The Stigma of Depression and Anxiety

It is difficult to fault “The Greatest Generation.”  After all, they came of age during THE great depression, fought off oppression in World War II, put two cars in every garage and made America into a super nation! This pride and tenacity, however, has led to some challenges for me as doctor.  In the great depression plenty of people were depressed, but back then they had two choices: pick themselves up or get left behind.  The thinking of the day was, “It’s all in your head, just fix it.” and “Weak-minded” was synonymous with depression.  

It's unfortunate that despite the progress we've made, despite enlightening findings with modern science, this stigma persists.

How Hormones Work - Three Helpful Analogies

Hormones are chemical messengers. 

Imagine them as boats.  Some hormones are like speedboats and cross the water at lightning speed.  Some are like ocean liners and move long after the impulse is given. 

Imagine them as as an orchestra. Hormones are like an orchestra making beautiful sounds when all playing in harmony.  But when just one instrument is off key the product is difficult to tolerate. 

Imagine them as a community. Hormones are also like a community, each hormone playing its special role.  Consider the insulin hormone, controlling the metabolism of glucose (sugar) that we take in and facilitating its use by our body. 

 ....Are you getting the picture that hormones are pretty important in our body? ;)

There are three hormones that play an important role in our mood.  These hormones are norepinephrine, dopamine and serotonin.  Deficiencies of these hormones can bring on the syndromes of depression and/or anxiety.

Hormone Deficiency and Depression

Various factors in our environment or from within our bodies can cause hormones to deplete. 

Consider one final analogy in illustration:  If a person gains weight and more weight, their body accumulates an excess of adipose (fat) tissue.  This leads to a dulling of the ability of the insulin hormone and can decompensate into the syndrome of diabetes.  People develop thirst from the dehydration of losing glucose and water volume in the urine, they get blurry vision and tingling toes from excess glucose accumulating in tissues and they also feel fatigued.  The problem here is an ineffective insulin hormone and the syndrome is predictable and varied.

The mood hormones are not dissimilar. 

A person in an adverse situation with the repeated weight of emotional burden can experience a dulling or deficiency of any of the three neurohormones.   Also like the example of diabetes, there may be a genetic predisposition.  A deficiency in these hormones gives for a rather predictable syndrome.  With deficiencies of norepinephrine a person feels fatigued, tired, disinterested and amotivated.  A deficiency in dopamine may also cause amotivational behavior in addition to appetite changes, loss of libido and loss of other drives. 

When serotonin deficient, a person can become  irritable, anxious and impulsive.  They may also be phobic.  At the heart of each of these deficiencies, however, is a depressed mood.  It should be noted that such syndromes may include deficiencies in more than one hormone or a more focused set of symptoms. 

Personality and Depression

It is important at this point to step back and consider personality.  Our personality is forged in our youth.  I’m sure that if I were to ask your family, friends and work acquaintances to describe you, certain resounding descriptions would prevail.  That is your personality, your “hard wiring.”  Depression or anxiety due to neurohormonal deficiency puts us outside of our personality.  There are certain personalities that involve a persistent depressed mood, but those are outside the scope of this discussion. 

My Advice

Seeing the problem as SIMPLY “depression” is to lose sight of the big picture.  I encourage my patients to inquire about any preconceived notions or past experiences.  When we engage in discussions about various therapies, all options are considered and put in the frame of the neurohormonal deficiency.  

There are many therapeutic options to be considered-- psychotherapy/behavioral, pharmaceutical and/or natural.  It is important for the attributes of all to be covered.  In the end, the patient makes the decision about what is to be done.  Owning this decision is important as a first step toward restoration. 

Are you feeling depressed or anxious? 

You are not alone.   

You do not have to go it by yourself. 

Do not be weighed down by the stigma of the past. 

Seek help and begin the process toward restoration.

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