Could Your Depression be Rooted in Chronic Inflammation?
With the chemical imbalance theory officially debunked, scientists are now focusing on the previously unknown link between inflammation and depression. To help us understand this complex dynamic, our research team sat down with renowned nutritionist and author Dr. Jenna Macciochi.
In July 2022, a significant umbrella study was published in the Molecular Psychiatry journal. The researchers reviewed all existing meta-analyses and systematic evaluations of how a chemical imbalance causes depression, only to discover that there is insufficient evidence to support this notion. In other words, chemical imbalances do not cause depression. Inevitably, their work called into question the effectiveness of antidepressants, as most are selective serotonin reuptake inhibitors (SSRIs), which, although effective at easing symptoms, were thought to function by correcting abnormally low serotonin levels.
Although these findings have been known in the field for some time, their work garnered extensive media attention. Consequently, with rates of depression ever-increasing, it has left many of us confused about how best to treat our depressive symptoms.
However, lesser-known studies (2019, 2016, 2013) have found that depression could actually be rooted in chronic inflammation. As we adopt a holistic treatment modality at Paracelsus Recovery, treating mood via food has always been an intrinsic element of our programmes. However, our diet is only one small piece of the puzzle regarding chronic inflammation.
To that end, we had the good fortune to sit down with a renowned nutritionist and immunity expert, Dr. Jenna Macciochi. Dr. Macciochi helped us understand the immune system, how inflammation relates to depression, and what steps we can take to look after our immunity-brain axis.
Read on for some of her key insights, and find the full transcript of our interview here.
How is the Immune System Related to Mental Health?
Simply put, the immune system is a complex network of organs, cells, and proteins that defend the body against infection. To do that, the immune system has various ‘’weapons’’ at its disposal, with inflammation being one of its strongest.
As Jenna explained, inflammation happens when our immune system picks up on a threat (an infection) and releases white blood centres into our blood or tissues to protect us from invaders. For example, if you are fighting off a virus, the subsequent aches, fever, and chills you experience are side effects of these white blood cells fighting the infection. In this instance, inflammation is an alley to our health and well-being.
However, chronic inflammation occurs when our body continues to send out inflammatory cells even though there is no invader. As a result, we feel sluggish and worn out all (or at least most) of the time. This can occur when we consume unhealthy substances that activate that immune reaction (e.g., nicotine, fast food, or alcohol). But it can also occur when the immune system has received so little of the factors it needs to function correctly (e.g., exercise, healthy germs, or social interaction) that it becomes essentially ‘’too tired to think.’’ As Jenna explained, these elements result in an immune system that will begin to “go wrong slowly over time by releasing this unwanted chronic inflammation that now seems to underlie every chronic health condition.”
What Causes Chronic Inflammation?
As Jenna explained, “ [when we think about inflammation], we tend to focus on diet and think to ourselves, oh, I can eat my way to a healthy immune system, but that’s only one piece of the puzzle.” Other factors include sedentary lifestyles like looking at computers for too long, toxic food environments where — in Jenna’s words — “there is a constant messaging that we need to eat,” and a lack of exposure to healthy germs or access to green spaces like we would have had 100 years ago.
But even more poignantly, there is the mental health component. In Jenna’s words, “our immune cells have receptors on their surface for all the different neurotransmitters,” meaning that what we feel will directly influence our immune system. For example, if we are stressed out, then our body releases cortisol, which will turn off our immune system and therefore leave us vulnerable to infection.
Known as the immunity-brain axis, Jenna highlighted how we now know from the scientific literature that things like mindset, self-esteem, and well-being will influence the levels of chronic inflammation in your body. Conversely, strengthening your immune system and decreasing chronic inflammation will also play a role in your mindset, self-esteem, and well-being.
…And How Does It Relate to Depression?
Firstly, studies show that autoimmune diseases were a marker for a 50% greater risk of mood disorders like depression. For years, experts thought this was simply because a chronic condition lowers your quality of life because it increases stress, which in turn, increases your chances of developing mental health issues.
However, as Jenna explained, recent studies actually show that the levels of depression were correlated with the levels of inflammation in the body. Remarkedly, they started giving people with depression anti-inflammatory drugs in clinical trials, which reduced their depressive symptoms. Poignantly, studies even show that improving immunity is a side-effect of classic antidepressant medications, perhaps explaining why SSRIs are still so effective, despite debunking the chemical imbalance theory.
Elaborating upon these findings, Jenna explained that:
“The inflammation acts on the brain directly and causes you to change your behaviour. For example, if you think about the last time you had a really bad flu, you probably didn’t go about your normal life doing the same things you normally do, you were probably a bit socially withdrawn, had changes to your sleep pattern, changes to your appetite, you might have felt very tired even though your sleep was not great.
All of those physical symptoms are caused by the inflammation in your body acting on your brain and telling your brain to change your behaviour to allow your body to heal from the infection. It’sIt’s called sickness behaviour, a very specific characteristic of being unwell. However, depression has a lot of parallels to sickness behaviours.”
Essentially, someone struggling with depression behaves and acts in a manner consistent with someone struggling with the flu because they have high levels of inflammation in the body. The inflammation is making them think, feel, and act that way. However, unlike when we have the flu, we do not necessarily realise that we need rest when we feel depressed, so we are all too quick to think that there is something ‘fundamentally’ wrong with us as human beings. For example, someone struggling with inflammation-induced depression might start to feel like a ‘failure’ because they cannot be as productive as someone else. Misunderstandings like these only fuel stress, inflammation, and pain.
Strategies for Improving Your Mental Health by Strengthening Your Immunity.
Inevitably, Jenna’s insights during our conversation led us to ask; what would her advice be for someone struggling with a mood disorder who wants to ensure their immunity is as strong as possible? Her top tips include:
- Be Kind to Yourself
Firstly, show yourself as much compassion as possible. As Jenna explained, “we know from the scientific literature that self-compassion is linked to lower levels of unwanted inflammation, which is going to be good for our mental and physical health.” For example, when you wake up in the morning, are your first thoughts harsh and self-accusatory like ‘oh I haven’t finished that task, I need to do x, y, z and oh I am so tired, I am such a terrible person’, etc? If yes, try to start there. Reframe that inner dialogue to something like, ‘’okay, this is where I am now, and I am tired; how can I achieve some of the tasks on my to-do list today while also accepting and honouring the fact my body needs rest?’’ The key is to be realistic with yourself. There is no fuel for the inner critic quite like setting ourselves an impossible to-do list and then punishing ourselves for being mere mortals and not completing everything on it.
And, as Jenna noted, “self-compassion is a better motivator for change, so when we beat ourselves up and say, “oh, I’m so rubbish at everything”, it doesn’t motivate us to make the changes we want to make.” Hence, if you want to improve your inflammation levels and state of mind, start treating yourself the way you would a friend or loved one.
2. Conduct an ‘’Immunity Audit’’
Secondly, Jenna recommends trying to do “a bit of an audit of your life” and asking yourself: what area are you struggling with the most? Is it that you are stuck at your computer all day and only take a break from screens at the end of the day? In that instance, can you find ways to break that up, e.g., getting up and moving or gardening for 10 minutes? Or are you struggling with a lack of social interaction? Are there friends or family members you can try to call or text, even once a week? Or maybe you are quite cruel to yourself and need to focus on improving your self-esteem. Are there some mantras you could say to yourself once a day? Try to figure out which immunity-related factors you struggle with most and work from there.
3. Make The Changes as Small as Possible
But, above all else, Jenna emphasised that we must make the changes as small as possible. For example, say you want to eat healthier; it doesn’t matter what it is or how much it is but try to think, as Jenna poignantly put it, “Okay, this week I’m going to add vegetables to every meal, or I’m going to get into the habit of being more mindful when I’m eating them, so I’m digesting them better which is great for that gut-brain axis. Just really small things you can do when you’re having a bad day so over time you develop habits that become automatic.”
Essentially, the goal is not to aim for perfection from the get-go, but to show yourself enough compassion that you allow yourself to start small. Try to focus on building habits and routines that will enable you to live a happier and healthier life without feeling like you need to force yourself to do so.
In conclusion, if you are struggling with depression, focusing on improving your immunity will only benefit your health and well-being. However, it cannot be overstated that if you or a loved one are showing signs of suicidal ideation, seek professional help as soon as possible. For example, contact your family GP or a treatment centre, or go to your local emergency room. Mental health treatment — like our immune system — is complex and requires multiple inputs. A treatment plan that includes psychiatric, psychological, and physical support is always the best way to go.
Dr. Jenna Macciochi
Dr. Jenna Macciochi has 20+ years of experience as an immunologist. Her work focuses on the interplay between nutrition, lifestyle, and immune systems. Her career is as extensive as her knowledge; she is a lecturer at Sussex University, a personal nutritionist, a fitness instructor, a TEDx speaker, an Editor at Scientific Journals, and a Fellow of the Higher Education Academy. In 2009, she was awarded a prestigious Presidential Fellowship to combine her interest in nutrition with studying the immune system.
Dr. Macciochi is also a regular contributor to various print and online media platforms and regularly appears on TV shows such as BBC HealthCheck UK. In 2020, she published her bestselling debut novel, Immunity: The Science of Staying Well (2020).
Follow her on Instagram or Twitter for more tips, tricks, and insights into how to stay well.
At Paracelsus Recovery, restoring the mind-body connection lies at the core of our treatment method. Through functional medicine, intensive laboratory tests, nutritional supplements, and biochemical restoration, we strive to restore your well-being on a physical and cellular level. In nurturing the link between body and mind, we make sure to give you the greatest chance of a robust recovery.
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