Posted 11/03/2014
You might not immediately think conditions as apparently disparate as depression and inflammation could be linked. Right up front, let me say if you’ve got a history of depression or anxiety, you’re not alone. With 11% of Americans over age ten taking antidepressants daily, we can probably triple that percentage to estimate the number who have depression or anxiety but aren’t taking medication.
When you’re depressed, you feel a pervasive sadness that won’t go away. The irony is that despite feeling depressed, you realize there’s not that much in your life to feel depressed about. You may be reasonably healthy, have some close friends and a job (or realize you won’t be unemployed much longer), and you’re not being held captive by ISIS. But, jeez, you just feel depressed.
When you look back, you know you’ve been through this before, maybe had some counseling, which helped or didn’t. Maybe some meds, but you didn’t like them…or you want to get off them but dare not try. You know you’d feel better after a good run or some yoga, but your motivation is less than zero.
And, oh crap, the clocks were just set back–winter, darkness, now you’re in for it.
Inflammation seems different
When you think your body might be inflamed, or your nutritionist says something like “We need you on a low-inflammation eating program,” we’re describing a situation that’s relatively new to a physician’s vocabulary. Inflammation isn’t an old word, of course, when it refers to your body’s limited physiologic response to some specific irritant. Leave a splinter in your thumb and you’ll see the area around it swell slightly, get warm, and turn red, your body’s elegant inflammatory defense mechanism to oust the splinter and protect the rest of you from more widespread infection.
Anything with the suffix “-itis” at the end indicates this type of local inflammation: dermatitis (skin), tonsillitis (tonsils), sinusitis (sinuses), appendicitis (appendix), and colitis (colon). Historically, most doctors have limited their use of the term “inflammation” to one specific –itis, the area that needs work.
Until relatively recently, little thought was given to the idea of total body inflammation, but as more chronic illnesses like Alzheimer’s, heart disease, and generalized achiness/constant tiredness are linked with inflammation, in certain circles curiosity is being aroused.
Could depression and inflammation be linked?
Why not? Depression can bring with it a plethora of physical symptoms: fatigue, the blahs, muscle pains, headaches, digestive issues. In fact, research over the past few years has shown that the blood tests used to measure inflammation when evaluating heart disease risk (high inflammation being a well-established risk factor for heart disease) return elevated results in many people with depression. These tests include sedimentation rate (sed rate), C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor (TNF).
In addition, the antidepressant meds (Prozac, Zoloft, Lexapro, et al.) all have a mild anti-inflammatory effect. Some researchers think this contributes strongly to their clinical benefits.
Now the question becomes: Can the anti-inflammatory family of medications (ibuprofen, for example) actually help with depression? Before I give away the answer, as an aside I’ll say that the research article I refer to just below is precisely what’s wrong with conventional medicine. Instead of exploring what might actually be causing the inflammation (generally, it’s those old villains diet and lifestyle), researchers develop more drugs.
This particular study, an important one, suggests that taking an anti-inflammatory (like ibuprofen or Celebrex) with an antidepressant will enhance the clinical effect of the antidepressant. The study itself is a meta-analysis, which means the researchers reviewed data from a range of previously published trials. In this analysis they looked at 14 trials with a total of 6,262 patients who had clinical depression in which an anti-inflammatory med or a placebo had been taken along with the antidepressant.
And, indeed, those who also took an anti-inflammatory fared better and the side effects were pretty minimal.
Getting to the source of inflammation
What’s unfortunate is how little attention is paid to exploring the source of our widespread inflammation. If a huge portion of the world’s population is walking around inflamed, let’s find out why.
Here’s a list of the most significant sources of inflammation, from a pretty obscure study out of Australia. Each of these factors appears to increase the risk for developing depression:
- Psychosocial stressors (including acute psychological trauma and early exposure to childhood trauma)
- Poor diet
- Physical inactivity
- Obesity
- Smoking
- Altered gut permeability
- Allergies
- Poor dental care
- Chronic gum disease
- Poor sleep
- Vitamin D deficiency
I can tell immediately this article isn’t from the US, with its reference to “altered gut permeability” (aka leaky gut syndrome), a condition simply not accepted as real by US-trained gastroenterologists.
But a low-inflammatory diet (not complicated–pretty much the Mediterranean diet plus sometimes eliminating gluten) will reduce your total body inflammation and has been shown to improve depression symptoms.
What should you do if you’re dealing with depression?
The study implies that all you have to do is just (“just” being one of my least favorite words) take an anti-inflammatory drug like Celebrex along with your antidepressant. But come on, unless you’re new to the Health Tips you know I never recommend pharmaceuticals as a first choice. The point is for you to get to work reducing your total body load of pro-inflammatory factors, like your marginal diet and poorly tended gums.
If you’re already taking an antidepressant, move to low-inflammatory eating. If you need help with this, or need to be tested for inflammation levels (sed rate, CRP, etc.) or leaky gut, make an appointment with one of our nutritionists.
If you’re not on an antidepressant, consider St. John’s wort (450 mg twice daily) combined with 5-HTP (100 mg at bedtime) to raise serotonin, which is what an antidepressant does.
Everyone can lower inflammation by quitting smoking, getting teeth cleaned regularly, flossing daily, and taking at least 5,000 IU of vitamin D per day.
If you want to add a mild anti-inflammatory, get Theracurmin HP, a high-potency form of the root turmeric and its powerful constituent curcumin, from our apothecary. This particular form is known to cross the blood-brain barrier and reduce brain inflammation.
Finally, get up the gumption to exercise and get out in the sunlight.
Be well,
David Edelberg, MD
My Friend sent me this article because she knows I suffer from severe chronic depression and many auto immune problems. I also have vitamin D deficiency. My family physician doesn’t take me seriously. I have had many tests to find out what is wrong with me, but most say I am within normal ranges. I am beginning to think I am a hypochondriac! I am scheduled to have my thyroid removed, it is very enlarged and is partially blocking my airway. Your article makes sense and I have long suspected all of my issues are related, but can’t get a doctor to take my symptoms seriously. How do I find a doctor who looks at the entire body and symptoms? How do I find a doctor that will not just treat the symptoms? I am beyond frustrated!
Dawn
Dawn; here are two organizations that can help you find a doctor.
Institute for Functional Medicine and the American College for Advancement in Medicine.
Good Luck.
Dr. R
Dr. E, I know you don’t mean insult. If I thought you meant insult, I wouldn’t have bothered responding. I genuinely respect you as a doctor and as a writer, and was mostly surprised to see those words because they struck such a sour note in what is generally good advice and good writing.
“I think of “gumption” as “initiative” or “resourcefulness”,” you say. That’s exactly the problem. Check your signs and symptoms of Depression; you define it very narrowly as “sadness.” In reality, the sadness is very often the least of the problem. The really stubborn, difficult and deadly symptoms of Depression are a lack of energy, initiative and resourcefulness.
Your advice to start with a small amount of movement and work up to meaningful levels of exercise is good. Spot on, in fact. It’s couching that in terms of “gumption”, “initiative” and/or “resourcefulness” that’s the problem. The lack of these things is in fact the symptom of the disease state. They are the reason – or a large part of the reason – that the patient is sitting in front of you asking for help. Severe Gumption Deficit in Room 3, Doctor. 😉
Such language is also going to have a tendency to feel judgemental and shaming to the patient. By the time most of us come to the doctor with Depression, things are pretty bad. We’ve been beating ourselves up for quite some time for our lack of gumption, telling ourselves we should go for a walk once in a while, get out of the house, grab those bootstraps and get over it already…and mostly failing. Taking the step of going to the doctor and being honest about that is huge, and then to hear the same blaming/shaming inner dialogue expressed to us from an external source…that’s harsh, man. I used up all my gumption working up the courage to come see the doctor.
“Move daily” sounds simple, but to someone with Depression, it just feels so overwhelming…more prohibitively overwhelming than someone who’s never had Depression can fathom. It’s okay, I can’t fathom the pain of a kidney stone, because I’ve never had one. But I avoid telling people with kidney stones to just get rid of their pain and they’ll feel better. No kidding. That’s just not useful advice, and it’s utterly tone deaf. Worse, it’s a tautology. If I had the gumption to exercise, I wouldn’t be in your office for my lack of gumption.
By all means, counsel exercise. It IS important, I’m not denying that. But I think you may find better patient outcomes by avoiding language that goes anywhere near demanding internal psychological resources of someone in the acute stage of a dis-ease that saps those resources, and focus on behavior: “In the next week, I’d like you to keep a log of your movement, because movement helps to alleviate the symptoms of Depression. I want you to walk around the block once a day. Next week, you’ll walk around the block twice a day. Does that sound do-able?” Goals: specific, measurable, time defined, and free of language that can be (mis)interpreted as blame, judgement, or just not understanding the symptoms of Depression.
Now, I understand that this was a blog post, in search of a “punchy” ending. This wasn’t patient interaction or patient education in the direct medical care sense. But it did indeed touch a nerve, and I hope that my perspective as a person with Depression offers something useful for your actual patient interactions, or at least food for thought. 🙂
Nicole
Nicole ,in my humble opinion, the term gumption can be interpreted in many different ways. your interpretation may be extreme although just as valid as any other.
using your diabetic analogy, yes insulin is required to help short term but additionally, the exercise is needed long term. my interpretation of dr E’s directing us to get up the gumption (as well as trying all the other suggestions) was directed at those physically and mentally capable of
such action, not those who are emotionally/physically
at the point of “hyperglycemic crisis.” but after saying all that…once darkness sets in, waiting for the light is the worst. not sure if it matters but you are not alone.
fm smith
Hi Nicole
I think of “gumption” as “initiative” or “resourcefulness” and I don’t mean to insult you> I am simply suggesting that “exercise” could simply mean “going for a walk” or taking a Yoga class. Generally, I’ll tell a deeply depressed patient, “Look, I know you aren’t up to going to a health club for an hour of aerobics, but I know you can get up and walk around the block.” Just about everyone answers, “Yes, I think I could do that.”
Dr E
Lisa
It is an individual thing. Some patients use these anti-inflammatory herbs (circumin, boswellia) for aches and pains. Others think they’re not strong enough
Dr E
“Get up the gumption…”? Ugh. You had me until that line. Honestly, it’s insulting. It’s like telling a diabetic to get up the gumption to lower their blood sugar in a hyperglycemic crisis instead of handing them insulin. True, better overall diet and exercise will reduce hyperglycemic crises, as well as depressive crises, but once you’re in a depressive state, “gumption” is exactly what you don’t have.
I’m not saying I have a better answer. But I know I don’t have gumption, whatever the heck that may be.
Nicole
Dr. Edelberg, does TheracurminHP work like NSAIDS for things like a headache?
Lisa