in circles, expanding and becoming more negative with each lap. It’s like
worry, but slower and less interesting. Rumination could be the result of
too much activity around the cingulate gyrus, and may improve with med-
ications and therapeutic techniques that reinforce control.
SLEEP DISTURBANCE. Depressed people have all kinds of problems with
sleep—too much, too little, or not the right kind. They have trouble getting
to sleep, staying asleep, and their nights are haunted by nightmares, or worse,
dreams that are exactly like their day-to-day existence, making them feel as
if they never sleep at all. Sleep is supposedly regulated by the Raphe nucleus,
the nexus of a number of serotonin pathways. The same medications can
put some people to sleep and keep others awake, just like depression.
Current theories suggest that different pathways of the same neu-
rotransmitter may have different functions. Some newer medications are
supposed to stimulate one serotonin or norepinephrine pathway and
block others.
Depression clearly involves some changes in neurochemistry, but it’s
uncertain whether this change is cause or effect. It’s likely that there are
different biochemical explanations for depression’s varied symptoms, or it
may be that the same physiological process manifests itself differently
because of different underlying personalities. Or both. Or all of the above.
And, despite the phenomenal success of antidepressant medications,
we still cannot remove psychology from the equation. Studies comparing the
effects of therapy and medication regularly show that the two together work
better than either alone, and that over the long run therapy works better than
medication in preventing the recurrence of depression. Though there are
difficulties with these sorts of studies, such as the impossibility of defining
therapy with anything like the specificity of drug dosage, the evidence does
point to the necessity for some sort of psychological intervention.
Medications for Depression
Antidepressant medications make people feel better, generally by deliver-
ing more of some transmitter substance to the synapses of the brain—
serotonin, norepinephrine, dopamine, or all of the above. What happens
after that is open to question. Nevertheless, each kind of medication
156 ❧Explosions into Sadness