Essentials: Understanding & Conquering Depression

**Andrew Huberman** (0:00)
Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health and performance.
I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today, we're discussing depression. In particular, we're going to talk about major depression. The phrase major depression is used to distinguish one form of depression from the other, the other one being bipolar depression. Major depression impacts 5% of the population. That is an enormous number. That means if you're in a class of 100 people, five of them are dealing with major depression or have at some point. Look around you in any environment, and you can be sure that a good portion of the people that you're surrounded by is impacted by depression or will be at some point. So this is something we really have to take seriously and that we want to understand.
It is the number four cause of disability. A lot of people miss work, miss school, and before then likely perform poorly in work or school due to major depression. So let's talk about the things that are present in somebody that has major depression. First of all, there tends to be a lot of grief. There tends to be a lot of sadness. That's no surprise. There's also this thing that we call anhedonia, a general lack of ability to enjoy things. For the time being, we want to frame up anhedonia, this lack of ability to achieve or experience pleasure, a kind of a flat affect as it's called. Sometimes even delusional thinking, negative delusional thinking, and in particular, anti-self confabulation. What is anti-self confabulation? Well, first of all, confabulation is an incredible aspect of our mind and our nervous system. You sometimes see other forms of confabulation in people who have memory deficits, either because they have brain damage or they have age-related dementia. A good example of this would be someone with age-related dementia sometimes will find themselves in a location in the house and not know how they got there. And if you ask them, oh, what are you doing here? They will create these elaborate stories. Oh, you know, I was thinking about going to the shopping today and I was, you know, and I was going to take the bus and then I was going to do, they create these elaborate stories. They confabulate. It's as if a brain circuit that writes stories just starts generating content. In major depression, there's often a state of delusional anti-self confabulation where the confabulations are not directly or completely linked to reality, but they are ones that make the self, the person describing them seem sick or in some way not well. A good example would be somebody who experiences a physical injury, perhaps, maybe they break their ankle, maybe it's an athlete, and they also happen to become depressed. And you'll talk to them, you say, how are things going? How's your rehab? And they'll be like, oh, it's okay. And I don't know, I'm just, I feel like I'm getting weaker and weaker by the day. I'm just not performing well. And then you'll talk to the person that they're working with, their kinesiologist or whoever the physical therapist is, and they'll say, no, they're actually really improving. And I tell them they're improving, but somehow they're not seeing that improvement. They're not registering that improvement. They are viewing themselves and they are confabulating according to a view that is very self-deprecating to the point where it doesn't match up with reality. The other common symptomology of major depression is what they call vegetative symptoms. So vegetative symptoms are symptoms that occur without any thinking, without any doing or without any confabulation. These are things that are related to our core physiology. Things like constantly being exhausted. The person just feels exhausted. They don't have the energy they once had. So it's not in their heads. Something is disrupted in the autonomic or so-called vegetative nervous system. And one of the most common symptoms of people with major depression, one of the signs of major depression is early waking and not being able to fall back asleep despite being exhausted. So waking up at 3 a.m. or 4 a.m. or 5 a.m. just spontaneously and not being able to go back to sleep. It's well known that the architecture of sleep is disrupted in depression. What's the architecture of sleep? Early in the night, you tend to have slow wave sleep more than REM sleep or rapid eye movement sleep. As the night goes on, you tend to have more rapid eye movement sleep. That architecture of slow wave sleep preceding rapid eye movement sleep is radically disrupted in major depression. In addition, the pattern of activity in the brain during particular phases of sleep is disrupted. And then there are some other things that relate to the autonomic nervous system, but that we normally think of as more voluntary in nature. And these are things like decreased appetite. So you could imagine that one could have decreased appetite because of the anhedonia, the lack of pleasure from food. So you can see that the symptomology of major depression impacts us at multiple levels. There's the conscious level of how excited we are generally. Well, that's reduced. There's grief, there's guilt, there's crying. But then there's also these vegetative things. There's disruptions in sleep, which of course make everything more challenging when we're awake. We know that sleep is so vital for resetting. You're waking up early, you can't get back to sleep.