Anti-Inflammatories, Anti-Depressants and Inflammation
In class we saw a lay article that stated that depression was a risk factor for increased inflammation. There was some question as to the relationship between depression and inflammation, therefore this blog determines if there was any validity in the claims of a relationship between inflammation and depression: and furthermore a relationship between depression and anti-inflammatories.
One article reviewed multiple studies with the goal of determining the relationship between inflammation and depression. As a reminder, when the body experiences an inflammatory episode it releases cytokines, these cytokines then launch signaling cascades, and then the immune system is activated. Type 1 cytokines (TNF and IL-1) enhance cellular immune responses while Type 2 cytokines (IL-6, IL-10, IL-13) enhance antibody response and CRP (C-Reactive Protein). In patients with depression there are higher levels of IL-6, IL1a, CRP, and TNF. However, the most significant increase of pro-inflammatory markers and depression is the elevation of TNF-a and IL-6. The table below shows major findings of pro-inflammatory markers and depression:
This relationship of inflammation and depression is strong enough to have initiated studies between anti-inflammatories and depression. Although there has not been any studies done ( to my knowledge) with just anti-inflammatories and depression, there has been multiple animal models and some human studies on anti-depressants, anti-inflammatories and depression. One major study encompassed "14 trials that looked at the effects of anti-inflammatory drug treatment in a total of 6,262 adults with depressive symptoms or depression." The researchers used Celebrex, which is a NSAID (Nonsteroidal anti-inflammatory drugs) with anti-depressants to determine that there was in fact some benefits of NSAIDs with antidepressants. Patients that had anti-inflammatories with anti-depressants had lower levels of TNF-a and IL-6 than people that just took the anti-depressants (the control group). It is remarkable that an over the counter drug such as Celebrex can have a known impact on a disease as complicated as depression.
Other aspects of depression and inflammation to look at is the whole chicken and egg theory, do people tend to have an inflammatory disease then become depressed, or does depression help trigger aspects of inflammation which can lead to a rapid onset of inflammatory diseases? While there is promising outlook on the future implications of anti-inflammatories in aid of depression, this is one of the first studies ever done. Researchers can examine and see that there is some correlation and promise in this field but a lot more research needs to be done.
Citations:
Almond, Maria, MD. "Depression and Inflammation: Examining the Link." Current Psychiatry, 12 June 2013. Web. 30 Nov. 2014. <http://www.currentpsychiatry.com/home/article/depression-and-inflammation-examining-the-link/b436332438ceca4baabe8be08701d6dc.html>.
"Analgesics, Anti-inflammatory Drugs Have Beneficial Effect on Treatment of Depression." News-Medical.net. N.p., 22 Oct. 2014. Web. 30 Nov. 2014. <http://www.news-medical.net/news/20141022/Analgesics-anti-inflammatory-drugs-have-beneficial-effect-on-treatment-of-depression.aspx>.
Anaiz, very interesting post. I was also curious as to how depression and inflammation are related, as at first glance they seem like very separate ailments. Naturally I was surprised to see such strong evidence that depression can cause many of the trademark markers of inflammation. However after some thought it does seem to make sense. As we have seen in many physiology classes, there is a strong correlation between mental inputs, such as stress, and detrimental downstream cascades.
ReplyDeleteOne question I had about the study you described is something you also touched on. Its seems more logical to me that the inflammatory markers seen in depression are a side effect of the illness. In this way it seems as though anti-inflammatories may help in the general health of the individual but not as a treatment for depression. I would be very interested to see any further studies on this topic, as it shows a lot of promise for treating such a widespread disease as depression.
Thanks Joel!
DeleteI would say that it is a lot more likely that inflammatory markers are a byproduct of depression if in fact there is eventually a proven correlation. I felt the need to mention the effects vis versa because I have not encountered any evidence to cancel out inflammation causing depression although I highly doubt that this is in fact the case. I defiantly agree that anti-inflammatories will probably not be a cure for depression (in my personal opinion I think the cure for depression is within the individual and not within the pharmaceutical counter) but I think it could help a person struggling with depression to live a better everyday life if the route they choose is through anti-depressants.
Great Post Anaiz! I like how you embedded the chart. It made me able to familiarize myself with some of the data referenced in the post. I'm glad you addressed the confounding issue that innflamatory diseases are a bummer. I distinctly remember never quite feeling “healthy” even on days when things went my way. I'm reassured that their findings match my subjective observations
ReplyDeleteHi Abraham!
DeleteI'm glad you liked the chart, I found it really helpful especially in regard to concepts that we are continuously discussing in class such as CRP, TNF alpha, IL-1 and IL-6. Take care!
Anaiz, you found a really interesting topic! Reading through the table I thought i found some examples of depression emerging after increased cytokine activity, but there is also evidence working the other way around. You mentioned the 'chicken or the egg' dilemma, I don't necessarily think this is a fitting comparison. While there has to be an egg before a chicken and vise versa, maybe depression increasing cytokine levels is a completely independent pathway than cytokines causing depression. Research will eventually find the answer, I'm sure.
ReplyDeleteHey Mario!
DeleteYeah, as this is relatvely new research I was just imposing some questions to see if anyone felt the same. I could be convinced that cytokine pathways could be independent of depression, however there is provoking evidence that they could in fact be related so at this point it would be safe to say that time will tell! I like that you question the relationship at all, it does keep me and the rest of the class thinking and our toes.
Great post Anaiz, I was considering doing a post on a link between depression and inflammation earlier as well! The study you mentioned that used the NSAID Celebrex in trial to attempt to treat depression was very interesting and seems to be very conclusive. These results remind us that the body functions as a fully integrated unit, and that a response in one area could trigger another response in a different area of the body.
ReplyDeleteI completely agree, it is remarkable how the body functions as a unit and I think its also a huge reminder of the mind/ body connection evident within out anatomy.
DeleteI agree with Abraham and Mike, perhaps if a doctor tells a patient that an anti-inflammatory will make them feel physiologically better it will in turn help them feel psychologically better. Part placebo effect on the depression and also a real effect on those inflammatory cytokines mentioned, all potentially leading to better health. Great idea for a post!
ReplyDeleteI agree! If there is one concept we've seen in this class over and over it's the notion that the placebo effect can do wonders on a persons well being.
DeleteThis is a really interesting topic. I remember we started to discuss this in class and I never would have assumed that depression would be linked to inflammation. It would be compelling to see some experiments done with just those two factors.
ReplyDeleteHey Bonnie!
DeleteYeah, I am not quite sure how much anti-inflammatories would help depression without antidepressants, but it would be really interesting to just eliminate other factors and see the true relation between the pure inflammation and depression.
I really like the way that you ended your blog post. When reading the first part about the study and the table, I kept thinking about what other factors go into a person becoming depressed. I do think that there needs to be more studies that look at how the depression is caused, and what specific factors different causes of depression can have on the body. Overall, I think you did a very good job at summarizing how depression and inflammation have been shown to be linked together, and the table you provided was very helpful.
ReplyDeleteHey Rebecca!
DeleteTruthfully the fact that there was already so many studies done that could be applicable to the depression/ inflammation relationship was really surprising to me also. Especially because many of us, including myself, in class had no idea that depression and inflammation were even studied together. This is evident of how much more we still have to learn!
Thanks for the post, Anaiz! Regarding the chicken and egg situation you mentioned - I wouldn't be surprised if they each influence each other. The seemingly omnipotent role inflammation plays in the body's tissues could easily be implicated in depression and the body-wide effects of being depressed could lead to an inflamed state.
ReplyDeleteYour chicken and egg theory made me think on what could be the answer. But because I know that stress can exacerbate and/or cause certain illnesses and diseases, it makes me think that depression would have the same affect. But as Nick said, I also wouldn't be surprised if it works both ways. The way the human body works physiologically and mentally is quite complicated and fickle after all, aha.
ReplyDeleteHey Sydney,
DeleteI should have added the aspect of inflammation and depression counteracting each other and not just one coming before the other. I completely agree that it probably works both ways like you and Nick mentioned. Very well said!
It is interesting to think of this relationship as one having the ability to cause the other and the reverse also be true. Both cases can definitely hold true, especially when you look at the idea of the mind-body interaction. It seems logical to me that someone could be depressed and therefore develop some sort of disease (be it an inflammatory related or not) because of alter chemistry in the brain. However, it also makes a lot of sense that depression can be the effect. The mind-body association is pretty strong, along with the placebo effect. I found it interesting that the control they used was anti-depressant only.
ReplyDelete