of the brain that control mood and those that control thinking/concentrating.

This finding could help improve diagnosis and treatment of mental illness and other disorders including schizophrenia, autism and dementia.

One of the possible side effects of ECT is memory loss. A neuropsychological assessment can be used in conjunction with ECT to monitor any changes in cognition. To find out more about our neuropsychological assessment services contact us.

Garry McDonald

Best known for his screen character Norman Gunston and show bearing the same name and endeared by the Australian community for his portrayal of Arthur Beare in ‘Mother and Son’ with Ruth Cracknell. Spoke candidly of his struggle with major depression and anxiety during an interview with Andrew Denton in an episode of ‘Enough Rope’. Speaking of depression and the symptoms, he said:

I couldn't get out of bed, I couldn't concentrate, I'd go to work and I'd just, was like a fog.

He went on to describe an extraordinary event, while waiting thirty minutes to see his doctor; he ended up sitting on the kerb at the edge of the road, almost in a foetal position.

And I went off to the doctors to see the GP and I remember they said, 'oh you can see him in half an hour'. And I went outside and sat in the gutter, well on the, on the sort of edge you know. And it was like you had this sort of extraordinary hangover. And you know eventually I mean you do, you end up being in the foetal position, it was extraordinary.

We all need a break sometimes, take some timeout, get away from it all, the pressures of work, the commitments, the dead-lines and work related stress factors. Usually we only need a couple of days at the shack, a weekend fishing up in the mountains or down the coast, a short getaway; but sometimes it’s more serious than that. We ignore the signs, press on regardless, keep up appearances, maintain the pace, but in the end the human brain will protect itself, it will shun the overload, it will take a break regardless.

Gary now an advocate for mental health awareness, a board member of Beyondblue, an Australian national depression initiative, for which he was recently awarded by becoming an Officer of the Order of Australia. He recommends walking on a daily basis, saying this is the best advice he received from any psychologist and the best advice he could offer to anyone struggling with severe depression.

Take a twenty minute brisk walk each morning; it’s very, very good.

It’s good advice, though exercise would possibly be the last thing you want to do when suffering from depression or anxiety, it doesn’t need to be intense exercise like one of Forrest Gumps marathons, try a little gardening, take a stroll in the park, walk the dog to the store to buy it a treat each morning, something for yourself too. The main thing is to get up, get going, anything to get you off the sofa. Exercise will help release good brain chemicals (endorphins) that will help counter depression; exercise is also a good detox, reducing bad chemicals in the immune system; exercise also raises the body temperature which can produce a calming effect, compensating feelings of anxiety.

Exercise has some positive psychological effects too, you will increase confidence levels and emotional feelings of self worth, by maintain goals and nurturing a sense of achievement on a daily basis. It’s also a great distraction, takes your mind off all the worries and junk thoughts that are holding you down. You may even meet people, a little social interaction along the way, a smile or a good morning greeting from other people in the neighborhood can have a positive effect on your mood. The journey through depression is a one step at a time process, but it starts with a single step and culminates in a new lifestyle, a new you, with your life back on track, maybe better than ever before.

It's a fine line

We have all heard the saying "there's a fine line between genius and insanity". There have been many great and inspired people through the ages, who have achieved fame and accolades, the same have also been mentally ill or psychologically impaired. Many who suffered the constant change of depression, battling mood swings from the lowest of lows to the highest of highs. In the high times they created masterpieces of literature inspired art or music, the same ones when enduring the low times, destroyed their own works, burned their literature, trashed their inventions or inflicted themselves with horrendous self-harm and in some cases, ultimately; chose death.

"On a clear day, you can see forever", who said that? Whoever it was, was no stranger to depression, because that's what it's like. When you are up, anything is possible, the thoughts flow freely, nothing can stop the creative process, a torrent of energy that knows no bounds. You make plans, big plans, long-term goals and visions, you can see it all so clearly, you set things in motion, make commitments, appointments and agendas. The problem is, when time comes to meet the commitments, attend the appointments, it's not a clear day anymore, cognitive functioning is diminished, you can't see it how you did the week before, a dull grey memory clouds the brilliance of yesterday.