An inflammatory story: Depression and immunity
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What is the historical view of melancholy and how does it relate to modern depression?
Natasha Mitchell on board. It's all in the mind time on ABC Radio National. Welcome. Now, is there a certain pleasure to be had in melancholy? I wonder if that's ever been your experience.
Friends and companions get you gone. It is my desire to be alone. Ne'er well but when my thoughts and I do domineer in privacy. No gem, no treasure like to this. Tis my delight, my crown, my bliss. All my joys to this are folly, naught so sweet as melancholy.
But of course, when melancholy turns sour, these days we tend to call it depression, don't we? Or perhaps even clinical depression. A rather different interpretation or experience.
Tis my soul plagued to be alone, I am a beast, a monster grown. I will no light nor company, I find it now my misery. The scene is turned, my joys are gone, Fear, discontent, and sorrows come. All my griefs to this are jolly, Nought so fierce as melancholy.
From Robert Burton's remarkable tome, The Anatomy of Melancholy, first published in 1621, and I really recommend it. You'll find a link to it on our website. Today on the show, could depression be an inflammatory illness? It's a provocative possibility and a story which links our immune system with our moods, with heart disease, with oxidative stress in the body, which of course we try and prevent by eating things rich in antioxidants. Could omega-3 supplements or even statin cholesterol medications be useful here? And what's all this got to do with depression?
I think most scientists believe in the story, so that there is a connection, an interconnection between depression and inflammation, or even that depression is an inflammatory disorder. I think there is a consensus in the scientific world. But of course there is a big gap between what we know as scientists and what general practitioners know. GPs or physicians are not aware of the possibilities of the relationship between inflammation and depression.
We've known this since antiquity. Hippocrates decided that depression was caused by an excess of black bile. It's interesting, it's only been in the last two decades that we're beginning to understand what this black bile might actually be. And the suggestion is, intriguingly, that it's got something to do with our immune function. Now, this is a bit of a break from conventional thinking, but it's increasingly clear that our brains are completely integrated into the physiology of the rest of the body, and what goes on in the brain alters the body, and what goes on in the body alters the brain.
The 16th century physician Nicholas Piso thought this was the case too, that the black dog was somehow caused by a black bile.
If no symptoms appear about the stomach, nor the blood be misaffected, and fear and sorrow continue, it is to be thought the brain itself is troubled, by reason of a melancholy juice bred in it, or otherwise conveyed into it. And that evil juice is from the distemperature of the part, or left after some inflammation.
Well, some four centuries later, where's the science at now? Joining me today is Michael Burke, Professor of Psychiatry at Deakin University and Professorial Research Fellow at the Mental Health Research Institute. Professor Michael Mars from Belgium, who collaborates with Michael Burke, amongst others, and now heads up the Mars Clinics from Thailand. And physiologist Dr Bronwyn Hegarty from the Black Dog Institute at the University of New South Wales. Welcome. Thanks for having us.
How do scientists link depression to inflammation and immune activation?
Absolute pleasure.
Michael Burke, can I start with you? If you had to summarise what happens to our immune system when we're depressed, how would you describe it?
Well, depression is a state of immune activation. So there's a low-grade but demonstrable increase in inflammation that occurs not only in depression but in actually most major psychiatric disorders, depression, bipolar disorder, schizophrenia. In this regard, they're actually quite similar.
Let's just give people a sense of what inflammation is in the body.
Well, inflammation is the body's defense against external assault. And that assault, for the most part, is bugs, microbes.
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Chapters
8 chapters
1
What is the historical view of melancholy and how does it relate to modern depression?
0:01–4:19
2
How do scientists link depression to inflammation and immune activation?
4:19–7:46
3
What evidence shows that cytokines are elevated in people with depression?
7:46–11:15
4
Does inflammation cause depression, or can depression trigger inflammation?
11:15–13:49
5
How might lifestyle factors like diet, exercise, and smoking influence inflammation‑related depression?
13:49–18:44
6
What role do omega‑3 fatty acids play in reducing inflammation and improving mood?
18:44–22:40
7
Can statins or aspirin be used as anti‑inflammatory treatments for depression?
22:40–26:42
8
Why is it important to view depression as a biological, inflammatory condition rather than just a serotonin issue?
26:42–29:57