Is Depression, Caused by Inflammation?

Depression is a leading cause of disability and is the fourth largest cause of burden of disease amongst all diseases (1) and affects one in three women.  Anybody who has ever suffered from depression or has a loved one who suffers from it knows how debilitating it can be. 

Treatment has traditionally focused on improving serotonin levels, but figures show around 35% remission after initial treatment and approximately 70% remission after four cumulative treatments (1) It is necessary to look beyond serotonin to find out what is causing depression, and adapt natural support to rebalance the underlying causes.

 

Raised inflammatory markers in depression

People with depression have increased levels of inflammatory substances such as interleukin-1 (IL-1), interleukin-6 (IL-6), tumour necrosis factor-α (TNF) or C-Reactive Protein (CPR) in the blood(1,2,6,8) Higher levels of these markers affect brain signalling and produce symptoms such as fatigue, changes in appetite, increased sleep, lack of motivation, negative mood, decreased cognition and weight changes (5,8) – the classical symptoms of depression.

Conversely, people who are treated with inflammatory substances (eg interferon in cancer treatment or chronic infections) start to show depression-like symptoms (2) So what is the link between inflammation and depression?

 

Inflammation depletes serotonin

Inflammatory substances such as IL1, IL-6, TNF and CRP stimulate the formation of IDO (indoleamine 2,3-dioxygenase), an enzyme involved in the tryptophan metabolism. Unfortunately, this enzyme does not push tryptophan towards the serotonin pathway, but towards the kynurenine pathway instead. (1,3) This can reduce serotonin levels by 25-50%. (1) It stands to reason that we need to reduce inflammation to help improve depression, but to effectively do this we need to find out where this inflammation is coming from in the first place.

 

Where does inflammation start?

Conditions such as endometriosis, PCOS and other reproductive disorders are linked with inflammation, and very often patients suffering from any of these conditions also suffer from low moods or depression. The debilitating symptoms are enough to make anyone feel low, but the underlying inflammation is the real trigger that needs to be looked at.

Research shows that inflammation also often starts in the digestive tract, with harmful bacteria causing leaky gut (7). As the intestinal wall becomes more permeable, the immune system is activated. As part of the immune response there is an increased production of pro-inflammatory hormones such as IL-1, IL-6, TNF and interferon-ϒ (IFN). As described above, these substances increase the metabolism of tryptophan to the neurotoxic quinolinic acid rather than the ‘feel good’ hormone serotonin (3).  These hormones can also trigger an auto immune response triggering conditions like Rheumatoid arthritis, hashimotto's, Lupus and possibly MS.

Not everybody who suffers from frequent low moods or is depressed will have PCOS, endometriosis, or bowel dysbiosis; but everybody would benefit from finding out what underlying causes trigger low moods or depression, especially if they have tried anti-depressants and find they don’t work.

 

What can you do about this yourself?

A holistic treatment plan that addresses the cause and not just the symptom is crucial.   Look beyond the boundries of a general 'symptom based' simplistic consultation.   Fourteen years of clinical experience highlights the need for segmentation based, multilayer, diagnosis techniques as part of the initial step in getting to the cause. 

 

Establishing the underlying cause, ensures effective natural support.  Targeting medicinal herbs and orthomolecular nutrients assist in reversing the cause. 

This was the case in Yvonnes journey.  Read her story here.

There is a great deal of research to promote the benefits of incorporating natural support in depression.  Even something as simple as EFA's such as Omega3 Fatty acids have been found to make a difference.  Omega 3 poly unsaturated fatty acids found in fish oil not only have a strong anti-inflammatory effect, but also improve fluidity of the cell membranes (3,9). There are many studies that associate increased intake of omega 3 EFA’s with improved cognition and moods. (9) Apart from this, they can improve serotonin binding (10), further improving moods.

EFA’s could be part of a holistic treatment plan, but as each patient is different and some may already be on anti-depressants, each treatment approach is different, too. It is always best to contact your health care practitioner to provide a solid platform to redefine your health.

Narelle Stegehuis, is a practicing medical herbalist and naturopath specializing in restorative endocrinology for women, with over 14 years clinical experience.  She is both an accomplished writer, editor and technical training advisor.  A recipient of the Australian Naturopathic Excellence Award, Narelle adopts an integrated approach of both medical science and traditional complementary health care principles.  She can be contacted at www.massattack.com.au

References:
1. DM Christmas, JP Potokar, SJC Davies, “A biological pathway linking inflammation and depression: activation of indoleamine 2,3-dioxygenase – Neuropsychiatric disease and treatment 2011:7 431-439
2. B Messay, A Lim, AL Marshland, “Current understanding of the bi-directional relationship of major depression with inflammation” – Biology of Mood & Anxiety Disorders, 2012, 2:4
3. M Maes, “The cytokine hypothesis of depression: inflammation, oxidative & nitrosative stress (IO&NS) and leaky gut as new targets for adjunctive treatments in depression” – Neuroendocrinology letters 2008:29(3):1-000
4. Chrousos GP et all, “ Interactive functional specificity of stress and immune response: the yin, the yang, and defence against two major classes of bacteria” – Journal of Infectious Disease, 15th Aug 2005;192(4):551-555
5. R Dantzer et all, “From inflammation to sickness and depression: when the immune system subjugates the brain” – Nature Reviews Neuroscienice 9, January 2009, 46-56, doi:10.1038/nrn2297
6. R Dantzer, “Depression and inflammation, and intricate relationship” – Biological Psychiatry, vol 71, issue 1, p 4-5, 1st January 2012-07-01
7. Maes M et all, “Increased IgA and IgM response against gut commensals in chronic depression” – Journal of Affective Disorders, 11th March 2012, doi:10.101/j.ad.2012.02.023
8. Krishnadas R, Cavanagh J, “Depression: an inflammatory illness?” – Journal of Neurology, Neurosurgery and Psychiatry, 83 (5) 495-502, doi:10.1126/jnnp-2011-301779
9. Nurk E, Devron CA, Refsum H et all, “Cognitive performance among the elderly and dietary fish intake: the Horland Health Study” – Am Journal of Clinical Nutrition 2007; 86:1470-1478
10. Huang JTJ, Leweke FM, Oxley D et all, “Disease biomarkers in cerebrospinal fluid of patients with first-onset psychosis” – Plos med 2006,3(11):e428

Natural Relief For Interstitial Cystitis

According to the National Institute of Health one in five women experience discomfort caused by Interstitial Cystitis (IC).

Women’s health expert and naturopath Narelle Stegehuis, explains that “effective management requires an individualised approach to provide long term relief”. 

Interstitial Cystitis is a complex condition caused by erosion of the protective bladder lining. This may be due to infection, inflammation, hormones,  autoimmune conditions or a combination of factors.  For many suffers, symptoms are often worse during ovulation and under stress due to a neuro-hormonal connection. 

Symptom relief can be achieved with traditional herbal support that targets the underlying cause.  This can be established with hormonal profiling and wellness mapping. 

For example, Rachel achieved relief from IC by applying a combination of antimicrobial herbs such as Thymus vulgaris and anti inflammatory herbs such Achillea millefolium, as the underlying cause of her IC was triggered by bacteria and inflammation.  Other herbs such as Passiflora incarnata were included in her tonic since stress was thought to be a contributing factor.  This is why a tailored herbal tonic is often the best choice of natural treatment.

So What Natural Support Is Available?

IC may improve with medical treatment but unfortunately infection associated with both of these conditions may be resistant to traditional antibiotic treatment which means symptoms may recur with time. 

Improving bladder tone and the health of the urinary tract is achievable in three easy steps:

Step 1 Identify The Cause

A diagnosis for IC can be both time consuming and frustrating and even once a diagnosis is made, treatment options can be limited until you isolate the cause. “Symptomatic health screening and hormonal profiling coupled with pathology testing to identify the underlying factors triggering the symptoms, is the first step in the right direction”, says Stegehuis.  “Once the cause is established, effective long term management is possible”.

Step 2 Diet and Lifestyle

Start making small changes such as giving up coffee and alcohol.  Consume foods that promote alkalinity within the body and remove allergens such as wheat or dairy from your diet.

Other changes depend upon a more individualised approach such as tailored diet and lifestyle changes to support immune or digestive health and hormonal balance.

Step 3 Targeted Treatment

Finally, the choice of traditional herbal medicine for IC and UTI’s depends upon the underlying contributing factors to the condition, such as hormones, auto-immunity, central nervous system excitability, bacterial infection, inflammation or digestive weakness .

According to Stegehuis, a common mistake is to take Vaccinium macrocarpon (cranberry) for IC.  For many women with this condition, taking this herb aggravates the condition. 

Probiotics such as Lactobacillus rhamnosus may provide beneficial support for IC caused by Escherichia coli due to their protective influence on the immune system. 

Remember, IC is a complex condition requiring an individualized treatment approach.  This is why I recommend sufferers seek the expertise of a qualified health practitioner and if symptoms persist seek medical advice.

Narelle Stegehuis, is a practicing naturopath and medical herbalist specializing in the natural treatment of women's health and hormonal imbalance for over 14 years. She is both an accomplished writer, editor and recipient of the Australian Naturopathic Excellence Award.  

To find out more, call 1300 133 536 or visit www.massattack.com.au

Getting Sick Too Often?

Beating the Winter Blues: Naturally

Most adults will get at least two colds every year, and children can get up to eight. This is hardly surprising given that there are more than 200 viruses known to cause respiratory tract infections. Although viral illnesses are rarely serious they certainly cause misery and may lower immune defenses against more dangerous secondary bacterial infections.

Fighting viral infections – Colds and 'flu

There are a number of clinically effective Natural Medicines that can be used to help your patients support their immune systems and fight viral infections this winter, including the Ayurvedic herb Andrographis paniculata. Traditional use of Andrographis effectively stimulates immunity and reduces inflammation; used in the acute stages of viral infection, Andrographis has been shown to reduce cold and ‘flu symptoms and shorten the duration of illness.

To enhance these effects, a personalized herbal tonic blends Andrographis with Picrorrhiza kurroa and Sambucus nigra to help relieve symptoms of fever, sore throats and excessive mucous secretions to shorten the duration of colds and 'flu.

Certain mushroom extracts may also help fight off viral infections. Research focused on the immune enhancing effects of Japanese mushrooms finds the extracts from Coriolus versicolor and Grifola frondosa to powerfully boost immune surveillance against viral infection and reduce the risk of secondary bacterial infection. Together these mushroom extracts help prevent and treat viral infections in those with poor immunity.

Nutritionally, zinc and vitamin C are important as they are both rapidly depleted during the acute stages of infection. An acute dosage strategy of up to four doses of Zinc and Vitamin C Powder daily from the first signs and symptoms of a viral infection is recommended to support immunity and prevent depletion.

Narelle Stegehuis, is a practicing medical herbalist and naturopath specializing in restorative endocrinology for women, with over 14 years clinical experience.  She is both an accomplished writer, editor and technical training advisor for the Complementary Health Care Council.  A recipient of the Australian Naturopathic Excellence Award, Narelle adopts an integrated approach of both medical science and traditional complementary health care principles. 

Her services can be accessed at www.massattack.com.au or www.bumpfertility.com.au

Natural Support for Bladder Infections

Interstitial Cystitis (IC) and Urinary Tract Infections (UTI’s) are two very different conditions experienced by women.  Two questions that women often ask are ‘what is the difference?’ and ‘are there effective natural solutions to help?’

So let’s firstly explore the difference between Interstitial cystitis (IC) and non complex Urinary Tract Infections (UTI’s).

Interstitial Cystitis is a complex condition of the bladder, caused by the protective bladder lining breaking down.  This may be due to infection, inflammation, hormones or autoimmune conditions.  With IC symptoms often worse during ovulation and under stress, a ‘neurohormonal' and immune connection is likely for many women [1-6].  

Urinary tract Infections however, are infections of the urinary tract.  Bacteria that live in the digestive tract, in the vagina, or around the urethra are the most common cause of UTIs.  Research also supports the influence of hormones such as estrogen associated with reproductive disorders (Poly Cystic Ovarian Disorder, or Endometriosis for example)  enhancing the growth of many bacteria associated with recurrent UTI’s [5].

Although symptoms like bladder pain and urinary symptoms, such as frequent voiding (feeling like you want to go to the toilet a lot) and urgency are common to both conditions, IC is vastly different with patients describing pain as intolerable. 

So what natural options are available?

Both IC and UTI’s may improve with medical treatment but unfortunately infection associated with both of these may be resistant to traditional antibiotic treatment which means symptoms may recur with time. 

Improving bladder and the health of the urinary tract is achievable in two easy steps.

Step 1 Identify the underlying cause 
Step 2 Implement a targeted treatment strategy to address the cause 

You can also start today by making small changes such as giving up coffee and alcohol and consuming a more alkaline diet.  Infact, adapting your diet and lifestyle according to your hormonal profile, can make the world of difference. 

Finally, the choice of traditional herbal medicine for IC and UTI’s depends upon the underlying contributing factors to the condition, such as hormones, auto-immunity,  central nervous system excitability, bacterial infection, inflammation or digestive weakness . So if you have tried over the counter remedies such as cranberry and still experience symptoms, a personalized herbal tonic by a qualified medical herbalist is best. 

These conditions are complex and require an individualized treatment approach.  It is recommended that you seek the expertise of a qualified health practitioner and if symptoms persist seek medical advice.

Narelle Stegehuis, is a practicing naturopath with over 30,000 hrs of in-clinic experience specializing in the natural treatment of women's health and hormonal imbalances. She is both an accomplished writer, editor and recipient of the Australian Naturopathic Excellence Award. 
To find out more, visit www.massattack.com.au

References

1.            Grover, S., et al., Role of inflammation in bladder function and interstitial cystitis. Therapeutic Advances in Urology, 2011. 3(1): p. 19-33.

2.            Montag, S. and R. Moldwin, Minimally Invasive Therapy for Interstitial Cystitis/Painful Bladder Syndrome, in Smith's Textbook of Endourology2012, Wiley-Blackwell. p. 1640-1649.

3.            Hsieh, C.-H., et al., Treatment of interstitial cystitis with hydrodistention and bladder training. International Urogynecology Journal, 2008. 19(10): p. 1379-1384.

4.            Fall, M., P. Hanno, and J. Nordling, Bladder Pain Syndrome, Interstitial Cystitis, Painful Bladder Syndrome, and Hypersensitive Bladder Syndrome: New Nomenclature/New Guidelines. Current Bladder Dysfunction Reports, 2011. 6(3): p. 116-127.

5.            Sonnex, C., Influence of ovarian hormones on urogenital infection. Sexually Transmitted Infections, 1998. 74(1): p. 11-19.

6.            Theoharides, T.C., et al., Interstitial Cystitis: A Neuroimmunoendocrine Disordera. Annals of the New York Academy of Sciences, 1998. 840(1): p. 619-634.

7.            Mills, S.B., K., Principles and practice of Phytotherapy2000: Churchill Livingstone.

8.            Naish, F.R., J., The Natural Way To Better Babies: preconception health care for prospective parents. Vol. 5. 1996: Random House.

9.            Mills, S.B., K., The Essential Guide To Herbal Safety2005: Elsevier, Churchill Livingstone.

10.          Sarris, J.W., J., Clinical Naturopathy2010: Elsevier.

11.          Pizzorno, J.S., P., Naturopathic Medicine: Fundamentals of Complementary and Integrative medicine.2006, St. Louis: saunders Elsevier.