WHAT CAUSES IT AND HOW BEST TO DEAL WITH IT?
The "disease" we call DEPRESSION is rampant in this country. But is Depression really what you have been taught that it is, and are drugs the only way of dealing with this common problem? I say "common" because according to Dr. Tom Insel who is head of the NIMH (a branch of our government's National Institutes of Health), "antidepressants were the second most commonly prescribed medications, right after drugs to lower cholesterol. About 254 million prescriptions were written for them, resulting in nearly $10 billion in costs." Although these statistics are over three years old, I can assure you that both numbers above (254 million / $10 billion) are dramatically higher now than they were then.
I also want you to note that in the quote above, Dr. Insel talks not only of antidepressant medications, he mentions STATIN DRUGS for controlling HIGH CHOLESTEROL. This is interesting, as High Cholesterol is a health problem that is known to be highly influenced by one's level of "Inflammation". In fact, not only are dozens of diseases known to be caused by INFLAMMATION (HERE is a list of some of them), Depression and High Cholesterol are both on that list. And in the same way that Statin Drugs rarely get to the root cause(s) of High Cholesterol, neither do Antidepressants get to the root of Depression. Much of this probably has to do with the fact that numerous studies tout Depression's insane numbers of false positives (positive diagnosis of Depression, even though the patient does not meet the published criteria for the disease).
Case in point, a study done at Johns Hopkins that was published in a 2013 issue of Psychotherapy and Psychosomatics (Clinician-identified Depression in Community Settings: Concordance with Structured-interview Diagnoses). The authors determined that according to the Diagnostic and Statistical Manual of Mental Disorders (the DSM) only about 1/3 of the study's 5,639 participants that had already been diagnosed with Depression, actually met the criteria. For those over 65, accuracy dropped to a jaw-dropping 14%. Unfortunately, we already know how the vast majority of these folks were treated. As the study itself says, they "were prescribed and used psychiatric medications". The study's conclusions stated that, "Depression overdiagnosis and overtreatment is common in community settings [GP's offices] in the USA." What are most of these doctors missing? Is Depression simply a chemical imbalance in the brain that can be easily solved by prescription, or is there a bigger boat that is being missed here?
Firstly, if you want to understand what Dr. Smith and others are really saying, you will have to have a cursory understanding of INFLAMMATION. It is worth your while to spend a bit of time in study. Secondly, I have repeatedly shown you that Cytokines are one of many Immune System chemicals that are collectively known as "Inflammation". Unfortunately, I find that even though the medical community banters the term "Inflammation" around on an every-day basis, few seem to have any real idea what it means, and fewer still are sharing these implications with their patients. Covering (or at least attempting to cover) symptoms with drugs is how things are done here in America. Medicating patients is simply too easy and too lucrative to do anything else. What people need to understand, however, when looking at some of this research is that Depression has moved from the realm of being 'hypothesized' as an inflammatory condition, to one that is well-known to be inflammatory. Although I am not always the biggest fan of "EVIDENCE-BASED MEDICINE" let me give you some proofs.
Just one short year ago this month, Dr. Michael Berk's team of a dozen elite Australian researchers published a paper in BMC Medicine called So Depression is an Inflammatory Disease, but where does the Inflammation come from? Listen to their summary. "The identification of known sources of inflammation provides support for inflammation as a mediating pathway to both risk and neuro-progression in depression. Critically, most of these factors are plastic, and potentially amenable to therapeutic and preventative interventions. Most, but not all, of the above mentioned sources of inflammation may play a role in other psychiatric disorders, such as bipolar disorder, schizophrenia, autism, and post-traumatic stress disorder."
By the way, what were some of the causes of Inflammation that the title of the paper leaves us wondering about? Just the usual suspects. STRESS, CRAPPY DIETS, PHYSICAL INACTIVITY, OBESITY, SMOKING, LEAKY GUT SYNDROME ("Altered Gut Permeability"), ALLERGIES, Dental Problems (dental problems are a huge cause of chronic infections), Problems Sleeping, and Vitamin D Deficiency, were a few that were mentioned. All of this is important to know because along with Depression, CANCER, HEART DISEASE, DIABETES, ARTHRITIS, ASTHMA, ALLERGIES, ALZHEIMER'S DISEASE, Obesity (see link above), and just about every other major health problem you can name off the top of your head are being touted as "inflammatory" (caused by Inflammation). But I regress. Let's talk for a moment about some of the specific research strongly linking Depression to Systemic Inflammation.
- DEPRESSION IS MUCH MORE COMMON IN PEOPLE WITH INFLAMMATORY ILLNESSES: I just mentioned a few of the problems that are considered 'inflammatory'. A 2010 study published in the medical journal Biological Psychiatry (A Meta-analysis of Cytokines in Major Depression) not only said that Major Depression occurs in up to 20% of the population, but that there were, "significantly higher concentrations of the pro-inflammatory cytokines in depressed subjects compared with control subjects..... and strengthens evidence that depression is accompanied by activation of the Inflammatory Response System."
- THE MORE SYSTEMIC INFLAMMATION YOU HAVE, THE GREATER YOUR CHANCES OF BEING DEPRESSED: A November 2010 study in the British Journal of Psychiatry (Association of High-sensitivity C-Reactive Protein with De Novo Major Depression) followed a group of women for ten years, then correlated the levels of C-Reactive Protein (CRP --- a blood marker for Systemic Inflammation) with developing "de novo" (new) Depression. The study concluded that, "CRP is an independent risk marker for de novo major depressive disorder in women. This supports an etiological role for inflammatory activity in the pathophysiology of depression." By the way, the study of the causes of disease is called 'etiology'.
- DEPRESSION CAN BE INDUCED BY CAUSING SYSTEMIC INFLAMMATION IN HEALTHY CONTROLS: A study published thirteen years ago --- in a 2001 issue of Archives of General Psychiatry ---- concluded that, "Mild stimulation of the primary host defense has negative effects on emotional and memory functions, which are probably caused by cytokine release." (The 'emotional responses' they specifically listed were "significant increase in the levels of anxiety and a depressed mood".) By the way, the term 'host defense' is describing the Immune System. It is critical to remember that Inflammation is an Immune System response. It is also important to remember that the stimulation in this experiment was 'mild'. Not surprisingly, instead of discussing things people could do to help their own cause, the authors let us know that they were all about the drugs, when they stated that, "cytokines represent a novel target for neuropsychopharmacological research." Again; figure out how to (temporarily anyway) cover the symptom without addressing underlying cause of that symptom.
- THE TREATMENT OF HEPATITIS OFTEN CAUSES DEPRESSION: Chronic Hepatitis C is often treated with Interferon --- a powerful Immune System chemical in the Inflammation family. A meta-analysis of numerous studies on this topic, published in the August 2012 issue of the Journal of Clinical Psychiatry (Interferon-Induced Depression in Chronic Hepatitis C: A Systematic Review and Meta-Analysis) revealed that one in four persons treated with Interferon, developed Depression ("One in 4 chronic hepatitis C patients who start interferon and ribavirin treatment will develop an induced major depressive episode".)
- FIXING DEPRESSION LOWERS LEVELS OF CYTOKINES: A 2011 meta-analysis of 22 studies published in the November 2011 issue of Neuropsychopharmacology showed that on some level, Cytokines are directly related to Depression. The study concluded that, "the possibility that inflammatory cytokines contribute to depressive symptoms and that antidepressants block the effects of inflammatory cytokines on the brain". The implication here is that SSRI's have an anti-inflammatory effect on the brain. While this may certainly be true to some degree, it is critical to remember that Antidepressant medications carry some brutal side effects; not the least of which are sexual (HERE). HERE and HERE are a couple of recent studies on the dangers of Anti-inflammation medications.
As you can begin to see, Depression is not simply an "imbalance". It often has a physical / tangible cause. If you want to better understand the common drivers of Inflammation, I would suggest that you go back and read Dr. Berks' list that I gave you earlier in the paper. This is good news for many of you, because like Dutch (Arnold Schwarzenegger) stated in 1988's classic movie, Predator, "If it bleeds, we can kill it."
Just knowing that there are steps you can be taking to help your cause is incredibly empowering. If you want to figure out how to begin to squelch Inflammation where it lives, I wrote THIS POST just for you. For those who are interested, I created a SERIES OF POSTS showing how most disease (Depression included) is really just one big thing, manifesting differently in different people. For example, people who are depressed frequently have IBS.