Is depression a kind of allergic reaction?

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Is depression a kind of allergic reaction?

A growing number of scientists are suggesting
that depression is a result of inflammation
caused by the bodys immune system

Caroline Williams
The Guardian, Sunday 4 January 2015 17.00 GMT

Could depression be a form of sickness behaviour? Photograph: Mads Perch/Getty Images

Barely a week goes by without a celebrity opening up about their battle with
depression. This, apparently, is a brave thing to do because, despite all efforts to get rid
of the stigma around depression, it is still seen as some kind of mental and emotional
weakness.
But what if was nothing of the sort? What if it was a physical illness that just happens to
make people feel pretty lousy? Would that make it less of a big deal to admit to? Could it
even put a final nail in the coffin of the idea that depression is all in the mind?
According to a growing number of scientists, this is exactly how we should be thinking
about the condition. George Slavich, a clinical psychologist at the University of
California in Los Angeles, has spent years studying depression, and has come to the
conclusion that it has as much to do with the body as the mind. I dont even talk about
it as a psychiatric condition any more, he says. It does involve psychology, but it also
involves equal parts of biology and physical health.

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The basis of this new view is blindingly obvious once it is pointed out: everyone feels
miserable when they are ill. That feeling of being too tired, bored and fed up to move off
the sofa and get on with life is known among psychologists as sickness behaviour. It
happens for a good reason, helping us avoid doing more damage or spreading an
infection any further.
It also looks a lot like depression. So if people with depression show classic sickness
behaviour and sick people feel a lot like people with depression might there be a
common cause that accounts for both?
The answer to that seems to be yes, and the best candidate so far is inflammation a
part of the immune system that acts as a burglar alarm to close wounds and call other
parts of the immune system into action. A family of proteins called cytokines sets off
inflammation in the body, and switches the brain into sickness mode.
Both cytokines and inflammation have been shown to rocket during depressive
episodes, and in people with bipolar to drop off in periods of remission. Healthy
people can also be temporarily put into a depressed, anxious state when given a vaccine
that causes a spike in inflammation. Brain imaging studies of people injected with a
typhoid vaccine found that this might be down to changes in the parts of the brain that
process reward and punishment.
There are other clues, too: people with inflammatory diseases such as rheumatoid
arthritis tend to suffer more than average with depression; cancer patients given a drug
called interferon alpha, which boosts their inflammatory response to help fight the
cancer, often become depressed as a side-effect.
As evidence like this continues to stack up, its not surprising that some people have
shifted their attention to what might be causing the inflammation in the first place.
Turhan Canli of Stony Brook University in New York thinks infections are the most
likely culprit, and even goes as far as to say that we should rebrand depression as an
infectious but not contagious disease.
Others arent willing to go that far, not least because infection is not the only way to set
off inflammation. A diet rich in trans fats and sugar has been shown to promote
inflammation, while a healthy one full of fruit, veg and oily fish helps keep it at bay.
Obesity is another risk factor, probably because body fat, particularly around the belly,
stores large quantities of cytokines.
Add this to the fact that stress, particularly the kind that follows social rejection or
loneliness, also causes inflammation, and it starts to look as if depression is a kind of
allergy to modern life which might explain its spiralling prevalence all over the world
as we increasingly eat, sloth and isolate ourselves into a state of chronic inflammation.
If thats the case, prevention is probably the place to start. Its not a great idea to turn off
inflammation entirely, because we need it to fend off infections, says Slavich, but

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lowering levels of systemic inflammation to manageable levels is a good goal to have.

The good news is that the few clinical trials done so far have found that adding
anti-inflammatory medicines to antidepressants not only improves symptoms, it also
increases the proportion of people who respond to treatment, although more trials will
be needed to confirm this. There is also some evidence that omega 3 and curcumin, an
extract of the spice turmeric, might have similar effects. Both are available over the
counter and might be worth a try, although as an add-on to any prescribed treatment
theres definitely not enough evidence to use them as a replacement.
In between five to 10 years, says Carmine Pariante, a psychiatrist at Kings College
London, there may be a blood test that can measure inflammation in people with
depression so that they can be treated accordingly. Researchers have already come up
with a simple finger-prick test that reliably measures inflammation markers in a single
drop of blood.
And as for the stigma could it really be killed off by shifting the blame from the mind
to the body? Time will tell. This is not the first time that depression has been linked to a
physical phenomenon, after all. A recent survey found that despite wider awareness of
the theory that chemical imbalances in the brain cause depression, this has done
nothing to reduce stigma; in fact, it seemed to make matters worse.
This time, though, the target is not any kind of brain or mind-based weakness but a
basic feature of everyones body that could strike anyone down given the right or
wrong turn of events. And if that doesnt inspire a greater sympathy and
understanding, then nothing will.
This article was amended on 4 January 2015. It originally stated that curcumin was an
extract of cumin. This has now been corrected.

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