Through discoveries in immunology, we know that inflammation has an impact on physical illness. What remains unclear is how inflammation influences thoughts and behaviors — a question that intersects the fields of immunology, neuroscience, psychology, and psychiatry. In The Inflamed Mind: A Radical New Approach to Depression, Edward Bullmore explores how inflammatory changes could impact the way the brain works, resulting in symptoms of depression as a result of the inflammation.
Bullmore is certainly knowledgeable about this area. A psychiatrist with expertise in neuroscience who is in the development stages of anti-inflammatory drugs for depression, he leaves the reader with a promise of more to come.
Bullmore provides a thorough analysis of the latest research on how inflammation might cause depression. Although much is still unknown, he confidently states, “we can move on from the old polarized view of depression as all in the mind or all in the brain to see it as rooted also in the body; to see depression instead as a response of the whole organism or human self to the challenges of survival in hostile world.” With more holistic treatments available for mental health than ten years ago, our culture is at least moving in the right direction to see more than one option for managing ailments like depression.
Bullmore explains, “Your body’s state of inflammation, your immune system’s level of threat arousal, can have a direct effect on how you feel, and what you think about.” Although this is not a direct statement of cause, it implies a relationship that cannot be ignored. Bullmore goes on to say, “Inflammation of the body can cause changes in how the brain works, which in turn causes the changes in mood, cognition and behavior that we recognize as depression.” In this scenario, traditional talk therapy is not enough to address symptoms if there is a clear physical component.
Although there is progress in mental health treatment, there are still silos in the medical field. Most medical doctors are trained to look at labs and scans, which offer a black and white picture of an illness. Their role is not about being attuned to behavioral symptoms or psychological complaints.
Also, our pharmaceutical approach is still one-size-fits-all, with SSRIs a common treatment offered by providers, even though serotonin biomarkers are not easy to measure, and without a biomarker, there is not a definitive guideline for patients about whether they should take an SSRI for their depression. Where there is evidence is for inflammation — “depression is associated with biomarker evidence of bodily inflammation.” That said, Bullmore still recognizes that that is not a causal relationship. But additional research shows that inflammation can precede depression, further indicating potential causality.
With the stigma that remains, patients unfortunately may view their depression as personal failure. If depression is resolved with new thinking patterns, the thesis is that depressed people need to change the way they think to find healing. Further confusion and feelings of failure may occur for patients if a medicine does not work for them when clinical evidence says it should.
Bullmore says, “Maybe we’ll see new drugs that, unlike the old drugs, are not vaguely supposed to work equally as well for everyone with depression but are scientifically predicted to work particularly well for some people.” So, although The Inflamed Mind does not offer a clear treatment plan, it does offer hope. People who may not understand the origination of their symptoms or why they do not experience improvement through traditional mental health treatment will learn more about the potential physical component to their experience.
If depression is not all in the mind and can also come from inflammation in the body, it makes sense that traditional antidepressants will not always be effective. For those who do change their thinking patterns yet do not recover, Bullmore’s work is encouraging. Readers may find that depression is more than just in their heads.
The Inflamed Mind: A Radical New Approach to Depression
Picador, Macmillan Publishing Group, December 2018
Hardcover, 256 pages