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Watch out! Got inflammation? The it's aggressive meds for you!

Messages
3,263
Neuroinflammation has been a known correlate to psychiatric diseases for a long time, but the evidence never seems to gain traction or lead to effective pharmaceutical treatment for neuroinflammation. It could be because medicine isn't very good at treating neuro-immune diseases. However, in the case of life threatening neiro-immune conditions like anti-NMDAR encephalitis, medicine will treat aggressively with immune suppressants and other full measures.

I think the real reason psychiatric problems, which are likely of a neuro-immune, and thus neuroinflammatory origin, are treated with half measures like anti-depressants, atypical antipsychotics, or behavioral therapies comes down to money plain and simple. The perfect combination of managed healthcare, robber-baron-like pharmaceutical companies, and doctors pressured to see more patients in less time, and finally, the unlikelyhood of imminent death are some of the reasons why psychiatric patients get destined to half measure treatments.

A perfect example of this idea is the diagnosis of treatment resistant depression. TRD is by credible accounts a neuroinflammatory condition, and thus deserves the real full measure treatments like this article suggests, yet so many TRD patients continue trying over 25 drug combos and other half measures. The fact that TRD is a real diagnosis that sticks, instead of the patient's health-care team seeking a new diagnosis when its obvious depression treatments aren't working, cynically demonstrates the pervasiveness of half measures in medicine and a lacking in a sense of urgency among individual physicians.

http://www.psychiatrictimes.com/maj...ent-resistance-major-depression-perfect-storm
I agree with pretty much everything you say here, @Dichotohmy. Except that I feel calling it neuro-inflammation begs the question. Its inflammation, pure and simple. Makes people feel tired and yuk. Looks to a doctor like depression (and maybe even feels a bit like that). Whether than inflammation is initiated within the CNS, I haven't yet seen any convincing evidence.

I wonder what the behavioral signature of this inflammation-related depression is. How it differs from other forms. I wonder if some of the more severe features might not be present as often - the loss of hope, low self-esteem and/or lack of desire to do things. Answering these sorts of questions might helps us build a better model of disorders that cause psychological distress, one that isn't so generic.
 

A.B.

Senior Member
Messages
3,780
I don't think the inflammation is being ignored, because in the above article it mentions that:

I did not say that inflammation is ignored. I said that the possibility that this is really an inflammatory disease is ignored. They're still trying to continue with complicated, unproven and vague cognitive behavioural psychosomatic models. They're writing that "stress" causes inflammation. We know what kind of stress they mean: that of emotional distress, negative thinking, etc. I could be wrong since as usual things are kept vague but these folks are from the King's College psychiatry department, big fans of this way of thinking.
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
Looks to a doctor like depression
That is the problem. Depression is just a symptom, and may in fact be many other things other than some psych issue, including inflammation and inflammatory processes.

Not one single mental diagnosis is proven to be a discrete entity. Schizophrenia and Alzheimers are in the process of such proof, largely due to advances in biomedicine. and they may yet turn out to be multiple entitites.

Scales and cursory interviews with doctors and psychs who have inadequate knowledge can easily misinterpret physical issues that cause some cognitive or emotional distress as depression. Questionnaires designed to detect depression may produce huge numbers of false positives.

Its not quackery for the most part. Its also not science for the most part. Its a diagnostic labeling system that is way past its due date. One problem is its very hard to retire such a system until after we have an alternative. If doctors treated the diagnoses cautiously, and treated the patient instead, without asserting any diagnosis was definitely right, I suspect things would be better.

The reason they typically do not try to cure inflammation, but just prescribe NSAIDs for example, is that they have no idea how to do so. How do they find the cause? It can be a long diagnostic process, taking years, with no guarantee they will find the answer or that a treatment even exists at this point in time.
 

knackers323

Senior Member
Messages
1,625
anyone know if any cfsers have tried immune suppressants (imuran for example) like those given for other suspected autoimmune illnesses? i
 

ukxmrv

Senior Member
Messages
4,413
Location
London
so are these two separate things then?

a group of patients who are dx'ed with Depression and respond to the conventional drugs and who don't have inflammation (well at least what they are looking for here). Could they have the old idea of a serotonin problem.

and a second group who have an inflammatory condition who are maybe being misdiagnosed as having "Depression"

I'm wondering if this second group has a whole host of other symptoms but only the mood ones are being reported or taken notice of.
 
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Messages
3,263
anyone know if any cfsers have tried immune suppressants (imuran for example) like those given for other suspected autoimmune illnesses?
No, never heard anyone trying that. I went on prednisone during a very bad crash last year. It worked a treat, but the effects sort of "wore off" after a while. Not sure why.
 

Hip

Senior Member
Messages
17,824
Neuroinflammation has been a known correlate to psychiatric diseases for a long time, but the evidence never seems to gain traction or lead to effective pharmaceutical treatment for neuroinflammation. It could be because medicine isn't very good at treating neuro-immune diseases. However, in the case of life threatening neiro-immune conditions like anti-NMDAR encephalitis, medicine will treat aggressively with immune suppressants and other full measures.

My understanding is that the association between neuroinflammation and psychiatric diseases has only come to light in recent years. For example, this 2015 article talks of:
A new study published this week is the first to demonstrate that the brains of people with schizophrenia – or at risk of developing it – have significantly higher levels of immune cell activity than those with no sign of the disorder.




How does psychological stress cause inflammation? Cortisol is an antiinflammatory hormone?

In the study posted earlier, the authors propose a model in which chronic psychological stress causes cortisol resistance, which then means cortisol loses some of its anti-inflammatory potency.

That is the first time I have come across this concept of cortisol resistance, although I am familiar with insulin resistance, leptin resistance, and even triiodothyronine resistance.

The study says:
GCR refers to a decrease in the sensitivity of immune cells to glucocorticoid hormones that normally terminate the inflammatory response (6–9). Evidence for GCR in response to chronic stress has been found in parents of children with cancer (10), spouses of brain-cancer patients (11) and in persons reporting high levels of loneliness (5).

However, I don't know how well the studies on this cortisol resistance were conducted, so don't know how valid this finding is.
 
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chipmunk1

Senior Member
Messages
765
Is there test for gullibility I wonder?

http://www.bbc.com/news/health-36459679

When the medical establishment start addressing the real issues, probably never. We need to start thinking why?

I think they will only accept an alternative explanation if they have a treatment to offer for it. Without that they will ignore anything that contradicts their theories.

Antidepressants were discovered by accident while researching a treatment for infection.(tuberculosis).

I think they would rather prefer to offer some an ineffective treatment before they admit that they might have been wrong and don't know how to treat it.

The problem is that if they don't accept that they have been wrong they will never be able to develop a suitable treatment.

You can see the same patterns in ME/Fibromyalgia and many other illnesses.

Very sad but true.
 
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erin

Senior Member
Messages
885
Thank you for the answer @chipmonk1 and it is indeed very sad. And maybe they know that they never be able to treat it. We need to think as well why that is the case.
 

chipmunk1

Senior Member
Messages
765
so are these two separate things then?

a group of patients who are dx'ed with Depression and respond to the conventional drugs and who don't have inflammation (well at least what they are looking for here). Could they have the old idea of a serotonin problem.

even prof. Edward Shorter thinks that the chemical imbalance theory has been dead for decades so that idea, low Serotonin=Depression must be really dated by now. Does Serotonin reduce inflammation?
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
We need to think as well why that is the case.
I think there are a huge number of factors playing into this. Some scientific, some cultural, some just poor reasoning.

First the science:

1. The brain is so very hard to study. The complexity is extreme, and the tools cannot handle that. Its about the hardest thing we have ever studied in science.

2. The issues cross specialties. Psychiatrists, for example, don't have a sufficient skill set. It takes a team, and a team across disciplines.

3. Because of the difficulty with this research, psychiatry has accepted low grade methodology. For example, if using standards in biomedicine I do not think ANY diagnosis in DSM would survive. The standards are very very low. A lot of psychiatry uses and tolerates very poor study methodology, as exemplified by the PACE trial. They use scientific trappings and claims, and in my view this makes much of it pseudoscience at best.

4. Evidence based approaches fail here because of three main reasons:
A. Evidence based on what diagnosis? If the diagnostic criteria are highly flawed, with poor diagnostic accuracy, then what can be said about studies based on them?
B. There are biases in a lot of psychiatric research, that act to increase the probability of making a positive finding. PACE is loaded with them. When you do a review or meta-analysis using EB methods then you risk reinforcing results due to bias. EBM is designed to minimize biases, that is the goal, but if you allow poor methodology, with entrenched biases, then you risk rubber stamping poor research.
C. Vested interests can distort the research base, and this is more worrying when this is due to funding bias and political support, which ties in with Zombie Science. If there are only 10 RCTs, and they were all funded by a small group of interests, then simply doing a review or meta-analysis will fail due to funding bias. Its a huge problem. Again, methodology counts.

I am not anti-psychiatry. I am indeed anti-bad-psychiatry. Psychiatry could be greatly improved, but as has already been posted on this thread that will not happen fast unless they acknowledge and keep working on the issues.


Cultural factors:

1. Psychiatry has failed to embrace science. They kind of do science, and hence its pseudoscience. We NEED something like psychiatry, its a travesty for poor research standards to be accepted.

2. Science used to proceed on the philosophy of logical positivism. Keep supporting your claims, its up to others to prove you are wrong. Most of science moved on from this in the middle of last century, instead moving to critical rationalism. (For the record, I am a pancritical rationalist, which is related to this.) Critical rationalism basically says that ideas need to be tested, and the better the tests the more sure you can be of the results, but you can never be certain. So methodology is critical, again.

3. Doctors do not, as a generalization, complain nearly enough about poor research. They tolerate it. I think this happens in psych a lot due to lack of confidence, and fear of failure. If they complain of other's poor research methodology, what then of their own methodology?

4. Medical culture suppresses dissent. There is this notion of not doing harm to the profession. There is a long history of ignoring or covering up mistakes.

5. Doctors are given privileged status under law. That has to change. Its abused for too often. Just look at the patients with ME or CFS who have been sectioned against their will. Look at the outcomes.

Just to be clear, in case anyone is thinking I am anti-doctor, my heroes are doctors. Top of that list is Barry Marshall, who almost lost his medical licence because he was a "quack". He later shared the Nobel prize. Most doctors who make my list have either had additional education, or worked hard to expand beyond traditional medical roles. Many are researchers.


Low standards of reasoning:

1. Much of medical reasoning is heuristic, designed for fast approximate answers. Time is often critical, either due to a medical crisis or due to insurance or bureaucratic demands. Such reasoning is fast, but its subject to serious flaws. Those flaws are often difficult to see. This kind of thing has been most investigated in economics, but I think it applies in many disciplines.

2. Doctors are not adequately trained in logical reasoning. They fail to see fallacies. Medicine has heavily embraced the dogma and fallacy known as Appeal to Authority. The PACE trial, especially when you consider not just the papers but press releases and interviews, is a morass of so many layered fallacies that I wanted to write a book on it. Maybe my health will improve and I will finish one day.

3. Most doctors do not adequately understand statistics. According to Gigerenzer that is about 80%+ in the USA.

4. Many doctors do not understand the reasoning behind EBM. RCTs are not actually the gold standard, you have to add a string of caveats. Anecdotal evidence is still evidence. Etcetera. Understanding why certain things are done in EBM tells you how the rules should be applied, and also when they do not apply.

5. As a special case of my comment on EBM, bureaucratic and insurance authorities misapply evidence based findings. Those findings are generalizations, and they limit the options of both doctors and patients if applied dogmatically. Even if some guideline (and they call them guidelines but sometimes treat them as hard rules) is 95% useful, then that still means that one in twenty patients will be poorly served by them. Doctors need the flexibility, training and resources to adapt to patients who do not fit the neat pigeonholes. We see that in the ME and CFS community a lot. Doctors are being trained to be inflexible. The bureaucrats want inflexible doctors.


I may no longer be capable of writing my book right now, but I can still give you some pieces of my analysis along the way.
 
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ebethc

Senior Member
Messages
1,901
Finding clear signs of inflammation in the brain should be enough to cause a paradigm shift here - why are they still calling it a mental disorder?

Oh yes that's right, negative thoughts and bad coping skills causes stress, which leads to inflammation in the brain. Now you need a lot of CBT and mindfulness to make you cope with everyday life.


haha.... everytime someone puts that kind of thinking on me, I tell them that I'm going to come over to their house the next time that they have the flu and start putting psychiatric labels on them.... sometimes, the only way ppl can empathize is if you make it about them
 

ebethc

Senior Member
Messages
1,901
These TRD diagnosed patients eventually find themselves abandoned by psychiatry, because none of the psychiatric treatments work. Medical doctors won't try to help them either, because they are diagnosed psych patients.

A TRD diagnosis means long term abandonment by the medical system with no treatment. It's appalling.

exactly!
 

Hip

Senior Member
Messages
17,824
I did not say that inflammation is ignored. I said that the possibility that this is really an inflammatory disease is ignored. They're still trying to continue with complicated, unproven and vague cognitive behavioural psychosomatic models. They're writing that "stress" causes inflammation.

Well looking at Professor Carmine Pariante's list of publications, these papers mostly seem to be trying to link mental symptoms with physiological correlates such as inflammation, reactive oxygen species, HPA axis dysfunction, immune system genes, and so forth. I don't see any psychosomatic models there (apart from the stress stuff, but that's the side of psychosomatic research I think is valid).

For example, this paper by Pariante:
Are mood and anxiety disorders inflammatory diseases? - Research Portal, King's College, London

Professor Pariante is head of the King's College Stress, Psychiatry and Immunology Laboratory.

This is a different research group to the King's College NIHR Biomedical Research Centre, where you find Wessely School members Simon Wessely, Trudie Chalder, Anthony Cleare and Anthony David.



Whether than inflammation is initiated within the CNS, I haven't yet seen any convincing evidence.

I should think it does not matter that much whether the neuroinflammation its initiated within the CNS, or whether the source of the neuroinflammation is further afield in the body: provided the source somehow causes inflammation in the brain, you might expect neuroinflammation-associated mental symptoms such as depression to arise.

It is now known that infection / inflammation in the body peripheries such as the gut can trigger neuroinflammation in the brain, by signals transmitted along the vagus nerve (and via other routes). This may explain why, for example in irritable bowel syndrome you can experience anxiety and depression: the inflammation in the gut may be triggering inflammation in the brain by a vagus nerve mechanism.

I sudden got significant and chronic anxiety symptoms after developing IBS, which did not make sense to me at the time, but now knowing about the vagus nerve connection from gut to brain, the pieces start to fall into place.


The source of inflammation I should think is important in terms of treatment, though: if a large component of your brain inflammation-induced anxiety or depression actually derives from the gut, then you may be better off treating the gut rather than the brain.

I found that supplements like prebiotics and probiotics which reduce gut inflammation significantly reduced my IBS-associated anxiety.
 
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ebethc

Senior Member
Messages
1,901
@ebethc
That is why I was pleased to see this new research, which has developed a test for the neuroinflammation that can cause depression. This is definitely psychiatry moving in the right direction: looking for abnormalities in the brain to explain mental symptoms.

In my case, I do not think that I have depression at all (in spite of much neuroinflammation)... I told a psych doctor that I was NOT depressed, and she told me that I just had a "somatic depression" ...confirmation bias! I think shrinks are usually too insecure to ever change their minds even when someone point blank tells them they're wrong... they'll just rationalize it another way, but stick to the original dx... my story is not unique..

Another thing is that I DO get depressed b/c anyone w chronic illness and all the big problems that go along with it (financial, social in my case) will break down sometimes.... However, this is very rare, and ultimately, it's been a good tool to help me differentiate between being physically ill and being psychologically ill.

So, no, neuroinflammation does not necessarily equal depression. 1) it CAN cause biological depression along with other factors, and 2) it can co-exist w a psychological depression.
 

wastwater

Senior Member
Messages
1,271
Location
uk
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Hip

Senior Member
Messages
17,824
So, no, neuroinflammation does not necessarily equal depression. 1) it CAN cause biological depression along with other factors, and 2) it can co-exist w a psychological depression.

My hunch is that it may depend on which areas of the brain have inflammation / immune activation. The nature of the mental symptoms will likely depend on which brain areas are involved.