Is inflammation a root cause of your depression?
There is clear evidence that the current global pandemic is affecting our mental health. Since the start of the pandemic there has been a significant increase in the use of crisis lines and other mental health services in Australia.[1] But mental health has been an issue for many Australians, long before the pandemic, with national survey data showing that 1 in 2 Australians aged 16-65 had experienced a mental health disorder during their lifetime.[2] In fact mental health disorders represent the the second highest non-fatal burden of disease.[3]
Depression is more than just a lack of serotonin
The underlying cause of depression is not fully understood. Whilst serotonin has been a major focus of treatment for several decades, we now know that in addition to changes in serotonin transmission, numerous genetic, environmental, hormonal, gastrointestinal and immunological factors can contribute. One or more underlying driver may be present in any one individual.[4]
Inflammation is a major driver of depression
Inflammation, which is a function of the immune system, is increasingly being recognised as a major driver of not only depression, but also anxiety and other mental health and neurological disorders. It is observed that on average, depressed individuals have higher levels of certain chemicals in the blood, which reflect a state of heightened inflammation.[5]
In addition, studies consistently show that individuals with an existing inflammatory condition, such as heart disease, high blood pressure, asthma, arthritis, chronic pain, or autoimmune conditions, have an increased risk of developing depression.[4]
Since this discovery, numerous studies have looked at the potential for various anti-inflammatory drugs to improve the symptoms of depression. In addition, there are a number of specific herbs and nutrients which have been studied either alone or in combination with standard antidepressant medication. Some natural medicine treatments have been found to even improve the efficacy of standard drug therapies. For example, nutrients such as curcumin,[6] zinc,[7] fish oil,[8] and palmitoylethanolamide (a neuroprotective compound known as PEA)[9] have all been shown to be effective for addressing the underlying inflammatory drivers in patients with depression.
Who will benefit from anti-inflammatory treatments?
While these nutrients can be used safely and effectively alongside some antidepressants, they are not suitable for everyone. Therefore, it is important to check with your healthcare professional if these therapies are right for you. New research is helping us understand who might benefit from anti-inflammatory drugs, herbs or nutrients. For instance, while it may appear obvious, individuals who have high levels of circulating inflammatory chemicals in the blood, (measureable by a simple blood test), tend to respond better to anti-inflammatory therapies. These simple tests can help determine the right treatment for you.[8,10] Additionally, it appears that those patients who are treatment resistant (depression that does not respond to standard serotonin modulating drugs) are more likely to benefit from anti-inflammatory therapies.[11]
The practitioners at Whole Health can help you navigate the complexities of managing mental health conditions. Visit the online clinic to book your appointment.
References
https://www.aihw.gov.au/suicide-self-harm-monitoring/data/covid-19
https://www.aihw.gov.au/reports/australias-health/mental-health
Jesulola, E., Micalos, P., & Baguley, I. J. (2018). Understanding the pathophysiology of depression: From monoamines to the neurogenesis hypothesis model - are we there yet? Behavioural Brain Research, 341, 79–90. https://doi.org/10.1016/j.bbr.2017.12.025
Herkenham, M., & Kigar, S. L. (2017). Contributions of the adaptive immune system to mood regulation: Mechanisms and pathways of neuroimmune interactions. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 79(Pt A), 49–57. https://doi.org/10.1016/j.pnpbp.2016.09.003
Ng, Q. X., Koh, S. S. H., Chan, H. W., & Ho, C. Y. X. (2017). Clinical Use of Curcumin in Depression: A Meta-Analysis. Journal of the American Medical Directors Association, 18(6), 503–508. https://doi.org/10.1016/j.jamda.2016.12.071
Ranjbar, E., Kasaei, M. S., Mohammad-Shirazi, M., Nasrollahzadeh, J., Rashidkhani, B., Shams, J., ... Mohammadi, M. R. (2013). Effects of zinc supplementation in patients with major depression: a randomized clinical trial. Iranian Journal of Psychiatry, 8(2), 73–79. Retrieved from http://www. ncbi.nlm.nih.gov/pubmed/24130605
Rapaport, M. H., Nierenberg, A. A., Schettler, P. J., Kinkead, B., Cardoos, A., Walker, R., & Mischoulon, D. (2016). Inflammation as a predictive biomarker for response to omega-3 fatty acids in major depressive disorder: a proof-of- concept study. Molecular Psychiatry, 21(1), 71–79. https://doi.org/10.1038/ mp.2015.22
Ghazizadeh-Hashemi, M., Ghajar, A., Shalbafan, M.-R., Ghazizadeh- Hashemi, F., Afarideh, M., Malekpour, F., ... Akhondzadeh, S. (2018). Palmitoylethanolamide as adjunctive therapy in major depressive disorder: A double-blind, randomized and placebo-controlled trial. Journal of Affective Disorders, 232, 127–133. https://doi.org/10.1016/j.jad.2018.02.057
Porcu, M., Urbano, M. R., Verri, W. A., Barbosa, D. S., Baracat, M., Vargas, H. O., ... Nunes, S. O. V. (2018). Effects of adjunctive N -acetylcysteine on depressive symptoms: Modulation by baseline high-sensitivity C-reactive protein. Psychiatry Research, 263, 268–274. https://doi.org/10.1016/j. psychres.2018.02.056
Kappelmann, N., Lewis, G., Dantzer, R., Jones, P. B., & Khandaker, G. M. (2018). Antidepressant activity of anti-cytokine treatment: a systematic review and meta-analysis of clinical trials of chronic inflammatory conditions. Molecular Psychiatry, 23(2), 335–343. https://doi.org/10.1038/ mp.2016.167