By September 20, 2016 8 Comments Read More →

Depression: It’s Not All in Your Head

Kelly Brogan, M.D., Green Med Info
Waking Times

No, it’s not “all in your head.” Depression and all of its relatives are manifestations of glitches in the immune system and inflammatory pathways—not a neurochemical deficiency disorder.

Psychiatry: A Very Special Specialty

Psychiatry, unlike other fields of medicine, is based on a highly subjective diagnostic system. Essentially you sit in the office with a physician, and you are labeled based on the doctor’s opinion of the symptoms you describe. There are no tests. You can’t pee in a cup or give a drop of blood to be analyzed for a substance that definitely indicates “you have depression” much in the way a blood test can tell you that you have diabetes or are anemic.

Psychiatry is infamous for saying “oops!” It has a long history of abusing patients with pseudoscience-driven treatments and has been sullied by its shameful lack of diagnostic rigor. Consider, for example, the 1949 Nobel Prize winner Egas Moniz, a Portuguese neurologist who introduced invasive surgical techniques to treat people with schizophrenia by cutting connections between their prefrontal region and other parts of the brain (i.e., the prefrontal lobotomy). And then we had the Rosenhan experiment in the 1970s, which exposed how difficult it is for a doctor to distinguish between an “insane patient” and a sane patient acting insane. Today’s prescription pads for psychotropic drugs are, in my belief, just as harmful and misguided as physically destroying critical brain tissue or labeling people as “psychiatric” when really they are anything but.

Is It All In Your Head?

My fellowship training was in consultation-liaison psychiatry, or “psychosomatic medicine.” I was drawn to this specialization because it seemed to be the only one that acknowledged physical processes and pathologies that could manifest behaviorally. I noticed that psychiatrists in this field appreciated the role of biological actions such asinflammation and the stress response. When I watched fellow psychiatrists consult on surgical patients in the hospital, they took these brain-body connections much more seriously than they did in their Park Avenue offices. They talked about delirium brought on by electrolyte imbalance, symptoms of dementia caused by B12 deficiency, and the onset of psychosis in someone who was recently prescribed anti-nausea medication. These root causes of mental challenges are far from the “it’s all in your head” banter that typically swirls around conversations about mental illness.

The term psychosomatic is a loaded and stigmatized term that implies “it’s all in your head.” Psychiatry remains the wastebasket for the shortcomings of conventional medicine in terms of diagnosing and treating. If doctors can’t explain your symptoms, or if the treatment doesn’t fix the problem and further testing doesn’t identify a concrete diagnosis, you’ll probably be referred to a psychiatrist or, more likely, be handed a prescription for an antidepressant by your family doctor. If you are very persistent that you still need real help, your doctor might throw an antipsychotic at you as well. Most prescriptions for antidepressants are doled out by family doctors—not psychiatrists, with 7 percent of all visits to a primary care doctor ending with an antidepressant prescription. And almost three-quarters of the prescriptions are written without a specific diagnosis. What’s more, when the Department of Mental Health at Johns Hopkins Bloomberg School of Public Health did its own examination into the prevalence of mental disorders, it found that “Many individuals who are prescribed and use antidepressant medications may not have met criteria for mental disorders. Our data indicate that antidepressants are commonly used in the absence of clear evidence-based indications.”

So we have overprescribing, but we also have some very sick women struggling in ways that are dismissed as “psychiatric”. In 2014 Scottish researchers addressed the gap between what the science says about the causes of depression and what patients experience when they find themselves caught in the default web of psychiatric care. In their paper they highlight the value of what I practice: psychoneuroimmunology. Indeed, it’s a mouthful of a word, but it simply refers to examining (and respecting) the complex interplay between various systems and organs of the body, especially those that syncopate the nervous, gastrointestinal, and immune systems in a brilliant dance that in turn affects mental well-being. These researchers point out that many patients who are told they have psychiatric conditions originating in their head or related to some (fictitious) brain chemical deficiency actually share real biological imbalances related to their immune-inflammatory pathways. These patients show elevated levels of inflammatory markers in their blood, signs that their body is on the defensive, activating processes that can result in unexplainable physical symptoms and that are diagnosed as psychiatric rather than biologic. And rather than treating the underlying biology, they are instead relegated to a lifetime of therapy and medication, to no avail.

Brain Body Connection

The idea that depression and all of its relatives are manifestations of glitches in the immune system and inflammatory pathways—not a neurochemical deficiency disorder—is a topic I explore at length throughout my book, A Mind of Your Own. This fact is not as new as you might think, but it’s probably not something your general doctor or even psychiatrist will talk about when you complain of symptoms and are hurried out of the office with a prescription for an antidepressant.

A multitude of studies now show an undeniable link between gut dysfunction and the brain, chiefly by revealing the relationship between the volume of inflammatory markers in the blood and risk for depression. Higher levels of inflammatory markers, which often indicate that the body’s immune system is on high alert, significantly increase the risk of developing depression. And these levels parallel the depth of the depression: higher levels equates with more severe depression. Which ultimately means that depression should join the ranks of other inflammatory disorders including heart disease, arthritis, multiple sclerosis, diabetes, cancer, and dementia. And it’s no surprise, at least to me, that depression is far more common in people with other inflammatory and autoimmune issues like irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia, insulin resistance, and obesity. All of these conditions are characterized by higher levels of inflammation.

To really grasp the fact that depression is not a disorder primarily rooted in the brain, look no further than some of the most demonstrative studies. When scientists purposefully trigger inflammation in the bodies of healthy people who exhibit no signs of depression by injecting them with a substance, they quickly develop classic symptoms of depression. And when people with hepatitis C are treated with the pro-inflammatory drug interferon, as many as 45 percent of those individuals develop major depression.

Depression: It’s a Lifestyle-Body Mismatch

So when people ask me about why we’re suffering from what appears to be an epidemic of depression despite the number of people taking antidepressants, I don’t think about brain chemistry. I turn to the impact of our sedentary lifestyles, processed food diets, and unrelenting stress. I turn to the medical literature that says a typical Western diet—high in refined carbs, unnatural fats, and foods that create chaos in our blood sugar balance—contribute to higher levels of inflammation. Contrary to what you might assume, one of the most influential risk factors for depression is unstable sugar. Most people view diabetes and depression as two distinct disorders, but new scientific findings are rewriting the textbooks. One game-changing study published in 2010 that followed more than 65,000 women over a decade showed that women with diabetes were nearly 30 percent more likely to develop depression. This heightened risk remained even after the researchers excluded other risk factors such as lack of physical exercise and weight.

Personalized lifestyle medicine that accounts for the role of the environment in triggering inflammation and the manipulation of the immune and endocrine systems is the most sensible way to approach those individuals who would otherwise be candidates for multiple medications. It turns out that it may not all be in your head—but rather in the interconnectedness among the gut, immune, and endocrine systems.

It’s time we rewrite the textbooks. And it’s time we treat depression for what it really is.

About the Author

Dr. Brogan is boarded in Psychiatry/Psychosomatic Medicine/Reproductive Psychiatry and Integrative Holistic Medicine, and practices Functional Medicine, a root-cause approach to illness as a manifestation of multiple-interrelated systems. After studying Cognitive Neuroscience at M.I.T., and receiving her M.D. from Cornell University, she completed her residency and fellowship at Bellevue/NYU. She is one of the nation’s only physicians with perinatal psychiatric training who takes a holistic evidence-based approach in the care of patients with a focus on environmental medicine and nutrition. She is also a mom of two, and an active supporter of women’s birth experience. She is the Medical Director for Fearless Parent, and an advisory board member for Visit her website.

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**© [9/12/16] GreenMedInfo LLC. This work is reproduced and distributed with the permission of GreenMedInfo LLC. Want to learn more from GreenMedInfo? Sign up for the newsletter here**

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of WakingTimes or its staff.

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  • mothman777

    God, Krishna, is infinite in spatial dimensions, and the beginingless, eternal, natural and constitutional nature of all spirit souls is to have cosmic consciousness, and cosmic bliss, co-functioning together within and through the Godhead Soul as a communal spiritual body of infinite proportions.

    The greater part of the spiritual cognitive function of each of us is only available by dovetailing our consciousness with Him, the infinite Soul, a multitude of individual souls then co-functioning in cosmic consciousness.

    Depression results when the individual soul turns away from it’s beginningless and eternal natural constitutional relationship with the Supersoul, the Godhead, and thus loses the greater part of it’s spiritual cognitive faculty. The total remedy for depression lies only in remedying that lack of connection, there is no other way.

    The ‘depression’ of the gross material brain and subtle body can be remedied by simple things, such as increasing prana intake, as prana is the medium of our connection with God on certain levels, and improving nutrition, activity and relationships, but the pure spiritual connection needs also to be properly addressed for this to be truly effective.

    God becomes transformed before us all in this world of ‘separation’, largely revealing Himself to us all here only as ‘material’ gross and subtle substance, though he exists eternally within the heart of the souls of each and every one of us in His true eternal spiritual nature and form, and also totally immerses all of us within Him, as a vast living ocean of pure consciousness of loving blissful consciousness, which can be felt to some degree even in this life, and fully when we are free of these material bodies.

    Anything that facilitates the better function of the brain, that improves cognitive function, improving availability and co-function of neurotransmitters etc, which enable our intelligence to become sharper in a way that enables us to turn increasingly towards the true vivifying Principle, Krishna Himself, is also valuable.

    Simple things like vitamin C, Vitamin D3, various B Vitamins etc., which themselves help us to assimilate various minerals, make our brains feel less ‘depressed’, as does some physical activity that encourages our breathing function to improve, drawing in more oxygen and prana.

    The yoga science goes into drawing different types of prana which affect consciousness differently, and channeling those energies in various ways.

    Beyond this level, subtle material prana and gross material are properly revealed as the Godhead Himself, these drawing us onward to a state in which nothing exists but the Godhead Himself enveloping all other souls, in many different types of transcendental spiritual relationships on the timeless eternal plane.

  • Meter

    Humans are triune beings: body, mind and spirit. There is a ‘force of sadness’ in all three levels. This article’s view is more evolved and holistic, yet only encompasses the body and mind levels, as it emerges from conventional science, which doesn’t acknowledge the science of spirit. Poor diet may feed depression, but depression also feeds poor diet. Which came first, the chicken or the egg? A paradox – a clue to another dimension at play.

    Body and mind disciplines can help restore wholeness, so that the human being is capable of expressing a wide range of feelings, like an actor with a good range. Thus anything the soul wishes to express through this healthy human being, it has the capacity. Compare this with a body-mind ‘depressed’ human being, who is stuck against the sadness rail by repetitive ego thoughts/memories as well as nutritional and chemical imbalances. Stuck against a rail means your range of motion is much more limited, so expression becomes compressed into a narrow band (makes you feel flat).

    Yet even when you restore wholeness to the mind and body, there is still a spiritual force of sadness. The spiritual adept (which many people are becoming) is often a pretty good master of mind and body, which often means having a highly sensitive and tuned body, and this spiritual sadness can be expressed and felt in a variety of ways through that level of mastery. That is to say, it’s not necessarily suffering, and isn’t necessarily a bad feeling. For example, it is the spiritual feeling at the heart of deep feelings of romantic love (true love is a kind of suffering and dying), feelings of living in a spectacular epic dream (majesty of life and death), feelings of heroism, and other very large super-experiences within the reach of spiritual adepts.

    One way to consider this sadness is as an analogue to physical gravity, always there, always pulling down. One’s vulnerability to gravity can be changed by adjusting one’s mass (which spiritual people know how to do – you can make yourself lighter or heaver at will, by releasing attachments, by changing mood and perception of the moment). So this sadness is a force which may be employed, like controlled falling and flight. One may soar, even defy it.

    Where this force pulls people is into the underworld, a spiritual plane below the current plane, rather than above. Again, below isn’t necessarily bad. The underworld can be described as a meta-world or dream world (really many) which also has a relationship to the normal world, being its roots. Unlike higher spiritual realms full of light and knowledge, the underworld is full of shadow and mystery. Rather than being a ‘hell’ or negative, it is simply full of both the wonderful and the terrible, just like all of life is.

    Like walking into a dark forest, the underworld can be dangerous, especially to the undisciplined and unprotected. This is why people avoid it, even as others are lost in it through unhealthy drugs, morbid tendencies, addictions, etc. Yet a spiritual adept may enter such forest with neither fear nor carelessness, instead with the light of mindfulness and presence.

    It’s natural to feel sadness or non-motivation as a spiritual wayfarer, even when your body and mind are in good order (or you have made peace with an ill or injured body). This sadness is an invitation to the underworld, which can be used to reformulate life itself. Often we come to this invitation because we are ready for new life. All higher consciousness rises from lower consciousness, so when we ‘run out’ of higher consciousness (when we no longer feel joy because we’ve grown comfortable in the palace, so to speak), we dip down into the well of lower consciousness to find more of the unevolved self. We merge with it and begin once again to raise this part of the self, to experience its rise into higher consciousness. One can think of oneself as a tree, always pulling water from below and raising it into the air.

    Everyone does this, especially during sleep in dreams, yet with limited awareness that it’s happening, and thus limited power. The invitation to the spiritual adept is to become a conscious, awakened participant in the process. Life then becomes lucid.

    In practical terms, initially such dips into the underworld (which can be accomplished through deep thought, daydreaming, deep breathing, depth psychology practices, shamanic drumming and dreaming, entheogens, etc.) brings one to lost parts of the psyche – memories of tough experiences from childhood which create emotional blocks and our core beliefs about life. Experiencing these and working with these can take decades, but other breakthroughs are also made in the meantime.

    Beneath that psychic jetsam is a realm of archetypes, mushroom people, ETs, monsters, fairies, angels, and gods. It is a realm of imagination, old and new. More importantly, one meet one’s own deeper meanings, the Earth, the natural human being.

    Anytime you’re feeling sad about the world as a spiritual person, and you wish the world could grow faster, keep up with your growth and be joyful, this is a sign you are ready to leave the sleeping blob that is conventional matrix humanity, and take a journey into your underworld. This is the depression, the lack of motivation to be involved in ‘the world’, the desire to fall and let it go. Where others are killing to stay here, you are dying to leave.

    Yet there is that fear and for good reasons: there be monsters here! This is where having your spiritual principles together is vital, knowing what you’re about. When heading into such journeys, I always try to keep at least one word in mind: love.

    Your state of being creates your road. The ‘right attitude’ for this purpose is one of compassion and benevolence projected gently toward all life, not merely thought but genuinely isness. This is a dance in creating safety through utter vulnerability. “If you want to be reborn, let yourself die.” It’s knowing deeply what you’re about.

    Beyond fear, you will also be letting go of your old world, who you were, so you may delay.

    Depression in more aware, spiritual people is often being caught in this gravity, being drawn into the underworld, yet having strong fears or resistance against it, thus resisting the unknown (even though it may contain your dreams). This holds one in a depressed state, where motivation is lacking, and which often contains sadness and despair. Spiritual people can get good at changing their mass and rising, experiencing inner joy and happiness even in such conditions (sort of fooling themselves into unconditional happiness), which can change the conditions too. (The more spiritually high-energy you become, the more you can interfere with natural processes.) Yet ultimately there will just be a lack of motivation, a disinterest in life, which will keep pulling down. Gently yielding to this and following it in a state of presence is usually quite transformational. Yet it is also often a complex and sometimes dark journey. BYOL – bring your own light.

    “All that is gold does not glitter,
    Not all those who wander are lost;
    The old that is strong does not wither,
    Deep roots are not reached by the frost.

    From the ashes a fire shall be woken,
    A light from the shadows shall spring;
    Renewed shall be blade that was broken,
    The crownless again shall be king.”

    • TrevorD

      Beautiful and inspiring mixed with unavoidable truths. Like it alot. Did you write an article yet for this site or others?

      • Meter

        I’ve never published in this area. I think of these longer comments as being like those paintings made of colored sand, which are brushed away after being enjoyed. ‘Cast a few seeds and move on.’ Thank you for your feedback!

        • TrevorD

          Poetic and understood. Keep casting those colored sand paintings. I am sure some will be become concrete in many peoples minds whether through your will or not.. We all have a calling. Good luck, see you around.

  • jmac54

    I for many years suffered from anxiety and depression. Went to a lot of psychiatrists, you name the pill, I took it. Sometimes I could function other times I couldn’t. My GP who I had known for many many years put me on an antidepressants. They work for me. Before taking the meds he prescribed, I spent a lot of time finding out what causes depression, and what drugs were being used to treat it. My life has changed for the better. There are still life’s ups and downs. Those I can deal with.

  • Daniel Bowman

    Just because you don’t bleed, doesn’t mean you are not hurt. Hurt more than anyone could possibly imagine. Mental health is grossly overlooked, and mental illnesses stigmatized.
    I battled depression for years, and I am so grateful that I managed to fight that daemon off. For anyone suffering from depression,
    I recommend something that has helped me a lot. It is a natural system developed by a
    former depression and PTSD sufferer, and teaches a totally natural 7 step process
    which relieves depression from your life. To see for yourself google lookingupstuff/depression

  • deenie1219

    I think that the effect of various viruses should be considered too. Also senescent cells that just keep hanging on and putting out inflammatory chemicals too. Then there the old nemeses of GM phude and vaccinations of wild viruses and assorted toxic chemicals. IMO, it is a wonder people are able to live beyond 60 these days with the gauntlet they must endure.

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