(2015-01-05) Alexander Chronic Psychitis

Scott Alexander: Chronic Psychitis. Some people have asked my opinion on a recent spate of articles like Is Depression Partly Caused By An Allergic Reaction? and Depression May Be Caused By Inflammation.

This is pretty legit.

response is closely linked to the idea of “inflammation”

All of this stuff is regulated by chemicals called cytokines, which are released by immune cells that have noticed an injury or infection or something. They are often compared to a body-wide “red alert”

being sick makes you feel lousy

Most inflammatory cytokines handle the immune response directly, but a few of them – especially interleukin-1B and tumor necrosis factor alpha – cause this depression-like sickness behavior

Stress increases inflammation and is a known trigger for depression.

Exercise, good diet and sleep reduce inflammation; they also help depression.

Rates of depression are increasing over time

But levels of inflammation are also increasing over time, probably because we have a terrible diet that disrupts the gut microbiota that are supposed to be symbioting with the immune system

SSRI antidepressants, like most medications, have about five zillion effects. One of the effects is to reduce the level of inflammatory cytokines in the body. Is it possible that this is why they work, and all of this stuff about serotonin receptors in the brain is a gigantic red herring?

antidepressants treat cancer-induced depression just as well as any other type

Along with cancer, depression is common in many other less immediately emotion-provoking illnesses like rheumatoid arthritis and diabetes. The common thread among these illnesses is inflammation.

Twenty years ago, everyone was super-convinced that depression was caused by low serotonin levels.

It was all very convincing. And right now everyone’s pretty sure it’s wrong.

Ten years ago, everyone was super-convinced that depression was caused by under-secretion of the neuro-hormone BDNF and subsequent decline in hippocampal neurogenesis.

All of the anxiety-inducing life events and intrapsychic conflicts and secret desires to marry your mother that Freud thought caused depression produce a lot of stress, which both releases cortisol and reduces normal ability to regulate inflammatory response.

It might be that inflammation is the master system which causes a cascade of events in all of the others. It might be that one of the others is the master system. It might be that depression is a collection of multiple different diseases, and some are caused by one thing and others by another

Anyway, all this is for much smarter people than me to figure out. The question I’m most interested in: can we treat depression by giving people anti-inflammatory drugs? The answer seems to be: it depends how strongly you object to getting a heart attack.

Most researchers have chosen to focus on celecoxib (Celebrex™®©, a high-tech next-generation anti-inflammatory). Here the evidence is actually very strong.

*They add: “We found no evidence of an increased number of gastrointestinal or cardiovascular events after 6 weeks.”

That’s probably because they didn’t wait long enough.*

50,000 extra heart attacks per year. Ouch.

your best bets are the anti-inflammatory mainstays: good diet, good sleep, plenty of exercise, low stress levels, and all the other things we already know work.