Cindra wakes up. She feels fear surge through her as she realizes she has another day to face. How can she make it through the day? She has emerged from a few hours of sleep, the blissful unawareness of a shapeless, invisible pain so great that she would end her life if she had the courage. What is this pain? Why can’t she see it? Why can’t the doctor locate it in her body and surgically remove it as he would a cancer? Oh, to only have some physical illness to do battle with, to wage a war against, but no one can see her illness on an x-ray or MRI or CT scan. No one can see what is causing her the greatest pain she has ever had to endure.
What exactly is depression?
To get a diagnosis of major depression, you have to meet certain criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), now in its 5th edition. These criteria are symptoms. They have nothing to do with what’s causing the disorder, or how to treat the disorder. They are symptoms that seem to go together and so, they get a label. The diagnosis of depression is a label that represents a cluster of symptoms. That’s it.
Imagine for a moment that someone is rushed to the ER with chest pain, shortness of breath, and pain radiating down the left arm. The ER doc looks at the symptoms of her patient and says with great authority, “This man is having Heavy Chest Syndrome! Put him in room 3 and teach him some relaxation exercises – STAT!”
That makes about as much sense as putting leeches on a patient to balance the four “humors,” right?
The symptoms of depression include feeling hopeless and helpless, loss of interest in daily activities, loss of appetite and weight loss, or increased appetite and weight gain, too little sleep, or too much sleep, anger, irritability, lack of energy, fatigue, self-loathing, feelings of worthlessness, feelings of guilt, impulsive behavior, and reckless behavior.
When you read that list of symptoms, do you get a sense of how much PAIN this person is in? This is the kind of pain that hurts everywhere and is so excruciating, it often seems impossible to live through another second of it. It might be like the kind of pain a person with burns all over the body feels, nerves seared, skin scorched and oozing.
Take that burn, that horrible, horrifying burn and put it inside the brain. Whoa. That’s gotta hurt. And it does. It hurts like hell.
How many people have depression?
According to the World Health Organization, depression is the leading cause of disability in the world. More than 350 million people suffer with depression. Depression is also a major contributing factor in the world’s overall disease burden. This means that depression is associated with other diseases, other major causes of death and disability, such as heart disease, stroke, diabetes, and asthma.
What do depression and other diseases have in common? Inflammation.
What is inflammation?
Inflammation is one of the body’s ways of healing itself. Think of a nasty cut and how it can become red and swollen. This is an acute inflammation reaction caused by white blood cells, fibrin, and antibodies rushing to the site to heal the injury. It’s a good thing. This process occurs inside the body, too, where we can’t see it, but we can feel it.
What happens if the inflammation persists? Chronic inflammation is a signal that the body is continuing to try to heal itself. At this point, macrophages, white blood cells that engulf and digest the bad guys (foreign substances, cancer cells, cellular debris, and pathogens), release toxins to kill the bad guys. However, these toxins can also injure the body’s own tissues. So, chronic inflammation almost always causes tissue destruction.
What are some major diseases associated with chronic inflammation?
• Cardiovascular disease (atherosclerosis, stroke, heart attack)
• Diabetes, Metabolic Syndrome, Pre-Diabetes
• Irritable Bowel Syndrome (IBS)
Perhaps you’re beginning to see why depression is associated with all the major diseases. The chronic inflammatory process is one of the root causes of most major disease.
How does inflammation cause depression?
Chronic inflammation releases toxins that injure neurons (nerve cells). It actually causes an increase in apoptosis (cell death) and reduces the size of certain parts of the brain that are essential for feeling happy.
Injury to neurons also causes changes in neurotransmitters. Neurotransmitters are chemicals that send messages throughout the nervous system and body. Some neurotransmitters you may have heard about are serotonin, dopamine, and norepinephrine. These neurotransmitters are manipulated by antidepressants such as Prozac, Effexor, Elavil, Celexa, Paxil, Lexapro, Zoloft, Cymbalta, Wellbutrin, and Pristiq.
We’ve long known that people who experience major stress and trauma in childhood also experience more depression in their lives. It turns out that stress and trauma increase inflammation in the body and brain. This is the same inflammatory reaction as that caused by an infection or cancer. The inflammation process is a built in mechanism of innate immunity. In other words, it’s not for specific stressors such as harmful bacteria. It’s for all stressors, and that includes stress that comes from the normal negative emotional reaction to being abused, being yelled at by a boss day in and day out, hating a job, having a terrible marriage, or being shot at and seeing buddies killed during war.
Other major causes of chronic inflammation include the following:
• Diets low in nutrient-dense foods and high in processed foods, including gluten
• Deficiencies of vitamins and minerals
• Toxins from the environment
• Sleep restriction or deprivation
• Physical inactivity
• Alcohol & drugs (including pharmaceutical drugs)
How can we put out the fire (reduce inflammation)?
The modern Western diet is the opposite of a nutrient-dense diet. Eating a diet of highly processed foods (foods in boxes, bags, and cans as well as restaurant food) increases systemic inflammation in the body.
- Because the body absolutely requires nutrients in abundance to operate efficiently. Nutrients in abundance can only be obtained by eating real food in its natural state.
- Because processed foods contain loads of unnatural chemicals in order to make the food have a longer shelf life. These unnatural chemicals cause inflammation.
The American diet changed dramatically in the second half of the 20th century. In that same time period, the modern diseases of atherosclerosis, diabetes, cancer, asthma, and depression increased astronomically.
Food corporations are using the same strategies that tobacco corporations used for decades to spread misinformation about the destructiveness of their products. They are well aware, as were the tobacco companies, that the foods they market are causing major health problems across the world. Not only that, they purposefully create food products that are addictive. This is one of the reasons many people find it hard to get off processed food.
And while we’re on the subject of addiction, alcohol and drugs, including some pharmaceutical drugs, also cause systemic inflammation. Anything that can cause addiction causes inflammation.
What can you do? Eat real food as close to its natural state as possible. Eat huge amounts of vegetables and fruits* with small (fist size) amounts of protein. Limit alcohol and drugs.
*Please note that if you have pre-diabetes, metabolic syndrome, or diabetes, you’ll need to go easy on fruit. Instead, focus on vegetables.
Regular physical activity reduces inflammation. Long-term, low intensity activity helps to reduce chronic, low grade inflammation. Short-term, acute intensity activity helps people with inflammatory diseases. But remember this: Exercise that exhausts you can lead to low grade inflammation. The take away message here is to do some low intensity activity every day while also doing some short, intense activity two or three times a week. Don’t do any activity that leads you to feel exhausted.
Effective antidepressants may help by not only increasing certain neurotransmitters, but by reducing inflammation.
There is also some clinical evidence that nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen have antidepressant effects.
Supplements can never be a substitute for real food. However, research has clearly shown that supplementing with a multivitamin/mineral, some extra vitamin C, vitamin B12 (methylcobalamin), folate (not folic acid), and all the other B vitamins can be very helpful at putting out the fire of inflammation.
“Brain on fire” feels not only like an accurate description of depression but an apt metaphor for how I felt when I went through three major depressions. I didn’t have headaches (although some people do), but I felt as if every nerve in my body, including my brain, was exposed and extremely vulnerable. I couldn’t handle any stress at all. I could only watch TV programs that were free of stress and violence. I couldn’t stand any negative thoughts, and I couldn’t take any criticism. The only thing that felt okay was when I was able to sleep. And waking up was excruciating. It felt like all those raw, exposed nerves were being hit by bricks and bombs. My nervous system was fried.
Inflammation is surely a root cause of most depression. It’s not the only root cause, but it’s a very fundamental one, and one that can be addressed successfully in most cases.
I hope you’ll leave your thoughts, comments, and questions below the references.
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