Ending the Stigma

Writing Gia Miller and Stacey Pfeffer

Artwork by Eliyahu Greenwald

If we’re being honest, no one is perfect. Some people have a mouth full of crooked teeth, while others cannot see two feet in front of them. There are people whose eyes itch and noses drip when flowers begin to bloom and others who cannot comfortably enjoy pizza or ice cream. And there are some people who are always sad or anxious and others who find it hard to focus, sit still or think before doing. Whether it’s poor vision, seasonal allergies or a mental health condition, none of these “problems” are the person’s fault. It’s just how they were made.

And luckily, we live in a time where there are glasses and contacts to compensate for vision problems as well as braces to fix crooked teeth. We can take allergy medication in the spring and fall as well as lactose pills before consuming dairy. And we can also go to therapy and/or take medication to help us if we’re struggling with depression, anxiety and/or attention-deficit/hyperactivity disorder (ADHD). If these are all treatable conditions, then why is there such a stigma around the mental health ones? We all need to function in society, and if glasses, antihistamines or antidepressants help us do that, then why the judgment?

Often, it’s because, unlike poor vision or lactose intolerance, people don’t really understand why depression, anxiety and ADHD occur. But knowledge is empowering, and that’s what we’re here to do. We’re breaking down the science and explaining how it all works so you, too, can empathize instead of judge.

Yes, the brain actually looks different

While some view depression, anxiety or ADHD as a weakness, if you listen to the stories of people who have experienced them, you’ll likely learn the opposite is true. Many of the people who struggle with these differences work incredibly hard to function in society.

“I started having crippling anxiety when I was five or six years old,” says Meghan Crystal, owner of Pearl, a retail shop in Katonah. “I was afraid of running water because I worried the bathtub would overflow, then the house would flood and we would all die. I was also afraid of electronic appliances blowing up. I was only in kindergarten and having these types of thoughts—this terrible, terrible anxiety.”

“And when the running water fear went away,” she continues, “it was replaced with being afraid that my parents were going to abandon me, that they weren’t going to pick me up from school.”

Her parents, Crystal says, did the “best they could with the tools that they had at that time.” They brought her to therapy and helped her however they could. Luckily, science has come a long way in identifying and understanding the neurological differences in people with depression, anxiety and ADHD. Now, we’ve learned these conditions are not illnesses in the traditional sense; they occur due to natural variations (size and “wiring”) in the brain.

To get you up to speed, below are some of the major findings over the past few years. But this list comes with a warning: Even though hours of research went into compiling this information, we’ve likely unintentionally missed something. So, we encourage you to view these findings as a comprehensive, but not complete, overview. And if you’re interested in learning more about any of the points made, check out our online version of this article—it links each statement to the corresponding research.

Depression

Over the past five years, researchers have found several key differences in the size, shape and function of brains among people with depression, including:

• The network that helps the brain focus on important emotional or behavioral signals, like rewards or dangers (called the frontostriatal salience network), is almost twice as large, according to a 2024 study in Nature.
• The size of the brain’s hippocampus (which helps us convert short-term memories into long-term ones) is “more consistently smaller than the amygdala” (which helps us process emotions like fear, anger and anxiety) in the brains of people with depression, according to a 2020 study in Sage Journals. (It’s typically the opposite in people without depression.)
• Certain areas of the brain (the left anterior cingulate gyrus and the left superior frontal gyrus) are thinner than others, according to a 2024 study in PubMed. This makes it difficult to manage emotions and make decisions, and it impacts focus, memory and negative self-reflection.
• A 2024 University of Colorado study explains that when someone is experiencing depression, the parts of their brain responsible for reward, happiness, mood, self-esteem and, in some cases, problem-solving are not properly communicating with each other. This means those parts cannot do their jobs correctly.

Anxiety

Recently, researchers found that when children experience increased anxiety, they have less emotional control, and others discovered that early-life stress and trauma can change the brain’s structure and development, laying the “groundwork for anxiety disorders that come later in life.” Plus, a 2021 study found that people struggling with anxiety “cannot control their feelings and behavior even if they want to.”

A 2024 study used EEG signals to examine the differences in people with generalized anxiety disorder (GAD) and found there is/are:

• Significant disruptions in the connectivity between the parts of our brain that impact emotional regulation (prefrontal cortex) and heighten fear responses (limbic structures).
• Increased activity in the amygdala, which results in exaggerated fear and vigilance, even when they are in a safe environment.
• Reduced activity in the part of the brain that is responsible for cognitive control and emotion regulation (dorsolateral prefrontal cortex, or DLPFC), making it more difficult to suppress inappropriate fear responses.
• Heightened activity in the insula, which helps create physical symptoms, like rapid heartbeat or shortness of breath.
• Lower levels of a neurotransmitter (gamma-aminobutyric acid, or GABA), which decreases the brain’s ability to suppress the circuits associated with anxiety.

ADHD

This article includes ADHD, a neurodevelopmental disorder, because it frequently co-occurs with anxiety and depression. One of the reasons they’re grouped together is because many people with ADHD also struggle with anxiety and/or depression (it’s called a co-occurring condition). Some of the latest research involves brain waves, connectivity and structure.

In 2024, researchers at the National Institutes of Health (NIH) found heightened connectivity between the part of the brain that helps with attention and control of unwanted behaviors (the frontal cortex) and the information processing centers deep in the brain that are involved with learning, movement, reward and emotions.

At the beginning of 2024, a study involving children ages nine and 10 found there is “a robust association between brain-wide connectivity and ADHD symptoms. Prior to this, most studies looked at certain regions, not all over brain connectivity.

A 2023 study published in Frontiers noted that several areas of the brain are smaller, including the nerve fibers that connect the two halves of the brain (corpus callosum), the part responsible for executive functions, motor control, emotions, personality, memory, learning, behavior and more (frontal lobe), and the part essential for coordinating movement, processing emotions, learning from experience and decision-making (caudate nucleus). It also found:

• The part that plays a role in motor control as well as cognitive and emotional functions (cerebellum) is approximately four percent smaller.
• Areas of the cerebellum that contribute to executive functioning have less gray matter (what helps brains process information).
• There are abnormalities in the white matter that connect various parts of the brain to each other.
• There are reduced volumes in several areas that are critical for attention, impulse control and executive functioning (dorsolateral prefrontal cortex, caudate nucleus, pallidum and corpus callosum).

In 2021, researchers discovered the P3B brain wave is typically weaker or delayed, leading to decreased attention and information processing. They also found abnormal functioning in the N200 brain wave, which helps detect errors as well as control impulses and focus.

Generally, all three of these disorders are the result of biology, genetics, environmental factors and life experience. And with the right assistance, they can usually be managed. “Psychiatry is complicated, but we have made great strides, and there are always new treatments available that can help those who are suffering,” explains Dr. Lorraine Innes, M.D., owner of the Mount Kisco-based TMS of Westchester and TTC Psychiatric, P.C., who treats patients with depression, anxiety and ADHD in her office.

So, let’s explore how they can be treated.

Learning skills

Therapy is often the first step to managing symptoms of anxiety, depression or ADHD, and finding the right therapist is important. “The therapist’s skill set is important,” says Chappaqua-based Alissa Gleacher, Ph.D. “You should ask about their training, and if they say they offer a specific type of therapy, find out how much experience they have. Did they take a three-day training course, or are they someone who has trained in it their whole career?”

For each of these conditions, Gleacher says learning skills through therapeutic approaches, like cognitive behavioral therapy (CBT), can help improve a person’s ability to manage their symptoms. “Therapy takes time,” she explains. “You can’t expect a person to just go out and do things again after one session. The steps need to be gradual.” That often means weekly sessions for anywhere from three to six months or a year. “The goal of therapy is to get the patient out of therapy and back to doing things they previously enjoyed,” she adds.

Gleacher often uses CBT for clients struggling with anxiety or depression. It helps them recognize the connection between thoughts and feelings and how they manifest in the body and their behavioral impact. She then helps them develop the skills needed to address those feelings and apply them to daily life. “It changes how they’re thinking about things, how they’re feeling, and the behaviors they’re engaging in,” she explains. “We use a lot of problem-solving,” she continues. “I figure out what motivates them and the proper progression of steps they should take to return to enjoying things and engaging again.”

Alex DiMauro, LMHC, with Pleasantville Wellness Group, says there are “no cookie-cutter mental health treatments” when it comes to anxiety and depression. “It can help reduce the severity of symptoms, but they also need to implement what they’ve learned, and that’s not always easy. The work we do in a 45-minute session needs to last beyond the session. They need to feel empowered enough to take it home with them.” And when they do, change will happen. Crystal says that even at a young age, therapy taught her how to manage her anxiety.

For ADHD, however, Gleacher says a combination of medication and therapy is most effective (more on this below). “Even the longest-acting ADHD stimulant doesn’t last all day long, so they need to learn executive functioning and organizational skills,” she explains. “When patients combine them, it can be like a visually impaired person wearing glasses for the first time. It can have a profound effect and lead to success.”

With all three conditions, life experiences and symptoms can change over time, so returning to therapy for a “tune-up” is common. And when therapy alone doesn’t help, medication is often added.

Improving connections

“I wasn’t medicated until I was 40 years old; I refused,” says Crystal. “I refused because I was afraid the drugs were going to change me, that they were going to make me crazy and not like myself. And when I speak to people now about medication, it’s a common theme. They’re afraid to dive in or even dip a toe into medication because they’re afraid of being altered somehow. But that’s not how it works. One of my therapists described medication as an umbrella during a rainstorm. It’s not meant to change you; it’s just meant to protect you so that you can heal.”

Most people believe antidepressants, used to treat both anxiety and depression, correct a “chemical imbalance” in the brain. However, several recent studies (the most recent one we found was published in mid-2024) say that’s not what actually happens. Instead, while many antidepressants do increase serotonin production (the “feel good” chemical your brain makes naturally), the serotonin isn’t correcting a supposed imbalance; it’s strengthening (or, depending on the person, restrengthening) the connections between the parts of the brain that aren’t currently communicating properly (the ones responsible for reward, happiness, mood, self-esteem and sometimes problem-solving). As these connections get stronger, their brain begins to resume normal functioning.

“The brain is a complicated organ,” says Innes. “But we continually learn more about how antidepressants work, especially since we’ve had different ways to scan the brain and look at structure, volume and metabolic activity. Antidepressants have been shown to increase BDNF (brain-derived neurotrophic factor), which is one element leading to neurogenesis (generating new neurons).”

Thinking about it logically, if anxiety and depression cause low levels of certain chemicals, then taking an antidepressant to increase them should work immediately. But that’s not typically the case. Instead, medications spur the growth of neurons, therefore strengthening nerve cell connections and communication. But that initial growth takes several weeks, and then significant change begins.

Talk therapy plays an important role when change begins to occur. “As the biological changes begin to happen, they don’t always make sense,” DiMauro explains. “Even though they’re beginning to feel better, they need a private, confidential, nonjudgmental space to be able to talk about those changes.”

For children and adults with ADHD, the most common medications are stimulants (like Adderall and Ritalin), which increase the amount of dopamine and/or norepinephrine entering the frontal lobe networks in the brain (including those responsible for executive functioning), so the neurons in the brain can talk to one another. In layman’s terms, this decreases the “noise” (a.k.a. distractions) people with ADHD experience, which improves their:

• ability to start and complete tasks.
• emotional regulation.
• impulse control.
• planning & organization.
• self-awareness.
• time management.
• working memory.

But most ADHD medications don’t last all day, so once the medication wears off (and before it “kicks in” in the morning), they must work much harder to function.

If it’s not working

Several years ago, Crystal’s anxiety took a turn for the worse. It began with extreme anxiety and exercising up to six hours a day; then it turned into a depression so severe that she couldn’t lift her head from her pillow. Everyone encouraged Crystal to try medication, but she refused. Eventually, Crystal realized she was unable to function and something needed to change, so she gave it a try.

“Listen, I went through a lot of trial and error with my medications,” Crystal remembers. “But that’s part of the process; it’s a bit painful. Now, I’m on a great mix of meds that are perfect for me, and they’ve definitely changed me for the better. They make me more capable as an individual, and they give me the ability to use all the coping methods I’ve learned to help me get out of anxious or depressive episodes.”

“Unfortunately, there is a bit of trial and error in psychiatry,” says Innes. “So, we try different things or a combination of treatments. Mental health conditions are real, and we have a lot to offer so you can get better.”

When antidepressants don’t work, there are other options. Innes, for example, says her patients struggling with depression who take intranasal esketamine (made from ketamine) experience improved symptoms in as little as 1-2 weeks. This drug increases levels of the most substantial chemical messenger in the brain: glutamate. Others, she says, see results from transcranial magnetic stimulation (TMS), a non-invasive treatment where an electromagnetic coil placed on the scalp delivers magnetic pulses that stimulate nerve cells in the affected region of the brain. “Between 80 and 90 percent of the people we have treated benefit, while 50 to 70 percent achieve remission,” she says.

Innes uses the same technology to perform a treatment called MeRT (Magnetic e-Resonance Therapy), which optimizes brain function. “Studies have shown that when the alpha waves in our brains are synchronized, organized, and maximized, our brains work at their best,” Innes explains. “Then, many other symptoms—like depression, anxiety, PTSD, cognitive problems, memory issues, sleep and even autism-related symptoms—will drop away.”

It can be tricky to find the right combination of therapy and medications for any of these conditions, so support and encouragement for someone who is struggling goes a long way.

So, if you’re one of those people who read the intro and then skipped to the end because you just wanted the conclusion, here it is: Anxiety, depression and ADHD are not the person’s fault, nor are they character flaws; some brains are simply built differently. Therapy can teach people struggling with these conditions the skills they need, and medication can help connect/reconnect parts of the brain that aren’t communicating well or properly. Just like we wouldn’t criticize someone who wears glasses or takes allergy medication, we shouldn’t judge those who need or receive support for a mental health condition. Knowledge gives us the power to better understand and therefore empathize instead of stigmatize

This article was published in the May/June 2025 edition of Connect to Northern Westchester.