Can lowering inflammation help major depression?
- New research data adds to mounting evidence that depression is linked to an inflammatory response
- Inflammation influences the quality of sleep, metabolism, stress response and the release of cytokines
- Antidepressant medications are associated with significant and dangerous side effects, including violence, aggression and suicide
- The senior population is especially vulnerable; the rate of antidepressant drug prescriptions for this group has doubled since 1990, increasing the risk of cognitive decline, dementia, osteoporosis, Type 2 diabetes and heart disease
- Effective nonpharmacological options for treatment include exercising, reducing sugar intake, and using light therapy for 30 minutes each day
It is estimated that 7.1% of the adult population in the U.S. experienced at least one major depressive episode in 2017. The highest rates are among those ages 18 to 25 years. Many people believe depression is caused by a chemical imbalance in the brain. This is a theory that has been widely promoted by drug companies and psychiatrists, to the point it is now accepted as fact.
However, this is just a theory and, worse, it's a theory that has been largely discredited. The idea spread quickly after it was proposed in the 1960s when it appeared antidepressant drugs altered brain chemicals. In the 1980s, Prozac (fluoxetine) was released by Eli Lilly and heavily promoted to balance brain chemicals and affect depression.
Prozac had fewer side effects than some of the earlier antidepressants and soon became the poster child for selective serotonin reuptake inhibitor (SSRI) class of antidepressants. However, while heavily prescribed, data repeatedly showed SSRIs worked no better than placebos for those experiencing mild to moderate depression.
Although antidepressants don't effectively treat depression, they do double the risk of harm from suicide and violence in healthy adults and increase aggression in children and adolescents.
Researchers also suggest major depression could be vastly overdiagnosed and overtreated with antidepressants. The majority who are prescribed these drugs end up staying on them long-term, which may compromise their health.
More Studies Link Depression to Inflammation
Researchers have found yet another link between inflammation and depression. In one study1 published in the Journal of Neurology, Neurosurgery & Psychiatry, researchers systematically reviewed the safety and effectiveness of anti-inflammatory agents in people suffering with major depression.
The literature review included results from 30 randomized control trials with a 1,610 participants. In an overall analysis of 26 studies, the researchers found anti-inflammatory agents reduced depressive disorder when compared with placebo. They found no differences in quality of life analysis but did find gastrointestinal event differences between the treatment periods.
A subanalysis of the data demonstrated an adjunctive treatment with antidepressants with nonsteroidal anti-inflammatory drugs, statins, omega-3 FAs and minocycline significantly reduced depressive symptoms.2
Results from another large metanalysis3 carried out by researchers from Aarhus University Hospital in Denmark revealed similar findings, showing anti-inflammatories may be effective in the treatment of depression. One researcher explains the study showed the combination of anti-inflammatory drugs along with antidepressants have beneficial effects.
The results also showed the effect against depression was present when the anti-inflammatory medication was used alone, compared against a placebo. The scientists analyzed 36 international studies of participants who suffered from depression or who had symptoms of depression. One of the researchers, Dr. Ole Köhler-Forsberg, commented on the results of the study:4
"This definitely bolsters our chances of being able to provide personalised treatment for individual patients in the longer term. Of course we always have to weigh the effects against the potential side-effects of the anti-inflammatory drugs.
We still need to clarify which patients will benefit from the medicine and the size of the doses they will require. The findings are interesting, but patients should consult their doctor before initiating additional treatment."
Yet in another recently published study in Molecular Psychiatry5 scientists found patients treated with immunotherapeutics for inflammatory disorders, who also presented with depression or depressive symptoms, experienced symptomatic relief. The team found the reduction in depressive symptoms was not associated with any treatment-related changes in their physical health.
Immune Dysregulation May Trigger Allergic-Type Reaction
There has been an increasing number of studies in which depression is reported to be linked to immune dysregulation and inflammation, mimicking an allergic reaction.6 Your body uses inflammation as a defense mechanism to an attack.
A localized, infected wound demonstrates an isolated inflammatory response as it turns red and sore. Inflammation is also triggered by stress and physical trauma; inflammation in turn triggers depression. This is related to response to the release of cytokines, which are small protein cells the body uses to help with the response.
This information may ultimately influence emotions and how you feel. By affecting the quality of your sleep, metabolism and stress responses, inflammation may create a biological environment triggering depressive symptoms.
The findings from these studies have contributed to a mounting body of evidence that inflammation may be a biochemical route of mental health symptoms. Thus, it may provide another nonpharmacological route for treating those who suffer with depression. Köhler-Forsberg and colleagues are interested in a pharmacological response, and he points out:7
"Some studies suggest that the choice of antidepressant can be decided by a blood sample that measures whether there is an inflammatory condition in the body. Other studies show that the same blood sample can be used as a guideline for whether a depressive patient can be treated with anti-inflammatory medicine that has a better effect when there is inflammation present at the same time as the depression.
However, we need to verify these findings and examine which patients can benefit from this before it can be implemented in everyday clinical practice."
Mental Health Screening May Overlook Contributing Factors
Physicians commonly use mental health screening tests to determine how best to treat depressive symptoms. The use of these screening tests is only as good as the physician administering them to analyze the data and how you feel when you enter the doctor's office.
In one 2013 study, an evaluation of 5,639 participants identified by their clinician as suffering with depression, researchers found only 38.4% met the DSM-4 criteria for a major depressive episode. In speaking to The New York Times, one of the researchers pointed out that not only are physicians prescribing more medications, but patients are demanding more as well.
He points out Americans have become used to using drugs to address the stresses of daily life that may trigger short-term situational sadness. Mental health screening tests do not often consider vitamin deficiencies, lack of exercise, poor nutrition, lack of sleep or inflammation.
Antidepressant Use Doubled in Seniors
In the 2013 study evaluating participants who were prescribed antidepressants by their physician, a mere 14.3% of those over age 65 met the DSM-4 criteria for a major depressive episode. To investigate whether the number of antidepressant drugs prescribed to seniors had risen, another team of researchers looked at data from 1991 to 1993.
They compared this against data gathered from studies occurring from 2008 to 2011. During the early period, 4.2% of adults were taking antidepressants. This number more than doubled to 10.7% during the later period. The rate of antidepressant use in older adults living in care homes in the English population cohort studies also rose, from 7.4% to 29.2%.
A study published in 2017 reviewed data from 1990 to 2015 gathered from Australia, Canada, England and the U.S. In this report it was noted that the prevalence of disorders and symptoms had not decreased despite an increase in the prescription of antidepressants.
In seniors, depression is associated with cognitive decline, dementia and poor medical outcomes. Those with depression also experience higher rates of suicide and mortality. Guidelines from the American Psychiatric Association suggest antidepressant medication with psychotherapy in the elderly. But, despite the increased risks with antidepressants, most seniors receive only medication.
Treatment with antidepressant drugs in seniors increases the risk of Type 2 diabetes, which increases the risk of other comorbid health conditions including heart disease and stroke. The drugs are also linked to the development of thicker arteries and dementia.
In addition, depending on the classification of drug, they are known to reduce several nutrients, including coenzyme Q10, vitamin B12, calcium and folate. Of concern in the elderly is the risk of osteoporosis and fractures associated with antidepressant medications.
One 2015 study compared women treated with indigestion drugs against those treated with SSRIs and found a 76% increased rate of fracture in the first year in those taking antidepressants. When these risks are combined with the knowledge the drugs work no better than placebo for mild to moderate depression, seniors may experience greater risk than any benefit they receive.
Consider Nonpharmacological Options to Reduce Depression
Reducing the inflammatory response in your body is crucial as it is a root cause of many chronic conditions, including depression. In addition to strategies to reduce inflammation, there are other approaches with a history of improving symptoms.
As you consider the following nonpharmacological suggestions, remember you don't have to do them all at once, and you can accomplish them no matter your age or current physical abilities. Begin the journey to better health taking small, permanent steps.
• Exercise — Exercise normalizes your insulin and leptin sensitivity and has a significant effect on kynurenine, a neurotoxic stress chemical produced from the amino acid tryptophan; brain-derived neurotrophic factor (BDNF), a growth factor regulating neuroplasticity and new growth of neurons and your endocannabinoid system, all of which
• Nutrition — There are several nutritional factors that affect your mood and emotions, not the least of which is eating too much sugar. Excessive amounts of sugar disrupt your leptin and insulin sensitivity, affect dopamine levels and damage your mitochondria, all of which affect your mood.
Nutrients such as omega-3 fats, magnesium, vitamin D and the B vitamins each influence your mood and brain health. You may experience the beneficial effects of boosting these nutrients to optimal levels in as little as two weeks.
• Light therapy — Light therapy is an effective treatment for seasonal affective disorder, and researchers8 find it is also effective against moderate to severe depression. Participants simply used a white light box for 30 minutes each day as soon as possible after waking up.
• Mindful meditation or Emotional Freedom Techniques (EFT) — In a study9 of 30 moderately to severely depressed college students, the depressed students were given four 90-minute EFT sessions. Students who received EFT showed significantly less depression than the control group when evaluated three weeks later.
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