Adventures in insanity: How some anti-depresants work - a personal interpretation

So hey, in case you didn't know, I suffer from bipolar disorder. Bipolar II, to be exact. That's the one with the mild little hypomanias (because full-blown manias are just too much fun, I can't be allowed to have me some) now and then and the monster depressions. We're in the depression part of the cycle right now and have been for more than a year.

It's getting kind of old, actually. Ally from Hyperbole and a Half explains this beautifully: the sadness for no reason, the trying to get yourself to do something (and failing miserably), the boredom and ennui. Oh Lordes, the ennui.

So anycase, it's been getting worse for a while now without me really noticing (thanks new meds! That worked out really well!) and now we have to do med-adjustment once again. Which kind of feels useless at this moment, but then so does everything else.

So I was thinking about how one would explain the chemical phenomenon of depression to someone else who wasn't familiar with it, maybe like someone who needed the meds but didn't want to take it because hey, stigma is still a thing in 2014. And I remembered parts of a pharmacology class I once interpreted that explained it really, really beautifully. But I only remember bits and pieces of it, and it simplifies things a lot. The real process is a lot more complex, but it gives one an idea of what's up with the constant damn depression, and so I thought "Hey self, we'd better get this shit written down, because our brain looses shit like that little chipmunk thing in Ice Age looses his acorns".  So here goes my extremely basic and limited understanding of the biochemistry involved.

In your brain there are stuff called neurotransmitters. Now when we're talking depression (and other psychological and non-psychological disorders like Alzheimer's and Parkinson's too! But for now we focus on depression) these neurotransmitters is where shit is at. Why? The answer is slightly complicated, so stay with me here.

Some complicated-ass picture that explains how the neurotransmitters and synapse work in transmitting a message (also called an action potential).

When the brain needs to send messages (and messages can be anything from "keep breathing" to "hey, hot pot touching = bad idea!" to whatever), the message goes from cell to cell until it reaches the place it needs to be (like the fingers, in the case of the hot pot). This happens incredibly fast, obviously, but that's neither here nor there. The important bit here is how the message goes from cell to cell in the brain.

So let's call the cell that currently contains the message the sender cell, and the cell where the message needs to go next the receiver cell. Of course you'll see that once the message reaches the receiver cell, the receiver cell now becomes the sender cell and the next cell in line becomes the new receiver cell, right? Right.

So now, when a message comes through (which happens very, very often, as you can imagine), your neurons have a set pattern of behaviour. The sender cell releases neurotransmitters that go out and fills the gap between the sender cell and receiver cell. These neurotransmitters relay the message from the sender cell to the receiver cell, and once this is done, it gets reabsorbed so that it can be ready for release when the next message comes.

There are more than 100 identified neurotransmitters, and the release of each one of them has a certain effect on the brain. When we talk about depression specifically, there are three specific neurotransmitters that seem to play a significant role: Serotonin, norepineprhine and dopamine.

Now, the reactions and  in the brain when one experiences trauma or stress is very, very complicated but once of the things that happens is that there are so many messages sent so quickly that the reabsorbtion (or reuptake) of serotonin, dopamine and norepinephrine go into overdrive, trying to reuptake them as soon as possible to deal with the burden of the stress. It's like the brain goes into a triage kind of system: doing this isn't a good thing in the long run, but it will help us survive for the short term so let's do this now and we'll sort out the long term later.

A brief overview of what the three neurotransmitters involved in depression do in the brain and how they interact with each other.

As you can see from the picture, the three neurotransmitters involved in depression each has an effect on the brain. You can also see how they interact with each other to have complex effects. So now it's easy to see how messed up shit can get when these neurotransmitters are not in the correct balance with each other, or if something else is out of whack with them, right? Right. So the effect of the stress we talked about earlier is that the brain, in order to keep up with the demands the stress place on the body, basically causes a disturbance in how much of these neurotransmitters are hanging around between the synapses, doing their thing. The longer this goes on and the more severe the imbalance is, the more pronounced the symptoms you'll show from this imbalance.

After the period of stress is relieved, the brain recognizes that it no longer needs to reuptake these neurotransmitters like a demon and gradually returns to its former functioning. If this happens, everything is fine, congratulations, collect your prize when you leave the door healthy and happy.

However, in depression, one of the things that can happen either because of a genetic predisposition, prolonged stress, or a number of other factors, some which aren't understood or known yet, this process sometimes doesn't return to normal.

The brain has gotten so used to dealing with the high stress environment and reuptaking these neurotransmitters as soon as possible, that it 'forgets' that this isn't actually the way it's supposed to do things. So now, when the cause of the the initial stress reaction is taken away, the brain keeps on following this same pattern it got used to when stress was high and fast reuptake was necessary. This means that there's not enough serotonin, dopamine and norepinephrine just lying around the brain, mellowing things out and doing what they're supposed to be doing to keep the brain functioning optimally.

This is obviously a problem, and depending on the degree in which the brain is malfunctioning and the balance of the neurotransmitters left in the brain, able to do their jobs before being reuptaken, things can get really serious really fast, to the point where the lack of appropriate neurochemicals can lead to the brain losing its number one drive: to stay alive.

When you look at the anti-depressants that are available with the knowledge you now have, you'll have a better understanding of what they do. Like SSRI's: that stands for Selective Serotonin Reuptake Inhibitors. The "inhibitor" part means that it prevents or discourages something (just as a quick, layman's explanation), so what SSRI's do is they discourage the reuptake of some ("selective", there's more than one type of receptor for serotonin, because things aren't complicated enough already) of the serotonin in the brain, meaning that there's more serotonin hanging out in the gap between synapses, able to do its thing to the brain.

And that's why taking medicine for depression is not a "weakness" or a "crutch" or any of the stygmatizing things that people like to say about this. It's taking medicine for a legitimate medical issue.

Just for interest's sake, did you know that Parkinson's is caused by a problem with the dopamine neurotransmitter in the brain? Just like depression is caused by a problem with dopamine, serotonin and norepinephrine in the brain. You wouldn't tell someone on meds for Parkinson's that they're just "weak", and that they need to pull themselves together and choose to (be more positive) tremble less and all that shit, would you? Of course not. Yet it's the same as depression!

So why is it different when it's depression?