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05-20-2015
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This article offers a neurological explanation for depression and other
"mental illnesses." The explanation suggests a link between (unspecified)
"trauma" and these conditions. See my comments after the article. The
highlites below are mine. - Peter Gerlach, MSW
+ + +
Public acts of violence seem to fill the
news media streams these days and are typically followed by outcries for
greater access to mental health care for those that need it most. And
although most individuals with serious mental illness are not dangerous,
many of the perpetrators of these heinous crimes later turn out to have a
documented history of depression or mental illness, which often went
untreated. So, what can we do to stop the anguish? What is it that we are
missing?
The Cost of Failure
Unfortunately, the number of Americans affected by serious depression and
anxiety disorders is enormous, as are the costs to society due to failure to
treat and/or treatment failure. The
National Institute of Mental Health reports that each year, approximately 57
million Americans suffer from depression, including chronic,
low-grade depression (dysthymia) and anxiety, and some 14.8 million of those
are dealing with major depressive disorder, the leading cause of disability
for people ages 15 to 44.
The cost of failing to effectively treat these conditions is not just the
individual's inability to complete college, hold a job or cultivate positive
relationships; it also includes the toll taken on an entire family and
community when a despairing person takes their own life. And in the most
extreme cases, the costs of acts of public violence -- in terms of
suffering, municipal expenses, personal medical and legal expenses, and lost
human potential -- are immeasurable.
Several months ago, Michael, a 17-year-old high school student, came to see
me. Michael had a long history of hospitalizations after attempting to take
his own life, and despite undergoing intensive psychiatric treatment, he
remained depressed and suicidal. Like 40 percent of those who suffer from
major depressive disorder, Michael was not responding to treatment.
When contemplating a situation like Michael's, the question "What am I
missing?" is never far from my mind.
Statistics show that only about one-third of patients with MDD respond to
antidepressant medication, with about the same number responding to
psychotherapy alone. If we combine the two approaches the numbers
improve slightly, but the fact remains that most people with MDD respond
only partially to medical interventions, with almost half remaining entirely
unresponsive.
A Central Nervous System in Turmoil
A mountain of scientific research over the last 10 years has demonstrated
that neuropsychiatric conditions such as depression, anxiety disorders and
possibly bipolar disease are, in a very high percentage of cases, the result
of inflammation occurring in the brain.
In the past few years, there's been a great
deal of publicity linking generalized inflammation to heart disease, chronic
pain and obesity. Inflammation in
the body takes many forms: When we have an allergic response to
pollen or food, our bodies' inflammatory response includes the release of
histamine, which makes our eyes itch and noses run; we see the inflammation
associated with a skin wound when the white cells of our immune system
respond to a bacterial infection.
Inflammation in our brains, however, is unique in that it is mediated by
tiny cells called microglia.
Microglia are the innate immune system of the central nervous system. Their
job is to respond to trauma and damage to the brain. In response to brain
injury, the microglia release a virtual symphony of chemical mediators that
orchestrate the destruction of bacterial invaders, the elimination of
damaged neuronal tissue and the initiation of the repair process.
After responding to an assault on the brain, microglia typically return to a
resting state. But ongoing and cumulative assaults to the brain (e.g.,
fever, physical assault and
emotional trauma) will cause the microglia to remain chronically
up-regulated, causing them to continuously spew out inflammatory,
tissue-destroying chemicals.
This brain inflammation produces a wide
range of symptoms including depression, anxiety, chronic pain, difficulty
focusing and concentrating, fatigue and sleep disturbances.
Further compounding the issue is the fact
that a solid understanding of the role of microglia in brain health is sadly
lacking among most medical
professionals, with the result that they
continue to treat what are in fact
"symptoms" as separate and unique "diseases."
Looking Beyond the Symptoms
A new framework, where physicians look beyond the symptoms, would involve
giving priority to discovery of the root causes of an individual's
depression or anxiety. This would primarily require an understanding of what
caused the microglia to up-regulate.
Research has shown that anything that can
damage neuronal tissue can be a trigger. So, an exploration of a patient's
depression may include asking them about possible traumatic head injuries,
psychological traumas (acute events
and chronic stress), infections (e.g., tick-born diseases, other
bacteria and viruses), and even biotoxins that may have entered the body
from exposure to toxic molds, celiac disease and hypoxia (usually related to
sleep apnea).
The list of triggers is long, and as such,
the process of identifying the possible underlying causes of the disease
requires putting together a thorough medical health timeline for each
patient. With this new approach, treatment options expand due to the greater
understanding of the origin of the illness, thereby increasing prospects for
recovery.
As for Michael, my 17-year-old patient who was depressed and suicidal, it
turned out that he has celiac disease. Now gluten-free, he is no longer
depressed, he has re-engaged in life and he's looking forward to going to
college. He is still taking antidepressant medications, but under medical
supervision is slowly weaning himself from them
(it takes time for the brain to heal
after the assault is removed). His life has been changed, for the
better, forever.
It is my hope that, with a modified model for understanding depression and
anxiety, involving a "whole" person, integrative approach, more patients
will be correctly diagnosed and treated, as Michael was. In his case, and I
suspect in many more,
we're learning that
all too often, depression is not just depression.
