A Mind of Your Own: The Truth About Depression and How Women Can Heal Their Bodies to Reclaim Their Lives. Dr Brogan Kelly
a primary-care doctor ending with an antidepressant prescription.13 And almost three-quarters of the prescriptions are written without a specific diagnosis.14 What’s more, when the Department of Mental Health at Johns Hopkins Bloomberg School of Public Health did its own examination into the prevalence of mental disorders, it found that “Many individuals who are prescribed and use antidepressant medications may not have met criteria for mental disorders. Our data indicate that antidepressants are commonly used in the absence of clear evidence-based indications.”15
I’ll never forget a case I consulted on several years ago that involved “psychosomatic” facial burning in a woman. Her story is insightful. She complained of an intense burning sensation in her face, though there was no explanation for it other than it being “all in her head.” Her symptoms were so disabling that she was barely able to function. I was still prescribing psychotropics at the time, but a voice inside of me knew there was something real going on, and it wasn’t at all in her head. But unfortunately the Western medical model had already labeled her as being a psychosomatic case, which called for psychiatric medication and couldn’t appreciate or even begin to understand the complexity of her condition. Antidepressants and benzodiazepines (tranquilizers including Valium or Xanax) didn’t help her. What ultimately did was dietary change, supplementation, and rebalancing of her bodily flora. Was this all a placebo effect? Clearly she wanted to feel better with such intensity that she would have done anything. But traditional medication didn’t cure her. At the heart of her pain and distress was an immune and inflammatory process that could not be remedied via antidepressants and antianxiety drugs. It was fixed through strategies that got to the core of her problem—that yanked the nail out of her foot and let the injury heal.
The idea that depression and all of its relatives are manifestations of glitches in the immune system and inflammatory pathways—not a neurochemical deficiency disorder—is a topic we will explore at length throughout this book. This fact is not as new as you might think, but it’s probably not something your general doctor or even psychiatrist will talk about when you complain of symptoms and are hurried out of the office with a prescription for an antidepressant. Nearly a century ago, scientific researchers were already exploring a connection between toxic conditions in the gut and mood and brain function. This phenomenon was given the name auto intoxication. But studying such a wild idea fell out of fashion. By mid-century no one was looking into how intestinal health could affect mental health. Instead, the thinking was quickly becoming the reverse—that depression and anxiety influenced the gut. And as the pharmaceutical industry took off in the second half of the twentieth century, gut theories were ignored and the brilliant researchers behind them were forgotten. The gut was regarded as the seat of health in ancient medical practices for centuries; now we can finally appreciate the validity of such old wisdom. Hippocrates, the father of medicine, who lived in the third century BCE, was among the first to say that “all disease begins in the gut.”
A multitude of studies now shows an undeniable link between gut dysfunction and the brain, chiefly by revealing the relationship between the volume of inflammatory markers in the blood (i.e., signs of inflammation) and risk for depression.16 Higher levels of inflammatory markers, which often indicate that the body’s immune system is on high alert, significantly increase the risk of developing depression. And these levels parallel the depth of the depression: higher levels equates with more severe depression. Which ultimately means that depression should be categorized with other inflammatory disorders including heart disease, arthritis, multiple sclerosis, diabetes, cancer, and dementia. And it’s no surprise, at least to me, that depression is far more common in people with other inflammatory and autoimmune issues like irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia, insulin resistance, and obesity. All of these conditions are characterized by higher levels of inflammation, a topic we’ll get into in Chapter 3.
To really grasp the fact that depression is not a disorder primarily rooted in the brain, look no further than some of the most demonstrative studies. When scientists purposefully trigger inflammation in the bodies of healthy people who exhibit no signs of depression by injecting them with a substance (more on this shortly), they quickly develop classic symptoms of depression.17 And when people with hepatitis C are treated with the pro-inflammatory drug interferon, as many as 45 percent of those individuals develop major depression.18
So when people ask me about why we’re suffering from what appears to be an epidemic of depression despite the number of people taking antidepressants, I don’t think about brain chemistry. I turn to the impact of our sedentary lifestyles, processed food diets, and unrelenting stress. I turn to the medical literature that says a typical Western diet—high in refined carbs, unnatural fats, and foods that create chaos in our blood sugar balance—contribute to higher levels of inflammation.19 Contrary to what you might assume, one of the most influential risk factors for depression is high blood sugar. Most people view diabetes and depression as two distinct conditions, but new scientific findings are rewriting the textbooks. One game-changing study published in 2010 that followed more than 65,000 women over a decade showed that women with diabetes were nearly 30 percent more likely to develop depression.20 This heightened risk remained even after the researchers excluded other risk factors such as lack of physical exercise and weight. Moreover, diabetic women who took insulin were 53 percent more likely to develop depression.
Certainly you can draw the same conclusions that I’ve made: the rates of diabetes have skyrocketed alongside those of depression in the past two decades. And so have the rates of obesity, which is also correlated with increased inflammatory markers. Studies show that obesity is associated with a 55 percent increased risk of depression, and it cuts the other way too: depression is associated with a 58 percent increased risk of developing obesity.21 In the cogent words of a group of Australian researchers in a 2013 paper: “A range of factors appear to increase the risk for the development of depression and seem to be associated with systemic inflammation; these include psychosocial stressors, poor diet, physical inactivity, obesity, smoking, altered gut [function], [allergies], dental [cavities], sleep and vitamin D deficiency.”22
In 2014 Scottish researchers addressed the gap between what the science says about the causes of depression and what patients experience when they find themselves caught in the default web of psychiatric care. In their paper they highlight the value of what I practice: psychoneuroimmunology.23 Indeed, it’s a mouthful of a word, but it simply refers to examining (and respecting) the complex interplay between various systems and organs of the body, especially those that syncopate the nervous, gastrointestinal, and immune systems in a brilliant dance that in turn affects mental well-being. These researchers point out that many patients who are told they have psychiatric conditions originating in their head or related to some (fictitious) brain chemical deficiency actually share real biological imbalances related to their immune-inflammatory pathways. These patients show elevated levels of inflammatory markers in their blood, signs that their body is on the defensive, activating processes that can result in unexplainable physical symptoms and that are diagnosed as psychiatric rather than biologic. And rather than treating the underlying biology, they are instead relegated to a lifetime of therapy and medication, to no avail.
The conditions examined by these researchers were depression, chronic fatigue, and “somatization,” the latter of which is what we call the production of symptoms with no plausible organic cause. These diagnoses have a lot in common in terms of symptoms: fatigue, sensitivity to pain, inability to concentrate, flu-like malaise, and cognitive issues. Isn’t it interesting that each of these conditions is often diagnosed as a separate illness and yet they share so much in common from a biological standpoint? As the authors state: “If psychiatry is to rise to the challenge of being a science, then it must respond to the [existing] data in reconceptualizing boundaries. As such, the data reviewed here challenge the organizational power structures in psychiatry.”24
Personalized lifestyle medicine that accounts for the role of the environment in triggering inflammation and the manipulation of the immune and endocrine systems is the most sensible way to approach those individuals who would otherwise be candidates for multiple medications. It turns out that it may not all be in your