It’s Not Depression, It’s Inflammation

We live in times of change, with new systems of values ​​and beliefs and new knowledge that force us to rethink everything. Not even the specialists agree, perhaps because it really is impossible to do so.

Each point of view is legitimate, contributes a part of the truth and is radically different from the perspective that contemplates the same object from another point of light.

Depression, that ancestral disease, so fashionable in our days, brings us a new perspective, in the light of new scientific findings that conceive it as an inflammatory disease.

Many factors in the environment and western lifestyle are pro-inflammatory, and from this perspective, diet, stress, physical inactivity, toxins, the intestinal microbiota, sleep or lack of vitamin D, are at the base of the alarming deteriorating mental health, including bipolar disorder, schizophrenia, autism, post-traumatic stress syndrome, and depression.

The good news is that all of them turn out to be plastic factors, modifiable sometimes with minimal intervention, others with a change in lifestyle and all of them within the reach of those who, with the knowledge and intention, start their own resources in your favor.

Depression and inflammation: a two-way relationship

At least 28 different symptoms have been identified in patients with depression. Of these, the DSM, the diagnostic manual for mental disorders, only includes 15, leaving out 13 among which are anxiety, panic, irritability or emotional reactivity.

Many doctors, psychiatrists, psychologists, and even scientific institutions seriously question the DSM criteria for diagnosing not only depression, but most mental health disorders.

The main criticism is that its diagnostic criteria are at the service of a drug approach as the basic treatment of the disease, when, for example, in depression, it has been shown that psychological therapy is as effective or more than antidepressants, but without its side effects .

In Spain, depression is usually treated by the family doctor, in Primary Care, in the easiest way, that is, by prescribing antidepressants. When that is not enough and if the patient himself insists, he will be referred to the psychiatrist, and only if he considers it appropriate, which will happen rarely, will he refer him to a psychologist, who will hopefully attend him after a few months.

The problem with antidepressants is that they constitute a mere treatment of the symptom, but they do not target the root, they do not correct the maladaptive thinking, emotions or behaviors that are at the base of the disease.

A well-known neurologist who has studied the effect of gluten on the brain for thirty years claims that inflammation is at the root of Alzheimer’s disease. And a few weeks ago a study from the University of Southampton in the United Kingdom discovered that, if inflammation of the brain is blocked, memory problems derived from Alzheimer’s are reduced and the progression of this disease is stopped.

Researchers at the University of California, San Francisco, studied 2,500 people for five to six years to find that those with depression developed almost twice as many dementias as those who did not.

Another group of researchers from Northwestern, Chicago, Illinois, studied depressed rats in a kind of amusement park, with toys and places to run, play, hide and climb. What they wanted to see was whether the environment could produce an improvement in the rats. The result was a drastic reduction in the depressive behavior of the animals, measured through appropriate tests.

And they already wanted to see if the opposite also happened. The question now was, can the environment trigger depression? This time they took normal rats and put them through a stressful situation for a couple of hours every day. The result: the stressed rats showed depressed behavior after a couple of weeks.

Conclusion: genes do not necessarily determine that a person suffers from depression, since the environment and its circumstances constitute an important factor capable of modifying the genetic predisposition to depression.

The next thing they did is study analytical markers in the blood capable of distinguishing between the group of depressed rats and those that are not. And what markers appeared? Markers of inflammation.

And where does the inflammation come from?

Of all the pro-inflammatory factors, stress and psychological trauma are surely the most studied, the more intense the sooner they appear: the perinatal period and early childhood are especially sensitive periods.

Psychosocial stressors induce elevations in pro-inflammatory cytokines that orchestrate inflammatory reactions accompanied by neuronal, mood, and behavioral changes.

Early experiences of stress, such as maltreatment, abuse, social isolation, and harsh economic, emotional, and social conditions double the likelihood of chronic inflammation, increase aging, and have been estimated to shorten an individual’s half-life by about 15 years.

In other words, stress that occurs early in childhood exerts persistent effects over long periods of time or perhaps throughout life, through increased inflammatory response and susceptibility to disease, both organic and mental health.

Studies show that the poorer the quality of the diet, the greater the likelihood of mental disorders.

A special relationship has been observed with the amount of omega 3, which has an outstanding anti-inflammatory effect, the proportion of fiber and, in the case of depression, the amount of selenium in water and lycopenes in the diet, which act by modifying inflammation levels

Depression and obesity

The Western diet, high in fat, animal protein and carbohydrates and rich in processed foods, is pro-inflammatory. In contrast, a month of Mediterranean diet rich in vegetables and fruits, whole grains (rich in beta-glucans), fish and legumes, is capable of reducing plasma levels of inflammatory markers.

Obesity, another inflammatory disorder, directly correlates with depression, while depression predisposes to obesity. And physical exercise acts as an excellent treatment against depression, while a sedentary lifestyle is associated with a higher risk of suffering from it.

Its mechanism of action is through its anti-inflammatory effect. The decrease in muscle mass, called sarcopenia, both due to age and obesity, is accompanied by cognitive impairment linked to inflammation.

Depression and tobacco

Tobacco use increases the risk of depression, while depression increases toxic behavior.

Once again, the mechanisms through which tobacco increases inflammatory markers and affects the resident immune cells in the brain, astrocytes and glia, have been studied and recognized , with a pattern exactly superimposable to that of depression.

Depression and dental health

Dental caries and gum and periodontal inflammation do not only act locally, but constitute a high degree of systemic inflammation that has become a real public health problem, in which almost half of the population is affected.

Gingivitis and periodontal inflammation correlate with numerous psychological factors, low self-esteem, loneliness, high levels of stress, and depression. The accumulation of bacterial plaque and the alteration of the oral microbiota leads to an inflammatory response not only locally, but also throughout the body, which is why it serves as a marker of immune failure to resolve inflammation.

Another different type of inflammatory response is that associated with allergic diseases, such as asthma, eczema, allergic rhinitis or any other type whose association with depression has also been proven.

Healthy and anti-inflammatory everyday measures

Antidepressant medications have a well-documented anti-inflammatory effect, which can also be produced by a variety of health and lifestyle factors, especially an anti-inflammatory diet, rich in omega three, probiotic and with adequate vitamin D3 supplements, physical exercise, good cardiovascular health and stress management tools.

What do all these factors have in common? Which are anti-inflammatory, from exercise to vitamin D3 and stress control, all of them dampen the pro-inflammatory effect of the immune system and regulate its proper functioning.

Depression and microbiota

One of the emerging knowledge that will surely revolutionize our life in the immediate future, from our diet, to the medical treatment of a multitude of diseases, childbirth, breastfeeding or personal care, is that of the microbiota.

Scientists have discovered that in depression there are high inflammatory levels of immunoglobulins against a part of the wall of Gram negative bacteria, called lipopolysaccharides.

In situations of increased intestinal permeability ( inflammatory disease, antibiotic treatment, stress, Western diet, constipation, etc.) these bacteria cross the wall of the intestine and reach the blood, where they generate an inflammatory response.

The beneficial microorganisms that inhabit the intestine act as modulators of the immune system and inflammation, apart from constituting a first-order hormonal stimulus and also for the manufacture of neurotransmitters.

90% of the serotonin used by our neurons, decreased in depression, is born precisely in our intestine, as a result of the stimulation of a preserved bacterial flora.

That is to say, it is necessary to take care of the intestinal microbiota since it is involved by active (neurotransmitters) and passively (inflammation) in the causes of mental alteration and, in particular, depression.

Depression and rest

Recovering sleep in the depressed person is very important, since their abnormal patterns are associated with numerous adverse health effects, including increased risk of mortality, morbidity and a poorer quality of life.

In depression, about 90% of people suffer some type of sleep disturbance, a bidirectional path, since patients with depression often suffer from insomnia, and insomnia facilitates the onset of depression.

Experimentally, sleep deprivation, both acute and chronic, produces an alteration in immunity, observable even with moderate sleep restrictions (between six and eight hours / night). This is accompanied by numerous hormonal and neurobiological changes, comparable to those found in depressed patients.

Depression and vitamin D

The most important and prevalent vitamin deficiency state in the Western world is that of vitamin D, which is associated with a wide range of diseases, from osteoporosis to cancer, to depression.

Receptors for this vitamin-hormone exist in the brain, where it plays a role in controlling circadian rhythms and sleep, glucocorticoid levels, and neuronal growth.

Vitamin D modulates the effect of the immune system and the response to infection, and its low levels have been associated with depression. Reasonable exposure to the sun, as well as the intake of supplements are capable of increasing the levels of this essential vitamin.

Scientists have identified a low-grade inflammatory response associated with depression, and research is now focused on its possible causes.

Numerous environmental risk factors act as mediators of the inflammatory process, such as stress, adverse psychosocial factors, the Western diet, sedentary lifestyle, overweight and obesity, tobacco, intestinal and flora alterations known as dysbiosis, allergies and atopias, tooth decay. dental and gum inflammation, sleep disturbances and vitamin D deficiency.