Depression & Gut Brain Axis Dysfunction

In this episode, we explore the complex relationship between depression and gut brain axis dysfunction.

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Contact Information:
Jerrodb@pathwayscounselingcenter.org

Disclaimer:
The information provided in this podcast is for educational purposes only and is not intended as medical or mental health advice. The content discussed should not replace professional judgment, diagnosis, or treatment. Always consult with a qualified healthcare provider regarding any medical or psychological concerns. The views expressed by our hosts and guests are their own and do not necessarily reflect those of any affiliated organizations.

Credits:
Executive Producer, Host: Jerrod Brown, Ph.D., M.A., M.S., M.S., M.S., M.S., M.S.

Producer, Technical Director: Megan Eichten, AAS, CPT, CES (NASM)

Audio Engineer, Sound Designer: Jen Carter, BS

Transcript

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SPEAKER_00 0:01

Welcome to the Psychogastroentermologist, the show where we explore the fascinating intersection of the brain-gut connection through a multidisciplinary lens informed by psychology, neuroscience, and gastroenterology, better known as psychogastroentermology. Our mission is to delve into the gut brain access and uncover how this powerful connection influences mental, physical, and overall well-being. Whether you work in behavioral health, health care, the criminal justice system, or health and wellness coaching, this podcast offers insights to inform and inspire your work. Join us as we break down complex concepts, share evidence-based perspectives, and discuss emerging trends in this rapidly evolving field. The information provided in this podcast is for educational purposes only and is not intended as medical or mental health advice. The content discussed should not replace professional judgment, diagnosis, or treatment. Always consult with a qualified healthcare provider regarding any medical or psychological concerns. The views expressed by our hosts and our guests are their own and do not necessarily reflect those of any affiliated organizations.

SPEAKER_01 1:03

Hello, everyone. Welcome back to our next episode for the Psychogastral Entomologist Podcast Program offered through Pathways Counseling Center. I'm your host, Jared Brown. In this episode, we are going to explore the topic of depression within the context of the gut brain access. And we're going to talk about a lot of moving parts today. We're going to be moving quickly. If you want to see this visually and take a look at the slides I'm presenting, please check out our YouTube channel. So if you see this visually, if you're new to our podcast program, here's a copy of my brief professional biography. I wear a couple different hats. I'm a professor, trainer, researcher, and consultant. And our agenda, just like all of our other episodes, are very straightforward. So today I'm going to give you a really broad spectrum overview of depression, but take it deeper into the weeds. I'm going to talk a lot about neuroscience today, nutrition, some biochemistry. Part two today, we're going to talk about what do we do with this information and how do we apply it in an intake screening or interviewing process. And then part three today will wrap it up with strategies, solutions, and interventions. So depression, I think we all have a good understanding of what is depression, but hopefully you walk away from today's talk really realizing how complex depression truly is. So if you see this slide here, I like to show this. And it's a good reminder why we want to become informed about the topic of depression, because it is one of the leading causes of disability worldwide. If you see this slide too, chronic pain and migraines are also leading causes of disability. We will be releasing an episode coming out in the following weeks or months on migraine and the gut brain access. So be on the lookout for that as well. So depression, major topic. If you're a human being, I'm sure you've dealt with depression at some point in your life. Some people deal with it more frequently than others. If you take a look at this slide here, again, it's a leading cause of disability. Some research indicates it impacts more than 350 million people worldwide. Again, it depends on how you classify this as well. But if you're working in clinical forensic settings, you're coming into contact with individuals impacted by various forms of depression all the time. Here's a really good statistic I like to show from time to time. This is just a reminder, again, why we want to study this topic. And this is a study that relates specifically to the United States. So it impacts millions of individuals. And on top of that, it causes billions and billions of dollars in loss, productivity, and economic growth. This slide here, just a good reminder of some of the symptoms of depression that may present in an individual. This can vary from individual to individual depending on a host of factors. Folks with depression frequently experience changes in eating and sleeping patterns. They might experience more fluctuations in energy, more daytime fatigue. It could really get in the way of self-esteem, being productive at school or on the job. It could be a triggering event for higher levels of irritability and anger in some cases. Here's some more symptoms of depression. It could be a factor in higher levels of feelings of helplessness, hopelessness, restlessness. And the list goes on and on and on. Here's where we start getting into the weeds a little bit with depression. So depression is a complex medical and neuropsychiatric condition. Depression can be a symptom. It can co-occur with all kinds of medical and cognitive and emotional kinds of disorders. It can be a standalone condition. Some of the common symptoms, again, associated with depression, if we get a little deeper in the weeds here, is your client may experience more negative cognitive styles. It can impact neuroplasticity. Typically, when someone's dealing with high levels of depression, there's going to be imbalances in hormones and neurotransmitters. Gut brain access dysfunction, without a doubt, is a factor. Depression really is a chronic inflammatory condition. So we'll talk about inflammation today. And when someone's dealing with high levels of depression, typically their HPA access is not working properly. We have an episode dedicated to the HPA access. I encourage you to check out. Breaking it down a little bit more here. So these are just eight more variables you'd want to consider. Again, this can vary from person to person, but some of the common symptoms of depression may include more daytime fatigue. You might experience more body-based symptoms, headaches, may have increases in cravings for unhealthy foods, higher levels of insomnia. It could be a factor in consuming higher levels of alcohol for some individuals. And it can really trigger emotional mood instability problems. This is a really good reminder why it's so important to get into the weeds when you study depression. Hopefully, this is one reason why. If you see this slide here, these are some of the biological models that have examined the topic of depression. Depression could be caused partially by genetic vulnerabilities. There could be some biological disturbances in one's immune system. Typically, when someone's dealing with a high degree of depression, they're going to have more biochemical abnormalities. So, again, very important to understand gut dysbiosis, hormones, blood sugar imbalances. We're going to talk about sleep today. It's very, very important to understand circadian rhythm misalignment and our neuroendocrine system, which part of this is going to be the HPA access and our hormones and the gut brain access, to name a few. Going a little bit deeper in the weeds here. So looking at this article, great article published in 2023 that really encourages us to learn about changes in neuroplasticity. Very, very important to understand again the hypothalamus, pituitary adrenal access. This is our body's main stress response system. It's a hormone regulator. And as I mentioned before, when you work with folks with depression, there's a pretty good chance that we're talking about someone that probably has higher levels of inflammation going on in their body. This is where it gets really interesting and complicated. So if you take a look at this, these are some of the brain structures and functions that are associated with depression. So we might have more brain-based changes in some of these or all of these areas. So very important to learn about the neuroscience aspects of depression. Some of these you're probably very familiar with, like the amygdala, the orbital frontal cortex, the hippocampus, the basal ganglia, the thalamus. A lot going on in the brain of somebody when they're dealing with chronic depression. When you work with folks with high levels of depression, especially over a long period of time, there's a pretty good chance, not always, but in a lot of cases, that client may also be dealing with higher levels of medical health comorbidity. So very important to understand when we talk about depression, it's not just the emotional and behavioral side of things we need to be aware of. We also need to be aware of any kind of chronic health conditions. If you work with clients with a long history of depression, it is also more common for some of your clients to be dealing with something called depressive rumination. This is when that client maybe overly thinks about something over and over and over again. And this is like pouring gasoline on a fire. And if this is going on with your client, this can just make the depressive symptoms grow. And if this happens to the client too, in a lot of cases, that client is probably not sleeping well. Just in general, if you take a look at this slide, when we talk about rumination, and this can vary from client to client, but if you have a client that deals with chronic rumination day in and day out, this can amplify negative emotions. It can contribute to more intrusive thinking, it can lead to longer-lasting depressive symptoms and an increase in occurrence of depressive episodes. So really important to understand the topic of rumination. So here's a little bit about inflammation. So when you study depression, very, very important to have at least a basic understanding of inflammation and chronic low-grade inflammation. So if your client's dealing with a high level of depression, pretty good chance they're dealing with higher levels of brain inflammation. If you look at this slide here, if somebody's dealing with a lot of brain inflammation, that client may be dealing with more brain fog, they may have slower processing speed, they may have lower levels of brain endurance, their thinking may be more unclear and disorganized, just to name a few. When you study inflammation, understand the topic of neuroinflammation. This is basically the brain and spinal cord dealing with higher levels of inflammation. And there's a multitude of factors that can contribute to higher levels of neuroinflammation. Depression being one of them. This slide here has a lot of these variables you'd want to consider, including problems with the gut brain access. When you study depression, this is a great article. If you see this here visually, the research really encourages us to learn about the HPA access and dysfunction in the autonomic nervous system. We also did an episode on autonomic nervous system dysfunction. Check out our YouTube channel. I think that episode is on our channel right now. When you study depression, it is also important to take into account that some of your clients' depression could be partially driven by adverse childhood experiences. So very important to understand how earlier forms of trauma in some cases may play a role in depression symptoms, even in adulthood. Has a very quick overview of part one. So part two, practical things you'd want to consider during your intake screening and interviewing process. So there's a lot of risk factors for depression. This article was published in 2014, 2024 that talks about you'd want to learn about disability status, socioeconomic status, unemployment status, histories of childhood trauma, education factors, even smoking cigarettes could be risk factors for depression. This is a great article published a few years ago that talks about why a higher percentage of clients with serious and persistent mental health issues, including folks with major depressive disorders, may experience more poor health outcomes. So some of the contributors are sedentary behaviors, alcohol use, drug use in some cases, tobacco use, unhealthy eating practices, stigma-related problems, cognitive-based impairments, and the list goes on. When you study depression, it's important to understand nervous system dysregulation. Again, we have an episode dedicated to the autonomic nervous system. So when you think about nervous system dysregulation, what do we want to think about? Well, it can trigger more depression. Depression and nervous system dysfunction do go hand in hand. What are some of the signs and symptoms of a dysregulated nervous system? Well, they're many and varied. It could be digestive health problems, body tension, a racing heart, problems focusing, sleep issues, dizziness. The list goes on and on and on. These are some factors that can impact our nervous system: poor sleep, traumatic stress, relationship conflicts, anxiety problems, depression, and many, many more. So the more we can understand the interconnectedness of all of these topics, I think we're going to be in better shape helping our clients. And what are some of the factors that can impact client cognition and brain-based functioning? Well, this slide should sum up several variables you'd want to take into account. Obviously, we're focusing on depression today, right here. But your client, if they smoke a lot of cigarettes, they're dealing with unmanaged diabetes, hypertension, high cholesterol issues, sedentary behaviors, obesity, these are all things that can impact cognition in your clients. When we look at this through a cognition lens, depression can impact the brain, obviously, on many levels. So this can vary from client to client. But according to empirical-based literature, when you're working with clients with high levels of depression, they may be dealing with more attention issues, working memory problems, disinhibition, and the list goes on. So very important to understand that when you work with people with high levels of depression, they're probably dealing with higher levels of executive function impairment, metacognitive impairments, to name a few. I mentioned neuroplasticity before. We have an episode on this very topic coming out very soon. High levels of depression can contribute to maladaptive neuroplasticity. Why do you want to care about this topic? Because good neuroplasticity really goes to the heart of memory and attention and learning. When our neuroplasticity isn't working properly, that really can impact attention, learning, and memory capabilities. As you can see on this slide, there's a multitude of factors that can contribute to maladaptive neuroplasticity, including depression. So this is a slide here you've seen in other episodes, but I wanted to remind us why do we want to learn about the gut microbiota access? Because alterations and changes in the gut brain access, including our gut microbiome, have been linked with higher levels of serious mental health issues, including depression. What are the factors that can adversely impact our gut microbiota? Untreated depression, unmanaged anxiety problems, and even self-indurous behaviors, the research indicates. We'll have an episode coming up in the next several months on irritable bowel syndrome, but I wanted to show you here and plant a seed. If you work with folks with IBS, irritable bowel syndrome, take a look at this. The prevalence of depression in folks with IBS may be as high as 84%, depending on what study you look at. We'll go a lot deeper in the weeds with IBS during that episode, but take a look at this. If you're working with folks with IBS, irritable bowel syndrome, depression is a very common comorbidity. So is anxiety, sleep issues, and even chronic pain-related problems. So back to the gut. So if you work with clients with an unhealthy gut, what could be some signs and symptoms that may alert you to the fact that maybe their gut's not working at optimal levels? Well, high levels of anxiety, depression, acid reflux, brain fog, unexplained fear, migraine, skin problems, the list goes on. These are signs that maybe that individual's gut is not working at optimal levels. We'll have several episodes coming up on various forms of various talks related to diet and nutrition. And what we're talking about today is for educational purposes only. Again, please consult with qualified professionals, including dietitians, nutritionists. But taking a look at this here, what are some potential nutritional factors associated with higher levels of depression? Well, this is a really great article that does talk about if clients eat processed foods day in and day out, like fried foods, pastries, donuts, processed meats, sugar-sweetened beverages, things like that. These factors could trigger higher levels of depression. When we talk about ultra-processed foods, junk food, things of that nature, those are foods that fall under the umbrella of the Western diet. This way of eating, day in and day out, year after year, may play a role in higher levels of depression, obesity, allergies, autoimmune issues, diabetes, and the list goes on. Here's another variable. Wish we had more time. We'll probably do an episode on vitamin D in the future. Vitamin D is a complex topic, it's an important topic. But if someone's dealing with depression, it probably wouldn't hurt that individual to go to their medical doctor, obviously get lab work. And you know, could it be one piece of the puzzle that that individual is dealing with low levels of vitamin D? Food insecurity, another variable to consider that has been linked with higher levels of depression. Why do you want to care about the topic of food insecurity? Well, it's very common in clinical and forensic populations, folks with substance use issues. And if you look at this slide here, there's a lot of mental health implications associated with food insecurity. It could amplify more mental health issues, including anxiety and depression, and trigger more stress in your client, which then can all trickle down into adversely impacting the gut brain access. Here's another piece of the puzzle that maybe we don't think about enough. Exposure to nighttime noise could be a factor in more depression because if that client is constantly getting woken up in the middle of the night from a lot of noise, from whatever noise exposure it is, that could overactivate the HPA access, which then could contribute to more depression. Alexithymia, another major topic to take into account. And if you work with folks with major depressive kinds of issues, some research has found that maybe 45, sick, 40, around 45% or so, according to literature, of your clients with major depression may actually be dealing with something called alexithymia, which is emotional blindness. This is when your client is going to have a hard time naming, labeling, and processing emotions. What are the causes for alexithymia? Really fascinating topic. A call to action. I encourage all of us to learn about this topic. Well, if you take a look at the causes here on this slide, there could be some genetic factors. There could be psychological kinds of issues, there could be physical health diseases that contribute to this, traumatic exposures, stress, anxiety, and depression. Here's another piece of this pie, this big puzzle we're trying to put together when we study depression is smoking. And if you look at this slide here, we know, according to the literature, that tobacco use is higher among folks with a psychiatric condition. When we talk about this within the context of psychiatric disorders, people with depression, anxiety, certain phobia, psychosis, agoraphobia, mania, hypomania, and even folks with antisocial personality disorder are going to be more likely to smoke cigarettes. This is a very important area to consider because smoking cigarettes can impact depression and sleep and/or gut brain access. Here's another piece of the puzzle. Air pollution exposure. Several studies are finding exposure to air pollution day in and day out could play a role in higher levels of depression. Chronic sedentary behaviors really is a threat to human health, and it can drive the bus with inflammation and depression. So really consider the role that exercise plays in combating depression. What are some of the health effects associated with prolonged sedentary behavior? This is someone that lives this way day in and day out. Well, take a look at this article. This is overwhelming. Chronic sedentary behaviors can impact blood sugar imbalances, joint problems, fatigue. It's not good for our brain. It's not good for our heart. It's not good for our gut. Very, very important to consider this when you're doing a screening session intake and developing a goal plan with clients. Ruling out sleep apnea, another can of worms we're opening here, but it's important to be aware of this. Untreated sleep apnea can play a role in triggering more depression. And we'll have an episode too on obstructive sleep apnea coming up. So be on the lookout for that. But here's a really great article that talks about obstructive sleep apnea within the context of depression. How can it lead to that? How can it cause more depression? Well, it can cause more inflammation, oxidative stress, and it can impact our gut microbiota. And all of these things can play a role in triggering more depression. Attachment has a lot to do with this. What is your client's attachment style? Interestingly, if you work with folks With insecure attachment patterns. This has been linked with higher levels of inflammatory markers because of chronic loneliness in some cases, problematic social relationships, difficulty handling social stressors, and higher levels of depression symptoms. If your client is dealing with loneliness or social isolation, take a look at this. This comes from several studies. Chronic loneliness and social isolation over a long period of time may be comparable to smoking 15 cigarettes a day on the human body. So if you see here, look at all these factors. We need to be aware of when we're talking about chronic loneliness and isolation. And I'm not advocating for you to use these scales. I just want to plant the seed here. There's many depression scales out there in the literature. Some of you are probably very familiar with most of these, but I just wanted to show some of them that come up in the literature frequently. So take a look at this. You'll have to decide. Look at the credentials you need, look at the research behind these scales. But there's many more out there, but these are some of the big ones you'd want to be aware of. Our last section today is all about tips, strategies, solutions, and interventions. So you hear me talk a lot about lifestyle medicine in our other episodes. We'll have a six-part series from one of our colleagues that will be doing a complex overview, really digging in the weeds on this topic of lifestyle medicine. But the research supports the fact a lifestyle medicine approach can be very good for combating depression. What is lifestyle medicine? Well, it's rooted in six core features. Again, getting good sleep, exercise, eating healthy, managing stress, avoiding harmful chemicals, and promoting positive social connection. Getting clients really feeling connected to others, helping them feel like they belong and matter. These are interventions. And if you see this slide here, what are the benefits associated with social belonging? Improving sleep, reducing pain, improving fatigue. It's a great way to combat anxiety and depression. So helping clients reduce loneliness and isolation and feeling like they belong is an intervention. Having a balanced lifestyle is very important to treating depression as well. If you take a look at this article here, creating more balance, not overdoing it in one area, not overcommitting, taking more time, slowing down, breathing more, not burning out. Very, very important. A balanced lifestyle is an intervention to treating depression. We know how important it is to exercise. Exercise is medicine, probably the greatest medicine ever developed, some say. Take a look at this slide here. Again, I'm not advocating for you to go out and do exercise with your client unless you have the proper credentials, education, and training. And the client's been cleared by their healthcare provider, of course. But getting exercise consistently, good for the brain and body, and it's a great way to combat depression. Walking interventions, very good for depression and anxiety. We have an episode that we will be releasing in the future. Check out our podcast program, and it'll be on therapeutic walking. So that be on the lookout for that. That really ties into what I'm showing here on this slide. Walking interventions are very helpful, very therapeutic, and supported in the literature. This slide here gives us seven reminders why it's so important to maybe consider implementing walking interventions into the good work you already do. Here's a really lovely article that was published last year in 2025 that talks about the use of walking within the context of talk therapy. This study looked at how therapists incorporated walking into talk therapy for male clients with depression. And the study results found that it definitely was positive in affecting positive change for men with depression. Eating healthy foods is another intervention. Working with dietitians, working with nutritionists, very important. And it is supported in the literature that healthy eating can reduce depression. I'm not advocating, please don't go out there and give clients advice on this here. This is complex. Talk to dietitians, nutritionists. But this is a great article that reminds us why we want to consider collaborating with dietitians, nutritionists, functional providers, doctors who have an expertise in this, because there's many nutrients that are very, very good for combating depression: magnesium, vitamin B6, folate, potassium, iron, zinc, long-chain omega-3 fatty acids, thiamine, vitamin B12, vitamin A, and the list goes on. Eating foods that fall under the Western diet, processed foods, not good for human health. The Mediterranean diet is probably one of the healthiest dietary patterns on the planet. Again, work with a nutritious dietitian who knows this stuff, but eating foods consistently under the Mediterranean diet may lead to reductions in depression, according to literature. Here's another great article that was published last year in 2025 that does talk about eating the Mediterranean diet consistently may be a good intervention for people with depression. What are some of the health benefits associated with living and eating a Mediterranean diet and lifestyle? Well, taking a look at this, it's good for cardiovascular health, it's good for blood sugar regulation, it's good for cognitive health. And the list goes on and on and on. When you are learning about depression, you're working with clients and you want to treat it holistically. Working with a provider who understands gastrointestinal behavioral health, working with a provider who has training in psychogastroentinology can be very, very helpful and is supported in the literature. So I want to remind us I showed us this slide earlier. There are a multitude of factors that can impact the gut brain access, depression being one of them. So by default, if you are working with people with depression, learn about the gut brain access, treat both simultaneously. It likely will lead to better outcomes. Another intervention, and we know this, but it's just a reminder working with individuals and helping them maybe develop a greater sense of gratitude can be a protective factor against stress and depression in some cases. Obviously, easier said than done. What does the literature say about the positive impact of gratitude on human health? Well, it's great for thinking, it's great for energy, it's great for sleep health. The list goes on. So the more we can cultivate an attitude of gratitude day in and day out, that might be one piece of the puzzle that can help reduce depression. And another intervention before we wrap it up today, and there's many more, but for sake of time, I'll end it on this note. Self-compassion interventions. Teaching people how to have greater levels of self-compassion is an intervention as well. And it's very, very good for our brains and our bodies, our thinking, and it can help reduce depression in some people. Appreciate all of you. Please reach out anytime. Here's my email address, and look forward to having you back for our next episode. Thanks, everyone.

SPEAKER_00 29:24

We hope today's episode provided you with valuable insights into the gut brain connection and its impact across diverse settings. If you enjoyed this episode, please subscribe and share. For more information on this topic, resources, and services, visit Pathways Counseling Center.org. Thank you for joining us on the Psychogastro Intermologist, where mental health and digestive science converge.