This past weekend, I had the opportunity to hear Dr Andrew
Weil speak at a conference put on by the University of Maryland’s Center for Integrative Medicine. Dr Weil deserves a lot of credit for recognizing the
importance of mind-body medicine and nutrition at a time (the early 70’s) when
it was almost entirely unheard of, and when the naturopathic profession was
only beginning to wake out of several decades of slumber. Additionally, he’s
become a focal point that has helped to bring shape to a diverse group of
healthcare practitioners who would otherwise be practicing in isolation. His
role in encouraging the evolution of medicine would be hard to understate.
Towards the end of his talk, Dr Weil discussed the possibility
that the root cause of depression might not be, as is often suspected, a
serotonin imbalance (for which the ‘solutions’ are Paxil, Prozac, Zoloft, etc),
but rather an inflammatory process. In the discussion, he mentioned a study in
which NSAIDs (non-steroidal anti-inflammatory drugs, such as aspirin or
ibuprofen) showed the same effect as traditional anti-depressants, and that, by
extension, turmeric or ginger might be effective anti-depressants. Fascinating
stuff, right? Needless to say, I was intrigued, and spent much of the next day
trying to pull articles.
After a few hours, I found that Dr Weil had probably
overstated things a bit in his presentation. There IS increasing evidence that
some forms of depression are linked to inflammatory disease markers, but there
AREN’T many studies that have looked at the therapeutic value of
anti-inflammatories on depression.
So, here’s what I was able to find. Many inflammatory
cytokines (chemical messengers) have been documented to be elevated among
depressed people, including several interleukins, and it appears that many
pro-inflammatory enzymes are up-regulated in patients suffering from major
depression (1, 2, 3, 4, 5, 6). Interestingly, some of the body's compensatory anti-inflammatory markers are similarly elevated. This body of evidence is growing steadily, and while there is some variability in which biomarkers are elevated, there is consistent evidence that certain pro-inflammatory cytokines are elevated in patients with depressive symptoms.
These observations have lead to the publication of many
articles that suggest that researchers investigate the use of anti-inflammatories
in the treatment of depression. Indeed, the number of articles I was able to
find advocating for research into this as a potential treatment for depression
far exceeds the number of articles I was able to find which either document the
effects of inflammatory cytokines on depression or the effects of
anti-inflammatory drugs on depression. I found a number of such articles, from
researchers all over the US and all over the world, but I’m only going to
provide links to a few of them, because many essentially say the same thing and
draw on the same sources (1, 2, 3). Researchers are writing about their interest in this
potential treatment, but few are actually researching the use of
anti-inflammatories as part of treatment.
What few clinical trials I was able to find mainly focus on
the use of celecoxib (Celebrex) as an adjunct treatment in depression. Two
articles I found supported the hypothesis that the combination of celecoxib and
an antidepressant provided greater relief from depression than an anti-depressant
alone (1, 2). An additional trial found that celecoxib provided significant relief from depressive episodes as an adjunct treatment in bipolar disorder. These
were all fairly small trials, but they certainly make us think, and as a
naturopathic physician, I find this information extremely useful – celecoxib is
nothing special, pharmacologically speaking, and it’s action can easily be
performed by a natural substance, such as turmeric or ginger.
However, the largest study I was able to find found no benefit.
It was a re-evaluation of data from a study investigating the use of
anti-inflammatory drugs to prevent Alzheimer’s progression, and among the 500
participants who also had major depressive symptoms, no relief was gained from
either celecoxib or naproxen. While the study methods weren’t ideal, it’s still
an important piece of information. The take-home message from these studies, I
believe, is that anti-inflammatories may have a beneficial effect on depression
in conjunction with an anti-depressant.
At the end of the day, though, what this whole line of
thinking actually indicates is that we really have very little understanding of
depression. On an individual level, practitioners can help people quite a lot
with depression, but it takes time and work, and above all, a deep
understanding of what is causing that person to be depressed. However, on a
large scale, we don’t understand depression – we don’t understand why so many
people are depressed, we don’t understand what’s making them depressed, and we
don’t understand how to fix them. Again, I underline that this is on a large
scale – on an individual scale, we can change lives, because depression is
individual in its origin and similarly unique in its resolution. It’s a result
of a combination of biochemical, environmental, and social factors, and
treatment must take into account all of these factors.
I think the reason we don’t understand depression on a large
scale is that, in some ways, there is no such disease as depression. A disease
has a clear etiology or can be diagnosed using a specific marker –
iron-deficiency anemia, lupus, strep throat, etc are examples of diseases.
‘Depression’, as we call it, is many, many diseases all masquerading around
with the same major symptom. These dis-eases arise from a variety of causes,
and vary significantly between patients. Though a variety of practitioners can
help work through depression, including MDs, psychologists, and therapists, I
believe that the individualized treatment that is a hallmark of naturopathic
medicine offers the personalized approach necessitated in depression.
