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Depression (known as clinical depression or major depressive disorder) is the most common mental health problem in the nation and across the globe. Everybody gets the blues from time to time. For most of us, we bounce back from these low moods and get back to enjoying our lives. For some people, however, the sense of sadness, emptiness, or hopelessness doesn’t dissipate, and it begins to affect how you think, how you feel, and how you act. When these feelings persist, this mood disorder can interfere with daily life and that can lead to psychological and physical issues.
Approximately 17.3 million people in America are affected by depression, representing over 7% of the adult population. The condition is more common in females, who are twice as likely as men to suffer a depressive episode. Research shows the condition is rising most rapidly among teens and young adults. About 36% of girls will experience clinical depression during their teenage years compared to 13% of teenage boys.
It is estimated that nearly 2 out of every 3 people struggling with depression don’t seek or receive treatment for their condition. When left untreated, depression can ruin your life. Clinical depression increases the risk of substance abuse, destroys relationships, interferes with your ability to excel at work, and makes you more vulnerable to certain medical conditions. For example, people with depression are more likely to develop heart disease and are more likely to die following a heart attack than people without the condition. Even more troubling is the fact that depression is the cause of two-thirds of suicides.
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Brain imaging studies show that depression is not a character flaw or personal weakness. It is associated with biological changes in the brain. People with depression often have too much activity in the deep limbic system—the brain’s emotional centers. But not everyone with depression has the same underlying brain patterns. Brain imaging has taught us is that there are 7 different brain patterns associated with depression, and knowing your type can be the key to getting the most effective treatment.
SPECT (single photon emission computed tomography) is a nuclear medicine study that evaluates blood flow and activity in the brain. Basically, it shows three things: healthy activity, too little activity, or too much activity. A healthy “active” scan shows the most active parts of the brain with blue representing the average activity and red (or sometimes red and white) representing the most active parts of the brain. In the healthy scan on the left, the most active area is in the cerebellum, at the back/bottom part of the brain. The brain scan on the right shows overactivity in the deep limbic system (the brain’s emotional center), a pattern commonly seen in depression.
As mentioned above, Pure Anxiety often results from too much activity in the basal ganglia, setting one’s “idle speed” on overdrive.
Common symptoms of Pure Anxiety include:
Since depression and anxiety frequently occur together, depression is included in this list of the 7 types. Pure Depression often results from overactivity in the deep limbic system—the brain’s emotional center. People with this type struggle with depressive symptoms that range from chronic mild sadness (dysthymia) to crippling major depression that can make it feel almost impossible to get out of bed.
Common symptoms of Pure Depression include:
Mixed Anxiety/Depression involves a combination of both Pure Anxiety and Pure Depression symptoms (listed above). This type shows excessive activity in the brain’s basal ganglia as well as in the deep limbic system. One type may predominate at any point in time, but symptoms of both are present on a regular basis.
Overfocused Anxiety/Depression involves excessive activity in the brain’s anterior cingulate gyrus, basal ganglia, and/or the deep limbic system. People with this type—which occurs more frequently in the children or grandchildren of alcoholics—have trouble shifting attention and often get locked into anxious and/or negative thoughts or behaviors. This can look like:
Common symptoms of Overfocused Anxiety/Depression include 4 symptoms of Pure Anxiety and/or Pure Depression (listed above), plus at least 4 of the following:
Temporal Lobe Anxiety/Depression reflects too little or too much activity in the temporal lobes, which are involved in mood, emotional regulation, and memory, in addition to overactivity in the basal ganglia and/or deep limbic system.
Common symptoms of Temporal Lobe Anxiety/Depression include 4 symptoms of Pure Anxiety and/or Pure Depression (listed above), plus at least 4 of the following:
Cyclic Anxiety/Depression is associated with extremely high activity in the brain’s basal ganglia and/or deep limbic system that fluctuate in intensity. These areas of excessive activity act like “emotional seizures” as the emotional centers hijack the brain for periods of time in a cyclical pattern. Cyclical disorders, such as cyclothymia, bipolar disorder, premenstrual tension syndrome, and panic attacks are part of this category because they are episodic and unpredictable.
Common symptoms of Cyclic Anxiety/Depression include 4 symptoms of Pure Anxiety and/or Pure Depression (listed above), plus periods of time with at least 4 of the following:
Unfocused Anxiety/Depression is associated with low activity in the prefrontal cortex (PFC) in addition to high activity in the basal ganglia and/or deep limbic system. The PFC is involved with attention, focus, impulse control, judgment, insight, organization, planning, and motivation. When the PFC is underactive, people often have problems with these executive functions.
Distinguishing Unfocused Anxiety/Depression from ADD/ADHD can be difficult because of the similarity in symptoms. However, brain imaging provides a window into the brain to see the areas with too little or too much activity. This allows for a more accurate diagnosis.
Symptoms of Unfocused Anxiety/Depression include at least 4 symptoms of Pure Anxiety and/or Pure Depression (listed above), plus at least 4 of the following:
A variation of Unfocused Anxiety/Depression is caused by overall reduced blood flow in the cortex along with too much activity in the basal ganglia and/or deep limbic system. This pattern may be related to physical illness, drug or alcohol abuse, hypoxia (lack of oxygen), infections (such as Lyme disease or COVID-19), traumatic brain injury, or exposure to toxic mold or other environmental toxins. Symptoms of this variation also include frequent feelings of sickness, mental dullness, brain fog, or cognitive impairment.
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