Solomon

"You are in touch with the real terribleness of your life. You can accept rationally that later, after the medication sets in, you will be better able to deal with the terribleness, but you will not be free of it. When you are depressed, the past and future are absorbed entirely by the present moment, as in the world of a three-year-old. You cannot remember a time when you felt better, at least not clearly; and you certainly cannot imagine a future time when you will feel better. Being upset, even profoundly upset, is a temporal experience, while depression is atemporal. Breakdowns leave you with no point of view.

There’s a lot going on during a depressive episode. There are changes in neurotransmitter function; changes in synaptic function; increased or decreased excitability between neurons; alterations of gene expression; hypometabolism in the frontal cortex (usually) or hypermetabolism in the same area; raised levels of thyroid releasing hormone (TRH); disruption of function in the amygdala and possibly the hypothalamus (areas within the brain); altered levels of melatonin (a hormone that the pineal gland makes from serotonin); increased prolactin (increased lactate in anxiety-prone individuals will bring on panic attacks); flattening of twenty-four-hour body temperature; distortion of twenty-four-hour cortisol secretion; disruption of the circuit that links the thalamus, basal ganglia, and frontal lobes (again, centers in the brain); increased blood flow to the frontal lobe of the dominant hemisphere; decreased blood flow to the occipital lobe (which controls vision); lowering of gastric secretions. It is difficult to know what to make of all of these phenomena. Which are causes of depression; which are symptoms; which are merely coincidental? You might think that the raised levels of TRH mean that TRH causes bad feelings, but in fact administering high doses of TRH may be a temporarily useful treatment of depression. As it turns out, the body begins producing TRH during depression for its antidepressant capacities. And TRH, which is not generally an antidepressant, can be utilized as an antidepressant immediately after a major depressive episode because the brain, though it is having a lot of problems in a depression, also becomes supersensitive to the things that can help to solve those problems. Brain cells change their functions readily, and during an episode, the ratio between the pathological changes (which cause depression) and the adaptive ones (which fight it) determines whether you stay sick or get better".

Andrew Solomon