A Compelling New Theory of Depression

A Compelling New Theory of Depression

A fascinating theory has been put forward by Turhan Canli PhD, Associate Professor of Psychology and Radiology at Stony Brook University, which could change the future direction for research and treatments of depression. 

According to Dr Canli, depression should be re-conceptualised as an infectious disease. His argument is a compelling one.

In a paper published in Biology of Mood & Anxiety Disorders, Dr Canli suggests that depression could be the result of a parasitic, bacterial or viral infection.

Depression is a pervasive illness, with around 16% of people experiencing an episode at some point in their lives.

There has been little change in treatments over the last few decades and although antidepressants are effective in reducing symptoms in patients with severe symptoms, in patients with mild to moderate symptoms they are no more clinically effective than placebos.

Recurrence of depression is common. Those who have experienced one episode have a 50% chance of recurrence. Those who have experienced depression twice have an 80% chance of experiencing it a third time.

Dr Canli explains, ‘Given this track record, I argue that it is time for an entirely different approach. Instead of conceptualising depression as an emotional disorder, I suggest to reconceptualise it as some form of an infectious disease.’

Dr Canli is also a member of the Program in Neuroscience, and a Senior Fellow in the Center for Medical Humanities, Compassionate Care, and Bioethics. ‘I propose that future research should conduct a concerted search for parasites, bacteria, or viruses that may play a causal role in the etiology of depression.

 Dr Canli presents three arguments for reconceptualising depression as an infectious disease:

  1. ‘Patients with depression experience sickness behaviour’.

    The main criteria for a diagnosis of depression are affective symptoms, specifically a loss of energy and diminished interest in the world and previously enjoyable activities. However  inflammatory biomarkers of depression strongly suggest the origin of depression to be illness related. Dr Canli suggests that the inflammatory markers may indicate the stimulation of the immune system in response to a pathogen such as a parasite, bacterium or virus. He acknowledges that there is currently no direct evidence that depression is caused by a micro-organism, however the process is a plausible one and warrants further research.

  2. There is clear evidence that parasites, bacteria and viruses can affect emotional behavior.

    Parasites: There is evidence that infection by the parasite, T. gondii is associated with elevated inflammatory biomarkers similar to that observed in depressed patients;

    Bacteria: Research has begun to investigating the causal links between emotional behaviour and bacteria in the gut.

    Viruses: A meta-analysis of 28 studies looked at the link between depression and infectious agents. Borna disease virus (BDV) has been found to be 3.25 times more likely to be found in depressed patients than in normal controls. Further research is necessary to understand the link.

  3. The genetics of the illness.

    Genetic studies to date have looked at human genes within the human genome (complete set of DNA). However, the human body is host to other micro-organisms, with their own genetic makeup, that can be passed across generations. As a result, ‘the opportunity for genetic discoveries is vastly amplified’.

Based on these three arguments, Dr Canli suggests the future research in the area involve large-scale studies with depressed patients, controls, and infectious-disease related protocols. He explains, ‘Such efforts, if successful, would represent the ‘end of the beginning’, as any such discovery would represent the first step toward developing a vaccination for major depression.’

[irp posts=”897″ name=”Depression: Why Talking Isn’t Enough”]

13 Comments

Jack

i have had terrible depressive symptoms for the past 9 months. my life had fallen apart around me. Anyway, two weeks ago i got a nasty ear and throat infection. i was prescribed antibiotics which didnt work. i was then prescribed a different type which worked a lot better.
This week, for the first time since January i have no depressive symptoms at all. i feel better than i have for a long time.
i was trying to understand what had happened. the only change was the antibiotics, which is what led me to this page. Could this be the answer?

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Meg

This is particularly fascinating to me as my 15-year-old son was brought almost literally to his knees by a sudden, severe depression the week after doing his first 5K obstacle mud run which took him through countless flooded swamps and even a flooded cow pasture. The depression has barely loosened its grip and continues to flare. Because he has never once had depression or even much sadness I am thoroughly convinced there is something biological at work. Blood tests today!

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heysigmund

That is really interesting. There seems to be a lot of research happening around depression at the moment. It’s opening up different pathways but it’s also making me realise that there’s so much more to know about it. I’m pleased your getting blood tests – it sounds as though your son is in good hands. It will be really interesting to see what they reveal. It must have been awful to see such a sudden change in your son. I hope they find something that can give you both comfort. Would love to hear how you go.

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Meg

Strange to say how upset I am that his blood tests showed nothing. They did a whole CBC workup and blood counts, adrenal function and thyroid are all perfectly normal. No sign of infection. I am waiting to hear the results of Lyme’s disease and thinking of using a consult with a pediatric neurologist to look at other testing. Has anyone heard of PANDAS? It’s a strep infection that affects the ganglia/brain stem and causes mood disorders, tics, etc. It’s a stretch but worth exploring. Maybe I’m in denial? But the suddeness and severity of this has me thinking physiological illness.

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heysigmund

I completely understand why you would be upset about the bloods not showing anything. It’s just not making any sense for you is it, that’s the awful thing about this. There was a comment in the article on the Anxiety in Kids post about PANDAS. The post is on the home page – the first one in the slider up the top. It was posted on 15 March by a mother who’s been there. There’s a link there that might be helpful for you. I really don’t know enough about it to comment but I think it’s good to be open to everything. Your doctors would be the ones to talk to. It sounds as though you have a good team there who are trying everything they can to get to the bottom of it. Having said that, there’s a lot to be said for a mother’s intuition.

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Debra Farrell

I have suffered since I was 15 years old, I have years where I am fine but it comes back. My mother and my daughter also suffer, my Daughter most off the time. It is very encouraging that research could be going in a new direction.

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heysigmund

Be assured that there is so much research happening around depression. It just affects so many people and it’s important that the research keeps moving forward so we can come up with better treatment options. Just know that it’s happening. Thank you for taking the time to make contact.

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Mandy Titterton

I think he could be right, i’ve suffered with depression all my life and have thought for some time i could have a bacterial infection or parasites

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Karen Young

His arguments make really good sense don’t they. We’re learning more about depression every day but there’s still so much to learn. It’s so good to see new research tracks opening up. Hope you’re doing okay.

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Susan

I became mentally ill at 37, at the same time I had bad acne rosacea, with lots of pustules, I have noticed that with a flare of this disease I also had major depression . So now when the flare starts i have two weeks on antibiotics and then have a treatment with Limelight strength laser to my face. This keeps it away for two years. I have also had weight gain and gut problems from the drugs I was prescribed, i know my gut flora was affected so i am also thinking there is a link to a germ. I still struggle but can manage with these measures and a sensible diet, however weight loss doesnt seem to happen easily once your body has aclimatISed to a larger weight.

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Behaviour is never from ‘bad’. It’s from ‘big’. Big hungry, big tired, big disconnection, big missing, big ‘too much right now’. The reason our responses might not work can often be because we’ve misread the story, or we’ve missed an important piece of it. Their story might be about now, today, yesterday, or any of the yesterdays before now. 

Our job isn’t to fix them. They aren’t broken. Our job is to understand them. Only then can we steer our response in the right direction. Otherwise we’re throwing darts at the wrong target - behaviour, instead of the need behind the behaviour. 

Watch, listen, breathe and be with. Feel what they feel. This will help them feel you with them. We all feel safer and calmer when we feel our people beside us - not judging or hurrying or questioning. What don’t you know, that they need you to know?♥️
We all have first up needs. The difference between adults and children is that we can delay the meeting of these needs for a bit longer than children - but we still need them met. 

The first most important question the brain needs answered is, ‘Is my body safe?’ - Am I free from threat, hunger, exhaustion, pain? This is usually an easier one to take care of or to recognise when it might need some attention. 

The next most important question is, ‘Is my heart safe?’ - Am I loved, noticed, valued, claimed, wanted, welcome? This can be an easy one to overlook, especially in the chaos of the morning. Of course we love them and want them - and sometimes we’ll get distracted, annoyed, frustrated, irritated. None of this changes how much we love and want them - not even for a second. We can feel two things at once - madly in love with them and annoyed/ distracted/ frustrated. Sometimes though, this can leave their ‘Is my heart safe?’ needs a little hungry. They have less capacity than us to delay the meeting of these needs. When these needs are hungry, we’ll be more likely to see big feelings or big behaviour. 

The more you can fill their love tanks at the start of the day, the more they’ll be able to handle the bumps. This doesn’t have to be big. It just has to be enough. It might look like having a cuddle, reading a story, having a chat, sitting with them while they have breakfast or while they pat the dog, touching their back when they walk past, telling them you love them.

All brains need to feel loved and wanted, and as though they aren’t a nuisance, but sometimes they’ll need to feel it more. The more their felt sense of relational safety is met, the more they’ll be able to then focus on ‘thinking brain’ things, such as planning, making good decisions, co-operating, behaving. 

(And if this today was a bumpy one, that’s okay. Those days are going to happen. If most of the time their love tanks are full, they’ll handle when it drops a little. Just top it up when you can. And don’t forget to top yours up too. Be kind to yourself. You deserve it as much as they do.)♥️
Things will always go wrong - a bad decision, a good decision with a bad outcome, a dilemma, wanting something that comes with risk. 

Often, the ‘right thing’ lives somewhere in the very blurry bounds of the grey. Sometimes it will be about what’s right for them. Sometimes what’s right for others. Sometimes it will be about taking a risk, and sometimes the ‘right’ thing just feels wrong right now, or wrong for them. Even as adults, we will often get things wrong. This isn’t because we’re bad, or because we don’t know the right thing from the wrong thing, but because few things are black and white. 

The problem with punishment and harsh consequences is that we remove ourselves as an option for them to turn to next time things end messy, or as a guide before the mess happens. 

Feeling safe in our important relationships is a primary need for all of us humans. That means making sure our relationships are free from judgement, humiliation, shame, separation. If our response to their ‘wrong things’ is to bring all of these things to the table we share with them with them, of course they’ll do anything to avoid it. This isn’t about lying or secrecy. It’s about maintaining relational ‘safety’, or closeness.

Kids want to do the right thing. They want us to love and accept them. But they’re going to get things wrong sometimes. When they do, our response will teach them either that we are safe for them to come to no matter what, or that we aren’t. 

So what do we do when things go wrong? Embrace them, reject the behaviour:

‘I love that you’ve been honest with me. That means everything to me. I know you didn’t expect things to end up like this, but here we are. Let’s talk about what’s happened and what can be different next time.’

Or, ‘Something must have made this (wrong thing) feel like the right thing to do, otherwise you wouldn’t have done it. We all do that sometimes. What do you think it was that was for you?’

Or, ‘I know you know lying isn’t okay. What made you feel like you couldn’t tell me the truth? How can we build the trust again. Let’s talk about how to do that.’

You will always be their greatest guide, but you can only be that if they let you.♥️
Whenever there is a call to courage, there will be anxiety - every time. That’s what makes it brave. This is why challenging things, brave things, important things will often drive anxiety. 

At these times - when they are safe, but doing something hard - the feelings that come with anxiety will be enough to drive avoidance. When it is avoidance of a threat, that’s important. That’s anxiety doing it’s job. But when the avoidance is in response to things that are important, brave, meaningful, that avoidance only serves to confirm the deficiency story. This is when we want to support them to take tiny steps towards that brave thing. It doesn’t have to happen all at once.l and it doesn’t matter how long it takes. Brave is about being able to handle the discomfort of anxiety enough to do the important, challenging thing. It’s built in tiny steps, one after the other. 

We don’t have to get rid of their anxiety and neither do they. They can feel anxious, and do brave. At these times (safe, but scary) they need us to take a posture of validation and confidence. ‘I believe you, and I believe in you.’ ‘I know this feels big, and I know you can handle it.’ 

What we’re saying is we know they can handle the discomfort of anxiety. They don’t have to handle it well, and they don’t have to handle it for too long. Handling it is handling it, and that’s the substance of ‘brave’. 

Being brave isn’t about doing the brave thing, but about being able to handle the discomfort of the anxiety that comes with that. And if they’ve done that today, at all, or for a moment longer than yesterday, then they’ve been brave today. It doesn’t matter how messy it was or how small it was. Let them see their brave through your eyes.‘That was big for you wasn’t it. And you did it. You felt anxious, and you stayed with it. That’s what being brave is all about.’♥️
A relationally unsafe (emotionally unsafe) environment can cause as much breakage as as a physically unsafe one. 

The brain’s priority will always be safety, so if a person or environment doesn’t feel emotionally safe, we might see big behaviour, avoidance, or reduced learning. In this case, it isn’t the child that’s broken. It’s the environment.

But here’s the thing, just because a child doesn’t feel safe, doesn’t mean the person or environment isn’t safe. What it means is that there aren’t enough signals of safety - yet, and there’s a little more work to do to build this. ‘Safety’ isn’t about what is actually safe or not, it’s about what the brain perceives. Children might have the safest, warmest, most loving adult in front of them, but that doesn’t mean they’ll feel safe. This is when we have to look at how we might extend bigger cues of warmth, welcome, inclusiveness, and what we can do (or what roles or responsibilities can we give them) to help them feel valued and needed. This might take time, and that’s okay. Children aren’t meant to feel safe with every adult in front of them, so sometimes what they need most is our patience and understanding as we continue to build this. 

This is the way it works for all of us, everywhere. None of us will be able to give our best or do our best if we don’t feel welcome, liked, valued, and free from hostility, humiliation or judgement. 

This is especially important for our schools. A brain that doesn’t feel safe can’t learn. For schools to be places of learning, they first have to be places of relationship. Before we focus too sharply on learning support and behaviour management, we first have to focus on felt sense of safety support. The most powerful way to do this is through relationship. Teachers who do this are magic-makers. They show a phenomenal capacity to expand a child’s capacity to learn, calm big behaviour, and open up a child’s world. But relationships take time, and felt safety takes time. The time it takes for this to happen is all part of the process. It’s not a waste of time, it’s the most important use of it.♥️

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