How to Factor Inflammation Into Your Treatment for Depression

When inflammatory disorders such as rheumatoid arthritis make strange bedfellows with depression or fatigue.

By Edward Bullmore M.D., published February 5, 2019 - last reviewed on February 5, 2019

Recognize that you're not alone. Being depressed tends to make people withdraw socially. In fact, depression is very common: about one in four people experiences an episode of major depression sometime in life. It touches every family on the planet.

If you know that you have an inflammatory disorder, like rheumatoid arthritis or Crohn's disease, and are also depressed or fatigued, talk to your physician about your psychological symptoms as well as your physical ones. Standard treatments for depression—SSRIs and psychotherapy—can help with comorbid depression, but many patients with physical illness do not access them. Your physician may refer you to a clinical psychologist or psychiatrist. Consider any antidepressant treatment options suggested by clinicians. And consider making contact and sharing experiences with others, perhaps through relevant patient advocacy groups.

Tracy Siermachesky Shutterstock
Tracy Siermachesky Shutterstock

If you are depressed but don't have a major inflammatory disorder, low levels of inflammation might still be contributing to your depression. A simple blood test for C-reactive protein or white blood cell count can "take the temperature" of your immune system and indicate your level of bodily inflammation. If blood tests are positive, try to work out the cause of the inflammation and eliminate it. Common possibilities include unrecognized periodontitis, obesity, and social stress.

Many anti-inflammatory drugs are already on the market but none has yet been shown to have significant antidepressant effects. Of the many nondrug approaches to depression—from yoga and meditation to diet and vagal nerve stimulation—none has yet been approved for treating depressive symptoms of inflammation. So proceed with caution. Ask critical questions about the evidence for and against any treatment. The risks of attending a yoga retreat or cutting food items from your diet are low. But it is still worth asking for proof that doing so will change the levels of inflammatory proteins or cells in your body.

The presence of inflammation does not mean that conventional treatments for depression (such as SSRIs and psychotherapy) have no role. They do. Do not stop or start any medication for depression except in consultation with a psychiatrist or other physician.  

Whatever therapeutic course you choose, keep track of your levels of inflammation with repeated blood tests. Review your approach if the inflammatory temperature of your immune system stays high.

Talk about it. Being depressed makes people self-critical and guilty, but don't be ashamed of your symptoms. Seek social or therapeutic contacts that can support you in recovering from depression.


Sources of Increased Inflammation:

Obesity

Sedentary lifestyle

Disordered sleep

Childhood maltreatment

Emotional and physical trauma

Medical illness such as cardiovascular disease, diabetes, autoimmune and inflammatory disorders

Bacterial or viral infection

Medical treatments such as surgery, radiation, and chemotherapy

Antidepressant treatment resistance

See the story: "Seeing Beyond Depression"