I was asked by a friend to explain my depression. She has a 'son-in-law' who is self-medicating his depression with metamphetamine and wanted to understand why he chose to become addicted to this powerful substance that would destroy his life in the end. He had insisted to her that this was a really magic drug for treating depression and should be made legal. I could really understand this sentiment. Not that I've tried meth but have read enough about brain neurochemistry to know what dopamine boosting drugs can do. Plus I have talked to a person who had tried meth once and he was gushing about the euphoria it brought to him. So I wrote her a longish Whatsapp message about what I knew. In this post, I will try to expand on that..
Depression is a real disease in the sense that it has a physical mechanism that turns a mood like sadness into a chronic rewiring of the brain circuitry to shift the brain into a persistent negative affective state marked by hopelessness. Simply put, evidence points to the lateral habenula, a tiny limbic brain region, that muzzles the reward center of the brain, becoming dominant. Suppressing this region has been proven to cure at least one patient of lifelong severe depression through the use of deep brain stimulation (suppression in this case).
A team of researchers at Zhejiang University in China did some outstanding research to demonstrate this mechanistic basis of depression. A shorter read here. It's a bit of Ying-Yang. Two things you must understand about the brain. First it is comprised of many interconnected parts, each doing different tasks. The connections between the parts strengthen and weaken with experiences, neuroplasticity. If the anti-reward center starts to dominate, that’s sadness. Normally everybody has a slight optimism bias i.e. the reward center is dominant. When events or biology starts to make the anti-reward center dominate, the sadness comes and if it doesn’t go back to the balance point, depression starts.
The reward center (or motivation center) runs on dopamine. So nictotine, cocaine and meth boost it's activity and shifts the balance towards positivity. But also cause addiction.
Not quite the right direction for treatment.
Suppressing the lateral habenula doesn’t come with addictive side-effects. Drugs that can do that are been investigated and may be the way forward in the future. To finally make depression a medically curable disease.
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