A Near-Death Experience

As my body prepares for wakefulness after a luxurious sleep of 4 hours with traces of punctilious nightmares, I develop a sneaking suspicion that I might be in a coffin, which is for sure six feet under already. But I don’t fight it. I, being a very patient human, sit tight. My dehydrated brain directs me to take part in this free trial of death. I oblige, and begin to do absolutely nothing. I just play dead. This celebratory experience is shortly halted by a poke, a poke that can eventually turn into a punch if I don’t attend it. It’s my mother, asking me to stop with the drama, and rise and shine.

Sparing her the details, but who is going to tell her that it’s not one of my theatrical pieces, this is exactly how I am feeling, dead, for the last couple of years. If anything, there should be a crowning moment for keeping up with the performances I have to put once I get out of this bottomless pit.

A walking, talking corpse disguised as a normal Human just trying to escape this chemical misery. My spirit is playing an on again off again thing. There’s a short supply of simple bliss in anything and everything I do. My passion has turned nonchalant. Someday I am the Hamster on a wheel, departing nowhere. And on the other, I am that clock ticking, leaving everything behind. I have become a still-breathing-barely- living thing, which is sinking in the quicksand, leading to Hell.

It’s high time for me to stop being delusional, and accept that I may be depressed, and my mental health is at an intense Red alert, which is irony at best- bright Red for a depressing affair. Wakeup before it’s too late. Gravely, stop making a spectacle out of my life. It’s a necessity for me to lend myself a helping hand before I am completely drenched in blue.

If you too are struggling or know someone else is, let’s inspect this venom called depression, which is eroding millions of life, together then, shall we?

Allow me to be your cautionary tale.

The Why(s) of Depression- An Evolutionary Narrative

Evolution gives the impression that Depression is a maladaptive exaggeration of something that is adaptive (favourable) only if present in smaller amounts.

There’s a noteworthy harmony of expressions our body displays in sickness and depression. For instance, Hyperthermia i.e. overheating of this living flesh. When we are awfully ill, our immune system switches on inflammation that further induces fever. Studies disclose that the body degrees of depressed humans are higher as compared to people who are not suffering from it. Well, that expounds my profound hotness.

At present, specified mutated form of a gene labelled as Neuropeptide Y(NPY) is linked with inflammation (an immune approach to wrestle off infections) build up, which presumably empowered our ancestors to be less ill (primarily, in childhood). Individuals with this mutated NPY gene were at higher possibility to free pass it to their progeny.

Now, here’s a compelling learning that Depressed ones are more likely to possess this mutated NPY gene. Looks like it’s time get my genealogy done.

The customary version (the normal one) of NPY gene codes for high measures of a neurotransmitter called Neuropeptide Y, which evidently aids to chase away depression by elevating our stress tolerance. Resultant, the very same recast version (the mutated one) of the NPY gene that likely shielded our ancestors from the microscopic bad guys, also boosts our likelihood of the venomous depression.

Let this be disclosed that Depression may not be just a swap for a potent immune reaction. Studies propose that gloomy warnings such as social withdrawal, lack of vigour, and a loss of delight in formerly delightful pastime were, believe it or not, advantageous to our ancestors. For instance, a depletion of energy might make sure that the body can force all its energy to oppose an infection. In addition to this, social withdrawal reduces the chances of being vulnerable to new contagious elements.

Habitats, which our predecessor inhabited, acute stress was frequently related with the risk of physical trauma, which in modern times has greatly been replaced by psychic torment. Unlike today, wounds speedily led to infections and death. Immune responses to acute stress are normally not a requisite since not every stressful circumstance is followed by an injury and infection.

Nonetheless, if our ancestors suffered any physical impairment, even once, and their immune response wasn’t offensive enough, the odds of them dying were soaring.

So, our brain essentially cannot accept the enormous dissimilarities among these tensions of exceedingly different times on Earth.

A Neurobiological Photograph Of Depression

There are crystal clear differences between a thriving brain and a depressed one.

There are hundreds of neurotransmitters(Chemical messengers) in the brain and billions of connections between neurons. Neurotransmitters in the superior hub of the brain are associated with the supervision of mood and emotion. The all over the place and overflowing Neurotransmitters among these are Glutamate and GABA, which actually run the brain’s dynamic operations and adapting accordingly.

When you are unprotected against severe stress and a long standing one too, a reasonable number of nerve cells’ links disconnect, and the signal transmission get disorganized and noisy. These turbulent broadcasting in the circuits participating in mood and emotion administration contribute to the biology of Depression.

When we narrate about the brain’s architecture there are subtle but obvious differences. A depressed brain kind of appears as follows:

1. Grey matter is thicker in the segments of the brain which is preoccupied in self insight and emotions.
   
2. Brain shrinkage can be seen. The magnitude of Hippocampus and Prefrontal cortex, which are concerned with memory and decisions fabrications, reduce.
   
3. Amygdala, typically associated with the tuning of emotions, is more operative.
   
4. Like, when we are sick, C-reactive protein(CRP), produced by liver rise, causing inflammation in the body. Similarly, more translocator protein is manufactured in the brain that further causes brain inflammation.

Change in brain wave electrical patterns while sleeping(like, lessened deep sleep, and time drained in dreaming), and alterations in cerebral blood flow have shown relatedness with depression.

A Hormonal Balance sheet Of Depression

People with clinical Depression usually have inflated levels of monoamine oxidase A(MAO-A), an enzyme that disintegrates principal Neurotransmitters, namely Serotonin, Dopamine, and Norepinephrine, leading to their decreased status in the body.

Deficiencies and an imbalance of these chemicals have been linked to depression.

These Neurotransmitters can also be classified as hormones depending on their location in the body and the mechanism of their production.

1. Serotonin: The “feel-good” hormone. It regulates mood, appetite and sleep. Chronic stress leads to its short supply.
   Sunlight aids in the maintenance of serotonin by dropping the serotonin transporter’s (SERT) task. Serotonin releasing neurons use SERT to recollect discharged serotonin. SERT achieves a peak status as night stretches, thus, increasing the perils of Depression. This can be effectively recognized in seasonal, especially, winter depression.
2. Dopamine: A catalyst for motivation and the reward system. It explicitly takes part in influencing the neurons that handle habit formation.

Its undersupply leads to anhedonia i.e. the shortage of pleasure or interest in things that were once enjoyable.

Types And Triggers of Depression

There are so many things that can push some people over the edge like trauma early in life, Hormonal changes, substance abuse, emotional and sudden loss, hereditary , sustained stress, any other chronic medical condition, etc.

This venom can manifest in the following versions:

1. Major Depressive Disorder(MDD): It’s the extremely usual one and is also called Clinical Depression. One can experience anhedonia and other symptoms that seriously impair daily tasks.
2. Persistent Depressive Disorder: Also called Dysthymia, is a milder, but a long standing version of Depression than MDD. It’s characterized by a persistent depressed frame of mind for at least two years.
3. Seasonal affective Disorder (SAD): Materializes during winter months when there is low sunlight. Experiences involve low mood, lethargy, overstepping, increased appetite.
4. Postpartum Depression(PPD): Occurs to women after childbirth. Hormonal changes is the key reason. Feelings of sadness, guilt, and difficulty bonding with the baby are prevalent.
5. Bipolar Disorder: Episodes of mood swings ranging from mania( abnormally high energy, happiness, decreased need to sleep) to hypomania( opposite of mania).
6. Psychotic Depression: Individuals can go through hallucinations and delusions.
7. Atypical Depression: Increased appetite, weight gain, oversleeping, feeling of heaviness in the limbs are some of the symptoms that can manifest.

Let’s talk Treatments of Depression

It’s critical to comprehend the evolution, Neurobiology, chemical misery and triggers of Depression in order to grasp the need and approach of the suitable treatment.

1. Antidepressants

At present, the most popularly recommended antidepressants class is the selective serotonin reuptake inhibitors (SSRIs), which include names like Prozac, Zoloft, Paxil, and Celexa. These drugs create a hindrance in the uptake of serotonin by the neurons that produced it, creating this neurochemical’s more availability to the nearest post synaptic neurons.

Similarly, there are other classes of antidepressants that labour on the same phenomenon, just with different chemicals. Such as-

• NRIs: Norepinephrine reuptake inhibitor, e.g. Ludiomil, Norpramin, Pamerol.
• SNRIs: Serotonin Norepinephrine reuptake inhibitor, e.g. Effexor, Cymbalta.

Some other classes of antidepressants include:

Tricyclic antidepressants (TCAs), Monoamine Oxidase inhibitors(MAOIs). These classes show some severe side effects and thereby are considered as a second line treatments i.e. they are only prescribed if drugs like SSRIs are not effective.

Based on the theory that Depression evolved to strongly withstand infectious agents, novel therapies are coming into existence. Like, Infliximab (intravenous route), it works by disrupting the communication between the immune cells that results into reduction in inflammation, but it’s noteworthy that inflammatory biomarkers are not raised in all individuals with depression and thus, may not be successful against it.

2. Psychotherapy (Talk therapy)

Talking, sharing, addressing the underlying causes of depression with a professional.

Cognitive behavioural therapy (CBT): In this type of talk therapy, negative or distorted thought patterns and way of acting are identified that may be contributing to individual’s mental health crisis.

Interpersonal therapy(IPT): This one focuses on improving the person’s relationships and social interactions.

Now let’s look at Mechanical treatments, which are generally reserved for severe cases of depression that have not responded to other treatments.

3. Electroconvulsive Therapy (ETC): Small electric currents are passed through the brain, which can produce changes in the brain chemistry that eases the Depressive symptoms.

4. Repetitive Transcranial Magnetic Stimulation(rTMS): Non-interfering procedure that utilizes magnetic fields to arouse nerve cells in the brain.

A Ritual Sprinkle Of A Personal Note

The most amusing thing I’ve heard when it comes to mental health is a tell by Rodney dangerfield, he says, “ I told my therapist I am having suicidal thoughts, he said I had to start paying him in advance”. It’s funny how challenging affairs like our deteriorating mental health can teach us humour and empathy.

Treatments are definitely available, but can we be real here for a second, it’s available only if money is available. Cheaper alternatives? Well, sunlight, animals, exercise( yeah, I know, but you've got to do what you’ve got to do), flowers, and everything and anything that makes you feel alive again.

After personally experiencing depression I know how exhausted one’s mind gets and how tired the soul already is, and going through so many different stories I realised how I am not alone in my isolated world. I have managed to make myself understand how fortunate I am that these tough times are going to soften for me and many others. No one is asking to find the silver lining here, just a microscopic assurance that we have come this far in all this darkness, searching for a little light from the outside, without knowing if there’s any, and if there is any, it’s definitely inside you.

Just a tiny hope and a tinier cry.

Drop that fake smile, brush off that dust and be there for you, for you with the help of you, within you, and fight for you. You are the one who is suffering, and you are the one who is going to kill it. How? Well, it’s your odyssey, I will leave it for you to explore.

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