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 29: Do you know what your Vitamin D level is?

This is funny!  Best_DUI_Ever

Do you know what your Vitamin D, 25-Hydroxy level is?

In November of 2007 I had some blood work done and found out my Vitamin D, 25-Hydroxy level was 20, LOW. The huge normal range is 30-150, and a toxic level for most people is above 150. At the time I was surprised because my diet was pretty healthy. After doing some reading about the subject, I am not surprised because I wasn't spending 15-20 minutes in the sun everyday without sunscreen. (Or with sunscreen either!)

I started taking 2,000 IU of Vitamin D a day and had good intentions of getting more sun. Then, December of 2007 came around and I made the fateful decision to come off my antidepressant, Zoloft, and try an amino acid therapy for depression. Well, the rest is history (a miserable one) and has already been documented in previous blog posts. For the next year my Vitamin D level was not a high priority for me. I felt there was a long list of things I "should" do, and didn't feel well enough to do very many of them.

In March of 2009 I had blood work done again and my Vitamin D level was 26. Yeah, I know it didn't come up much. The amount of Vitamin D I was taking and feeling depressed and sick in the house wasn't very effective. My doctor started me on a 50,000 IU capsule of a prescription Vitamin D, the generic for Drisdol, that I took once per month. In February of 2010 I started taking the supplements Dr. Hyman recommends (See Chapter 12:  I Hate Clonazepam, Supplements) so I was taking 3,200 IU of Vitamin D each day, and 50,000 IU once per month.

In April of 2010 my blood work showed a Vitamin D level of 45. In the gigantic normal range! Maybe I don't absorb it very well. =) My psychiatrist at the Amen Clinic recommended I get my level up to at least 70, because it has a good chance of improving my mood. My doctor here at home is helping me and I am now taking a 50,000 IU capsule every two weeks and 3200 IU every day. I will be tested again in January of 2011; if I am not up to 70 I will begin taking the 50,000 IU capsule every week. I know it would help if I spent some time in the sun, but you know I don't have a good track record for this. I am going to try!

I am hoping a higher Vitamin D level will be one more thing contributing to overcoming the depression symptoms. One more piece of the healing depression puzzle. For me this puzzle has been difficult. I will keep you posted.

I am in the process of reading the book, The Vitamin D Solution, A 3-Step Strategy to Cure Our Most Common Health Problem, by Michael F. Holick, Ph.D., M.D., Foreword by Andrew Weil, M.D. Dr. Holick says having enough Vitamin D can prevent and treat Osteoporosis, Heart Disease, Cancer, Autoimmune Diseases, Depression, Insomnia, Arthritis, Diabetes, Chronic Pain, Psoriasis, Fibromyalgia, and Autism. . .as well as other diseases, chronic conditions, and mild ailments. Wow, it is important. Is the sun out today?

Review of the book, The Vitamin D Solution, A 3-Step Strategy to Cure Our Most Common Health Problem.
http://livinlavidalowcarb.com/blog/review-the-vitamin-d-solution-by-dr-michael-holick/9144%20

Michael F. Holick, Ph.D., M.D., is called the "Pioneer In Vitamin D Research."  This is a video of a speech he gave at a Diagnosis and Treatment of Vitamin D Seminar. This seminar was called, "D-Lightful Vitamin D; Bone and Muscle Health and Prevention of Autoimmune and Chronic Diseases."  It is long, 58 minutes and 52 seconds, but entertaining.

This Vitamin D Quiz is in, The UltraMind Solution, by Mark Hyman, M.D.  It may help you determine if you have a vitamin D deficiency.

VITAMIN D QUIZ

I have seasonal affective disorder.

I experience a loss of mental sharpness or memory.

I have sore or weak muscles.

I have tender bones (press on your shin bone--if it hurts you are vitamin D deficient).

I work indoors.

I avoid the sun.

I wear sunblock most of the time.

I live north of Florida.

I don't eat small fatty fish such as mackerel, herring, or sardines (the main sources of dietary vitamin D).

I have osteoporosis.

I have broken more than two bones or had a hip fracture.

I have autoimmune disease (i.e., multiple sclerosis).

I have osteoarthritis (vitamin D deficiency weakens bones and leads to deterioration).

I have frequent infections.

I have prostate cancer.

I have dark skin (any race other than Caucasian).

I am sixty years old or older.

SCORE:  0-8 Yes Answers---You may have a slightly low level of vitamin D.

                 9 And Above Yes Answers---You may have a severely low level of vitamin D.

I recommend these videos.  They share good information about vitamin D.

Dr. Oz on Good Morning America -- Vitamin D, Swine Flu, Cancer, and the Sun. 

 

 

The Real Story on Vitamin D 

Dr. John Cannell, Vitamin D Council, and Bill Sardi, Knowledge of Health, Inc. 

 

This is an article written by Dr. John Cannell on the history of depression and vitamin D research.  It is called, "Vitamin D and Depression."  Dr. Cannell

http://www.vitamindcouncil.org/depression.shtml

Chapter 10: Detailed Treatment Plan

I believe the psychiatric diagnosis I received at the Amen Clinic is based on a higher level of education than I have experienced in the past. Each person I worked with at the clinic was professional, knowledgeable, friendly, and caring.

This is my treatment plan:

1. Blood tests: CBC with differential, thyroid panel, chemistry panel, lipid panel, hemoglobin A1c, and 25 hydroxy vitamin D level.
2. Neurontin:  Prescription drug I started when I got home. I am taking the supplements Neuro PS, Restful Sleep, and Brain Vitale. Neurontin and the supplements are helping calm down the anxiety, and I have been able to slowly lower the dose of clonazepam. I will continue to take Luvox.
3. Clonazepam:  When I am off this drug and the anxiety has calmed down, I will begin taking Welbutrin SR or XL to stimulate the prefrontal cortex.
4. Effexor XR: This antidepressant may be effective for me. I would like to try Wellbutrin first, because I don't want to go through Luvox withdrawal and adjusting to Effexor XR side effects.
5. Vitamin D:  I need to raise my level from 45 to 70.
6. Fish Oil, Omega 3 Fatty Acids:  I am taking 6,000 mg per day.
7. Aerobic Exercise:  30 minutes every day. I have only missed a few days since we got home. I feel so much better when I exercise it motivates me to be consistent.
8. Psychotherapy:  My husband and I went to a therapist for 2 years.  Then I went on my own for 3 three years.  In the past I have done group work dealing with depression.
9. Education in Brain Healthy Strategies:  Reading Dr. Amen's books, Healing Anxiety and Depression, and Change Your Brain, Change Your Life, have helped. There is also a lot of good information in my AMEN CLINICS, INC. notebook.  This notebook also has a copy of my scans and treatment plan. I'm sure there are other authors who could help in this area as well.
10. Dietary Strategies: The Amen Clinic supports the diet recommendations in the UltraMind Solution, book by Dr. Hyman.  I want to continue with the diet changes I made before going to the clinic.
11. Transcranial Magnetic Stimulation: Would be helpful on the prefrontal cortex and cortex. This therapy is available at the Neuropsychiatric Institute in my area.  My insurance company considers this therapy experimental for depression and will not cover it.  I need to find out how much each therapy session would cost.  If I were to have it done in Newport Beach it would be $180.00 per session.  The number of sessions needed can be 20-40, or sometimes more.
12. Mental Exercises:  Reading, playing music, doing puzzles, or playing memory games to keep the brain active.
13. Behaviors To Avoid:  Anything putting me at risk for a brain injury or toxic exposure.
14. Television:  Limit my time watching the tube.

The supplements I am taking have the following ingredients. I purchased the supplements at the Amen Clinic.

Restful Sleep:  4 at bedtime   Serving 4 capsules
Vitamin B6 10 mg, Magnesium 100 mg, Melatonin (immediate release) 2.5 mg, Melatonin (controlled release) 2.5 mg, Valerian 600 mg, GABA 100 mg.

Neuro PS:  2 at bedtime   Serving 1 capsule
Phosphatidyl Serine 120 mg, Phosphatidylcholine 72 mg, Phosphatidylethanlamine 54 mg, Phosphatidylinositol 30 mg.

Brain Vitale:  2 in the morning   Serving 2 capsules
Acetyl L-Carnitine 500 mg, GlyceroPhosphoCholine (GPC) 200 mg, Inositol 200 mg, Phosphatidylserine 120 mg, GinkgoSelect Phytosome 90 mg.

I am following my treatment plan everyday and I am making slow, steady progress.  It has not been easy to come off the drug clonazepam, and I was only taking .25 mg at night before bed.  I have been shaving a small amount off the tablet every ten days.  Three or four days later I have a headache pain medication doesn't relieve, nausea, and a dizzy feeling.  These withdrawal symptoms will last 2-3 days until my body adjusts.  I have a healthy dislike for this medication, but I also know I should not come off too fast.  There are some days I feel impatient.  

It makes me angry I am addicted to a prescription drug that is damaging my brain!

This is the program I was watching on PBS when I first heard about 

Dr. Amen and SPECT Brain Scans.