Barely a week goes by without a
celebrity “opening up” about their “battle with depression”.
This, apparently, is a brave thing to do because, despite all
efforts to get rid of the stigma around depression, it is still
seen as some kind of mental and emotional weakness.
But what if was nothing of the sort? What if it was a physical
illness that just happens to make people feel pretty lousy?
Would that make it less of a big deal to admit to? Could it even
put a final nail in the coffin of the idea that depression is
all in the mind?
According to a growing number of scientists, this is exactly how
we should be thinking about the condition. George Slavich, a
clinical psychologist at the University of California in Los
Angeles, has spent years studying depression, and has come to
the conclusion that it has as much to do with the body as the
mind. “I don’t even talk about it as a psychiatric condition any
more,” he says. “It does involve psychology, but it also
involves equal parts of biology and physical health.”
The basis of this new view is blindingly obvious once it is
pointed out: everyone feels miserable when they are ill. That
feeling of being too tired, bored and fed up to move off the
sofa and get on with life is known among psychologists as
sickness behaviour. It happens for a good reason, helping us
avoid doing more damage or spreading an infection any further.
It also looks a lot like depression. So if people with
depression show classic sickness behaviour and sick people feel
a lot like people with depression – might there be a common
cause that accounts for both?
The answer to that seems to be yes, and the best candidate so
far is inflammation – a part of the immune system that acts as a
burglar alarm to close wounds and call other parts of the immune
system into action. A family of proteins called cytokines sets
off inflammation in the body, and switches the brain into
sickness mode.
Both cytokines and inflammation have been shown to rocket during
depressive episodes, and – in people with bipolar – to drop off
in periods of remission. Healthy people can also be temporarily
put into a depressed, anxious state when given a vaccine that
causes a spike in inflammation. Brain imaging studies of people
injected with a typhoid vaccine found that this might be down to
changes in the parts of the brain that process reward and
punishment.
There are other clues, too: people with inflammatory diseases
such as rheumatoid arthritis tend to suffer more than average
with depression; cancer patients given a drug called interferon
alpha, which boosts their inflammatory response to help fight
the cancer, often become depressed as a side-effect.
As evidence like this continues to stack up, it’s not surprising
that some people have shifted their attention to what might be
causing the inflammation in the first place. Turhan Canli of
Stony Brook University in New York thinks infections are the
most likely culprit, and even goes as far as to say that we
should rebrand depressionas an infectious – but not contagious –
disease.
Others aren’t willing to go that far, not least because
infection is not the only way to set off inflammation. A diet
rich in trans fats and sugar has been shown to promote
inflammation, while a healthy one full of fruit, veg and oily
fish helps keep it at bay. Obesity is another risk factor,
probably because body fat, particularly around the belly, stores
large quantities of cytokines.
Add this to the fact that stress, particularly the kind that
follows social rejection or loneliness, also causes
inflammation, and it starts to look as if depression is a kind
of allergy to modern life – which might explain its spiralling
prevalence all over the world as we increasingly eat, sloth and
isolate ourselves into a state of chronic inflammation.
If that’s the case, prevention is probably the place to start.
It’s not a great idea to turn off inflammation entirely, because
we need it to fend off infections, says Slavich, but “lowering
levels of systemic inflammation to manageable levels is a good
goal to have”.
The good news is that the few clinical trials done so far have
found that adding anti-inflammatory medicines to antidepressants
not only improves symptoms, it also increases the proportion of
people who respond to treatment, although more trials will be
needed to confirm this. There is also some evidence that omega 3
and curcumin, an extract of the spice turmeric, might have
similar effects. Both are available over the counter and might
be worth a try, although as an add-on to any prescribed
treatment – there’s definitely not enough evidence to use them
as a replacement.
In between five to 10 years, says Carmine Pariante, a
psychiatrist at Kings College London, there may be a blood test
that can measure inflammation in people with depression so that
they can be treated accordingly. Researchers have already come
up with a simple finger-prick test that reliably measures
inflammation markers in a single drop of blood.
And as for the stigma – could it really be killed off by
shifting the blame from the mind to the body? Time will tell.
This is not the first time that depression has been linked to a
physical phenomenon, after all. A recent survey found that
despite wider awareness of the theory that “chemical imbalances”
in the brain cause depression, this has done nothing to reduce
stigma; in fact, it seemed to make matters worse.
This time, though, the target is not any kind of brain or
mind-based weakness but a basic feature of everyone’s body that
could strike anyone down given the right – or wrong – turn of
events. And if that doesn’t inspire a greater sympathy and
understanding, then nothing will. |