Depression is a very common illness. About 17 percent of the population will have at least one episode in their lifetime. WHO predicts that by 2030, depression will cause more disability and mortality than any other illness including cancer, cardiovascular disease, accidents and war! It has been known for a number of years that antidepressants are no better than placebo for mild or moderate depression and only about 10 percent more effective for the severely depressed. In fact, a good clinical rule of thumb is that SSRI’s get about 50 percent of patients about 50 percent better. However, these facts do not discourage clinicians and patients from using antidepressants. 250 million prescriptions are written a year – that translates into one out of every ten patients in the US being handed an antidepressant prescription.
Our treatment of depression by manipulating neurotransmitters has remained fundamentally unchanged for the last decades. In fact, there is no data demonstrating that any of the antidepressants developed since imipramine in the 50’s WORK ANY BETTER in both achieving full remission and preventing relapse. 50 percent of patients relapse after their first episode, which mean SSRI’s don’t do anything actually to cure depression. In short, we have a very common and debilitating illness – some would say an epidemic – and our treatment modalities remain stuck in an ineffective paradigm.
A more fruitful approach is to approach depression with fresh eyes. As humans, we find it very easy to find meaning in the cluster of symptoms we label depression. Loss of interest in usual activities, withdrawal from the world, inability to find pleasure in ordinary pursuits, low energy, aches and pains changes in sleep and appetite – that must be from grief, or sadness, feelings of guilt or reaction. There must be an emotional reason for these behaviors. However, when we observe the same behaviors in an animal, we recognize the presence of a physical illness and take our pet to the vet. In humans, psychological meaning is attached to the behaviors, and therapy or antidepressants are prescribed, while in animals we simply call it sickness behavior and test for infectious disease.
There is lots of good research to suggest that animals and humans are not very different and that what we call depression is highly associated with the presence of inflammatory cytokines (Dowlati et al. 2010). Even more exciting news is recent research showing that inflammation probably precedes the development of depression (Hodes et al. 2014). Mice were checked for the presence of Interleukin 6, an inflammatory cytokine, and then placed in cages with physically bigger mice. Some mice lost their taste for sugar water and sex, and began to avoid the other mice. This is considered similar to a depressive state. What the researchers found was that the mice that developed “depression” had the higher IL-6 beforehand. In other words, the presence of inflammation made the mice less resilient in the face of stress. A similar finding was recently demonstrated in children. IL-6 levels were measured in 9 year olds and again when the children were 18. The levels of IL-6 at age 9 were positively correlated with the development of depression and psychosis at age 18 (Khandaker et al. 2014)
What causes the increase in IL-6? The precise causes are not yet known. However, proposed candidates include infectious elements such as viruses, parasites and bacteria, inflammagens such as biotoxins, and stress. In children, early abuse has been correlated with increasing IL- 6 by 2.35 percent (Gouin et al.. 2012). One common parasite found in cats, toxoplasmosis, is linked with increased suicides, and has also been proposed as a causative agent for neuroinflammatory depression (Canli 2014) I suggest watching Dr. Canli’s TED talk for more insight into infectious causes of depression (http://youtu.be/1dD29XHp6CU).
Putting all this research together then allows us to rephrase the dramatic WHO prediction that in 2030 the leading cause of disability and mortality will be depression. No, what WHO is acknowledging is that by 2030 NEUROINFLAMMATION, caused by inflamagens such as biotoxins, Lyme, viruses, poor diet, bad fats, lack of exercise and child abuse, will be the leading cause of disability and mortality. It will be , at least, if new approaches to treatment are not researched and applied.
The exciting news about inflammation and depression is that there are many more ways to treat neuroinflammation than simply popping SSRI’s. Possible treatments include diet, exercise, anti-inflammatory supplements and of course diagnosing and treating the underlying cause of inflammation such as mold or Lyme. For more information about these topics, I suggest browsing through other blog pieces. In addition, if you read last month’s blog on fermented foods you may also enjoy reading this well researched article on fermented foods and mental health (Selhub, Logan, and Bested 2014).
Canli, Turhan. 2014. “Reconceptualizing Major Depressive Disorder as an Infectious Disease.” Biology of Mood & Anxiety Disorders 4 (1). BioMed Central Ltd: 10. doi:10.1186/2045-5380-4-10.
Dowlati, Yekta, Nathan Herrmann, Walter Swardfager, Helena Liu, Lauren Sham, Elyse K Reim, and Krista L Lanctôt. 2010. “A Meta-Analysis of Cytokines in Major Depression.” Biological Psychiatry 67 (5): 446–57. doi:10.1016/j.biopsych.2009.09.033.
Gouin, Jean-Philippe, Ronald Glaser, William B Malarkey, David Beversdorf, and Janice K Kiecolt-Glaser. 2012. “Childhood Abuse and Inflammatory Responses to Daily Stressors.” Annals of Behavioral Medicine : A Publication of the Society of Behavioral Medicine 44 (2): 287–92. doi:10.1007/s12160-012-9386-1.
Hodes, Georgia E, Madeline L Pfau, Marylene Leboeuf, Sam A Golden, Daniel J Christoffel, Dana Bregman, Nicole Rebusi, et al. 2014. “Individual Differences in the Peripheral Immune System Promote Resilience versus Susceptibility to Social Stress.” Proceedings of the National Academy of Sciences of the United States of America 111 (45): 16136–41. doi:10.1073/pnas.1415191111.
Khandaker, Golam M, Rebecca M Pearson, Stanley Zammit, Glyn Lewis, and Peter B Jones. 2014. “Association of Serum Interleukin 6 and C-Reactive Protein in Childhood with Depression and Psychosis in Young Adult Life: A Population-Based Longitudinal Study.” JAMA Psychiatry 71 (10). American Medical Association: 1121–28. doi:10.1001/jamapsychiatry.2014.1332.
Selhub, Eva M, Alan C Logan, and Alison C Bested. 2014. “Fermented Foods, Microbiota, and Mental Health: Ancient Practice Meets Nutritional Psychiatry.” Journal of Physiological Anthropology 33 (1): 2. doi:10.1186/1880-6805-33-2.
- Dr. Canli’s TED talk on depression as an infectious disease can be viewed here: (http://youtu.be/1dD29XHp6CU)
Sent: Saturday, January 01, 2005
http://bmj.bmjjournals. Rapid Response
Subject: The Sixth Sense
I’m an Army veteran, and I was taught the importance of “knowing your enemy” and turning a weakness into a strength with strategy, if at all possible.
I identified my intense reactivity to mold and asked doctors to help me study the problem and deal with it – All refused.
So I took a sample of the offending irritant to a “safe place” and tried sleeping in gradually increasing proximity to determine the most subtle signs of a response that I could discern.
Much to my amazement, the initial and earliest sign of any shift in my symptoms was a relative shift in “depression”, the sensation that I am constantly assured is “the product of an undisciplined mind to emotional stimulus”.
This response occurred as a precursor to headaches, rash or any of the neurological symptoms that people normally associate with a “mold hit”. This was such a consistent response that I came to the conclusion that depression is not what psychiatrists think it is; It is a warning.
When I thought about it for a while, it seemed logical that if Nature wanted to devise a mental response that would induce a creature to change its habits or location to avoid an immunological irritant by leaving an area, what “emotional” stimulus would serve better than “anxiety” and “depression”?
Our senses that interface with our tactile environment are exquisitely designed to correlate with our need to interpret damage and act accordingly, but what about toxic exposures? It seemed logical to me that an immunological message of dysfunction caused by toxins would create a commensurate impulse to “run like Hell” or at least try to change an animals circumstances in some manner to alter the exposure.
It seemed to me that if my proximity to a toxic irritant consistently resulted in an “anxiety/depression” response, that this was actually a useful warning instead of the “emotional response of a disordered mental state”.
So I set out to devise a strategy of extreme mycotoxin avoidance based on my perception of exposure.
I have many clues for overt responses and “mold slams”.
But the primary sense that I am using to detect the lowest level of exposure is the “depression response”.
Several years ago I was describing my strategy to a doctor who offered me antidepressants. I was stunned and amazed that despite my description of the rationale for my strategy, that I was still so misunderstood. “What? Take antidepressants and blunt my most useful tool for detection of immunological upregulation? I don’t want to deprive myself of the depression response – I rely on it and have learned to turn this so called “weakness” into a strength”.
Despite the demonstrable immunological effects of mycotoxins, my descriptions of this strategy to doctors and psychiatrists results in a proposal of “Obsessive Avoidance Behaviors” to account for my actions.
This “psychologizing” of a demonstrable, reproducible and provable response to known neurotoxins says more about the obsessions of psychiatrists than it does about my “behaviors” and I sincerely hope that someday these psychiatric-obsessive theorists will get the counseling they so desperately need.
The evidence is building that “depression” is sickness behavior and represents “The Sixth Sense” , a perception of immunological response which, if correlated with infections or toxic irritants, can be an extremely useful indicator of a cytokine induced inflammatory condition.
I concur with your observations. Perhaps because I am a psychiatrist, and treat suicidal ideation as matter of factly as recording shortness of breath, I have observed that it is a common phenomenon in biotoxins patients. Many other patients have also learned that out of the blue thoughts about suicide indicate exposure, and seem to be the brains response to the threat of inflammatory damage – an alert signal that brain is in danger of damage. For others there is a chronic passive suicidal ideation – a feeling that life isn’t worth living and death would be welcome if it happened naturally. For many learning what you have already figured out, that it is just an “alert” signal, or sixth sense, to reassess their surroundings and remove the body from exposure, is a welcome relief. Others have a harder time believing that their thoughts are not always “meaningful” and can be allowed, as is taught in mindfulness training , to just dissipate. I hope to write more about this phenomenon, including some possible cytokine and biochemical mechanisms underlying the thoughts, in the future.
In the meantime however, I want to make it clear, as a physician who wants to ultimately to see my patients live healthy, happy and long lives, that talking to someone trusted about the thoughts, and getting perspective, is much better than keeping them secret. In addition, although the ultimate goal is removal from exposure and eradication of the inflammation in the body, I will offer allopathic and natural treatments to help alleviate suffering during the process, since many do find them helpful when the depression overtakes the ability to act rationally.
Reading about child abuse, inflammation and depression, I began to think about chinese medicine and yin yang hot cold.
And the. I read Eric’s reply about running away from mold reaction…children can’t run away from abuse, but they get angry and afraid which are hot emotions which leads to inflammation? Adrenal exhaustion Is that part of the equation? FEAR. FIGHT OR FLIGHT. Emotions channel into the body via the energy pathway of the chakras into the glandular system. We have an energetic emotional body field which interpenetrates the physical body. SEE Barbara Ann Brennan School of Healing and her books on Human Energy Fields and illness. HANDS OF LIGHT, LIGHT EMERGING.