Depression in the brain and body

Depression is a debilitating condition that impacts all aspects of a child’s life. The effects also ripple out through the family. One of the most overlooked parts of the condition is the body sensations, or somatic symptoms, that children with depression complain about.

It can be a key way we look at treating depression differently.

Somatic symptoms are mentioned in a great majority of depressed patients, particularly somatic anxiety and fatigue, which was documented in up to 80% of people suffering from major depression. This study confirmed that depressive disorders with body based symptoms were the most common form of depression, both in inpatient and outpatient care. They even found that somatic symptoms significantly correlated to a person’s risk regarding suicide.

That’s why it’s our mission to help children and families become mindful of bodily sensations. This awareness helps reduce the intensity of high emotional arousal significantly!

It is body awareness that helps these children become mindful, better behaved and more in control of their inner and outer worlds.

Changes in the Brain:

Structural Changes:

Hippocampus: The hippocampus, which is involved in memory formation and emotional regulation, tends to be smaller in people with depression. Chronic stress associated with depression can lead to the loss of neurons in this region.

Prefrontal Cortex: This area, responsible for decision-making, self-control, and regulating emotions, often shows reduced volume and activity in individuals with depression. This reduction can affect executive functioning and emotional regulation.

Amygdala: The amygdala, which processes emotions such as fear and pleasure, often becomes overactive. This heightened activity can contribute to the intense emotional responses typical of depression.

Functional Changes:

Neurotransmitter Imbalances: Levels of neurotransmitters like serotonin, dopamine, and norepinephrine are often dysregulated in depression. These chemicals play critical roles in mood regulation, motivation, and pleasure.

Neuroplasticity: Depression can impair neuroplasticity, the brain’s ability to adapt and form new connections. This impairment can hinder the brain’s ability to recover from stressful events and adapt to new information or experiences.

Neural Connectivity:

- Default Mode Network (DMN): The DMN, associated with self-referential thinking and rumination, tends to be overactive in depression. This overactivity can lead to persistent negative thoughts and excessive focus on past failures or future worries.
- Connectivity Issues: Depression can disrupt the connectivity between different brain regions, affecting how information is processed and leading to symptoms like difficulty concentrating and making decisions.

Changes in the Body:

The nervous system of a person with depression has significant differences compared to a typical nervous system, including ANS imbalance, HPA axis dysfunction, and neurotransmitter imbalances. These changes often result in various physical symptoms like chronic pain, fatigue, sleep disturbances, and altered stress responses.

Understanding the ways depression impacts the body can help in more comprehensive treatment plans that better address both the mental and physical impacts depression makes in the lives of children.

Let’s explore what is happening inside the body.

Nervous System Differences in Depression

Autonomic Nervous System (ANS) Imbalance: The ANS, which regulates involuntary bodily functions like heart rate, digestion, and respiratory rate, is often dysregulated in people with depression.
- Sympathetic Nervous System (SNS): This part of the ANS is responsible for the fight/flight response. In depression, the SNS can be either overactive or underactive, leading to chronic stress responses or a lack of appropriate stress responses.
- Parasympathetic Nervous System (PNS): The PNS promotes rest and digestion. In depression, the PNS can be underactive, leading to difficulty calming down and relaxing.
Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysfunction: The HPA axis controls the body’s response to stress. In depression, this axis often becomes dysregulated.
- Cortisol Levels: Chronic depression can lead to elevated cortisol levels, a stress hormone, which can cause various physical health issues and perpetuate the cycle of depression.
Neurotransmitter Imbalances: Neurotransmitters like serotonin, norepinephrine, and dopamine are critical for mood regulation. In depression, these neurotransmitters are often imbalanced, affecting not only mood but also bodily functions such as appetite, sleep, and energy levels.

Differences in Body Sensations and Experiences

Chronic Pain and Somatic Symptoms: Individuals with depression often experience chronic pain and somatic symptoms such as headaches, muscle aches, joint pain, and gastrointestinal issues.

- These symptoms can be due to heightened pain sensitivity and inflammation linked to depression.

Fatigue and Low Energy: Persistent fatigue and low energy levels are common. Even with adequate rest, people with depression may feel physically exhausted, making it difficult to engage in daily activities.

Sleep Disturbances: Insomnia or hypersomnia (excessive sleeping) can occur. Sleep patterns are often disrupted, leading to difficulty falling asleep, staying asleep, or waking up early.

Appetite and Weight Changes: Depression can cause changes in appetite, leading to significant weight loss or gain. Some individuals may experience a lack of interest in food, while others may turn to overeating as a coping mechanism.

Reduced Physical Sensation: Some individuals report a feeling of numbness or a reduced ability to feel physical sensations, which can contribute to a sense of detachment from their bodies.

Fight-or-Flight Response in Depression

Altered Stress Response: The fight/flight response can be blunted or exaggerated in depression. Some individuals may have a heightened response to minor stressors, while others may feel an inability to respond to significant stress.

Chronic Hyperarousal: An overactive SNS can lead to chronic hyperarousal, where the body is in a constant state of heightened alertness. This can result in symptoms like increased heart rate, rapid breathing, sweating, and tension.

Hypoarousal and Apathy: On the flip side, some individuals may experience hypoarousal, where the body’s stress response is diminished. This can manifest as a lack of motivation, emotional numbness, and a sense of disconnection from the environment.

Difficulty Regulating Emotions: Due to the imbalance between the SNS and PNS, people with depression may struggle to regulate their emotions effectively. They might experience rapid mood swings, irritability, or prolonged periods of sadness and despair.

Living with Depression: Mindset and Lived Experience

Negative Thinking Patterns: People with depression often experience pervasive negative thoughts about themselves, the world, and the future. This negative cognitive triad can dominate their mindset, leading to feelings of hopelessness and worthlessness.

Anhedonia: Anhedonia, or the inability to experience pleasure, is a common symptom. Activities that once brought joy and satisfaction may no longer provide the same positive feelings, contributing to a sense of emptiness and disinterest.

Emotional Dysregulation: Individuals with depression often struggle to regulate their emotions. They may feel overwhelming sadness, irritability, or numbness, and small stressors can trigger intense emotional reactions.

Cognitive Impairments: Depression can affect cognitive functions such as memory, attention, and decision-making. This can manifest as forgetfulness, difficulty concentrating, and indecisiveness, making daily tasks more challenging.

Physical Symptoms: Depression is not just a mental condition; it also has physical manifestations. Individuals may experience fatigue, changes in appetite and sleep patterns, and unexplained aches and pains.

Social Withdrawal: People with depression often withdraw from social interactions. They may feel isolated, misunderstood, or unable to engage in social activities, which can further exacerbate feelings of loneliness and depression.

Supporting children with Depression:

When somatic symptoms, particularly painful physical conditions, accompany the already debilitating psychiatric and behavioral symptoms of depression, the course of the illness may be more severe. That can imply higher risks of early relapse, suicide, or mortality due to other natural causes.

The family’s quality of life may be lowered dramatically.

By focusing on the somatic symptoms in depression, parents may be able to guide children into more promising treatment approaches.

Here are several body-based coping skills that can help:

Developing Somatic Awareness

In somatic therapy, we educate clients about what body awareness is, and how to cultivate body awareness in and around your body. This is a prerequisite to creating change on a cellular level. We begin by identifying areas of tension and areas of constriction, as well as thoughts, feelings and behaviors that promote a feeling of calm and safety, and bring these to conscious awareness. We may practice something small such as softening a “hunched” back to a more straightened posture, to begin working towards body alignment.

By focusing on, and amplifying the sensations in your body, you begin to deepen your brain and body connection, which can allow for a more embodied experience in those feeling numb from depression.

Grounding in the Here-And-Now

Grounding refers to our ability to experience our full selves as connected and “embodied”.

The concept of grounding is at the root of mind-body focused interventions. Alexander Lowen, developer of bioenergetics, introduced grounding as a concept in which we can live life, fully experiencing ourselves- connected in the world around us. We use grounding tools to help calm and regulate our nervous systems when we are feeling overly activated or triggered, as grounding helps sooth and settle.

An easy way to remember this is to use the 4 Elements Exercise where you encourage children to get in touch with the elements around us; earth, air, water and fire. Think running cold water over your hands or rubbing them until they feel warm.

Using Descriptive Language

Somatic approaches focus on getting curious and descriptive, while staying close to the experience that’s happening in and around your body. That’s because tension, anxiety and traumatic memories get processed as long as you can track, contact, describe and allow the experience to move through you.

Here is an easy illustration; you’re angry at something that’s happened, but you don’t want to stay angry and irritated. A somatic approach reminds you to get descriptive about your body experience because that would help you move through it.

You may begin with something like: “It feels like a raging fiery feeling welling up in my chest….”. As you stay with the physical sensations, and follow what happens next, you’ll notice the anger moves, and how it slowly shifts as you focus on the descriptive body sensation instead of the details of the upsetting event. This distancing helps with the mental processing while the body begins to work through the retained stress of that trauma.

You can encourage children to use descriptive language about physical sensations as a method to deepen their brain body connection! Some descriptive words are: warmth, cold, tingly, sharp sensation, numb, dull pressure, ease, spinning, lifting, swirling, or calming.

Other important habits to keep in mind:

Physical Exercise

Aerobic Activities: Activities such as running, cycling, swimming, or dancing can help release endorphins and regulate neurotransmitter levels, improving mood and attention.
Yoga and Pilates: These practices combine physical movement with mindfulness and breath control, promoting relaxation, balance, and body awareness. This helps children slow thoughts down and bring mindfulness down into the body, which is practice for other experiences throughout the day.

Breathing Techniques

Deep Breathing: Slow, deep breathing can activate the parasympathetic nervous system, helping to calm the body and mind. Deep “belly breathing” involves inhaling slowly through the nose, allowing the chest and belly to rise. Hold each breath for four seconds, then release it through the mouth for four seconds. By fully expanding the lungs, this technique counteracts the rapid, shallow breathing that accompanies panic, and calms the amygdala, the brain’s emotion processing center.
Box Breathing: This involves inhaling for four counts, holding for four counts, exhaling for four counts, and holding again for four counts. It helps in reducing stress and enhancing focus.

Meditation

Mindfulness Meditation: Practicing mindfulness helps individuals become more aware of their thoughts and feelings without judgment. It can improve attention and reduce impulsivity.
Body Scan Meditation: This involves mentally scanning the body from head to toe, paying attention to physical sensations. It is the first and main practice we promote for children with Depression because it teaches them a relaxation skills and body awareness that becomes the training they need to achieve better behavior and health throughout their entire lives.

Sensory Activities

Weighted Blankets: The deep pressure stimulation from weighted blankets can have a calming effect on the nervous system.
Sensory Toys: Fidget spinners, stress balls, or tactile toys can help individuals with ADHD stay focused and reduce anxiety by providing a physical outlet for restlessness.
Essential Oils: Aromatherapy using essential oils like lavender, chamomile, or peppermint can promote relaxation and focus.

Body-Based Therapies

Occupational Therapy: Occupational therapists can provide sensory integration therapy, helping individuals with ADHD manage sensory processing issues through tailored activities.
Somatic Experiencing: This therapeutic approach focuses on creating a stronger brain and body connection so that body awareness of physical sensations are noticed and dealt with. Greater body awareness facilitates better behavior and the releasing trauma stored in the body, which has proven to help individuals with ADHD regulate their stress responses.

Grounding Techniques

Progressive Muscle Relaxation: This involves tensing and then slowly releasing different muscle groups in the body, promoting physical and mental relaxation. This is the number 1 exercise we recommend for building a strong brain-body awareness.
5-4-3-2-1 Technique: Identifying five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste can help ground individuals in the present moment and reduce anxiety.

Structured Routine

Daily Schedule: Maintaining a consistent daily routine can help manage time more effectively and reduce the chaos that can exacerbate ADHD symptoms. Children with ADHD are more easily impacted by unpredictability and hectic days, which means that they may begin to act more negatively when their routine is changed unexpectedly. The predictability of routines help a child’s nervous system remain in states of safety. Predictability also helps children with ADHD prepare mentally and physically for experiences so they can bring coping items, use strategies that have worked before or use pre-planned calming options.

Nutrition & Hydration

Balanced Diet: Eating a diet rich in whole foods, including fruits, vegetables, lean proteins, and whole grains, can help regulate energy levels and improve cognitive function.
Stay Hydrated: Adequate hydration is essential for optimal brain function and can help maintain focus and reduce irritability.

Sleep Hygiene

Consistent Sleep Schedule: Going to bed and waking up at the same time every day can help regulate the body’s internal clock and improve sleep quality. Changing sleeping habits can make significant impacts in improving a child’s ability to focus and cranky behavior. All children need consistent sleep schedules that take their developmental needs into account, but children with ADHD can show symptoms of sleep imbalances quickly and severely.
Relaxation Techniques Before Bed: Practices like reading, listening to calming music, or taking a warm bath can signal to the body that it’s time to wind down. This is especially important for children that are more stimulated than normal by fast paced shows, high pitches and bright, colorful media.

Helping Children with Depression

Extra Support for Families dealing with Depression

CREATE uses a family first approach that focuses on building connection between parent and child. We combine that with a body centered framework that aims to build a child’s capability to identify, sit with and process strong feelings.

Contact us to work with our therapist if you are interested in addressing your child’s specific needs with our approach. We offer one-on-one therapy, homework and school support, activities focused on improving the family and more.