by Neha Jadhav and Pratibha Choudhury
T.Y.B.Sc Department of Biotechnology DES Fergusson College, Pune. For BTH3507
Blog Category: Psychology/Mental Health
We all know that our everyday behavior and emotions do modulate our bodies in many ways in the form of either mood suppressor or mood enhancer. Among both these forms, first one can occur due to various stressful events happened in life concerning the personal or social aspects; while later can be a result of what you do on daily basis including your activities and hobbies as well. But, there’s one common thing about both these emotions and that thing is interference they create with your body systems. This interference is dependent on which type of event you’ve been exposed to and hence changes your very being from time to time. The epitome of both these two types are depression and happiness respectively. These are interdependent and most of the research studies have revealed that depression is one of the most leading causes in the world and hence more precise diagnostic methods have been structured to identify it. On the contrary, the emotion of happiness comes when you are happy inside out, and that can be enhanced by the most powerful technique of laughter. Yes, laughter, despite being highly complex process, can make your body system pretty smooth going and simple to make your being even more positive. This blog will certainly take you to all those diagnostic methods of depression explaining you some of the causes as well and some information about the laughter in the next part will make your understanding more precise as to how laughter affects your body and becomes an antidote of what you’d read in the previous section of this blog. But you’d question, how it all works! So, here you go…
In the case of diseases and their impact on a population; numbers give the best report. Depression has become one of the most common illnesses worldwide, disabling about 264 million people by causing instability of mental health with lingering feelings of sadness with or without any reason, hopelessness, apathy, fatigue and other varied bitter emotions. An extreme case of clinically depressed individual ends up becoming their own enemy by committing suicide. Over 50% of all people who die by suicide in a year are found to be clinically depressed; the figure rises to 75% if alcoholics with depression are included. This alarming figure of suicide among the depressed calls for better psychiatry professionals, early identification of disease and proper treatment methods. WHO says “Although there are known and effective treatments for mental health disorder, between 76% and 85% of people in low and middle income countries receive no treatment for this disorder, the main barrier could be lack of awareness of depression being a serious health issue, stigmatizing patients as maniac and pessimists, incorrect diagnosis of patients and sometimes misdiagnosis of people in an emotional phase as depressed.
Diagnosis of depression has been a challenge for the health care sector as it has multitudes of facets. Depression as a disease shows different symptoms for different age groups. The reason behind depression may vary among the same age group of patients, thus each having a different physiological abnormality associated with the disease. Thus scientists are focusing their work on analyzing different pathways in which depression can occur which includes chemical imbalance in brain, genetic vulnerabilities, deficiency or abnormalities in certain proteins, other physical health issues etc. followed by a search for a particular diagnostic method for each, so that patients can go through varied depression diagnostic tests and finally be treated accurately depending on what is exactly wrong and the category of depression they belong to.
There are two methods by which depression can be diagnosed. Non laboratory method and laboratory method. The non laboratory method includes the psychiatrist taking history from the patient along with questioning about their life events, followed by a set of standardized questions that will help the doctor to identify if the patient is clinically depressed. This method is quite subjective in approach. Although it could identify depression, it can’t particularly identify the biology behind it, thus medicating and treating becomes difficult. Thus after a non laboratory test, the patient is asked to undergo a series of emerging and traditional diagnostic methods for sophisticated and accurate diagnosis of depression and its category.
The laboratory based diagnostic method generally looks for certain biomarkers of depression that is chemicals, genes and proteins that are not in the usual form. The presence or absence of these biomarkers helps the doctor to backtrack the reason behind depression and provide individualized medication and treatment. Now let’s see how these methods help to identify depression.
The most common cause behind depression is found to be chemical imbalance in brain. The neurotransmitter serotonin is responsible for regulating sleep, appetite and mood. Low levels of serotonin transmission are linked with depression and higher risks of suicide. The serotonin levels can be detected and measured through an innovative device called WINCS (Wireless Instantaneous Neurotransmitter Concentration system). Serotonin imbalance is treated by prescribing antidepressants such as Selective Serotonin Reuptake Inhibitors (SSRIs), these drugs inhibit the reuptake of serotonin by neurons thus concentrating it between neuronal junction so that messages can be sent correctly.
Although some patients can be depressed but still have normal serotonin levels, this calls for multiple diagnostic tests to be conducted, so that clinically depressed patients are not misdiagnosed based on their adequate serotonin levels. The next diagnostic test is the traditional Dexamethasone Suppression Test (DST). Dexamethasone is like cortisol, upon consumption it decreases the ACTH secretion by pituitary glands which in turn inhibits cortisol production by adrenal glands( by negative feedback mechanism) but in case of patients with depression, dexamethanosome couldn’t suppress the ACTH secretion, thus cortisol levels remain elevated in the blood suggesting a hyperactive pituitary gland. Depression due to hyperactive pituitary gland is considered to be a result of episodic stressful events in a persons’s life accompanied by failed stress management strategy. Whenever there is an external stress, the HPA axis is activated which leads to the production of CRH, ACTH and cortisol. This hormones also affect parts of the brain like amygdala, cerebral cortex and brain stem, which are thought to play a major role in co-ordinating thoughts, behaviours and emotional reactions. Continuous stressful events increase these hormones frequently and disturb the feedback mechanism, thus the cortisol level either rises too often or remains elevated. Dysthymia i.e. persistent mild depression is mainly caused due to this and is often treated with antidepressants and electroconvulsive therapy which are both known to reduce high CRH levels. It can be clearly concluded that stress and improper stress management could be a precursor of depression, thus it’s highly important to monitor yourself and inculcate proper stress management practices including meditation, journaling, optimism etc.
“A healthy body is an abode for healthy mind” and vice versa. It has been seen that patients with depression show a long history of being physically unhealthy due to injuries, infection and other illness. In the past two decades, researchers have tied depression to inflammation; the body’s natural response to stress and foreign particles. But high levels of cytokines can cross the blood brain barrier, adhere to the nerve endings and negatively affect the transmission of neurotransmitters like serotonin, dopamine and glutamate. It also ramps up the stress hormones which are a known cause for entering the depression pit. A total diagnostic test for depression includes measuring the circulating cytokine level; if it’s more than normal, doctors prescribe patients with an anti-inflammatory along with antidepressants.
An interesting fact about antidepressants is that although these medications immediately surge up the concentration of chemical messengers in brain ,yet people don’t attain their mental vigour for weeks and longer; a study on this fact clarified that mood only improves when nerves grow and nerve cell connections are enhanced which actually takes weeks. Well this process is termed as neurogenesis and is controlled by BDNF- Brain Derived Neurotrophic Factor, which belongs to a group of neurotrophin growth factor. The BDNF gene acts as a biomarker to diagnose inherited depression, a defective or mutated gene couldn’t perform neurogenesis , that is required in certain parts of brain to improve memory, learning, mood , social behavior etc.
Proteomics and metabolomics techniques help to identify certain defective and abnormal proteins and metabolites that are generally found in patients with depression only. A recent metabolomic study in depressed elderly adults analysed 800 metabolites and several fatty acid along with glycerol and aminobutyric acid having lower levels than usual in blood of currently depressed compared to never depressed patients. Studies suggest that changes in lipid and neurotransmitter metabolism may alter the metabolic pathway, these metabolites act as signatures to identify depressed patients.
The laboratory methods are more objective in approach and can help to investigate the root cause of depression. This will help the psychiatrist to be more particular in treatment and provide personalized medicines to their patient rather than just prescribing an antidepressant that does not correct the abnormality that has led to depression. The following illustration can make your understanding more clear.
You must be tensed by now that whether your emotion of sadness, questioning of worthiness and periods of feeling blue are emotions that will pass or depression! Okay, if you want to, leave its fear first, rejuvenate your thoughts and mood channel and read the next part to get how laughter and humor would help you to live a healthy and disease free life.
Each and every emotional phase right starting from a facial smile to a mirthful laughter plays a key role in releasing some enzymes and make you feel better. So, let’s first go to the pumping organ and talk about the events a laughter initiate in it. The heart is the organ which is the hub for the circulation in our body. Our daily lifestyle does affect its working, nonetheless it manages to work efficiently. But sometimes, a lifestyle of a human can severely affect his or her heart leading to heart attack or myocardial infarction. So, can’t we manage to prevent it? Well, when you see a well humorous video, you certainly give a mirthful laughter and this action immediately produces a substance- Epithelial Growth Factor in the epithelial lining of the heart that protects the lining of the heart and makes it more difficult to have a heart attack. It doesn’t mean that you wouldn’t be having any such kind but it decreases the incidence of heart attack. Unlike our heart, it has the other effects as well. Further going to muscles, we all have a problem of being disable to move our muscles easily. This is called a muscle tone that is the resistance to easy movements of the muscles, for a laughter can decrease this muscle tone giving you freedom like feeling from the locked muscles. It can actually make the muscles relax thus diminishing the illness if any. In addition to the muscle tone, it immediately secrets the chemical in the brain called endorphin which makes you feel good and helps to cut down the depression, release the stress and pain due to depressed feelings.
Isn’t it strange to know about so many things about the emotion that comes out to be so reflective? And when you realize this emotion, how our body responds to the emotion is again a kind of reflecting episode. For a matter we can actually imagine our interior as a piece of land where some cruel people are trying to reside by destroying many things. Now, this episode must have an incidence that will change the power and protect the area from the entire group of cruel people. Overcoming many of the battles, there will come the kind people and protect that land from the enemies. The same scenario happens in our body where we can have different bacteria or viruses ( directly or indirectly entered) which can be pathogenic to our body. Additionally, there can be some tumors getting formed due to negative thoughts of most stressful events. It is not that every disease or infection gets cured only when you go to the doctor, rather if it woud be a real case we would have visited the clinics everyday. When you laugh, interleukin-2 is liberated that plays important role in activating the natural killer cells and perform their NK cell cytotoxicity. Natural Killer cells are like those kind and protective people, they come and kill the tumorigenic cells or virally infected cells in your body and boosts your immune system. So, you can compare this scene with the previous story. Additionally, such laughter expands alveoli in your lungs. This expansion leads to the wider area for oxygen exchange and increases the oxygen distribution which makes the oxygen move faster. At the same time, the stale air is thrown out of the lungs.
This way, the following illustration can tell you a gist of how your laughter actually activates your body pharmacy.
So, have you ever had this thought how your one laugh is actually a great savior? It nullifies all those negative thoughts or a blink of blue feelings indirectly even if you don’t get diagnosed for any such depression. With the emerging diagnostic techniques of depression, this condition is found to be more accurately identified. Nevertheless, patients with depression require constant care rather than medication, where care givers come into role. A proper diagnosis helps the caregiver to identify the social causes disturbing the patient and the seriousness of the disease. This builds a belief system between the patient and the caregiver. They realize that depression is more than mood fluctuation and pessimism and care for the patient as they would for any physically ill individual. Always remember that every situation happening around you is what it is and not what you think about it. But, if you change the perspective towards the incidents happening around you and start to enjoy your very being, then the things can be managed anyhow may be with the laughter and so do you!! It’s the cascade that takes the social nature and makes you happier than ever since. So, what are you waiting for? Laugh out loud, activate your internal body pharmacy and be your own savior…
References:
Wang et.al.2007 Use of mental health services for anxiety, mood, and substance disorders in 17 countries in WHO world mental health surveys. The Lancet. 370(9590): 841-50
Katie M. Smith, Perry F. Renshaw, and John Bilello.2012. The diagnosis of depression: Current and emerging methods. Comprehensive psychiatry.54 (1) 1-6
Health-wise staff (2019) Overnight Dexamethanosome Suppression test. Article. Michigan Medicine
Retrieved from : Fischbach FT ,Dunning MB III, eds.2009. Manual of laboratory and Diagnostics Tests. 8th Edition Philadelphia: Lippincott Williams and Wilkins.
What causes depression? 2009. Harvard Health Publishing.
Carina Storrs .2014 When Inflammation can lead to Depression. Discover magazine
Prof Catherine J Harmer, DPhil , Prof Ronald S Duman, PhD, Prof Philip J Cowen, FRC Psych. 2017. How do antidepressants work ? New perspectives for refining future treatment approaches. Lancet Psychiatry. 4(5): 409-418
Smitha Bhandari, MD.2019. What are SSRIs? Web MD
Yogesh Dwivedi.2009. Brain Derived Neurotrophic Factor : Role in depression and suicide. NeuropsychiatrDis Treat. 5:433-449
Phillipe Taupin.2006.Neurogenesis and the effect of Antidepressants. Drug Target Insights .1: 1-17
Robert Dantzer.2009. Cytokine, sickness behaviour and depression. Immunology Allergy Clinical North Am. 29(2):247-264
Role of cytokinesis in depression. Article. Suno Biological
M. P. Bennett and C. Langacher. 2009
Humor and Laughetr May Influence Health IV. Humor and Immune Function. Hindawi 6 (2): 159-164
M. P. Bennett, J. M. Zeller, L. Rosenberg and J. McCann. 2003
The Effect of Mirthful Laugher on Stress and Natural Killer Cell Activity. Alternative therapies in health and medicine 9(2): 38-45
N. J. Topham and E. W. Hewitt. 2009
Natural killer cell cytotoxicity: how do they pull the trigger? Immunology The Journal of cells, molecules, systems and technologies 128(1): 7-15
T. Matsuzaki, A. Nakajima, S. Ishigami, M. tanno and S. Yoshino. 2006
Mirthful laughter differentially affects serum pro- and anti- inflammatory cytokine levels depending on the level of disease activity in patients with rheumatoid arthritis. Rheumatology 45 (2): 182-186
M. Statsna. 2017