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What's the difference between depression and sadness? How do antidepressants work? And do ALL therapists wear tweed jackets?

Depression is a mental illness that affects millions of people, so let's try our best to really understand it. Time to break down some common myths and misconceptions about mental illness.

Join host Justin Dodd in an endless pursuit of the truth.

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Either you or someone you know probably goes to therapy.

For me, it’s every Thursday evening. You show up, you lay down on a fancy old couch, your therapist, who probably sports a goatee and tweed jacket, asks you about your childhood and shows you some Rorschach ink blots.

By the end of the session, you truly understand your deep-seated fear of clowns. Sound about right? That image represents a pretty common misconception about therapy.

What we just described is actually a fairly outdated amalgamation of psychoanalysis, made famous by Sigmund Freud, and Hermann Rorschach, among others. And most psychologists can tell you, we’ve moved on from many of these early practices. And while this work has influenced the more-modern psychodynamic therapy, this is still just one of many kinds of therapy treatments for depression.

Some more common forms of therapy are cognitive behavioral therapy and dialectical behavioral therapy. But that’s just the tip of the iceberg, there’s also music therapy, somatic therapy, hypnotherapy. All very real ways to help people deal with depression.

Which, according to the World Health Organization, is something that over 260 million people worldwide deal with. So if you thought this was an uncommon problem, congratulations, you’ve been misconcepted. Or, uh, misconceived?

Misconceptionized. Nope can't get it. Hi, welcome to Misconceptions.

I am your host who suffers from depression, anxiety, and acute bipolar disorder, Justin Dodd. Today we’re talking about misconceptions about depression. I know, I know, it sounds like it’s going to be a FUN and HILARIOUS EPISODE.

But in truth, talking about mental health, breaking down stigmas and socially constructed walls, these are things I’m truly passionate about and I think is very important for everyone, those who suffer from mental illnesses and those who don’t! And what’s more fun than debunking myths with your friends? Let’s go.

While public knowledge and understanding of mental health has gotten much better in recent years, there still is a strange, underlying conception that some people have: It’s all in your head. Depression is something that can be thought away, because that’s all it really is, bad thoughts. I mean, why be depressed?

Just be happy. Holders of this belief are dumb buttheads and I do not respect them, but they have inadvertently landed on an important truth about depression. It is, in some respects, all in your head.

Like, literally, the very real, biological realities of your brain. Also real quick, we like to use images in our videos to help convey ideas, but fair warning, I’ve discovered that photographers and illustrators have a hard time portraying depression in a way that isn’t… patronizing or dramatic. So, bear with me a little bit.

A bonus misconception, depression looks like sitting sadly near a rainy window, according to stock photography. Like, the description for this one is literally “depressed baby”. Yeesh.

Anyway. The causes of depression are a very active area of research—wonkiness with certain neurotransmitters in the brain are widely thought to be a major cause, and according to Harvard Medical School “nerve cell connections, nerve cell growth, and the functioning of nerve circuits have a major impact on depression. Still, [researchers’] understanding of the neurological underpinnings of mood is incomplete.” Part of the problem is that there’s a massive chicken-and-egg problem with a lot of studies.

For instance, one study found an association between depression and a lack of certain gut bacteria. That could be caused by something as simple as people with depression eat differently, or there might be some link with compounds those bacteria produce. No matter what though, there are physical things happening that underpin depression, even if it’s not fully understood.

But while the knowledge that it’s a real biochemical illness might be validating, it might not be very comforting. In fact, there have even been studies that suggest that the biological and genetic nature of depression can make people pretty pessimistic about battling depression. A 2013 study tried to combat this pervasive pessimism by providing a “psychoeducation intervention” that basically taught people with depression that these biological factors are malleable and can be treated, which led to increased optimism about a diagnosis of depression.

That's good news but man, depression is hard enough but now we have to deal with depression about our depression? Thanks a lot brain. Depression has very real physical symptoms.

A 2004 study published in The Primary Care Companion to the Journal of Clinical Psychiatry, and believe me the articles are just as fun to read as the title is, listed some of the common physical symptoms of depression: chronic joint pain, back and limb pain, sleep disturbances, appetite changes, psychomotor activity changes, and gastrointestinal problems. Here’s how they described the relationship between neurochemistry and physical symptoms: - Which really hammers in the reality of depression: it’s biological. It isn’t made up, it’s not in your head, it’s biology.

So the next time one of your friends shrugs off depression as something that’s “all in your head,” give them a little biology lesson. Also, get better friends. Let’s talk about antidepressants real quick.

There are a few kinds of antidepressants, but the ones you’ve heard of all function in similar ways. The main goal of the medication is to supply the brain with more of a certain neurotransmitter that it might be lacking. SSRIs are one of the most common types of antidepressants, and the name stands for selective serotonin reuptake inhibitors.

As you might be able to guess, they aim to increase the level of serotonin in the brain. Serotonin is a neurotransmitter that is linked with mood, emotions, and sleep regulation, among other things. If the brain has a healthier level of serotonin, or whatever brain chemical the drug is aimed at, then depression symptoms will alleviate, hypothetically.

So, now that we know how they work, it seems like… Yeah, antidepressants should cure depression, right? I mean the name is literally antidepressant. How could it not be THE cure?

Depression is widely regarded as an illness that can be treated, but not necessarily cured. At least, not yet. So medication should be thought of as that, a treatment.

A way to relieve symptoms in some people, and make living with depression more manageable. In addition, antidepressants have been found to be the most effective in people with severe depression. A 2010 study in the Journal of the American Medical Association concluded that antidepressants are substantially better than a placebo for patients with severe depression, but those benefits “may be minimal or nonexistent, on average, in patients with mild or moderate symptoms.” Antidepressants can be helpful, but they are oftentimes only one piece of the puzzle.

Which is why they are frequently paired with forms of psychotherapy and other holistic approaches. Some doctors recommend exercise to combat mild depression. Brandon Alderman, associate professor of kinesiology at Rutgers University, literally says, “Exercise is an antidepressant.” Finding the right combination of medication, therapy, and lifestyle improvements seems to be the key.

It is largely a case-by-case basis. Some medications work for some people, others don’t. So I, for example, have been on nearly every SSRI on the market.

Zoloft, Prozac, Paxil, Lexapro, you name it, I’ve been on it. But I’ve never found them to be effective for my depression symptoms. So my new psychiatrist tells me, I’ve been getting treatment for a serotonin deficiency, when that might not be the root of my depression.

It might be dopamine, I might need wellbutrin or maybe an antipsychotic, which sounds a lot scarier than it is. The point is, antidepressants work in different ways, and everyone’s depression works in different ways, so finding the right fit and balance is difficult. Antidepressants are not the cure for depression.

But to some, they might be a helpful treatment. Another misconception is that antidepressants will drastically change your personality. Because these medications affect your brain chemistry, it isn’t a radical idea to believe that this means it’s going to change how your brain thinks or feels, and turn you into a different person.

Oftentimes the image is that of a zombie. You become a muted version of yourself. These fears, luckily, are based on misconceptions.

Most scientists argue that antidepressants are meant to bring you back to a level playing field. By affecting the chemicals in your brain, they’re lifting certain levels of neurotransmitters up to a normal, healthy amount. Now, some studies have found that antidepressants have had noticeable effects on personality.

Specifically, on levels of neuroticism and extraversion. Data from these studies shows that medication has, in some instances, lowered the levels of neuroticism and increased the levels of extraversion in some patients. This is a big deal because those are two of the five characteristics that make up The Big Five personality traits, along with agreeableness, conscientiousness, and openness.

Many psychologists believe that one’s personality is made up of where you fall on the spectrum of these five traits. But, in this case, the researchers associated these changed personality dimensions with the changing depressive symptoms. So, as of now, this data is inconclusive.

In regards to zombification, the science is pretty sparse. A 2010 study by doctors Lori and Randy Sansone classify the phenomenon as “emotional blunting” and “behavioral apathy.” Which is arguably a little more professional than “zombification.” They determined that it is a real, albeit largely unstudied symptom of certain antidepressants. Their data seems to show that it can be treated by lowering the dosage or changing medications.

So it’s fair to say that antidepressants could potentially dull your emotions, but they aren’t supposed to. Which comes back to the whole idea of antidepressants: their effectiveness is different from person to person, and everyone reacts to them differently. If they are making you feel like a zombie, they’re not doing what they’re supposed to, and you should reevaluate with your doctor.

Depression and its treatments are still being researched, and the science is far from exact. For some people, when you’re hungry, you’re hungry, but when you’re really hungry, you’re “starving.” Some people make a similar verbal leap when discussing sadness. When you’re sad, you’re sad, but when you’re feeling really sad, you’re depressed.

This is a common simplification that ultimately misses the point. That’s why vocabulary is important. Thinking of depression as just “big sadness” is inherently dismissive of the effect it has on people who suffer from it.

Psychologist and author Dr. Guy Winch describes it like this: “Sadness is a normal human emotion... [It] is usually triggered by a difficult, hurtful, challenging, or disappointing event, experience, or situation. In other words, we tend to feel sad about something.

Depression is an abnormal emotional state, a mental illness that affects our thinking, emotions, perceptions, and behaviors in pervasive and chronic ways... Depression does not necessarily require a difficult event or situation, a loss, or a change of circumstance as a trigger. In fact, it often occurs in the absence of any such triggers.” The diction around depression can be an important tool to understanding it as a society.

It’s not a deeper emotion, it’s an illness. But that doesn’t mean that you are doomed to a life bereft of happiness or accomplishment. Abraham Lincoln is said to have dealt with intense depressive episodes throughout his adulthood.

Georgia O'Keeffe, Franz Kafka, even Winston Churchill is believed by some to have suffered from depression. So yes, being depressed is not the same as being sad, it’s much more than that. But it’s nothing to be ashamed of, and at least you’re in good company.

Thanks for watching Misconceptions. Let’s continue to squash the stigma around mental health. Talk about it with your friends, your family, and definitely your doctor.

Financial considerations can make it challenging, but help is more accessible than ever. There are organizations like National Alliance for Mental Health and Open Path Psychotherapy Collective that seek to expand access to mental health services. If you’re thinking about talking to a therapist or a psychiatrist, I highly encourage you to take those steps.

It’s scary and tough, but you’re not alone. If you or someone needs help, there’s absolutely no shame in calling one of these numbers, too. I’ll see you next time.