Minds, Chemicals, Nerves: Depression

Depression is an infection in that place where light should enter.

“Run from what’s comfortable. Live where you fear to live. Destroy your reputation.”
— Jalāl al-Dīn Muḥammad Rūmī

States

I’m all about states of mind. Each of my various projects requires a different state, and navigating between states is critical.

I am familiar with these states and I shuffle between them like I put clothes on for the day. I have expectations and plans and I intentionally move between several states of mind.

Chemistry

Chemistry affects the mind. The simplest are those chemicals that create pain or pleasure. Then there are biological effects on the mind, like sleep, a good meal, indigestion, and exercise. With some skill, we manage these to positive effect.

I had an infected wisdom tooth removed months ago, but the infection remained. It’s taken me three courses of increasingly strong antibiotics to knock it out. Now, I hope, it’s gone.

This last course was unusual as we added Metronidazole, a drug designed to kill anaerobic bacteria. It has a long list of negative side effects, and I experienced many of them. One of them was depression.

Depression’s Many Faces

There are many depressing things, but, for some reason, we don’t recognize them as having separate effects on our mind. We feel the same malaise whether it’s triggered by ill health, bad luck, or low self-esteem. This is a human mental defect because these causes should enable us to recognize distinct situations. Instead, they all contribute to depression.

A large amount of counseling for depression teases these causes apart. Cognitive therapy supposes that identifying separate triggers and approaching them with separate solutions will lift depression’s causes. To this is attached the pharmaceutical approach, which claims to address depression’s chemical origins.

There is little crossover between these two approaches. Psychiatrists prescribe drugs with little understanding of emotions, while counselors engage emotionally without the ability to prescribe drugs. My experience with Metronidazole reminded me that the third approach of mental state management is pursued by neither counselors nor psychiatrists.

Mental State Management

Mental states can be described as states of thought, behavior, or neurology. These are different, but interdependent. Many of our states are automatic and habitual. We can recognize our state of mind even when we have no control over it. It may take some time to cool off or heat up, but this doesn’t provide control.

You can control your behavior using your intentions. This comes naturally to some extent, but we have limited experience in dealing with stressful situations. We’d rather avoid them. Depression gets the better of us.

Developing control over your state of mind through focus and attention is the goal of mindfulness and meditation. But skill in entering a relaxed state gives you little control over other mental states.

It’s valuable to be able to attain a calm and relaxed state. It’s a gateway to peace, awareness, and sleep. But dealing with depression, high stress, or demanding actions in the moment, requires special skills. In particular, skills that are not relaxed and contemplative. You may have a desire to reach a relaxed and contemplative state, but relaxation and contemplation will not resolve the pain.

During my treatment with Metronidazole, I’d wake up depressed and have bouts of hopelessness. It would take me a minute to realize this was an induced state of mind and not a true reflection of my situation. The state was induced.

This recognition was a path to clearing my head. I would say to myself, “This is the drug. It is making me feel this way because it’s interfering with my chemistry. I do not need to accept these feelings.” It was encouraging to know these moods would end when I stopped the drug.

The Drug Pushers

Selective serotonin and norepinephrine reuptake inhibitors, SSRIs, are drugs which interfere with the communication between nerve cells. We’re told that a deficiency of these enzymes leads to depression, and that depression can be relieved by boosting their concentration. According to the theory, increasing them in the blood will increase them in the brain, which will increase them in the synapses, which will enhance happy, life-affirming thoughts.

There is no real understanding behind this theory, but it’s tested by giving people these drugs and seeing if they work. When they work, we say they’ve demonstrated their efficacy and prescribe them.

Careful experiments show they work half the time (Hengartner 2020, Pies 2012), are “modestly” effective (Cipriani et al. 2018), or work poorly (Kirsch et al. 2008, Penn 2012). Antidepressant drugs may not improve long-term quality of life (Moyer 2023), yet we prescribe them anyway, and people swear they are effective.

Part of this paradox is resolved by the placebo effect in which a person’s positive intention contributes to the treatment outcome. In this, stimulating a person to think they can get better encourages and fortifies them. Subjective feelings help to rejuvenate and vitalize us.

The chemical effects are not separate from environment, behavior, and awareness. My experience with Metronidazole showed there is a mind-drug connection. This was further confirmed when I finished with the drug and the depression wore off. What I had experienced was a side effect of the drug, and not a natural depression.

It’s not clear if this is related to serotonin, but most of the brain’s serotonin is produced by organisms in the gut. Metronidazole, an antibiotic, may kill the organisms that produce serotonin. This could have precipitated my depression, but it could also be due to more subtle pathways.

No one knows why SSRIs are effective or why they fail, but my experience shows there is a gut-brain connection. It’s also clear that one’s intentions, behaviors, and expectations play a role.

My clients will tell me they’re depressed, and it’s hard to relieve depression through conversation. It’s unclear how much control a person has over their depression, and it’s unclear if their problem is living a depressing life, or having too little control over their state of mind.

The Neurology Underneath

One part of your brain feeds you anxious thoughts. Another part feeds thoughts of contentment. Training a person to lower the amplitude of their brain waves in the anxious area while raising the amplitude in the contentment area reduces depression in half of those trained (Hammond 2005). This is a more robust and enduring effect than results from the administration of drugs, but you have not heard of it.

Not all depressed persons exhibit this electrically unbalanced condition, so not all depressed persons benefit from this kind of training. But the real reason this treatment is not offered is because it threatens the profits of pharmaceutical corporations. Such political and financial barriers are common in the world of medicine.

Forget the Psychology

There is little consensus about what it means to be intentional. Does it mean that you say you want to do something, or that you act as if you do? What resources does a person marshal when they make an effort? Just because a person says they want something doesn’t mean they know how to get it.

Most psychotherapy addresses reasonable or unreasonable thinking. This cognitive behavioral approach is based on the idea that if you’re directed to do the right thing, then the right thing will result. This seems small minded to me.

I argue with my clients about what they really want, and how committed they are in working for it. Things always come up: conditions, exceptions, details, and interpretations. Most of what I talk about is finding one’s goals and aligning with them.

I talk about what it means to commit and to act. Is this just encouragement to “do whatever,” or is there some new skill involved? I direct clients toward the idea that it’s not just what they think about, it’s how they assemble and maintain their thoughts. Until you can manage a project, it doesn’t matter what project you pursue.

I’m most interested in whether people recognize the importance of attention, focus, patience, and mood. This brings me back to the issue of state of mind. It is one’s state of mind that generates the placebo effect. It’s more than wishful thinking. Once you direct your state and align your mind the effects are synergistic. Things start working in synchrony.

Understand that your thinking mind is just a manager, a cheerleader for your sense of purpose and commitment. Your effect is more than mechanical. It’s your intuitive abilities, which you learn through practice, that create results.

Do It Your Way

This is where I use hypnosis. I want people to immersively visualize what they want. If there are reservations, I encourage them to present themselves. And where people need guidance, I want that guidance to come forward.

I feel this is similar to dreamwork, and that’s why I encourage dreamwork. In dreams, situations arise where fears and reservations present themselves. This happens in a preverbal and authentic way which demonstrates the ambiguity of our feelings. We visualize our feelings. Until we encounter all of what we feel, we cannot understand our feelings.

This is my approach to everything from depression to physics. The most important question is what does this mean, not how can I understand it. The most important questions don’t have answers, or have answers you may never find. They have meaning, and meaning is something you have access to at every moment.

“Whoever finds love beneath hurt and grief disappears into emptiness with a thousand new disguises.” — Jalāl al-Dīn Muḥammad Rūmī

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References

Cipriani, A.They A., Salanti, G., et al. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis, The Lancet, 391 (Apr. 7):1357-66. https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)32802-7.pdf

Hammond, C. (2005). Neurofeedback Treatment of Depression and Anxiety, Journal of Adult Development, 12 (2-3): 131-7. https://www.brainmaster.com/software/pubs/brain/Hammond%20JAdultDevelop.pdf

Hengartner, M. P. (2020 Jan-Dec). How effective are antidepressants for depression over the long term? A critical review of relapse prevention trials and the issue of withdrawal confounding, Therapeutic Advances in Psychopharmacology, 10. https://journals.sagepub.com/doi/10.1177/2045125320921694

Kirsch, I., Deacon, B., Huedo-Medina, T., Scoboria, A., Moore, T. and Johnson, B. (2008) Initial severity and antidepressant benefits: A meta-analysis of data submitted to the food and drug administration. PLoS Med 5: 260–268. https://pubmed.ncbi.nlm.nih.gov/18303940/

Moyer, M. W. (2023 Jun 22). How Much Do Antidepressants Help, Really? The New York Times. https://www.nytimes.com/2022/04/21/well/antidepressants-ssri-effectiveness.html

Penn, E., Tracy, D. K. (2012). The drugs don’t work? antidepressants and the current and future pharmacological management of depression, Therapeutic Advances in Psychopharmacology, 2(5): 179-188. https://doi.org/10.1177/2045125312445469

Pies, R. (2012 May). Are Antidepressants Effective in the Acute and Long-term Treatment of

Depression? Sic et Non, Innovations in Clinical Neuroscience, 9 (5-6). 31-40. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398684/pdf/icns_9_5-6_31.pdf