Webchat about depression and its treatment with Dr Edward Bullmore, Wednesday 2 May at 9pm

[RachelMumsnet]

We’re running a webchat on Wednesday evening at 9pm with Professor Ed Bullmore about depression. Prof Bullmore’s book: The Inflamed Mind offers a breakthrough in our understanding of depression by presenting a link between depression and inflammation of the body and brain. He believes this new research will revolutionise the treatment of depression.

Worldwide, depression will be the single biggest cause of disability in the next 20 years, yet treatment for it has not changed much in the last three decades. Professor Bullmore’s breakthrough research challenges this and shows we need to look at new approaches to the treatment of depression.

Edward Bullmore is Professor and Head of the Department of Psychiatry, University of Cambridge. He is a world expert in neuroscience and mental health, who is leading the development of new anti-inflammatory drugs for depression in partnership with industry. Find out more about his background on the website, The Inflamed Mind

Join the webchat and put questions to Prof Bullmore on Wednesday evening between 9 and 10pm. If you’re unable to join us at that time, post questions in advance on this thread.

@Tinlegs

I suffer from winter depression. I live quite far north so it seems to hit about mid September when I then take Sertraline (low dose) for about 5 months.

Anything I can do to get over this? I walk daily (weather permitting) and try to get sunshine in October overseas. I am pretty healthy but on HRT.

And advice? Or will I need medication every year?

Thanks for sharing your experience of winter depression.

Unfortunately I cant offer any professional advice about your treatment - best to talk to your doctor or other healthcare practitioner

Many people report that mood is sensitive to light, sometimes called seasonal affective disorder, or winter blues. Some people get benefit from phototherapy but the clinical trial evidence that light treatment works is not strong.

Interesting recent study found that levels of inflammatory proteins (cytokines) oscillate over the course of the year – high levels in winter. This coincides with seasonal mood drop but the link between the two is not yet proven.

You mention you are on HRT – there is also some evidence for increased inflammation in post-menopausal women, which might contribute to greater risk of depression in women. Again the evidence is circumstantial rather than definitive at this stage – we don't know for sure that menopause causes inflammation causes depression but it seems to be a conceivable “chain reaction”

Do you think that depression in menopause could be linked with increased inflammation? If so is there any life-style changes we can make to reduce this?

@MyRunMyPace

Can you please summarise the data that suggests that there's a link between inflammation and depression?

I'd also be interested to look at the primary literature, so it would be great if you could give one or two key references.

There is a lot of evidence for an association between inflammation and depression or – more broadly – depressive symptoms. To summarise some of it:
• Increased risk of depression in people with inflammatory disease, like rheumatoid arthritis
• About a third of people with clinical depression have increased inflammatory proteins circulating in their blood
• People who are not depressed to begin with often become depressed after they have experienced acute inflammation – infection, vaccination, inflammatory drug treatment

There are several references to reviews and primary research papers on the underlying science listed in the book if you want to know more. If you search on google scholar for "depression inflammation" you will find a lot of highly cited open access papers

Can I ask what the treatment might be for inflammation induced depression? Is it the same as anti inflammatories for other conditions, which as you know can bring their own problems if taken long term (NSAIDs).

There may be something else in the pipeline or extant though. Thanks

@SilverHairedCat

I on low dose sertraline for moderate depression and high anxiety.

Should I consider taking ibuprofen daily as well, or should I see my GP before making that type of decision?

I'd be concerned about them not being aware of your research, so should I take details to an appointment if I want to explore this with them?

Your question makes a lot of sense - if inflammation causes depression then an anti-inflammatory drug could be anti-depressant. But there is no evidence from clinical trials that ibuprofen works as an anti-depressant. And like all drugs it has side-effects. So it is not recommended to start ibuprofen or other NSAIDs for depression. We need to do more research studies to find anti-inflammatory treatments (not necessarily drugs) that really work as anti-depressants - and if we can find them I think we will also find that they do not work for everyone who is depressed but only for people who are both depressed and inflamed.

So is it possible that a low dose of (enteric coated) aspirin (75mg per day) might in future be prescribed to reduce inflammation and associated depression?

@perfectparentintraining

Are there any storytelling ideas and books for sharing with my 9 and a half year old son about mental health and protecting and maintaining positive mental health?

I like these two short movies, just published by Short Books to explain the background ideas about mood and inflammation. I'd be interested to know what your son thinks of them....

This is a fun, fast animation by Felix Massie and Nexus Studios that runs for less than 2 minutes

This is probably better for a slightly older person - its a quick-draw infographic featuring Helena Maxwell, who also drew the immunoji illustrations in the book

Do you know of any clinical trials that are currently looking at new anti-inflammatory drugs?

@Vangoghsear

So is it possible that a low dose of (enteric coated) aspirin (75mg per day) might in future be prescribed to reduce inflammation and associated depression?

The enteric coating would make aspirin safer, by reducing the stomach irritation and bleeding that it can cause. But aspirin and other NSAIDs dont look like the most promising type of anti-inflammatory drugs that might be anti-depressant. Some of the newer anti-inflammatory drugs - like the antibody treatments for arthritis - might be more effective than NSAIDs. But we still need to do the clinical trials to generate definite evidence that any anti-inflammatory drug really works well as an anti-depressant

Since I was born I've always had psoriasis. For decades now there are a few psoriasis plaques on my arms and legs which get worse when I experience stress. As my psoriasis isn't debilitating I've always seen this increase in plaques as my body sending me a friendly message to say "Pay attention to your stress coping mechanisms" but now I am thinking I should pay more attention to the long standing inflammation - is that likely to be more correct?

My mum suffers with acute rheumatoid arthritis. A few years ago she was in intensive care for some time after a kidney infection resulted in sepsis. Her inflammatory levels are, at times, off the scale but she remains fairly calm. I read your research in the paper recently with interest. Do you believe high inflammatory levels generally will lead to depression or other problems with mental health?

@iVampire

How far does this apply to (what I think of as reactive) depression, following major adverse events? I’m thinking here specifically of living with cancer.

Also, how does your research fit with approaches such as mindfulness based cognitive therapy?

Reactive depression is the way that I was taught as a medical student to think about the association between physical and mental illness. But now I think that there is probably also a direct connection between a physical illness, like cancer, and mental health symptoms like depression

Mindfulness and other meditation or stress management techniques have been shown in some studies to reduce inflammation of the body. So future treatments for depression that work by reducing inflammation wouldnt necessarily be drugs. It will be very interesting to learn more about the anti-inflammatory effects of psychological treatments like mindfulness

Hi Ed, there is a very clear genetic pattern if severe depression in my family and I worry about what this means for my children. Do you think that hereditary depression could also be caused by inflammation?

I've experienced mental health issues in the past, and I've found that I haven't exactly wanted to shout about these from the rooftops - either then or now. Why is the onus for talking about these things put onto those who are affected?

Interesting theories!
Do you think depression should be treated without the body/mind separation?
For example looking at the food we consume and other illnesses or malnourishment?

@GorkyPark

My mum suffers with acute rheumatoid arthritis. A few years ago she was in intensive care for some time after a kidney infection resulted in sepsis. Her inflammatory levels are, at times, off the scale but she remains fairly calm. I read your research in the paper recently with interest. Do you believe high inflammatory levels generally will lead to depression or other problems with mental health?

As you point out - not everybody who becomes inflamed gets depressed. You could say your mother was resilient to the effects of inflammation on her mood. Other people are more vulnerable.

Research has shown that many people who have interferon treatment - which is a strong drug that actually makes inflammation worse in order to help the body control viral infection - will subsequently become depressed. But not all of them. Only about a third of interferon treated patients became depressed - the rest were resilient - and there is some evidence that genetic differences between people help to explain the differences in their mood response to inflammation

@EqualityIllusion

I've experienced mental health issues in the past, and I've found that I haven't exactly wanted to shout about these from the rooftops - either then or now. Why is the onus for talking about these things put onto those who are affected?

I think youre touching on the issue of stigma. One very common way of stigmatising mental illness is not to talk about it. People "dont know what to say", so as you say the onus often falls on the depressed person, who is not at their most sociable by definition, to introduce the subject into the conversation....not easy

Personally I think that better understanding of the causes of depression will help to address stigma in future. If depression has a bodily cause, at least in some people, that helps, I think, to deal with it less silently and shamefully than we tend to do at the moment

@Gingerbiscuit83

Do you know of any clinical trials that are currently looking at new anti-inflammatory drugs?

Please check on clinicaltrials.gov for a full and uptodate list of all clinical trials currently ongoing

@Choccywoccyhooha

Hi Ed, there is a very clear genetic pattern if severe depression in my family and I worry about what this means for my children. Do you think that hereditary depression could also be caused by inflammation?

Hi - the genetics of depression are only just now swimming into focus in the sense that we are just beginning to see which genes in particular are most important. I wrote an article recently about the genetics of depression that you might find interesting

www.theguardian.com/commentisfree/2018/apr/29/revolution-in-our-understaning-of-depression-will-be-life-transforming

Hi Ed, for those who currently experiencing depression, what would you suggest is the best way to manage it (given that the research into inflammation is very new and you have said more work needs to be done before treatments etc are known about?)

Thanks!

@Ethelswith

I have psoriasis, so am probably have inflammation most of the time.

a) what shouid I look out for in terms of early, subtle manufestations?
b) what if anything can be done to reduce inflammation? Diet? Supplements? Exercise?

Personally I think that diet is likely to have effects on the immune system, possibly because what you eat influences the microbiome - the colony of bacteria living in the gut - and if the microbiome becomes more toxic under some dietary regimes you can see how this could cause inflammation. But to my knowledge the scientific data to link diet to inflammation isnt yet compelling...I could be wrong about that, its not an area Ive really looked into but my impression is that the connection is plausible rather than proven at this point

Oh, I read that article!

I actually found this sentence really upsetting:

'Is the depressed son of a depressed mother the victim of her inadequate parenting and the emotionally chilly, unloving environment she provided during the early years of his life?'

I felt that it suggested that depressed Mothers are emotionally distant and inadequate - is this actually true? And what about depressed Fathers? (I appreciate that you were probably just trying to say Or is it nurture?).

And thank you for your reply to my earlier question 🙂.

Do you think all causes of depression are caused by inflammation - or some - it is it just too early to say?

@Notmybag

I started to take ssri medication for postnatal depression. A while later I was diagnosed with idiopathic urticaria - it was severe at times and made life difficult to cope with. It had no established cause or trigger. This was attempted to be treated with doxepin, montelukast, fexofenadine at higher and higher doses. The urticaria didn't budge and the depression was getting worse. The conditions became intertwined. After several years the urticaria went into remission and so did the depression.

I always felt there was a link. I will read your comments with interest.

Thanks for sharing your experience. I have not heard of a link between urticaria and depression before. Urticaria is an immune (allergic) response, a bit like asthma or hay fever, and this type of immune disorder doesnt seem to be as strongly associated with depression as other immune disorders like rheumatoid arthritis or multiple sclerosis.