The Depression-inflamation link

You’re running late, you still have a thousand things to do, and the deadlines are closing in. And it isn’t just today. Every day you feel stressed.

Now note the result: your body becomes inflamed, and the inflammation enters your brain. You feel depressed. That chain of cause and effect sounded like a stretch to me at first, but Dr Edward Bullmore¹ has discovered that inflammation in the body can cause depression in the mind.

Today Dr Bullmore is a professor of psychiatry at the University of Cambridge in the UK. However, back in 1989, when he was a medical student, a patient who had an autoimmune disease was referred to him. Her immune system was attacking her body, causing her joints to be swollen and inflamed. After a routine exam, he diagnosed her with rheumatoid arthritis. However, deviating a bit from standard medical procedure, he also asked her about her mood. She said she felt “very low;” she was tired much of the time, had a hard time sleeping and was losing the will to live. That’s why Dr Bullmore added depression to his diagnosis of rheumatoid arthritis.

So was this a medical or a psychological issue?

A common prescription doctors give for depression is a selective serotonin reuptake inhibitor (SSRI), which increases the level of the neurotransmitter serotonin in the brain. What’s surprising, however, is that there’s no way to test neurotransmitter levels. Thus, there’s no way to know, other than through trial and error, whether a person’s serotonin level is adequate.

This problem led Dr Bullmore to extend his research into another field of medical practice: immunology. An immune response involves inflammation, which results from an increase in the flow of blood to the area of an infection or injury in the body. This increased blood flow is triggered by the release of chemicals from white blood cells into the blood and affected tissues. White blood cells act like good guys fighting bacteria and viruses in the body, but the good guys can turn on us and start fighting our healthy cells. And immunology research shows links between inflammation and diseases such as diabetes, heart disease and Alzheimer’s disease—and also depression.

Dr Bullmore discovered that the blood from people who said they felt depressed showed higher levels of inflammation—the more depressed they felt, the more inflammation was found in their blood. And because the genes common to depressed people are also the genes for immune function, it seems this is a cause rather than merely a correlation. The mutation of one key immune function gene, olfactomedin 4, causes a strong inflammatory response to certain types of bacteria when it enters the gut.

The Bible suggests something quite consistent with this observation. Proverbs 12:25 says, “Anxiety in the heart of man causes depression, but a good word makes it glad” (NKJV²). Stress causes inflammation in the heart and eventually throughout the whole body, which can lead to depression.

We experience more stress in this day and age than ever before, leaving our bodies chronically inflamed. One in ten people are depressed and that statistic is on the rise. This suggests that our lifestyle produces the inflammation that may trigger depression.

I turned to internationally recognised Australian lifestyle medicine expert Dr Darren Morton to find out more about this issue. Both his recent book Live More Happy and his online self-guided program, The Lift Project, arose out of his desire to “let people know there are scientifically proven ways to lift your mood and your life.” The Lift Project includes 10 online lessons and combines strategies from the fields of neuroscience, positive psychology and lifestyle medicine to lift your mood and your life.³

 

The problem

When we take a closer look at what makes us more likely to experience depression, most of the risk factors are lifestyle related and can be reduced with lifestyle changes. “Many of the modern lifestyle habits are pro-inflammatory and what we know is that more traditional forms of lifestyle are actually anti-inflammatory,” says Dr Morton. He addresses these pro-inflammatory aspects of our modern lives in The Lift Project —including poor nutrition, lack of physical activity, pesticides and environmental toxins—and suggests simple yet effective strategies. By implementing these lifestyle changes, the causes of depression are addressed rather than just alleviating a symptom or two in the short term.

Morton goes on to point out that “what we actually now know is that probably the root cause of most chronic conditions is actually a low-grade systemic inflammation.” He cites the same conditions that Dr Bullmore found were linked to inflammation, and he emphasises that nutrition is a critical aspect of the lifestyle shift that needs to take place to improve these conditions. Scientists have shown that the highly processed foods many of us eat today are pro-inflammatory, and not only does the body have an inflammatory response to these foods, it also launches an immunological defense.

Historically, most people died from infectious diseases such as tuberculosis, smallpox or influenza. People experienced low energy as their body conserved energy for fighting off foreign invaders, and they went into social isolation to stop the spread of infection. Low energy and social withdrawal are also symptoms of depression, and considered in that light, we can see how depression could be a response to the body’s effort to avoid contracting a disease. But today, Dr Morton says, the highly processed foods we consume on a daily basis are recognised as foes by our bodies and result in symptoms that are similar to those of infectious diseases. Interestingly, low mood can also be a symptom of food intolerances to gluten and dairy. Maybe depression is the also the body’s natural reaction to foods it isn’t used to or that it recognises as enemies.

 

What to do

Eating more anti-inflammatory foods can help in the fight against low mood. These foods include fibre, which is found only in plants. Due to the strong association between poor health of the “good bacteria” in the gut and the resulting adverse mental and physical health problems, our gut is sometimes referred to as the second brain. These microbiota feed on fibre, and there’s a positive correlation between the consumption of fruit and vegetables on the one hand and people’s emotional vitality on the other. The more fruit and vegetables we eat, the happier we’ll feel!

Many times, when a client has described to me feeling depressed, not enjoying the things they usually do and not wanting to be alive, it has also come up that they aren’t exercising, they aren’t eating healthily, and they’re withdrawing from people, including those they love and from whom they usually seek comfort (or should). These behaviours are all pro-inflammatory, Dr Morton says, as is the emotion of loneliness.

As a counsellor, I can unpack the beliefs my clients have about themselves as well as the emotions they’re experiencing over what’s happening in their life. From that I can teach them some techniques for coping with stress. These insights can all be a useful part of the healing process and contribute to personal growth, but they can also take time.

Implementing simple lifestyle changes can provide a boost in mood fairly quickly, and they can also help in the long term by treating the body’s inflammatory response. Dr Morton says that moving for less than 10 minutes is enough to change your mood, and science indicates that the day after consuming more fruits and vegetables you’ll feel happier. These are small steps with rapid results that may provide that extra boost you need to lift your life and mood.

 

The Bible says

What fascinates me is the apparent evidence that God used these lifestyle interventions to help the Old Testament Hebrew prophet Elijah. First Kings 19 recounts the story of how Elijah, fleeing for his life, went alone into the wilderness and prayed for the Lord to take his life. Then he stopped to sleep for a while. He was clearly depressed, feeling worthless, fatigued, socially withdrawn and suicidal—all symptoms of depression. Verse 7 says that an angel appeared to him and told him to get up and eat and move forward on his journey. Later in the story, God provided Elijah with a helper named Elisha, who was to be his assistant. Yes, God provided depression-fighting opportunities for Elijah, encouraging him to eat properly, keep moving and get support.

Does today’s lifestyle produce the inflammation that may trigger depression? Medical science suggests that the answer is yes, as does the anti-inflammatory nature of effective lifestyle changes. And both recent scientific research and the ancient wisdom of the Bible suggest some practical ways forward.

 

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1. This article’s discussion of Dr Bullmore’s work is based on William Leith, “The Depression Epidemic and Why the Medical Profession Is Failing Patients,” The Times, April 21, 2018, available from https://www.thetimes.co.uk/magazine/the-times-magazine/the-depression-epidemic-and-why-the-medical-profession-is-failing-patients-cgd08lbv6.
2. Bible verses marked NKJV are taken from the New King James Version^®. Copyright © 1982 by Thomas Nelson. Used with permission. All rights reserved.
3. For more information about The Lift Project or to sign up, go to The Lift Project website at http://www.theliftproject.global.