Depression, Inflammation, and You

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 CurcuPlex-95, a high-potency form of the root turmeric and its powerful constituent curcumin (please call our apothecary at 773-296-6700 to order). This particular form is known to cross the blood-brain barrier and reduce brain inflammation.
Addressing depression alone can be challenging.  If you're having trouble and need support, consider seeing a therapist.  At WHC we have Christine Savas, Jennifer Davis, and Janet Chandler who can help.  Our Yoga Therapist Renee Zambo uses stress reduction, body awareness and mindfulness techniques to help our patients work with and ease depression.  Last year, Renee wrote a health tip about the benefits of mindfulness practices for people struggling with depression.
Finally, get up the gumption to exercise and get out in the sunlight.
Be well,
David Edelberg, MD