Updated: Aug 9, 2019
It's strange: when we are sick with the flu or a stomach bug, we can just lay in bed all day and think to ourselves, “Wow, I’m really sick! Let me just sleep this one off… hopefully I’ll get back to normal by tomorrow.” No shame. No guilt. No confusion.
But, when we’re depressed, or anxious, or just mentally and emotionally unwell, the conversation in our head sounds really different. We can easily look down upon ourselves for staying in bed too long (in some cases most of the day). We don’t consider that rest as a good thing. We do think that we are not recuperating. We think we are being weak, lazy, or weird.
Our ‘normal self’ would be out there in the world, socializing with others, working hard on stuff, and exploring our passions. But, when we’re depressed, we have no energy for any of that. We really don’t want to leave our bed, and we definitely don’t want to be in situations where we have to talk to others. We don’t feel like ourselves. Our days moving through the sludge can be confusing, aching, and filled with shame.
That shame is why we tend to keep all this hiding in bed situation a big secret. It’s not the same as when we return to work after a stomach bug. How many times have you explained in graphic detail to all your favorite co-workers (without any explicit invitation) all the gritty details of how you vomited all over the place on our first day back to work after a ‘stomach bug’? No shame there, huh?
What we need to realize is that this reaction— wanting to go away, sleep all day, avoid everything, and just recede from the world— is actually biologically driven. It’s common for many people with Depression. But, it’s also common in other inflammatory states. Including that flu we get once a year.
Yet, we think there’s a difference. A difference between staying in bed because we are ‘legitimately’ sick, and staying in bed because we’re depressed. In reality, when we are sick, we are inflamed, and our body is awash with cytokines (cytokines are inflammatory messengers triggered by reactions to infections, stress, and other insults). For many with Depression (and other mental illnesses), the exact same cytokines are released and are circulating in our brain and body (Kuhlman 2018)!
So, in a way, it’s the same thing. Depression (again, for many not all) and the flu are both mediated by inflammation. The body doesn’t know (or care about) the difference. Maybe with a little explanation here, we can see the similarities.
Researchers have a name for this observed decrease in energy and drive to isolate that occurs when we are sick,whether it's from an infection or depression. It’s called sickness behavior (Dantzer 2008).
Here’s a rundown of what’s happening…
Stress (mental, physical, emotional) adds up, and begins to overwhelm us. Our diet is “not the best.” We fail to exercise and end up being sedentary most of our days. We smoke cigarettes - because we’re so dang stressed. Our digestive tract starts getting out of whack - with too much bacteria that don’t belong there, not enough bacteria that do belong there, and gaps in the gut lining that allow undigested food particles, toxins and harmful bacteria to invade us. We don’t sleep enough. Our skin doesn’t see the light of day, other than the short walk to our car before our daily commute. And on and on...
Our bodies react to all those stressors with a dose of inflammation (Berk 2013). What is inflammation again? It’s a whole-body wide coordinated response that produces both major and minor effects in our bodies. The kind of inflammation we are talking about here, is chronic (all the time), low-grade (steady faucet rather than flood) inflammation that comes from habits and environmental stressors described above. When that inflammation reaches the brain, it’s called neuroinflammation (Calcia et al. 2016).
At the most basic level, however, after inflammation is triggered, those cytokines are released and begin to circulate throughout the body. These cytokines all have their characteristic Latin, scientific sounding names - Interleukin-1 beta, Interleukin-6, TNF-alpha, interferon - among many others (Raison et al. 2006). The end result? The release of cytokines prepares the body to defend itself— to get ready to attack what’s attacking you. As woo woo as it sounds, even psychological stress (daily life stress) can create inflammation, as the body thinks it’s under attack (Rohleder 2014).
When it comes to inflammation and depression/anxiety, Interleukin-1 beta aggravates the brain in two ways.
First, it can over excite a really important nerve that runs from the base of the brain down into the gut. It’s called the vagal nerve, and it sends messages back and forth between the brain and gut. Once stimulated by Interleukin-1 beta, down in the gut or in other body tissues, the vagal nerve will signal the brain to focus strongly on the social environment (Dantzer 2009). That cues the brain to scan for threats, as well as supportive connections (Eisenberger et al. 2017). Now the brain is dialed in on what can hurt us and what can help up now that we are ready to be hurt.
Second, all those cytokines named above can bypass guards at the barrier of the brain, and activate receptors in the amygdala - the brain’s fear center (Eisenberger et al. 2017). This colors our experience with a shade of “I suck... nobody likes me... they’re gonna hate me.”
So, in an inflammatory/depressive state, we first become sensitive to all the good and bad that awaits out there in the world. And then we can’t stop thinking about all the negative that could happen (and in our mind is so absolutely going to happen) to us (Hafner et al. 2011, Eisenberger et al. 2017). Faced with that heightened awareness and flood of negativity, we shrink backwards, and try to find some safety at home, often under the covers. At the same time, we wish we had a friend or loved one who we could connect with (Eisenberger et al. 2017). Someone that could relieve us of that loneliness that makes us feel hollow inside during all this isolating.
If any of this relates to you, realize that there are others out there that do care, and can be there for you. Think about the people in your life: who do you have that you KNOW they care about you? If you are isolating a lot, now’s the time to share with them what really is going on. Talk to them now, before it gets worse. Let them know what happens for you, and they may just be there when you need them most— in the biggest way!
If family or friends are not an option for you, there are so many people out there who would be honored to help. In urgent situations, there’s the suicide hotline - 1-800-273-8255 https://suicidepreventionlifeline.org/
Otherwise, there are so many caring and talented professionals out there to help. It’s just one google search away from someone near you. And, there are those people out there, who may not be a clinician, but have been through it before, and they are usually the best listeners.
All you have to do is reach out and ask. We are here for you!
Kuhlman, K. R., Robles, T. F., Dooley, L. N., Boyle, C. C., Haydon, M. D., & Bower, J. E. (2018). Within-subject associations between inflammation and features of depression: Using the flu vaccine as a mild inflammatory stimulus. Brain, Behavior, and Immunity, 69, 540–547. http://doi.org/10.1016/j.bbi.2018.02.001
Dantzer, R., O'Connor, J. C., Freund, G. G., Johnson, R. W., & Kelley, K. W. (2008). From inflammation to sickness and depression: when the immune system subjugates the brain. Nature Reviews. Neuroscience, 9(1), 46–56. http://doi.org/10.1038/nrn2297
Berk, M., Williams, L. J., Jacka, F. N., O’Neil, A., Pasco, J. A., Moylan, S., et al. (2013). So depression is an inflammatory disease, but where does the inflammation come from? BMC Medicine, 11(1), 200. http://doi.org/10.1186/1741-7015-11-200
Rohleder, N. (2014). Stimulation of Systemic Low-Grade Inflammation by Psychosocial Stress. Psychosomatic Medicine, 76(3), 181–189. http://doi.org/10.1097/PSY.0000000000000049
Raison, C. L., Capuron, L., & Miller, A. H. (2006). Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends in Immunology, 27(1), 24–31. http://doi.org/10.1016/j.it.2005.11.006
Calcia, M. A., Bonsall, D. R., Bloomfield, P. S., Selvaraj, S., Barichello, T., & Howes, O. D. (2016). Stress and neuroinflammation: a systematic review of the effects of stress on microglia and the implications for mental illness. Psychopharmacology, 233(9), 1637–1650. http://doi.org/10.1007/s00213-016-4218-9
Dantzer, R. (2009). Cytokine, Sickness Behavior, and Depression. Immunology and Allergy Clinics of North America, 29(2), 247–264. http://doi.org/10.1016/j.iac.2009.02.002
Eisenberger, N. I., Moieni, M., Inagaki, T. K., Muscatell, K. A., & Irwin, M. R. (2017). In Sickness and in Health: The Co-Regulation of Inflammation and Social Behavior. Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology, 42(1), 242–253. http://doi.org/10.1038/npp.2016.141
Häfner, S., Emeny, R. T., Lacruz, M. E., Baumert, J., Herder, C., Koenig, W., et al. (2011). Association between social isolation and inflammatory markers in depressed and non-depressed individuals: Results from the MONICA/KORA study. Brain, Behavior, and Immunity, 25(8), 1701–1707. http://doi.org/10.1016/j.bbi.2011.06.017
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