Did you know? One out of four people who suffer from depression and anxiety also have elevated inflammatory markers(1)!
When I read that statistic, I immediately had to know if this was true and how the two are related.
Inflammation
First, let’s review the basics so when I get to the good part, you know what I’m talking about.
When you think of inflammation, you might think about an injury or allergic reaction. You hit your head on the cabinet and end up with a painful, red, swollen welt on your forehead. Or you get hives after eating peanuts.
These are examples of acute inflammation, but there’s another type of inflammation that can have deadly results- chronic inflammation.
To learn more about our immune system, check out Inflammation Got You Down?
Chronic Inflammation
Chronic inflammation occurs in response to low-intensity ‘irritants’ over a period of time. Irritants are things that either damage cells or our bodies recognize as foreign and include both food and non-food contaminants.
Non-Food Contaminants
Non-food contaminants include physical items or chemical compounds that are not intended to enter the body. For example, working in a profession that exposes us to a chemical on a regular basis. Over time, this exposure can make you sick in some way.
Foods
Generally, foods nourish our bodies and help us to grow and function optimally, but they can also make us sick. Our diet has the power to either directly or indirectly impact inflammation, both acutely and chronically, positively and negatively.
Examples of how our diet can promote inflammation include:
- eating foods that cause an allergic reaction
- consuming foods using dirty hands can introduce harmful bacteria or chemicals
- consuming a product made with an unnatural preservative or a fat that has gone rancid
- consuming too much of a good thing (sugars)
- consuming excessively processed foods, particularly fried foods that contain nutrients that have a pro-inflammatory effect
Other Reasons For Chronic Inflammation
Inflammation may also occur in response to emotional stressors, inadequate sleep, or a sedentary lifestyle. These situations add hormones and other metabolites produced in the body, which also affect the immune response.
In addition, certain medical conditions promote inflammation. For example, autoimmune diseases like rheumatoid arthritis, type 1 DM, or multiple sclerosis alter and dysregulate our immune systems. These conditions can also cause depression, but I will not include them beyond mention because they require advanced medical care and oversight. If you have one of these conditions, seek your doctor’s approval before making any dietary or lifestyle changes.
The Negative Effects of Chronic Inflammation
Most of the time, the immune response is helpful. We heal, or we start to feel better and continue on with our lives. Other times, we might begin to experience new or worsening symptoms.
Each body system is affected by inflammation slightly differently. The outcome can be minor things like premature aging to catastrophic things like heart attacks or even death.
There are two primary ways chronic inflammation can wreak havoc on our bodies and minds.
Cytokine Build-Up
Cytokines, proteins released from damaged tissues, moderate the cascade of events that make up our immune response. But, over time, as is the case with chronic inflammation, cytokines can build up and do more damage than good.
Excessive cytokines accumulate in tissues and bind with cell wall receptors which impede signaling and communication pathways. Ultimately, this leads to discomfort, additional tissue damage, tissue death, and eventual organ failure.
Altered Permeability
Permeability refers to how nutrients, and other biological compounds, travel across a barrier or, in this case, blood vessels to tissues. It’s how oxygen gets to muscle fibers during exercise or how alcohol alters our thoughts/actions.
Chronic inflammation alters vascular permeability in two ways.
The first is through damage. When we overload our blood with chemicals (natural or unnatural), we damage our blood vessels, particularly our capillaries, our tiniest blood vessels. Think of these like very small crystals floating through our blood and bumping up against the wall. Each time it bumps into the wall, a small cut or scrap is made, triggering an immune response and subsequent inflammation.
The second is through vasodilation. Vasodilation widens the path and increases vessel permeability to flood the damaged area with white blood cells and other materials needed for repair.
Chronically impaired permeability can either allow or prevent materials, both good and bad, from crossing freely.
Inflammation and The Human Brain
The Blood-Brain Barrier
Chronic inflammation affects what science refers to as the blood-brain barrier. The Blood-Brain Barrier is exactly what it sounds like, the barrier between the blood and brain. If this barrier is compromised in any way, we experience poor mental performance, mood dysregulation, and cognitive decline.
Remember those two key mechanisms I mentioned above? Excessive cytokines and altered permeability- Let’s look at how these affect our mental health.
Altered permeability affects the blood-brain barrier, restricting the flow of nutrients to the brain and/or allowing ‘toxic’ materials to enter our brain. Included in the toxic materials are cytokines.
Excessive cytokine activity upsets our neurons and impairs neurotransmitter synthesis, reuptake, and release, all of which are implicated in mood and cognition. Simply put, excessive cytokines in the brain can alter our thoughts by disrupting signaling between neurons.
Depression and Inflammation
Remember that statistic I threw out at the beginning?
I’ll remind you.
One out of four people with depression and anxiety also have inflammation!
Depression can be acute or chronic, and symptoms can range from mild to severe. It can occur alone or be secondary to other illnesses (mental or physical).
Several decades ago, doctors and researchers noticed that many people with depression also have elevated markers of inflammation, suggesting a relationship between the two conditions.
In fact, two longitudinal studies, completed in 2009 and 2014, found that higher levels of inflammatory markers (IL-6 and CRP) in childhood are associated with an increased risk of depression and psychosis in young adulthood.
It should be noted that if you are experiencing depression symptoms that include intrusive thoughts about harm to yourself or others, please seek help. Major depression and suicidal ideation require treatments that exceed the power of food.
Is Inflammation the Cause of- or Effect of Depression?
Which came first, the chicken or the egg?
Many people with depression have lifestyle factors (i.e., smoking, drinking, or elevated BMI) or other medical conditions (medications or comorbid conditions) that muddy things up and skew data in the research world.
It seems logical that depression would result from having certain conditions that limit the quality of life and/or promote inflammation. For example, being diagnosed with type 2 diabetes may lead to symptoms of depression.
But, a recent meta-analysis of the data found the correlation between depression and inflammation is independent of any potential confounding factors.
It appears depression is an inflammatory disease, with depression and inflammation having a ‘bidirectional’ relationship. What is the best solution or treatment?
Do antidepressants reduce inflammation?
Research in this area reveals that treatment with antidepressants can lower circulating inflammatory markers and lessen the symptoms of depression.
However, so do alternative treatments such as electric shock therapies (more appropriately termed transcranial direct current stimulation [tDCS] and electroconvulsive therapy [ECT]), exercise, and psychotherapy.
This suggests that the effects of traditional treatments may improve symptomatology and other factors contributing to inflammation, like improving one’s sleep or reducing stress.
Does treatment with anti-inflammatories reduce symptoms of depression?
Treatment with anti-inflammatory (NSAIDs and anti-cytokine drugs like methotrexate) also appears to improve symptoms of depression. Reducing inflammation may alleviate the negative effects excessive cytokines have on our various body systems, and with less discomfort, we gain a sense of relief.
This might sound promising but daily pain-killers can irritate the linking of our stomach and may lead to addiction.
Speak with your doctor or psychiatrist before adding daily anti-inflammatory drugs.
There are ways to reduce inflammation without adding additional drugs, too!
Lifestyle Choices Matter
For generally healthy women struggling with depression, there’s a possibility that chronic inflammation may be a contributing factor. Here’s what you can do reduce inflammation.
- Increase Exercise to a minimum of 30 minutes most days of the week
- Maintain adequate amounts of Rest and Relaxation (i.e., sleep and anti-stress activities like meditation)
- Choose a Healthy Diet
The foods we consume are so important! I suppose that’s why I chose to do what I do for a living and the reason for the whole ‘Foods for Moods’ series.
And we’re talking about inflammation, the foods we choose have either pro-inflammatory or anti-inflammatory actions within the body. And it boils down to a PERFECT BALANCE.
The Anti-Inflammatory Diet
Anti-Inflammatory Diet
The anti-inflammatory diet is one way of eating that helps prevent and reduce inflammation. Like the Mediterranean Diet, it includes loads of legumes, fresh fruits and vegetables, lean proteins, nuts and seeds, seafood, and fermented products.
These foods are often low-calorie and contain nutrients that are known to have antioxidant or anti-inflammatory properties.
For example, omega-3s, found in fatty fish, exert anti-inflammatory properties through their role in cellular communication. Read more about Omega-3s in Be Free with Omega-3s.
Dark leafy greens contain vitamin C and polyphenols, which are potent antioxidants that help to offset damage to DNA created during inflammation.
Fermented foods, like kimchi, miso, pickles, and sauerkraut, also offer anti-inflammatory benefits through their role in gut health.
Every BODY is different, and there is no “one-size fits all” when it comes to our food. If you are interested in learning more about the anti-inflammatory diet, there are loads of resources available, from cookbooks to websites outlining the various approaches.
You can also meet with a Registered Dietitian who can help you develop a plan that fits your lifestyle and goals.
Stay Up-Beet, Witches!
References
- Osimo EF, Baxter LJ, Lewis G, Jones PB, Khandaker GM. Prevalence of low-grade inflammation in depression: a systematic review and meta-analysis of CRP levels. Psychol Med. 2019 Sep;49(12):1958-1970. doi: 10.1017/S0033291719001454. Epub 2019 Jul 1. PMID: 31258105; PMCID: PMC6712955. Full-Text Link
- Lee CH, Giuliani F. The Role of Inflammation in Depression and Fatigue. Front Immunol. 2019 Jul 19;10:1696. doi: 10.3389/fimmu.2019.01696. PMID: 31379879; PMCID: PMC6658985. Full-text link.
- Kappelmann N, Lewis G, Dantzer R, Jones PB, Khandaker GM. Antidepressant activity of anti-cytokine treatment: a systematic review and meta-analysis of clinical trials of chronic inflammatory conditions. Mol Psychiatry. 2018 Feb;23(2):335-343. doi: 10.1038/mp.2016.167. Epub 2016 Oct 18. PMID: 27752078; PMCID: PMC5794896. Full-Text Link
- Beurel E, Toups M, Nemeroff CB. The Bidirectional Relationship of Depression and Inflammation: Double Trouble. Neuron. 2020 Jul 22;107(2):234-256. doi: 10.1016/j.neuron.2020.06.002. Epub 2020 Jun 17. PMID: 32553197; PMCID: PMC7381373. Full-text link.
- Appleton KM, Voyias PD, Sallis HM, Dawson S, Ness AR, Churchill R, Perry R. Omega-3 fatty acids for depression in adults. Cochrane Database Syst Rev. 2021 Nov 24;11(11):CD004692. doi: 10.1002/14651858.CD004692.pub5. PMID: 34817851; PMCID: PMC8612309. Full-text link.
- American Psychological Association Clinical Practice Guidelines for the Treatment of Depression Across Three Age Cohorts (2019). Accessed 12/17/22 from https://www.apa.org/depression-guideline/guideline.pdf
