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Stress Sending Brain on One-Way Road to Depression



Stress and depression - perhaps the two psychological states discussed most by Americans in recent years - are profoundly linked, top officials at the National Institute of Mental Health say.

Psychologists and psychiatrists have known for decades that stress can lead to depression. "A rat always chased by a cat doesn't have much time to enjoy life," said Philip Gold of the institute. Post-traumatic stress disorder also often involves depression.

But recent developments in brain imaging and other areas of neurology show that stress actually works to "rewire" the brain's emotional circuits. So depression becomes not just an emotional and psychological result, but a physiological one.

Especially with victims of severe stress, depression can be caused by more than just chemical imbalance in the brain. A stressed-depressed brain alters its connections and actually operates differently.

"This is a systemic disorder," Gold says. "It affects the circuits of the brain."

Severe stress like growing up in poverty can reshape the brain, but so can ongoing work stress, experts say. Suddenly the little, mock horror-movie poster pinned up in your office cubicle, the one that reads "The Job That Ate My Brain!", has a very serious connotation.

"Stressed-out" is a national buzzword, and more than 18 million Americans suffer from clinical depression each year. Many sufferers have a genetic tendency toward depression passed down from a family member. They are especially vulnerable to stress.

Millions of school kids are beginning stressful schedules far earlier in life than previous generations. So this stress-depression link presents both a major concern for the future, and new clues for researchers. Gold and others say this link could lead to important new medications and "a roadmap to treatment."

The hope is that stress-mediators could work with anti-depressants to stop the cycle before it reshapes the "wiring" between the brain's fear center in the amygdala and the emotional monitoring that goes on in the prefrontal cortex.

And there's another reason for hope: The reshaping of the brain might be reversible. One of the key findings of recent brain imaging is that the brain is highly adaptable.

Nerve cell connections can be destroyed by depression, but perhaps they can also be rebuilt again. "The big news is the structural plasticity of the adult brain, the remodeling of neurons," neurobiologist Bruce McEwen of Rockefeller University told Psychology Today.

The stress-depression connection could also lead to applications for our daily lives - especially if we know we're at risk for depression.

For instance, if work is taking over your life at the expense of common pleasures, you need to make time in your daily routine to give your stressed-out brain a break. Many of us think we can "put our heads down" and get all our work out of the way, then enjoy a large block of free time. But as work expands and our communities wither, many Americans find themselves either working hard or socially isolated. And that makes us increasingly vulnerable for stress-depression cycles.

Stress causes the "fear center" in the amygdala part of our brains to take over our emotions and affect our thinking. Some people are able to use that healthy fear to respond to a hectic or frightening situation. The stress response is supposed to shut down when the stressful event passes. Then most people can enjoy a full range of emotions again.

But if someone is clinically depressed, the chemical imbalance in their brain often keeps the stress system active. High-tech brain imaging scans show that victims of long-term stress actually fail to experience positive feelings in the prefrontal cortex, the area of the brain just behind the forehead that establishes and maintains emotions. In these brains rewired by stress, fear and dread then surge unchecked from the amygdala to the prefrontal cortex.

And the stress response never rests, precipitating depression.

Drug companies are pushing for new drugs that address the stress-depression connection, Gold says. In the meantime, antidepressants like Prozac might not be enough; psychotherapy is also often needed.

"You can't just give them medication and say goodbye," says Gold, a product of Duke University and its medical school. Talking about the stressful memories and situations that often lead to depression can help to reverse the cycle.

Yet the number of patients taking medication has risen as the number treated with therapy has fallen. Studies back up Gold's assertion that a combination of both medication and therapy provide the most effective treatment.

Gold's boss at the NIMH, Director Thomas Insel, agrees.

"Many people say therapy is too inconvenient. They can't get a sitter or take time out from their day," Insel says.

Perhaps our culture needs to learn to view therapy as being like rehabbing a knee injury, Insel suggests. If you don't put in the time to strengthen that knee, it won't recover and regain its stability. Recognizing therapy as a tangible and common-sense approach might help remove some of the stigma against it.

The psychiatrists, neurologists and other experts on the brain and behavior spoke at a seminar on the brain last month at the Knight Center for Specialized Journalism at the University of Maryland.


  1. Stress and depression are profoundly connected. There are things you can do to battle both.

  2. Sleep and rest - Essential for coping with hectic situations and recovering psychologically.

  3. Healthy diet - Processed and junk food can add to both stress and depression.

  4. Avoiding alcohol - It might seem to relieve stress, but it also acts as a depressant.

  5. Avoiding caffeine - It can play havoc with stress and disrupt your health and sleep.

  6. Regular exercise - A great reliever of stress and natural anti-depressant.

  7. Social connections and diversions - Taking time for more than work is important.

  8. Taking work breaks - Remember, your emotional and psychological health might be involved.

  9. Getting therapy if you need it - Anti-depressants might not be enough. Many people need both.

Dave Turo-Shields (email)
Veteran Psychotherapist, Trainer & Life Coach

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"The time to relax is when you don't have time for it."

  ~Attributed to both Jim Goodwin and Sydney J. Harris


Comments on article

Common sense has told us for years that stress leads directly to depression, as well as many other medical illnesses.  Now we are beginning to accumulate proof of the physical manifestations of stress.  

Many of these conditions are reversible if you take action.  Some of you may already be depressed, others have a high level of stress and are on the brink of depression and anxiety.  

Take the action you know you've been putting off.  If it's therapy, so be it.   You're worth it.  If it's high stress, a great coach can help you lift yourself onto a whole new, and much happier playing field in life.

Give me a call to discuss options.

Dave Turo-Shields

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