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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 44. This is the beginning of the thread.
Posted by SLS on January 2, 2013, at 7:54:16
Hi.
Here is a summary of another study demonstrating an association between inflammation and depression. Although the cross-sectional design of the study could not determine cause-and-effect directionality, people with CRP levels in excess of 10.00 mg/L were three times as likely to be depressed.
Minocycline is a potent anti-inflammatory in the brain, and this is one of the reasons I continue to take it. However, for some people, remission may take as long as a year to attain. I felt an improvement with in a week of starting minocycline. This was also the case with a friend of mine. It might not be as important to establish directionality as it is to treat the inflammation when it appears. Apparently, the brain can be a source of pro-inflammatory cytokines, and may not need peripheral inducers to become inflamed.
I don't subscribe to the inflammation causes depression school of thought. In my mind, stress comes first, depression comes second, and inflammation comes third. Of course this is only a guess. At most, there might be a convergence. However, there are too many different non-inflammatory biomarkers associated with depression to ignore, including genetic.
- Scott
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"Elevated levels of C-reactive protein (CRP), a biomarker commonly used to assess inflammation, may be associated with an increased risk for depression, new research suggests.Data from 2 general population studies conducted in Denmark, which included a total of more than 73,000 adults, showed that those who had the highest levels of CRP were more than twice as likely to have psychological distress and depression than those with normal levels of CRP.
Increasing levels of CRP were also associated with an increased risk for hospitalization due to depression.
"Contrary to previous studies, these associations did not disappear when we adjusted for BMI [body mass index] or chronic disease," write Marie Kim Wium-Andersen, MD, from the Department of Clinical Biochemistry at Herlev Hospital and from the Copenhagen University Hospital in Denmark, and colleagues.
The investigators note that more research is now needed "to establish the direction of the association between CRP and depression" especially because these studies were primarily cross-sectional.
"The results also support the initiation of intervention studies to examine whether adding anti-inflammatory drugs to antidepressants for treatment of depression will improve outcome," they write.
The study was published online December 24 in Archives of General Psychiatry."
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Posted by gadchik on January 2, 2013, at 8:48:42
In reply to More evidence of inflammation and depression., posted by SLS on January 2, 2013, at 7:54:16
what are your thoughts on fish oil used as an anti inflammatory added to antidepressant therapy? i have taken fish oil on and off with my klonopin,and i notice a difference,not huge,but enough. I also dont take a gram when I take it,probably need to in order to get max benefit.
Posted by gadchik on January 2, 2013, at 8:51:21
In reply to Re: More evidence of inflammation and depression. » SLS, posted by gadchik on January 2, 2013, at 8:48:42
I just read an interesting book, Brain on Fire. True story, the girl's brain became inflamed from an immune reaction problem. Anyway, the inflammation caused all kinds of mayhem with her mental health.
Posted by Phil on January 2, 2013, at 9:38:31
In reply to Re: More evidence of inflammation and depression. » gadchik, posted by gadchik on January 2, 2013, at 8:51:21
What exactly is inflammation? I know in physical cases what the word means but it would be great to have a simple explanation about what is happening. Is the brain itself physically inflamed?
gadchik, have you had any sexual dysfunction on Clonazepam. You have the option to not answer but God we talk about everything here, right?
I enjoy your posts.
Posted by Phillipa on January 2, 2013, at 9:47:42
In reply to Re: More evidence of inflammation and depression. » gadchik, posted by Phil on January 2, 2013, at 9:38:31
This has always been my theory first stress which left untreated then can lead to depression. As for the inflammation sometimes motrin makes me feel a bit better. Fish oil gave me anxiety. I read a while back that CRP had been replaced with another test. I think the word "May" cause is inportant in the equation. More research. So Gadchik to you keep taking the klonopin is keeping depression away. As for minocycline other than with bipolar I personally couldn't find any other studies. I just know it can cause lupus reaction and that when the med is discontinued can take more than a year to return to normal. And blackened teeth and forgot the other stuff I found when I tried it for the perioral dermatitis. Cytokines aren't they involved with the heart? Phillipa
Posted by gadchik on January 2, 2013, at 10:58:24
In reply to Re: More evidence of inflammation and depression. » gadchik, posted by Phil on January 2, 2013, at 9:38:31
Phil,I enjoy your posts as well. And yes,everything is discussed here! About the klonopin and sex-I was going to respond before to the other dysfunction thread-but I only had a robust sex drive when I was in my 20s and running around all hrs, drinking. I feel both klonopin and zoloft did not affect my sex drive. I dont know what did. Ive always been very self conscious, worry wart, etc. So to start,I wasnt born a "sexual person".Ive been happily married for 21 yrs,have sex sev times a week,try to be engaging,keep in shape,etc., but i just dont really care if I have sex or not.But I know those pills take "sexual" people and kill their sex drives. For me, doesnt matter.
Posted by gadchik on January 2, 2013, at 11:02:57
In reply to Re: More evidence of inflammation and depression., posted by Phillipa on January 2, 2013, at 9:47:42
Ive been interested in the cytokines too. And inflammation. I had one of those crp tests,showed no inflammation-was an excellent result. I really dont know if klonopin is keeping me from depression or anxiety. Its such a low dose,once a day. I just wonder if the fear of withdrawal keeps me on it?
Posted by Phil on January 2, 2013, at 11:51:40
In reply to Re: More evidence of inflammation and depression. » Phil, posted by gadchik on January 2, 2013, at 10:58:24
I don't care about sex right now but I don't care about shooting guns either. Still if I needed to it would be nice to have bullets. (turns red)
I blazed a trail from 20 to around 35. Alcohol was the engine. I could walk into a club, have a few drinks, and I became animated. I was quite good looking in those days and had my choice. I had absolutely no fear.
Somewhere towards the end of that run the one night stands became very depressing. When I quit drinking I became a bit more realistic.
While it lasted it was a lot of fun. Pre-Aids. No ethics.
Posted by SLS on January 2, 2013, at 11:55:19
In reply to More evidence of inflammation and depression., posted by SLS on January 2, 2013, at 7:54:16
> "The results also support the initiation of intervention studies to examine whether adding anti-inflammatory drugs to antidepressants for treatment of depression will improve outcome," they write.
This is an ongoing study comparing the antidepressant potential of minocycline and aspirin:
Minocycline and Aspirin in the Treatment of Bipolar Depression
http://clinicaltrials.gov/show/NCT01429272
- Scott
Posted by brynb on January 2, 2013, at 11:58:26
In reply to More evidence of inflammation and depression., posted by SLS on January 2, 2013, at 7:54:16
Scott,
It makes a lot of sense. I don't know about other antibiotics, but I've been sick all month, and I've been on Keflex (cephalexin) for a week and a half and I think it's been helping this recent depressive period.
Thanks for the info.
b
Posted by Phil on January 2, 2013, at 11:58:51
In reply to Re: More evidence of inflammation and depression., posted by SLS on January 2, 2013, at 11:55:19
Should I take an aspirin a day. I guess it helps with heart attacks too?
Posted by gadchik on January 2, 2013, at 12:05:25
In reply to Re: More evidence of inflammation and depression. » gadchik, posted by Phil on January 2, 2013, at 11:51:40
Well,my run ended when I fell in love. But yeah,I remember walking into a room,after a few drinks,and feeling a rush of happiness,power,I guess just dopamine being released,or something in the alcohol...had no worries,fears. I really only wanted one person to bond with for life,and so, I did...
Posted by Phil on January 2, 2013, at 12:23:38
In reply to Re: More evidence of inflammation and depression. » Phil, posted by gadchik on January 2, 2013, at 12:05:25
I left a club one night at 2 then headed to a great, big 24 hour restaurant. I walked around and saw three pretty young girls sitting in a booth. I said hi and just sat down. We had a great time.
Sunday morning I opened the paper and on the front page was a picture of one of them, Miss San Antonio. LOL
That was my thing. I didn't ask someone to dance, I just sat down at their table. I was very much an 'Arthur' kind of character. Hey, whatever closed the deal.
God knows it wasn't just me. Everybody was on the hunt. :)
Back then I drank Crown and water doubles. Two or three of those....
Posted by gadchik on January 2, 2013, at 12:34:47
In reply to Re: More evidence of inflammation and depression. » gadchik, posted by Phil on January 2, 2013, at 12:23:38
it was magical, the things that could happen in the space of one night! I felt like a social butterfly,just flitting from one drama to the next! So,did u ever run into Miss San Antonio again? Well,I must confess that I partied with Hall & Oats one crazy night,after a concert in Roanoke Va.
Posted by Phil on January 2, 2013, at 13:11:36
In reply to Re: More evidence of inflammation and depression. » Phil, posted by gadchik on January 2, 2013, at 12:34:47
You go girl!! I called her after reading the story. Stalker? I said you didn't tell me you were Miss SA. I don't remember what she said but she laughed. She was a sweetheart. If I was Mr anything I would have been slipping it into every conversation I had.
I sat down next to two ladies at an IHOP one time. They said you might want to move, our husbands are in the bathroom. I think that cured me.
I won't go into sitting with two ladies, a doctor and an RN. I talked them into going to the coast two and a half hours away. But I tell you what, it was a long night. I was absolutely sh*tfaced that night.
Posted by Phil on January 2, 2013, at 13:13:47
In reply to Re: More evidence of inflammation and depression. » Phil, posted by gadchik on January 2, 2013, at 12:34:47
Daryl Hall is a great singer and turns out a really cool musician. I never was quite sure what Oates was.
Posted by gadchik on January 2, 2013, at 13:17:22
In reply to Re: More evidence of inflammation and depression. » gadchik, posted by Phil on January 2, 2013, at 13:13:47
Posted by Emme_V2 on January 2, 2013, at 16:59:00
In reply to More evidence of inflammation and depression., posted by SLS on January 2, 2013, at 7:54:16
> I don't subscribe to the inflammation causes depression school of thought. In my mind, stress comes first, depression comes second, and inflammation comes third. Of course this is only a guess. At most, there might be a convergence. However, there are too many different non-inflammatory biomarkers associated with depression to ignore, including genetic.
Below are a couple of articles that can support the "inflammation leading to depression" directionality. (I've skimmed them quickly, but I haven't read them in detail.)
I'm sure researchers will gather more information before things are sorted out one way or the other. And of course, there are probably a number of etiologies for depression, including genetic contributions. Who knows, perhaps stress leads to inflammatory response, which helps trigger depression for Person A, while a different pathway produces depression for Person B.
http://www.ncbi.nlm.nih.gov/pubmed/22197082
http://stevebmd.files.wordpress.com/2011/04/cytokines-sing-the-blues2006.pdf
Posted by SLS on January 2, 2013, at 17:46:40
In reply to Re: More evidence of inflammation and depression. » SLS, posted by Emme_V2 on January 2, 2013, at 16:59:00
Hi Emme_V2
When you have a chance, can you excise and quote the passages that you believe are proof of directionality?
I still don't see it.
- Scott
Posted by SLS on January 2, 2013, at 19:06:43
In reply to Re: More evidence of inflammation and depression. » Emme_V2, posted by SLS on January 2, 2013, at 17:46:40
> Hi Emme_V2
>
> When you have a chance, can you excise and quote the passages that you believe are proof of directionality?
>
> I still don't see it.Perhaps I haven't made myself clear. I believe that, once established, major depressive disorder (MDD) can produce inflammation, which then contributes to the the worsening and persistence of the disease. It should be expected that there will be findings that describe the mechanics behind inflammation producing depression, otherwise my scenario wouldn't work. So far, everyone has been focusing on how inflammation might cause depression. I haven't seen any efforts made to evaluate how depression might cause inflammation. Depression causes cell damage and cell death through excitotoxicity, why would these events not provoke an immune response? They in fact, do. Microglial activation is the mechanism involved here, as this provokes the release of proinflammatory cytokines. What's more, intact neurons have a suppressive effect on inflammatory processes. Dead neurons provoke them.
I think there is an interplay between depression and inflammation. Each does not exist in a vacuum, and their contributions to the evolution of MDD are not mutually exclusive. It will take elegant study designs to tease out cause and effect. Such a study might look like this:
http://onlinelibrary.wiley.com/doi/10.1111/j.1528-1157.1998.tb01911.x/abstract
"Conclusions: In the kindling model of epilepsy, neither DNA fragmentation nor immune responses were detected. The result indicates that epileptic seizures do not depend on the immune responses. In the KA-treated model of epilepsy, immune responses were closely related to DNA fragmentation, suggesting an association of immune responses with neuronal death. We therefore suggest that immune responses play an important role in the neuronal death process induces by KA"
Robert M. Post and others have suggested that the progression of MDD and BD operate according to a kindling model. It is no mistake that I use this study to demonstrate directionality. Seizures do not depend on inflammation, but they do cause cytotoxicity and cell death. Cell death then provokes inflammatory responses. Inflammatory processes provoked by microglial release of cytokines causes even more cell death. My guess is that a resultant sclerotic scaring of tissue focally makes the epilepsy worse.
For now, I suspect that the induction of MDD does not require inflammation.
Does inflammation promote depression? Yes.
Must inflammation exist before MDD evolves? My guess is no.
- Scott
Posted by baseball55 on January 2, 2013, at 19:13:31
In reply to Re: More evidence of inflammation and depression. » SLS, posted by SLS on January 2, 2013, at 19:06:43
If inflammation directly causes depression, then why doesn't depression lift with an anti-inflammatory drug like aspirin or ibuprofin. If anyone has put their depression into remission with an NSAID, I'd love to hear about it.
Posted by Emme_V2 on January 2, 2013, at 19:22:38
In reply to Re: More evidence of inflammation and depression. » Emme_V2, posted by SLS on January 2, 2013, at 17:46:40
> Hi Emme_V2
>
> When you have a chance, can you excise and quote the passages that you believe are proof of directionality?
>
> I still don't see it.
>
>
> - Scott
>Sure. I'm afraid it might take me a week or so before I have a chance to sit down and fully digest the content, and you will probably beat me to it. :)
But it's really not my conclusions. (If only I were that smart!) Leonard and Maes state in their abstract:
"It is concluded that depression may be the consequence of a complex interplay between CMI activation and inflammation and their sequels/concomitants which all together cause neuroprogression that further shapes the depression phenotype. Future research should employ high throughput technologies to collect genetic and gene expression and protein data from patients with depression and analyze these data by means of systems biology methods to define the dynamic interactions between the different cell signaling networks and O&NS pathways that cause depression."
And they do describe a sequence of processes and what they think needs to come next. Note that they use "may." This is a different field of science than mine, so I'll probably get a bit lost in the details without logging some study time. Since the authors worked through the info and got the thing published in a peer-reviewed journal, I figure that may have a case. Of course they may be totally wrong as well, but that will hopefully get sorted out as the science progresses. And of course, the cause of depression for one person may be completely than the cause for another person, so your idea that depression can cause in inflammatory response may hold true as well.
Posted by jono_in_adelaide on January 3, 2013, at 18:42:39
In reply to More evidence of inflammation and depression., posted by SLS on January 2, 2013, at 7:54:16
Again, this suggests to me that omega 3 fatty acids would be an usefull supplement to antidepressant drugs for a lot of people.
Posted by gadchik on January 3, 2013, at 18:53:56
In reply to Re: More evidence of inflammation and depression., posted by jono_in_adelaide on January 3, 2013, at 18:42:39
I feel a boost when I take fish oil in the morning with breakfast and vit d, and I take klonopin at night. I eat wild salmon when I can too.
Posted by jono_in_adelaide on January 3, 2013, at 19:20:58
In reply to Re: More evidence of inflammation and depression. » jono_in_adelaide, posted by gadchik on January 3, 2013, at 18:53:56
I'm not a fan of fish, so I take 4 x 1000mg fish oil capsules a day with dinner, 2 x 1000mg capsules of flaxseed oil, along with a high potency multivitamin/mineral
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