When you are physically unwell, it is easy to be depressed. But Nature also designed our body’s to change our behavior when we are sick and unwell, this is called “Sickness Behavior.” This behavior is a response to try to get you well again.
We see many patients, who on their first visit, have a smile on their face but an underlying concern. “Why do I feel so bad?,” they will ask. People who do not feel physically well can be sad, they can also be depressed. There is a big difference. Sadness, it is said, is a response to something bad happening in your life, the response to loss or disappointment or even medical concerns. There is a physical and emotional stimulus that makes you feel sad. If that stimulus is repaired or fades away, as the old expression goes, “time heals all wounds,” then the sadness fades away.
It is said about depression that a major characteristic of the sufferer is that they cannot overcome the physical and emotional stimulus of sadness. Why? In this brief article we are going to discuss a different theory. That a major characteristic of the depression sufferer is NOT that they cannot overcome the stimulus of sadness, but that they cannot overcome the stimulus of chronic inflammation.
Inflammation increases the risk of occurrence of major depressive episodes in sick people
This would seem an obvious statement to make, you are depressed because you are not feeling well. We are going to start our research journey in 2008 where doctors at the University of Illinois helped bring us a clue that people who are not well physically, become depressed because of a phenomena called “sickness behavior.” Sickness behavior is caused by the immune system’s inflammatory response to illness. This study was published in the prestigious Nature reviews. Neuroscience.(1)
Here is a quote from the research, it will explain what sickness behavior is. You may realize as you read this that you already knew what sickness behavior is:
“In response to a peripheral infection, innate immune cells produce pro-inflammatory cytokines (immune messengers) that act on the brain to cause sickness behavior. When activation of the peripheral immune system continues unabated, such as during systemic infections, cancer or autoimmune diseases, the ensuing immune signaling to the brain can lead to an exacerbation of sickness and the development of symptoms of depression in vulnerable individuals. These phenomena might account for the increased prevalence of clinical depression in physically ill people. Inflammation is therefore an important biological event that might increase the risk of major depressive episodes, much like the more traditional psychosocial factors.”
The talking point here: “inflammation increases the risk of occurrence of major depressive episodes (in sick people).”
Can we reprogram this response to reduce inflammation and depression?
Depression is a great complexity and enigma as you will see from research in the following study. There are no easy answers but there are correct paths to treatment. This is expressed by research from the University of Illinois, published in 2013 in The Journal of experimental biology.(2) To these researchers you need to look at the way animals and humans respond to chronic illness and sickness to understand depression that comes with illness and treatment that may be more effective than traditional medications.
Symptoms of depression appear after pro-inflammatory cytokines (inflammatory cells) are produced by the body.
Immune activation can precipitate (cause an unwanted) depression.
Several symptoms of inflammation-induced depression overlap with sickness behaviors, including fatigue, changes in sleep pattern, lack of interest in daily or pleasurable activities (anhedonia), changes in appetite or body mass and unexplained aches and pains.
Fatigue, sleep disorders, changes in eating habits, and pain associated with depression in humans are also found in sick animals. This is “natural programming,” that needs to be unprogrammed in people.
The key to this research is that the fatigue, sleep disorders, changes in eating habits, and pain associated with depression in humans are also found in sick animals. These symptoms are Nature’s way to protect the survival of the animal by making itself (the host) undesirable to the disease that is trying to kill it.
The researchers suggest that by making the body an undesirable host, no food, no sleep, the animal is in “survival mode.” For human beings, depressive thoughts are added for greater impact on the illness. Depressive thoughts are created by and rebroadcast through cellular signaling. The expression of chemicals that initiate cellular response. The chemical environment in the body is being altered to attack the illness.
The talking point here: “inflammation increases the risk of occurrence of major depressive episodes as a survival mechanism.” If you treat the problems that are convincing your body that you need to be in survival mode, that is a state of chronic inflammation, your body may find it may not need to be depressed.
Lack of sleep, abundance of inflammation, sickness behavior
In 2019, researchers at Harvard University and the Institute of Medical Psychology and Behavioral Neurobiology at the University of Tübingen in Germany (3) suggested this connection between sleep, inflammation and sickness.
“Sleep and immunity are bidirectionally linked. Immune system activation alters sleep, and sleep in turn affects the innate and adaptive arm of our body’s defense system. Stimulation of the immune system by microbial challenges triggers an inflammatory response, which, depending on its magnitude and time course, can induce an increase in sleep duration and intensity, but also a disruption of sleep.”
When you are sick, your body seeks to sleep more to help with the recovery, however, in some cases inflammation associated with chronic or acute illness can prevent this sleep from occurring.
“Enhancement of sleep during an infection is assumed to feedback to the immune system to promote host defense. Indeed, sleep affects various immune parameters, is associated with a reduced infection risk, and can improve infection outcome .
In the absence of an infectious challenge, sleep appears to promote inflammatory homeostasis through effects on several inflammatory mediators, such as cytokines. This notion is supported by findings that prolonged sleep deficiency (e.g., short sleep duration, sleep disturbance) can lead to chronic, systemic low-grade inflammation and is associated with various diseases that have an inflammatory component, like diabetes, atherosclerosis, and neurodegeneration.”
If you do not get adequate sleep, inflammatory disease including neurodegenerative disease increase in risk.
“An increasing number of studies are revealing that diet and nutrition are critical not only for physiology and body composition, but also have significant effects on mood and mental well-being.”
A March 2021 study in the journal: Frontiers in nutrition (4) offers us an overview of the impact on good nutritional status in maintaining normal body function and preventing or mitigating the dysfunction induced by internal or external factors (such as sickness behavior).
“Nutritional deficiencies often result in impaired function, and, conversely, intakes at recommended levels can resume or further enhance body functions. An increasing number of studies are revealing that diet and nutrition are critical not only for physiology and body composition, but also have significant effects on mood and mental well-being. In particular, Western dietary habits have been the object of several research studies focusing on the relationship between nutrition and mental health.”
The study author’s found that overall data support a positive role for the nutrients such as eicosapentaenoic acid (an omega-3 fatty acid), docosahexaenoic acid (an omega-3 fatty acid), alpha-tocopherol (a type of vitamin E), magnesium and folic acid in the preservation of normal brain function and mental well-being, also through the control of neuroinflammation, and encourage their integration in a well-balanced and varied diet, accompanied by a healthy lifestyle.”
Depression can be managed with wellness
In this simple article we can see the extreme complexity of dealing with just one factor in treating depression, inflammation. So what are we to consider from these two studies and ongoing research into the connection between inflammation and depression.
Nature’s response to illness is inflammation.
Chronic, unabated inflammation leads to continuous symptoms of “unwellness” including depression.
Depression is one factor that the body utilizes to make itself unappealing to viral, parasitic, infectious disease and immune disorders.
From surviving to thriving
When you treat the cause of chronic inflammation, such as diabetes, such as cholesterol issues, such as environmental illness, such as obesity and weight issues and others, you make yourself unappealing to these diseases and your inflammation goes away.
If you would like to explore more information, please contact our office so we can start a conversation with you.
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References
1 Dantzer R, O’Connor JC, Freund GG, Johnson RW, Kelley KW. From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci. 2008;9(1):46-56.
2 McCusker RH, Kelley KW. Immune-neural connections: how the immune system’s response to infectious agents influences behavior. J Exp Biol. 2013;216(Pt 1):84-98.
3 Besedovsky L, Lange T, Haack M. The Sleep-Immune Crosstalk in Health and Disease. Physiol Rev. 2019 Jul 1;99(3):1325-1380. doi: 10.1152/physrev.00010.2018. PMID: 30920354; PMCID: PMC6689741.
4 Muscaritoli M. The Impact of Nutrients on Mental Health and Well-Being: Insights From the Literature. Frontiers in Nutrition. 2021 Mar 8;8:97.
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