If you are struggling with a chronic illness, chances are you’ve also fought or are fighting with depression. When I ask people why they have depression, I get a myriad of different answers. Among the most common are things like, “I’m depressed from all the stress I’ve had in my life” or “I’m depressed because I don’t have enough serotonin”. Most people also recognize that depression is a brain problem. Today I’ll outline the parts of your brain that typically break down during depression, how various anti-depressant drugs work, and how brain-based stimulation can help you!
The biggest players involved in depression are the frontal lobes of the brain. Collectively the frontal lobes are responsible for functions like cognition, judgment, problem-solving, attention, initiative, movement, behavior, libido, and inhibition. We have much more developed frontal lobes than any other animal, so most of our human intellect is contained in this part of the brain. When this area of the brain breaks down, patients are often left feeling depressed, have a lack of motivation, poor cognition, low libido etc. Exactly which problems arise depend on which part of the frontal lobes are not healthy.
The frontal lobes do vary in function and signaling from side to side. For example, there tend to be more epinephrine signals on the right side of the brain and more dopamine signals in the L frontal lobe. Serotonin is highly active in both hemispheres of the frontal lobe.
Let’s take a look at a few different therapies for people with depression and how they work to help the frontal lobe function better.
1. Anti-depressant medication/vitamins:
The most famous class of drugs is called Selective Serotonin Reuptake Inhibitors (SSRIs). Serotonin is a neurotransmitter used for one neuron to signal to another. Basically, these drugs increase the time serotonin hangs out in the synapse (the space between neurons) and thus it increases the firing rate of neurons that use serotonin. There are similar drugs for other neurotransmitters like dopamine and epinephrine. Similarly, these drugs will increase the firing rate of neurons that use dopamine or epinephrine. Since these chemicals are so prevalent in the frontal lobes in general, increasing their levels can help the function of the frontal lobes and help alleviate the depression.
There are also various natural vitamins and herbs that can help with depression including St. John’s Wort, SAMe, Beta-Phenylethylamine (PEA), D, LPhenylalanine (DLPA), and others. I’ll write an article in the future more on the medications and natural antidepressants, but, for now, know that these natural compounds work similarly to the drugs. These compounds tend to increase a particular neurotransmitter such as serotonin or dopamine and thus also increase the firing rate of neurons in the frontal lobes that receive signals from those neurotransmitters.
2. Therapy and Counseling:
I am not going to go into a debate about which type of psychotherapy is the most beneficial, but at this point research clearly shows there is a role for therapy in helping depressed patients.
3. Exercise and Physical Therapies:
Various studies have found exercise to be just as effective in the treatment of depression as antidepressant medication and psychotherapy. While most studies with exercise have been for mild to moderate depression, there have also been positive effects of exercise with major depression. In 1999, a study done on elderly patients with major depressive disorder (MDD) found exercise to be just as effective in treating depression as medication in a 16-week study. While better research on exercise and depression outcomes is needed, the big question we want to ask is how does exercise help a depressed person? Another good question is what type of exercise is most helpful? Indeed, an article in 2009 in the Journal of Neural Transmission describes that the “clinical use” of exercise on depression and anxiety is in its infancy with little known about optimal type, intensity, frequency, and duration.
Originally it was thought the benefit from exercise was strictly cardiovascular. This means it was the blood flow caused by cardio exercise that accounted for exercise’s positive effects. A study published in 1992 blew that concept out of the water. This study compared aerobic and nonaerobic exercise on depression and found while both types of exercise were beneficial, the anaerobic was superior! So if it isn’t blood flow (or at least not exclusively the blood flow), then what is it? Exercise helps to stimulate the frontal lobes, therefore aiding in alleviating depression!
Here is where functional neurology takes this concept to the next level! We’ve established that depression is a brain problem and particularly a problem in the frontal lobes. To help alleviate depression we need to somehow stimulate those neurons so they work better. We can do this with drugs, nutrition, therapy, and exercise. Where functional neurology comes in is in the specifics of brain stimulation to help you.
Exercise is an extremely general stimulation to the brain. Movement sends signals into both sides of the cerebellum which fires the rest of your brain. What if you could do a specific exercise to stimulate the exact area of your brain that needed stimulation? Let’s talk through an example.
I met a patient who really struggled with fatigue and depression. On my exam, I found their left frontal lobe did not function well, and the right globose nuclei of their cerebellum did not function well. I was able to stimulate her right cerebellum exactly where I needed to in order to change her exam, and alleviate her depression. What does this look like practically? I had this patient doing a ton of Right shoulder exercises(stimulates the R. globose nucleus in the cerebellum which feeds into the L frontal lobe) while they smelled a strong scent in their L nostril (stimulates L frontal lobe). Why did this work? It worked because it stimulated exactly the areas of the brain that needed to be stimulated. Is the cure for depression smelling in the L nostril while doing shoulder exercises? NO! However, in this person, I saw how that input changed their frontal lobe tests and since they changed when I did the therapy in my office, I knew it would be effective.
The amazing part about specific, neurological stimulation is it is incredibly easy. In fact, many of my patients can’t believe how simple it is. I have people doing spins in a chair to the right or left (stimulates the vestibular centers in the cerebellum), playing piano with only one hand (stimulates the dentate nucleus in the cerebellum), tracking targets with their eyes in specific directions(again cerebellar), playing catch with only one hand(cerebellar), blinking lights in a specific field of vision(occipital lobe), looking at magic eyes(Parietal Lobe), playing memory(temporal lobe), learning origami(R frontal lobe), playing word games like scrabble (L frontal lobe), and much more. Why does it work? It works because on an exam I can test different parts of their brain and then I can test different therapies right in the office and see if they work! It happens that fast. In order to lock in the changes, I have my patients do these exercises at home.
This stimulation causes something called neuroplasticity. This is literally the growth, development, and ability of your brain to build new pathways and connections! You create these new pathways through constant stimulation and if we know where your brain needs help, we can develop exercises and habits that promote this neuroplasticity in the exact area of the brain you need!
If you’d like to begin to learn about which parts of the brain do what I recommend the book Disconnected Kids by Dr. Robert Melillo. It is written about children but most of the testing in that book you can apply to anyone. He goes through some great lists and tests for various parts of the brain. The Executive Brain by Elkhonon Goldberg also has a chapter in which he goes through several of the brain’s major players in a nice concise way.
Just so you have an idea of what some of the neurological testings are, I’ll link some videos:
Here is a very short video on Optokinetic testing. In this test, the woman has a normal response as her eyes dart back and forth. Many people have a gaze deviation which tells me things about your brain. When I bring the tape to the L you are supposed to stay looking pretty much in front of you. Many people end up looking to one side (either R or L) and that suggests different parts of your brain aren’t working. I would suspect left frontal lobe problems if your eyes moved to the Right when I brought the tape to the Left.
Another piece of the brain involved in many perpetual health problems is the Cerebellum. This is your balance and coordination center. This person is a relatively “normal” guy who has a decrease in function of the R cerebellum? Did you see the left hand go directly to the tip of his nose and the right hand went up on the bridge? As this was subtle and not glaring I would want to confirm with other tests for the cerebellum.
To bring this all together as we end, please remember depression is really caused by aberrant brain activity. Typically this involves poor functioning of the frontal lobes and all therapy should be aimed at increasing the function of the frontal lobes. In order to help the frontal lobes, we can test different areas of the brain and then stimulate them through very specific exercises or movements! The individuality of neurological stimulation can be the missing key to unlocking many chronic illnesses including depression.
If you found this interesting please post questions or comments below. I will do a series where I outline different parts of the brain and some of their connections if people are interested.