People who have depression are very well aware of just how debilitating the condition can be. Depression causes persistent feelings of sadness, despair, and hopelessness. At the same time, depression may also cause many physical symptoms such as fatigue, sleep problems, weight loss, and various aches and pains. However, what many people do not pay attention to is that this sneaky condition can also cause subtle changes in your thinking. Read on to find out about how can depression impact your ability to think.
Depression and Its Impact On Your Thinking
The National Institute of Mental Health (NIMH) estimates that over 16 million adults in the United States alone have been diagnosed with having at least one major depressive episode in 2016. (1) According to the World Health Organization (WHO), there are more than 264 million people of all ages who suffer from depression. (2) Not only are the statistics sky high, but it is expected that nearly 75 to 85 percent of people in middle and low-income countries receive no treatment for their depression. (3) A survey carried out by the US Centers for Disease Control, and Prevention (CDC) found that the prevalence of depression reduces in adults as the family income increases. (4)
It has been observed that one of the very first signs of depression in older adults is a change in their thinking. Depression is believed to disrupt or reduce the chemical messengers in the brain known as neurotransmitters, including dopamine, serotonin, and norepinephrine. (5,6)
These chemical changes in the brain might very well be the cause of your depression, especially if the brain systems responsible for these chemicals start to go haywire. Or, they may also be a result of other depression triggers, including: (7,8)
Structural Changes In Your Brain: This is likely to occur as the brain shrinks with age. Research shows that the size of some areas of the brain can also decrease in those who have depression. (9) However, there is a lot of ongoing debate about which parts of the brain decrease in size due to depression and by exactly how much. Nevertheless, it is believed that the hippocampus, the amygdala, prefrontal cortices, and the thalamus are the most affected. (10) The amount these regions shrink is associated with the length and severity of your depressive episode.
Underlying Medical Condition: Stroke, heart disease, and even an underactive thyroid gland are just some of the many health conditions associated with depression. However, there is no clear evidence that shows which comes first – depression or the underlying associated health condition.
Side Effects of Some Medications: Some of these conventional medications include benzodiazepines such as alprazolam (brand name Xanax), diazepam (brand name Valium), lorazepam (brand name Ativan), and beta-blockers such as metoprolol (brand name Lopressor).
Stressors or Major Life Changes: This may include the loss of a loved one, isolation, thoughts of your mortality, etc. (11)
Brain Changes May Lead To Cognitive Changes
Some or all of the triggers mentioned above, along with the physical brain changes in depression, is believed to impair cognition or your thinking skills. Here are some of the cognitive functions that depression impacts:
Depression may affect your memory. You may find yourself failing to recall what you ate for dinner the previous day, or you may not recall the details of an important life event. (12,13)
A study in 2013 found that people who have depression were not able to identify objects on a screen that were similar or exactly identical to an object they were shown previously. According to the research team, this suggested that memory is directly affected and diminished due to depression. (14)
Another 2015 study also found the same results and concluded that depression might even be responsible for short-term memory loss. (15)
Studies have shown that people who have depression often have trouble concentrating or focusing on the task at hand. According to the National Alliance on Mental Illness, this lack of attention or concentration is a relatively common symptom of depression. (16)
People with depression and their inability to pay attention to things sometimes makes it difficult for them to make even small decisions. For example, a 2014 study found that the lack of focus was one of the key reasons why depression has such a significant impact on a person’s social life. When you are unable to pay attention and focus, it becomes harder for you to keep with your relationships and also perform properly at work. (17)
This lack of concentration is believed to be because of the damage caused to the amygdala and the hippocampus in the brain. As the volume of the hippocampus shrinks, it affects your attention span, causing the neural circuits to start functioning in a different manner. Moreover, multiple episodes of depression, if left untreated, is known to increase the severity of these symptoms. These continuing physical changes in the brain thus makes it harder to pay attention when you are depressed.
As mentioned above as well, depression affects your ability to make good decisions. Surprisingly, taking antidepressants also does not appear to improve a person’s decision making capability much, even though these medications can improve their mood.
Depression affects a person’s decision-making abilities in many ways. The first way, of course, is that people with depression are more indecisive. They have trouble making even the smallest decisions. The second fact is that people with depression are more likely to believe that a given situation will turn out badly for them. If they feel that making an active decision will lead to a negative result, then they are less likely to make it.
Another common feature of depressed people and decision making is risk aversion. Studies have shown that people with depression are more likely to make decisions just to avoid anxiety. (18) Depressed people usually feel hopeless, and due to this, they don’t want to waste any energy on making plans that they believe will not work.
All of this leads to lesser information gathering, less idea generation, and also less thinking through the various options available to them.
People with depression are not likely to have the mental ability to get things done, such as returning phone calls of paying bills.
Conclusion: Necessary to Seek Help
Problems with memory, attention, decision making, and executive function are symptoms that are similar to many other health conditions such as dementia, urinary tract infection, a ministroke, or heart disease. Due to this, depression is often overlooked as being the underlying cause. Many older people also chalk up these cognitive changes to the normal aging process and, therefore, don’t pay attention to them. However, it is not always normal to be affected by a slowed-down thought process. This is why it is necessary to reach out to your doctor and undertake a depression screening and rule out other medical causes.
- Nimh.nih.gov. 2020. NIMH » Major Depression. [online] Available at: <https://www.nimh.nih.gov/health/statistics/major-depression.shtml> [Accessed 25 May 2020].
- Who.int. 2020. Depression. [online] Available at: <https://www.who.int/news-room/fact-sheets/detail/depression> [Accessed 25 May 2020].
- Wang et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. The Lancet. 2007; 370(9590):841-50.
- Cdc.gov. 2020. Products – Data Briefs – Number 303 – February 2018. [online] Available at: <https://www.cdc.gov/nchs/products/databriefs/db303.htm> [Accessed 25 May 2020].
- Werner, F.M. and Covenas, R., 2010. Classical neurotransmitters and neuropeptides involved in major depression: a review. International Journal of Neuroscience, 120(7), pp.455-470.
- Sperner-Unterweger, B., Kohl, C. and Fuchs, D., 2014. Immune changes and neurotransmitters: possible interactions in depression?. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 48, pp.268-276.
- Nutt, D.J., 2008. Relationship of neurotransmitters to the symptoms of major depressive disorder. The Journal of clinical psychiatry, 69, pp.4-7.
- Maas, J.W., 1979. Neurotransmitters and depression Too much, too little, or too unstable?. Trends in Neurosciences, 2, pp.306-308.
- Yüksel, D., Engelen, J., Schuster, V., Dietsche, B., Konrad, C., Jansen, A., Dannlowski, U., Kircher, T. and Krug, A., 2018. Longitudinal brain volume changes in major depressive disorder. Journal of Neural Transmission, 125(10), pp.1433-1447.
- Palazidou, E., 2012. The neurobiology of depression. British medical bulletin, 101(1), pp.127-145.
- Johnson, J.H. and Sarason, I.G., 1978. Life stress, depression and anxiety: Internal-external control as a moderator variable. Journal of psychosomatic research, 22(3), pp.205-208.
- Burt, D.B., Zembar, M.J. and Niederehe, G., 1995. Depression and memory impairment: a meta-analysis of the association, its pattern, and specificity. Psychological bulletin, 117(2), p.285.
- Strömgren, L.S., 1977. The influence of depression on memory. Acta psychiatrica scandinavica, 56(2), pp.109-128.
- Shelton, D.J. and Kirwan, C.B., 2013. A possible negative influence of depression on the ability to overcome memory interference. Behavioural brain research, 256, pp.20-26.
- Hubbard, N.A., Hutchison, J.L., Turner, M., Montroy, J., Bowles, R.P. and Rypma, B., 2016. Depressive thoughts limit working memory capacity in dysphoria. Cognition and Emotion, 30(2), pp.193-209.
- Nami.org. 2020. Depression | NAMI: National Alliance On Mental Illness. [online] Available at: <https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Depression> [Accessed 25 May 2020].
- Fried, E.I. and Nesse, R.M., 2014. The impact of individual depressive symptoms on impairment of psychosocial functioning. PloS one, 9(2).
- Simon, D., Loh, A., Wills, C.E. and Härter, M., 2007. Depressed patients’ perceptions of depression treatment decision‐making. Health Expectations, 10(1), pp.62-74.
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