This Integrative Psychiatrist Wants You To Treat Depression Like The Flu
If you ask anyone on the street what causes depression, and come across someone who knows a thing or two about mental illness, you're bound to get an answer like "a chemical imbalance" or perhaps even "a serotonin deficiency."
This idea has been so effectively marketed to us that we almost unanimously accept it as fact. You might be surprised to hear this theory has not been well-documented in the scientific literature. Through blood test, lumbar puncture, and brain scan, the well-meaning world of mental health researchers has failed to document this so-called chemical imbalance of depression.
There is, however, an emerging theory of depression called the cytokine or inflammatory model of depression. The idea here is that if your body is inflamed, then there are inflammatory molecules in your bloodstream. These molecules affect all your organs, including your brain. When our brain "hears" that our body is inflamed, we are programmed to feel down and tired with a sense of malaise, losing our appetite, tending to isolate ourselves socially, and generally wanting to crawl under a rock.
The overlapping symptoms between depression and acute inflammation are no coincidence.
This makes evolutionary sense; thousands of years ago, if you were inflamed, it likely meant that you had an infection, like a parasite or a viral infection. It makes sense that the body's natural response would be to socially isolate (because you don't want to infect other members of the group) and rest so your body could focus its energy and resources on killing off the pathogen. Once your immune system finished the job, you would be back to feeling well again.
These symptoms that happen in response to inflammation bear a striking resemblance to the official criteria for major depression. Low energy, low appetite, wanting to withdraw from others, decreased libido, decreased concentration, sleeping more or having difficulty sleeping, low motivation, loss of interest in your regular activities, and a general lack of vitality or ability to feel joy. What it means to be depressed overlaps with what it feels like to be acutely inflamed.
On the Savannah, these symptoms made sense. They helped us rest, recover, and get back to health. But life in 2018 is an entirely different matter. Our primary sources of inflammation are no longer parasites or pathogenic viruses; these days, we're much more likely to be inflamed by processed, inflammatory foods and an overall imbalance in our gut ecology. Furthermore, our immune systems are dysregulated by various aspects of modern life, including chronic stress, poor nutrition, sleeping out of sync with the sun and moon, and antibiotics and other medical interventions. We're inflamed, but it's not a parasite or bacterium. And it's not so easy to beat this modern inflammation by simply resting for a few days.
Our bodies are inflamed because our immune system is constantly being triggered by food and environmental factors.
Say your body is inflamed by gluten or industrial vegetable oils. When you eat these foods, your body goes into that same inflammatory response you would have gone into from the virus on the Savannah. You feel sick, tired, and sad; you're not motivated to work; and you want to isolate. It's the same inflammatory response either way. The catch is that our immune system isn't designed to handle this type of trigger. Our immune system is a powerful engine, ingeniously designed to fight off infectious causes of inflammation but not these modern sources of inflammation. Human immune software is woefully overdue for an update; it has no idea how to protect us from the inflammatory foods many of us consume meal after meal. In other words, our immune system can conquer the flu, but it can't beat back refined carbs, processed meats, high-fructose corn syrup, and red dye No. 40. It's just not designed for that.
Our immune system keeps chugging, but it never actually finishes the job and we keep feeling sick, with the associated low energy, sad mood, and lack of motivation. We never make progress toward beating the inflammation because, by the next meal, we ingest those trigger foods again, and it's back to square one with inflammation. Herein lies the modern plague: chronic low-grade inflammation caused by modern environmental factors like food that our immune system was not designed to protect us from.
Many of us are chronically inflamed, and this sick feeling can feel identical to depression. So if you're depressed, consider the possibility that it's not a genetic chemical imbalance or Prozac-deficiency disorder; it may be the chronic flu of modern living. Of course, there isn't a simple answer to the question "What causes depression?" Inflammation is not the sole root cause of all cases of depression. But in my experience, it frequently plays a significant role in driving depressive symptoms. My advice to you is to do the simple and safe experiment of reducing your inflammatory burden and see if your depressive symptoms improve.
Focus on three main areas to decrease depression and improve mood.
So how do you decrease inflammation? Focus on three main areas. First, eat real food and then cultivate a diverse ecosystem in your gut. Finally, make sure to rest.
1. Eat real food.
The most important thing you can do to reduce inflammation is change the way you feed your body. Eat a nutrient-dense diet that soothes the immune system, and ditch all the inflammatory foods that provoke it. The nitty-gritty details of this are covered at length in my depression class—Managing Depression: A Mind, Body & Spirit Approach—but the quick take-away is to eat a combination of well-sourced, pasture-raised meat and poultry, as well as wild, cold-water, fatty fish, along with plenty of veggies and starchy tubers, all prepared with liberal amounts of healthy fats. Round that out with nuts, seeds, and fruit, and be sure to eat fermented foods like sauerkraut and kimchi on a daily basis. Meanwhile, cut out processed foods.
2. Diversify your gut flora.
Since about 80 percent of your immune function is headquartered in your gut, one of the best ways to tell your immune system to "calm the hell down" is to cultivate a healthy, diverse gut flora. This requires some concerted gut healing. Start by eliminating the foods and substances that inflame the gut (this means gluten, industrial vegetable oils, sugar, alcohol, antibiotics, antacids, stimulants, and various other medications). Then, add in the foods and substances that heal the gut (like fermented foods, starchy tubers, bone broth, ghee, collagen, glutamine, and probiotics). Finally, create the conditions for the gut to heal (i.e., rest, acupuncture, rest, yoga, meditation, rest, and did I mention actual, genuine rest?). For some people, it’s also necessary to work with a functional doc or naturopath to address conditions like SIBO and dysbiosis.
For some of us, the flu of modern life has distracted our immune system so much that we actually do have chronic infections lurking beneath the surface. In these cases, you really do need to simulate the Savannah man crawling into his cave for a while to give your body the adequate rest for your immune system to address the issue. The running on empty, go-go-go lifestyle, where we operate in a state of bone-tired chronic exhaustion—masked by coffee, sugar, and sometimes Adderall—creates the perfect conditions for infections to get a foothold in your body. Give your body deep rest, and hopefully your immune system will do what it's designed to do to take care of these infections.
Even in the absence of chronic underlying infections, it's still critical to sync up your sleep with the sun and the moon. Our immune system functions best when we sleep in total darkness and when we're awake with exposure to sun and fresh air. If you live disconnected from nature, do your best to push your bedtime to approximately three hours after sunset, then simulate darkness at night and bright natural light during the day.
Once you've soothed the inflammation in your body, you'll hopefully be well on your way to feeling like you just got over your chronic flu. Ideally, you'll be feeling more energetic, more motivated, less depressed, and able to crawl out of your cave.
Ellen Vora, M.D. is a board-certified psychiatrist, acupuncturist, and yoga teacher, and she is the author of the No. 1 bestselling book The Anatomy of Anxiety. She takes a functional medicine approach to mental health—considering the whole person and addressing imbalance at the root. Vora received her B.A. from Yale University and her M.D. from Columbia University.