Chapter 38: Depression & Inflammation ARE Linked

 Another excellent article explaining why inflammation can cause depression.

Strong link seen between depression, inflammation

Clinical Psychiatry News, June, 2006 by Damian McNamara

SAN JUAN, P.R. -- Growing evidence points to an association between inflammation and depression, according to a presentation at the annual meeting of the American College of Psychiatrists.

For example, depressed patients have elevated inflammatory markers--such as interleukin-6 and C-reactive protein. In fact, the levels of proinflammatory cytokines correlate with the severity of depressive symptoms in studies. In addition, administration of cytokine antagonists can effectively reverse depressive symptoms in patients, Dr. Andrew H. Miller said.

"We really stand at a point that is very exciting in terms of novel therapies and translation of research," Dr. Miller said. "The notion quite simply is that stress or depression affects the HPA [hypothalamic-pituitary-adrenal] axis, [affects] the endocrine system, alters the immune system, and leaves patients open to diseases."

Physicians from many specialties already recognize that inflammation plays a key role in cardiovascular disease, diabetes, metabolic syndrome, and cancer, said Dr. Miller, professor in the department of psychiatry and behavioral sciences at Emory University, Atlanta.

"We did not want to be left out in terms of psychiatry," said Dr. Miller, who also is director of the psychiatric oncology program at the Winship Cancer Institute at Emory.

There are multiple possible mechanisms whereby inflammation could cause depression. Inflammatory cytokines released peripherally might reach the brain through active transport, passage through leaky regions in the blood-brain barrier, or transmission through afferent nerve fibers (vagus nerve), Dr. Miller said. There is a cytokine network in the central nervous system, and glia and microglia are the richest source of cytokines in the brain. Neurons also produce and express cytokines.

"We've learned these cytokines have access to the brain and ... ultimately can change behavior," Dr. Miller said. Inflammatory cytokines cause anhedonia (an inability to experience pleasure), fatigue, cognitive dysfunction, and other flu-like symptoms in sick patients. In addition, researchers induced behavioral changes that resemble major depression in human and animal studies with administration of proinflammatory cytokines.

Some therapeutic cytokines cause depression. For example, interferon-[alpha] (IFN-[alpha]) is used to treat viral infections and cancer because it is a potent inducer of the inflammatory cytokine network, especially interleukin-6, Dr. Miller said. "Oncologists told us early on this drug causes a lot of depression."

A total of 60% of patients treated with IFN-[alpha] reported depressed mood in one study (Neuropsychopharmacology 2002;26:643-52). Dr. Miller and his associates also found a 45% incidence of major depression among patients with malignant melanoma treated with IFN-[alpha] (N. Engl. J. Med. 2001;344:961-6).

The good news is that paroxetine (Paxil) aggressively blocked development of depression. "Just 11% developed depression, so there was a fourfold reduction with this pretreatment.

"There is a caveat. If you give a drug that causes release of dopamine--for example, paroxetine--that dopamine becomes oxidized and in the long term can damage basal ganglia," Dr. Miller said in response to a question from a person attending the meeting. "So we're using dopamine antagonists to block this until we get more information about what we are doing to patients."

Physician reaction to his study varied, Dr. Miller said. "The people who got on us the most for that study with paroxetine were the ones who were treating hepatitis C. They said we'd expose a lot of people to antidepressants who don't really need them." However, "with melanoma, many patients will not go back on interferon therapy, and giving antidepressant prophylaxis might help."

In another study, patients with psoriasis treated with the cytokine antagonist etanercept experienced reversal of their depressive symptoms (Lancet 2006;367:29-35). Improvement in depression was independent of the drug's effect on disease progress.

The wider picture may be a link between stress, depression, and illness, Dr. Miller said. In one study in review, patients with major depressive disorder exhibited an exaggerated inflammatory response to stress.

"There is an interesting possible link between depression and a wide variety of medical disorders where inflammation plays a role," Dr. Miller said. It "may explain high comorbidity of some medical conditions with depression.

"Psychiatry is now catching up to other medical specialties in recognizing the adverse effects of inflammation," Dr. Miller added. "Psychiatrists need to keep an eye on this. The idea that the immune system might affect the brain and vice versa presents a lot of novel targets for treating psychiatric disorders."

BY DAMIAN MCNAMARA

Miami Bureau

COPYRIGHT 2006 International Medical News Group

COPYRIGHT 2008 Gale, Cengage Learning

My Summary of the Article:  Strong link seen between depression, inflammation

Clinical Psychiatry News, June, 2006 by Damian McNamara

1.  Patients with depression have elevated inflammatory markers in their blood such as interleukin-6 and C-reactive protein.  

 2.  The levels of elevated inflammatory markers in the blood of depressed patients, called proinflammatory cytokines, correlate with the severity of depressive symptoms. 

 3.  Administration of cytokine antagonist drugs can effectively reverse depressive symptoms in patients.
 4.  Stress or depression affects the HPA [hypothalamic-pituitary-adrenal] axis, affects the endocrine system, alters the immune system, and leaves people open to diseases.

 5.  Inflammatory cytokines may reach the brain by transport through the blood, giving them passage through leaky regions in the blood-brain barrier, or transmission through nerve fibers to the central nervous system.

 6.  Inflammatory cytokines in the brain cause the inability to experience pleasure (anhedonia), fatigue, cognitive dysfunction, and flu-like symptoms in sick patients.

 7.  When researchers administered proinflammatory cytokine drugs in human and animal studies it induced behavioral changes that resembled major depression.

 8.  Interferon is a drug called a therapeutic cytokine used to treat viral infections and cancer.  It induces the inflammatory cytokine network, especially interleukin-6, and causes depression in patients taking the drug.

 9.  Dr. Andrew H. Miller and his associates found a 45% incidence of major depression among patients with malignant melanoma treated with IFN-[alpha], another therapeutic cytokine.

10.  Patients taking Paxil while using a therapeutic cytokine were relieved of depression symptoms.  This may help patients stay on a therapeutic cytokine drug that is causing depression.

11.  Patients with psoriasis were treated with the cytokine antagonist drug etanercept (Enbral). They experienced reversal of their depressive symptoms even if the drug wasn't effective on the psoriasis.
12.  Patients with major depressive disorder showed an exaggerated inflammatory response to stress.
13.  There is a possible link between depression and a wide variety of medical disorders where inflammation plays a role.
14.  Psychiatry is now catching up to other medical specialties in recognizing the adverse effects of inflammation.
15.  The immune system affecting the brain, and the brain affecting the immune system presents a lot of new ways to treat psychiatric disorders.

Cytokines were talked about so much in the above article, I wanted to learn more about them.  The following article is from BioPortal / Cytokines. 

  What are Cytokines? 

Cytokines, also known as immune factors, are protein produced naturally by the cells and organs of the human immune system. They act on other immune system cells modulating the body's response to disease and infection. Cytokines can also regulate the growth of new blood cells in the bone marrow.

Cytokines play a crucial role in the immune system response to all kinds of disease. They interact with organs and cells, alone and in combination with each other. The diverse role that cytokines serve in the immune system make them an ideal target for intervening or bolstering immune responses. Using recombinant DNA technology cytokines can be created in a laboratory. They have many treatment applications including cancer, multiple sclerosis, anaemia, and rheumatoid arthritis.

  Types of Cytokines

There are several types of cytokines with different varieties within each type. The following are the cytokines naturally produced by the body and the immune cells that produce them: 

Interferons (IFNs) have three main varieties. Produced by a number of immune system cells. Eg: White blood cells.  

Interleukins (ILs) have more than ten varieties. Produced by the white blood cells (leukocytes). 

Tumour Necrosis Factors (TNFs) have two main varieties. Produced by a number of immune system cells. Eg: T-Cells, white blood cells.  

Colony Stimulating Factors (CSFs) have many varieties and names. Produced by T-Cells and macrophages. 

Erythropoietin (Epoetin/EPO) has several varieties. Mainly produced by the kidney (10-15 percent originating in the liver). 

Thymopoietin has three main varieties. Produced by the thymus.

The Science - How do Cytokines Work?

Cytokines work in ways very similar to hormones. They are released by immune cells into the circulation or locally in a tissue. Cytokines interact with receptors on target immune system cells. This interaction triggers a cascade of biochemical reactions such as the release of other cytokines, cell division, or cell differentiation, that leads to a given event. Each type and variety of cytokine has distinct effects on specific targets: 

Interleukin 2 (IL-2) - This is the only variety of IL that is currently used therapeutically. It Interacts with T-cells that have been activated by an infection and triggers T-cell division increasing the number in circulation. IL-2 also stimulates the division of B-Cells and works in the bone marrow to promote the differentiation of stem cells into immune cells.

Interferon - Has numerous therapeutic applications including:

  Stimulating activity in other immune system cells,

  Inhibiting growth in some types of cancer cells,

  Increasing immune cell capacity to bind foreign particles,

  Modulating the production of antibodies, and 

  Inhibiting viral protein synthesis, through a system of interactions.

Erythropoietin - Stimulates stem cells in the bone marrow to differentiate into mature red blood cells. 

Colony Simulating Factors - Stimulate stem cells in the bone marrow to differentiate into immune cells called "neutrophils." Neutrophils are an important component of the body's inflammatory response to infection. CSF's can also stimulate activity in other immune system cells.

Cytokines can also work in combination to produce different effects in the body. Some therapies combine more than one cytokine to achieve their results.

  Biotechnology and Cytokines

Therapeutic cytokines are produced through recombinant DNA techniques. The human gene that codes for the desired cytokine is inserted into a host cell, such as the bacteria species E-coli, yeast, or the cells of mammals or insects. The cells then act as factories, producing the desired human protein.

Proteins produced by non-human cells (like those produced through yeast or E-coli) will vary slightly from the those produced naturally in the body. Small variations in structure can cause therapeutic cytokines to behave differently from their natural counterparts. Therefore, recombinant cytokines are studied further to determine if they will behave differently due to the variations.

I want to ask my psychiatrist if anti-inflammatory drugs may help my depression symptoms, or if there are other cytokine antagonist drugs that would be more effective.  This short abstract of an article talks about cytokine-based therapies.  An Overview of Cytokines and Cytokine Antagonists as Therapeutic Agents

Donnelly, R. P., Young, H. A. and Rosenberg, A. S. (2009), An Overview of Cytokines and Cytokine Antagonists as Therapeutic Agents. Annals of the New York Academy of Sciences, 1182: 1–13. doi: 10.1111/j.1749-6632.2009.05382.x

Keywords:

• cytokines;
• inflammation;
• interferons;
• interleukins;
• receptors

Cytokine-based therapies have the potential to provide novel treatments for cancer, autoimmune diseases, and many types of infectious disease. However, to date, the full clinical potential of cytokines as drugs has been limited by a number of factors. To discuss these limitations and explore ways to overcome them, the FDA partnered with the New York Academy of Sciences in March 2009 to host a two-day forum to discuss more effective ways to harness the clinical potential of cytokines and cytokine antagonists as therapeutic agents. The first day was focused primarily on the use of recombinant cytokines as therapeutic agents for treatment of human diseases. The second day focused largely on the use of cytokine antagonists as therapeutic agents for treatment of human diseases. This issue of the Annals includes more than a dozen papers that summarize much of the information that was presented during this very informative two-day conference.

I hope research in the link between inflammation and depression will lead to new, effective treatment options for depression!

Chapter 37: Treat INFLAMMATION Ease DEPRESSION?

"By 2020, depressive disorders are projected to be the 2nd leading cause of worldwide disability. The burden of Mood Disorders is rising both for the individual, the family, and for the society. Currently, most people who are treated for depression are partially responsive or non-responsive. New tools are needed. One of these tools involves a focus on the inflammation, immune dysfunction, and infections that are often associated with depression."  

Above quote by:

Robert J. Hedaya, M.D., D.F.A.P.A., a Clinical Professor of Psychiatry at the Georgetown University Hospital and Founder of the National Center for Whole Psychiatry; from an article he wrote for, Psychology Today, published on March 31, 2009, called Depression, Inflammation, Immunity and Infection.

I agree that many people treated for depression are only partially responsive or non-responsive, and new treatment tools are needed! I believe the research in inflammation, immunity, and infection could lead to new types of therapy for depression.  What do you think?

The following disorders are caused by immunity-inflammation:  Heart disease, diabetes, Crohn's disease, autoimmune diseases, cancers, HIV, and Multiple Sclerosis.  Depression is a second condition that goes along with these diseases.

I believe the information in the article written by Dr. Robert J. Hedaya is so important I have included all of it in my blog.

"The brain and the immune system talk to each other, and the communication is bi-directional. This means that inflammation (such as that which occurs due to infection) affects the brain. It also means that changes in brain immunity and inflammation affect the body. A meta-analysis of several studies on this issue found that several cytokines (hormones of the immune system) and markers of inflammation (C-reactive protein, interleukin 1 and 6) were positively correlated with depression. This means the more depression there is, the more inflammation there is. Cytokines seem to trigger a quick onset of what is called ‘sickness behavior'-meaning malaise and fatigue, as well as a delayed onset of depressed mood. One study found the same very close correlation between certain cytokines, mood, anxiety and memory. 

Reducing inflammation may help alleviate depression: In a randomized placebo controlled trial of a COX-2 inhibitor -celebrex-(celecoxib-blocks pro-inflammatory eicosanoids) with reboxetine (a noradrenergic-reuptake inhibitor antidepressant) augmentation with celecoxib was superior to placebo.

A second randomized double blind placebo controlled study showed that etanercept (a TNF-tumor necrosis factor-blocker) reduced depressive symptoms in people with psoriasis, independent of improvement in the psoriasis. This is consistent with elevated levels of plasma TNF elevations found in depressed patients.

Of further relevance is the fact that the core stress response system in the brain activates and regulates the adrenalin-immune connection in the body (this includes the bone marrow and the thymus gland), as well as secondary immune organs (spleen and lymph nodes). Thus, through this pathway (and there are others), stress affects immune function. On the other hand, not only do the brain stress circuits affect the immune system, but the hormones of the immune system-the cytokines referred to above-are known to make the stress circuits of the brain more sensitive.

Another interesting linkage path between the immune system and the brain is the vagus nerve. This nerve system, when activated, opposes the adrenalin system. When it is activated it stimulates the motivational centers in the brain directly, and through the brain's own immune cells (called microglia) increases nor-adrenalin and serotonin.

Chemicals of inflammation, the cytokines I referred to above, can be released by the brain microglia, causing a shift in the balance between helping neurons to grow, and putting them to death. When shifted in the wrong direction, these microglia actually stop the brain from making serotonin, and in that case, any medication that works on serotonin-such as Prozac, Zoloft etc-can not work. (This is part of the reason for ‘Prozac poop out', and this is why I regularly tell my patients that if an anti-depressant has worked for you for 6 months, and then stops working, something else is going on.) The brain production of serotonin does not return to normal for months after an infection.

How can you know if inflammation, infection, or immune dysfunction are playing a role in your depression? Ask yourself these questions: Yes answers imply immune/inflammatory/infectious processes. The more ‘yes' answers the higher the likelihood.

Do I have a physical sense of ‘brain fog'?

Do I have a recent reduction in ‘room-to-room' memory (short term memory)?
Do I have trouble finding words?
Do I sometimes feel confused?
Do I have learning disabilities, or neurodegenerative disorders (e.g.,Alzheimer's is an inflammatory disorder)
Do I feel that if I had plenty of energy my depression would be gone?
Do I have a lot of muscle or joint aches?
Do I feel swollen, puffy?
Do I have a lot of pain?
Do I have gastrointestinal problems?

What to do? Get your doctor to work you up for inflammatory processes, and then try to get to the underlying causes. You will notice an improvement in your depression, if you are on medication it will work better, and many of your symptoms will clear gradually. Remember inflammation is like a smoldering fire. When you treat it, it can take several months for the fire to go out. But the juice is worth the squeeze-you will not only have less depression, but your risk for a host of other diseases will go down."

To Life,

Robert Hedaya, DFAPA
WholePsychiatry.com

Mark Hyman, M.D. also has strong feelings about inflammation causing depression symptoms.  I talked about Dr. Hyman and his book, The Simple Way to Defeat Depression, Overcome Anxiety, and Sharpen Your Mind-The UltraMind Solution-Fix Your Broken Brain By Healing Your Body First, in Chapter 7 and Chapter 22 if you are interested in looking at them.

I want to have the C-reactive protein (CRP) (and the interleukin 1 and 6 if my doctor recommends) blood tests done.  C-reactive protein measures general levels of inflammation in the body.  A CRP test will not show exactly where the inflammation is located or what is causing it. Other tests are needed to find the location and cause.

 

I recently had my blood drawn to check my vitamin D level, and to see if I have had recent mercury exposure from silver lined dental implants. So I will probably wait for a little while before I have the CRP test done. I finally got my vitamin D level up to 72. Find out more about vitamin D and depression in Chapter 10 and Chapter 29.  Find out more about mercury toxicity and depression, and the controversy about testing in Chapter 27 and Chapter 28.

 

To get my vitamin D level up from 45 to 72, I have been taking a 50,000 iu tablet (prescription) every two weeks, and 3,400 mg in daily supplements. I will continue this regimen to keep the level up. I don't absorb vitamin D very well, but I need to be in the sun more often. =)

 

I am going to ask my psychiatrist about having the CRP and interleukin 1 and 6 blood tests done.  If my results are high (normal CRP levels vary from lab to lab, but generally there is no CRP detectable in the blood) I am going to ask him if I could try an anti-inflammatory drug to see if it helps my depression symptoms. Dr. Hedaya (quoted above) said if I am on medication it could help it work even better!

Chapter 36: Blood Type & Diet, Healing Depression Symptoms

Have you heard about the diets based on your blood type?  I decided to find out more about them. I have made many diet changes to help heal the depression symptoms and I want to consider making more changes based on my blood type.  Dr. Peter J. D'Adamo has written a book called 4 Blood Types, 4 Diets, Eat Right For (4) Your Type, The Individualized Diet Solution to Staying Healthy, Living Longer & Achieving Your Ideal Weight.  Dr. D'Adamo gives an overview of the 4 blood types and the 4 diets in the video below.

I

Karl Landsteiner, a medical doctor born in Vienna, Austria in 1868, discovered that people had different blood types in 1901.  He made numerous contributions in pathological anatomy, histology and immunology, but his name will be honored for his discovery and outstanding work on the blood groups.  He was given the Nobel Prize for Physiology or Medicine in 1930.  Here is more information about his work taken from Karl Landsteiner - Biography.

In 1875 it was reported that, when man is given transfusions of the blood of other animals, these foreign blood corpuscles are clumped and broken up in the blood vessels of man with the liberation of haemoglobin. In 1901-1903 Landsteiner pointed out that a similar reaction may occur when the blood of one human individual is transfused, not with the blood of another animal, but with that of another human being, and that this might be the cause of shock, jaundice, and haemoglobinuria that had followed some earlier attempts at blood transfusions.

His suggestions, however, received little attention until, in 1909, he classified the bloods of human beings into the now well-known A, B, AB, and O groups and showed that transfusions between individuals of groups A or B do not result in the destruction of new blood cells and that this catastrophe occurs only when a person is transfused with the blood of a person belonging to a different group. Earlier, in 1901-1903, Landsteiner had suggested that, because the characteristics which determine the blood groups are inherited, the blood groups may be used to decide instances of doubtful paternity.

Much of the subsequent work that Landsteiner and his pupils did on blood groups and the immunological uses they made of them was done, not in Vienna, but in New York. For in 1919 conditions in Vienna were such that laboratory work was very difficult and, seeing no future for Austria, Landsteiner obtained the appointment of Prosector to a small Roman Catholic Hospital at The Hague. Here he published, from 1919-1922, twelve papers on new haptens that he had discovered, on conjugates with proteins which were capable of inducing anaphylaxis and on related problems, and also on the serological specificity of the haemoglobins of different species of animals.

His work in Holland came to an end when he was offered a post in the Rockefeller Institute for Medical Research in New York and he moved there together with his family. It was here that he did, in collaboration with Levine and Wiener, the further work on the blood groups which greatly extended the number of these groups, and here in collaboration with Wiener studied bleeding in the new-born, leading to the discovery of the Rh-factor in blood, which relates the human blood to the blood of the rhesus monkey.

I have Blood Type O+.  The + means I have the Rh-factor in my blood.  A person's Rh type is usually significant only with respect to pregnancies.  An Rh-positive child born to an Rh-negative woman runs the risk of developing Rh disease.  More than 85% of people have the antigen, Rhesus factor, in their blood.  People that do not have the antigen in their blood are Rh-negative. You can find out more about the Rh-factor below and at Rhesus Factor (Rh-Factor). 

The Rhesus factor, also known as the Rh factor, gets its name from experiments conducted in 1937 by scientists Karl Landsteiner and Alexander S. Weiner. These revolutionary case studies involved rabbits which, when injected with the Rhesus monkey's red blood cells, produced an antigen present in the red blood cells of many humans. The Rhesus factor is an antigen, or more specifically a protein, that exists on the surface of red blood cells. 

Originally, Karl Landsteiner listed the blood groups as A, B, and 0 (zero).  (Type AB was found later.)  He called it zero because this blood type did not have the A antigen or the B antigen on the surface of red blood cells.  People assumed this blood type was the letter O because the other types were a letter.  People in the United States have continued to call this blood type O instead of 0.  People in other countries and languages call it zero, or null.

Dr. D'Adamo talks about the diets he recommends for the different blood types.

Blood Type O

Blood Type A

Blood Types B & AB

Dr. D'Adamo talks about each blood type in more detail on his website.  He writes about lifestyle, wellness, stress, exercise, and personality of individuals with each blood type.  If you are interested, go to Eat Right For Your Blood Type, The Official Website of Dr. Peter D'Adamo &The Blood Type Diet.  See if you agree with the characteristics he attributes to your blood type.

These are characteristics Dr. D'Adamo states to describe people with my blood Type O.  They describe me well.

1.  People with Type O blood are vulnerable to inflammation and depression.  

2.  People with Type O blood digest animal protein well because of more stomach acid and an    enzyme in the intestinal tract.  I feel better if I eat protein in every meal.  The only way for my body to get amino acids is from protein. 

3.  Eggs are a poor source of protein for Type O's.  The Elisa food sensitivity test rated my sensitivity to eggs at +4.  That is the highest number on the sensitivity scale.  After eliminating eggs from my diet for 3-4 months my cholesterol count came down from 213 to 163.

4.  People with Type O blood can not digest dairy products and grains efficiently.  I have a +1 sensitivity to casein in dairy products and a +1 for wheat.  My digestive tract has appreciated my eliminating these foods from my diet and I lost 10-12 pounds without trying.

5. The system of a Type O does well with intense aerobic exercise.  Exercise will help eliminate stress.  I feel aerobic exercise is as important to my depression treatment as my antidepressant medications.

6.  Type O's respond well to oils, especially olive and flaxseed, for nutrition and an aid in elimination.  I have been taking 6,000 mg of fish oil since March of 2010.  It is part of my depression treatment.  My fingernails grow faster and are stronger, the acne on my face has improved, and my hair looks healthier.  I hope my arteries and heart are seeing improvements too. =)

I have talked about other diet changes I have made to help heal my depression symptoms in Chapter 7: Keys to UltraWellness, Food Sensitivity and Chapter 32: 6,000mg Of Fish Oil A Day. 

I am feeling pretty stable on 150 mg of Effexor XR.  I don't feel great, but I am doing better!

Chapter 22: Serotonin, Deep Limbic System

"Depression is known to be caused by a deficit of certain neuro-chemicals or neurotransmitters, especially norephinephrine and serotonin.  In my experience, this deficit can cause increased metabolism or inflammation in the deep limbic system, which in turn causes many of the problems associated with depression. . .  Because the deep limbic system is intimately tied to moods, when it is overactive the ensuing problems with depression snowball and affect all the other deep limbic system functions."

Daniel G. Amen, M.D.; From the book, Change Your Brain, Change Your Life:  The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Anger, and Impulsiveness, page 47

FUNCTIONS OF THE DEEP LIMBIC SYSTEM  (page 37)

• sets the emotional tone of the mind
• filters external events through internal states (creates emotional coloring)
• tags events as internally important
• stores highly charged emotional memories
• modulates motivation
• controls appetite and sleep cycles
• promotes bonding
• directly processes the sense of smell
• modulates libido 

 

PROBLEMS IN THE DEEP LIMBIC SYSTEM  (page 43)

• moodiness, irritability, clinical depression
• increased negative thinking
• negative perception of events
• decreased motivation
• flood of negative emotions
• appetite and sleep problems
• decreased or increased sexual responsiveness
• social isolation

"We thought that excessive activity in the part of the brain that controlled emotion might correlate with enhanced feelings of all kinds, not solely negative ones.  Yet we noticed, again and again, that when this area was overactive on SPECT, it correlated with the subject's depression and negativity.  It seems that when the deep limbic system is inflamed, painful emotional shading results.  New research on depression from other laboratories around the world has borne this out."  (page 39)

     SPECT Brain Scans 3D Active View

                      White arrows are pointing to the Deep Limbic System/Thalamus areas

These scans show hyperactive areas in the brain.  A normal scan shows increased activity in the front of the brain, the cerebellum, with all else being relatively quiet. 

NORMAL SPECT BRAIN SCANS

Scans are from the Amen Clinics

I believe my body does not make enough serotonin, and other neurotransmitters, because of a genetic predisposition.  The incidence of depression is high on both sides of my parents families.  The information on page 105 in, The UltraMind Solution, by Mark Hyman, MD was interesting to me.  He says the activity of any neurotransmitter can malfunction is some way.  Below are some of the reasons why serotonin levels go down.  I want to do all I can to help my antidepressant assist my body in creating more serotonin.

1.  A tryptophan-deficient or low-protein diet.  Tryptophan is the primary amino acid out of which serotonin is created.  No tryptophan equals no serotonin equals a very unhappy mood.  In fact, studies show that if you feed a group of people a mixture of amino acids without tryptophan you can induce depression within hours! 

2.  Stress and high cortisol levels (the stress hormone).  Cortisol increases the activity of enzymes that break down tryptophan.  That leaves less around to make serotonin.

3.  Anything that causes inflammation (such as food allergies, infections, toxins, or a high-sugar diet).  Inflammatory messenger molecules called cytokines such as interferon gamma stimulate the enzymes TDO and IDO, which break down tryptophan and force it into a pathway that makes the excitatory neurotransmitter glutamate, which kills brain cells.

4.  Simply not making enough serotonin.  This happens for many reasons.  You may not have enough of the building blocks (the amino-acid tryptophan) because you eat too much sugar and not enough protein as suggested above, or you may have genetic predispositions that make it more difficult for you to create the neurotransmitter in the first place.  Those who have an SNP (single nucleotide polymorphism) or genetic variation of the enzyme THP2 have an 80 percent reduction in ability to make serotonin.

5.  Blood-sugar imbalances (insulin resistance or prediabetes).  This condition comes from eating a processed-food, high-sugar diet.  It depletes your serotonin after a short spike, leading to mood swings.

6.  You may be deficient in vitamin B-6. B-6 is the helper or catalyst for the enzyme that converts tryptophan into serotonin.  Deficiency in B-6 is often caused by stress, alcohol, and medications like birth-control pills.

7.  Magnesium deficiency.  This is so common in our society because stress, caffeine, sugar, and alcohol all deplete magnesium, which in turn prevents the body from making serotonin.

Chapter 17: Effexor XR, ADHD & Viral Meningitis

I have been on 37.5 mg of Effexor XR for 9 days and I feel the same.  This is a good thing!  I have not felt any side effects or withdrawal symptoms from lowering the dose of Luvox.  (Or at least not enough to notice.)  I will go up to 75 mg of Effexor XR tomorrow morning, and lower the dose of Luvox to 25 mg in the morning and 25 mg in the afternoon.  I am hopeful!

I think it was my last post I mentioned the new psychiatrist in my city that supports my trip to the Amen Clinic.  I think I told you how AWESOME he is.  :)  He discussed an interesting possibility with me.  I was diagnosed with ADHD from the results of my brain scans at the Amen Clinic.  I feel I have had ADHD for the past 2 1/2 years, but not my whole life.  My doctor was a teacher and researcher at a university before he recently went into private practice.  The research he was involved with indicated there is usually something that precipitates the onset of ADHD later in someone's life.

He asked me if I had a brain injury, or a major illness such as encephalitis or meningitis.  I said no, but then I said wait a minute, I may have had meningitis.  In February of 2003 I went in to the emergency room on a Friday night with a severe head and neck ache.  They gave me morphine in an IV for the pain and said it could be meningitis, but I didn't seem sick enough to warrant a spinal tap (lumbar puncture).

By Sunday morning the pain in my head and neck was excruciating; I had never felt anything like it before.  I may have passed out more than once as my husband drove me to the hospital.  I was in such bad shape I was admitted immediately into the emergency room, no waiting!  :)  The fluid in the spinal tap was negative for bacterial meningitis.  My white blood count was extremely high, but they couldn't find a specific cause of the infection.  I was given morphine through an IV that whole day and sent home Sunday night.  The possibility of viral meningitis was never mentioned.

The next four days I took a combination of prescription pain killers.  I could barely get out of bed and had no appetite because of nausea.  I could not tolerate any light and had to keep my room dimly lit.  By Wednesday of that week I could no longer tolerate the pain.  The pleading with my Higher Power changed in content from asking for help, to asking if this was the time for me to die.  I had never been so sick and I asked my Higher Power if death was going to be the outcome, "Could we do it now?"  If I had a choice I wanted to stay to finish raising my sons, but if that wasn't part of the plan I was ready to "move on".  I remember feeling surprised at how simple the decision was.

Thursday night as I went to sleep I was planning on asking my husband to admit me to the hospital the next morning. Friday morning I woke up slowly and realized the fever had broken and food sounded good.  I believed recovery was possible and I felt blessed.  Full recovery took another week.  Now I believe I had viral meningitis.  This inflammation in the membranes around my spinal cord and brain may have made me more vulnerable to ADHD.  Interesting!  Here are the symptoms and the differences in meningitis and encephalitis if you would like more information.  

Taken from:

http://www.ehow.com/facts_6186800_difference-between-meningitis-_amp_-encephalitis.html

Difference Between Meningitis & Encephalitis

By Anjus Chiedozie, eHow Contributing Writer

I want to do this! What's This?

Meningitis and encephalitis are two medical conditions that involve inflammation, thus the suffix "itis." Despite their similarities, meningitis and encephalitis are not quite the same.

Description

1. Meningitis is an inflammation of meninges, which are membranes that envelop the nervous system, particularly the brain and spinal cord. Encephalitis is an inflammation of the brain itself.

 

Causes

2. Meningitis usually results from either viral or bacterial infection. Encephalitis is usually caused by viral infection.

 

Symptoms

3. Symptoms of meningitis and encephalitis include high fever, seizures and headache. Additional symptoms of meningitis include stiff neck, vomiting or nausea with the headache, and sensitivity to light. Encephalitis-specific symptoms include hallucinations, tremors and loss of consciousness.

 

Treatment

4. Bacterial meningitis is usually combated with intravenous antibiotics. People infected with viral meningitis or encephalitis usually require substantial fluid intake, over-the-counter pain medications and lots of rest for treatment.

 

Prevention

5. Bacterial meningitis can be prevented by maintaining a healthy lifestyle and avoiding instances that can put you in contact with bacteria. Viral meningitis and encephalitis can be avoided by immunization, and preventative measures include keeping away from major viral agents such as mosquitoes.

Read more: Difference Between Meningitis & Encephalitis | eHow.com http://www.ehow.com/facts_6186800_difference-between-meningitis-_amp_-encephalitis.html#ixzz0u5llOx3N

Chapter 7: Keys to UltraWellness, Food Sensitivity

A friend who knew I was battling depression recommended I read the book, The UltraMind Solution, by Mark Hyman, M.D. An excellent recommendation! Dr Hyman writes, "I call myself the 'accidental psychiatrist.' I never set out to be a brain or mood expert. In fact, my focus was more on how the body works as a whole system. And people saw me not to treat depression or autism or Alzheimer's, but to deal with chronic complaints and illnesses of the body. . .Over the years as I worked to correct the fundamental imbalances that are the cause of all disease (the seven keys to UltraWellness, which you will learn about in a moment), I discovered that mood and brain disorders would often magically disappear as I treated a patient's physical problems."

I have been dealing with depression since 1981, and I have a strong genetic predisposition for the illness. But I wanted to find out about other ways to help my brain heal, along with taking psychiatric medications. These are the seven keys to UltraWellness:

1. Optimize Nutrition
2. Balance Your Hormones
3. Cool Off Inflammation
4. Fix Your Digestion
5. Enhance Detoxification
6. Boost Energy Metabolism
7. Calm Your Mind 

Meet Dr. Mark Hyman as he talks about the 
future of medicine and the Seven Keys to UltraWellness.

I was motivated to make major changes in my diet after reading this book.  Dr. Hyman recommends taking dairy and wheat out of your diet for at least six weeks to see if you feel better. If you read this book it will help you decide what diet changes may be helpful for you.  I have several allergies to weeds, trees, and grasses, and have responded well to immunotherapy allergy shots.  If you have an allergy to something it usually causes an immediate reaction; if you have a sensitivity it can take 2-5 days to cause a reaction in your immune system.  I don't have any allergies to foods, but I thought I may have some sensitivities since I am so allergic to other things.

My son and I had blood drawn for the IgG Comprehensive Food Sensitivity Assay test. It is also known as the ELISA test. Dr. Hyman talks about this test in the book. We found out my son is gluten intolerant, so that has changed our diet dramatically. After receiving the results of my ELISA test I have eliminated or cut back on all of the foods I am sensitive to. I am hoping this will help reduce the inflammation in my body and help heal my brain.  Dr Hyman educated me on this issue in his book.  I eat the +1 foods occasionally.

These are the results of my test: +4 is the highest sensitivity and +1 is the lowest sensitivity.

Alfalfa +1               Mustard +1                 Salmon +1                           Wheat +1
Cumin +1               Onion +1                    Seed, Caraway +1               Yeast, Baker's +3
Egg +4                   Paprika +1                 Squash, Yellow +1                Yeast, Brewer's +4
Garlic +1                Pumpkin +1               Tomato +2                            Zucchini +1
Milk, Cow's +1

If you are interested in finding out more about the IgG ELISA test, go to http://www.immunolabs.com/.  Their customer service was very helpful.
  
I also decided to eliminate white flour, white sugar, and most fats other than olive oil from my diet.  (I still put a little butter on my sweet potatoes and baked white potatoes. :)  My digestion is more efficient and I feel better after I eat.  It hasn't cured my depression, but I believe it is an important part of my treatment plan.  The changes in my diet, and exercise helped bring my cholesterol down from 216 to 163.  Yay!

Dr. Hyman includes The UltraMind Solution Companion Guide with his book.  It has a page in the, Set the Stage for Success, section which recommends items you may need to prepare the food in his recipes.  He calls them UltraEssentials.  Amazon.com has many of these items if you are interested.  I love to shop at Amazon.  They usually have what I need (or want) for the best prices.