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Understanding the Relationship between Depression and the Immune System
Jules Washington
The immune system is one of the body's most valuable assets. Immune cells race to the site of a new infection or injury, where they work tirelessly against bacteria and viruses or repair tissue damage.
Yet depression and the immune system are inextricably linked. Research shows, for example, that depression is more common in people with other disorders of the immune system, such as diabetes and rheumatoid arthritis. For instance,
diabetes doubles the risk of depression . At the same time, people with depression have up to
t
hree times as many inflammatory cells as those without depression. This excess of inflammatory cells signals that the immune system isn't functioning normally. People with treatment-resistant depression are even more likely to have elevated inflammatory markers.
However, these links also mean that seeking depression treatment can benefit your overall health. Read more for a closer look at the relationship between depression and the immune system.
How Depression Affects the Immune System
While evidence shows that depression and the immune system are connected, researchers don't fully understand that connection, though they have established some theories.
For example, chronic stress—an integral feature of depression—raises levels of a stress hormone called cortisol. This affects microglia cells, traditionally known as "housekeeper" cells because they calmly protect healthy nerve cells and efficiently remove debris. Their ability to migrate quickly to an accident site (any part of our body that is infected or injured) to do so highlights their crucial role in the body's
immune response.
A stress-related cortisol surge causes previously calm housekeeper cells to go "rogue." The
microglia begin to churn out cytokines , which are pro-inflammatory proteins. These cytokines damage the microglia themselves, causing them to churn out even more cytokines. This inflammatory cascade damages synapses—the gaps between nerve cells—and provokes inflammation throughout the brain. The brain regions responsible for controlling mood and emotion are especially susceptible to this inflammatory attack.
These dramatic events decrease the availability of chemical messengers like serotonin and dopamine, thus interrupting normal communication between our brain cells. These chemical messengers are especially important in regulating sleep, appetite, emotion, and memory—all things that are disrupted in depression.
In short, chronic stress can contribute to impaired function of the immune system, and this triggers an inflammatory response in the brain, leading to the symptoms of depression.
Which Immune Disorders Are Associated with Depression?
It's important to understand the basics of how depression and the immune system interact, but specific examples can help illuminate the relationship.
You're
more likely to develop a common cold , for instance, if you've experienced ongoing psychological stress. Not only that, but a cold can linger for longer, far outstaying its welcome. Scientists believe this is because the immune system is dialed up with chronic stress, leading to excess inflammation.
If you have depression, you could have a greater
tendency toward cardiovascular disease , another disorder related to inflammation. Up to 40 percent of people with
heart disease develop depression at some point in their lives, and those with heart disease develop depression at three times the rate of the general population. People with depression have a 64 percent greater risk of
developing coronary artery disease .
Evidence also points to a higher risk of cancer in people with depression. This could be related to a greater tendency of some patients with untreated depression to smoke, drink alcohol to excess, or remain sedentary—all risk factors for cancer. But there also appears to be a consistent, independent link between depression and an impaired immune system in cancer: the same pro-inflammatory proteins, cytokines, exist in both conditions. This association has been reported in
pancreatic cancer and
ovarian cancer , among others.
Reassuringly, treating depression could make a difference. Research published in the
Journal of Clinical Oncology found that decreasing the symptoms of depression in women with advanced breast cancer was associated with
longer subsequent survival.
Treating Your Mental Health Can Benefit Your Physical Well-Being
Indeed, seeking treatment for depression can help your physical and mental health alike. One study followed people over eight years and found that treating depression as soon as possible decreased their risk of strokes and heart attacks by half. Depression treatment has also been found to improve sugar levels , decrease pain , and boost cardiovascular health.
Remarkably, depression treatment can cause inflammation in the brain to vanish, showing how closely depression and the immune system are intertwined. A major study in the
Lancet journal focused on people with longstanding untreated depression. These patients had high levels of immune system activation (as measured by activated microglia cells) that built year on year in brain regions crucial for mood and behavior. However, when these patients received antidepressant treatment, this
yearly increase in inflammation disappeared.
Given the far-reaching impact of depression treatment on the brain and body, what can you do if depression medication hasn't provided the symptom relief you hoped for? One non-drug treatment option for depression is
Transcranial Magnetic Stimulation (TMS). TMS applies highly focused magnetic pulses to the brain regions that regulate mood. TMS has been cleared by the FDA for Major Depressive Disorder and has been shown to
decrease signals of brain inflammation in people with depression.
Whichever treatment option you choose, one thing is clear: proactively addressing your symptoms of depression can enhance your overall health. Dialing down your immune system to a healthy level by reaching out for depression treatment is a way to heal your body and mind.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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