The Inflamed Mind: A Radical New Approach to Depression by Edward Bullmore — why doctors get mental health wrong

Could our immune systems affect our minds? 

Isabel Hardman

Saturday May 12 2018

The Times

It’s fashionable nowadays to claim you understand mental illness. The stigma is fading and society is proud of being kinder and more open. But do we really understand it? We may not question whether depression is really an illness, as many once did, but we still don’t know what causes it — or how to treat it.

A new generation of books is moving on from tackling the misconceptions about depression to trying to answer the question of what lies behind it and how to treat it. The journalist Johann Hari in Lost Connections had a go, suggesting that it’s all about broken connections in society; his villain is big pharma, which pumps patients full of drugs that don’t work.

However, there has been precious little popular writing from experts. Edward Bullmore fits the expert bill very nicely; he is a professor of psychiatry at the University of Cambridge who has worked as a physician and as a psychiatrist.

The germ of his idea about an “inflamed mind” came early in his career. One of his patients, Mrs P, had rheumatoid arthritis, but Bullmore quickly realised that she was also depressed. When he told a senior colleague, though, the doctor responded: “Well, you would be, wouldn’t you?” This sounds like a reasonable assumption, given the debilitating nature of inflammatory diseases such as rheumatoid arthritis. Wouldn’t you be struggling mentally if you found yourself so physically constrained?

This book turns the “well you would be depressed, wouldn’t you?” question on its head — and suggests that the inflammation causes not just trouble with joints, but with the mind itself.

Bullmore takes us off on what at first seems like nothing more than an interesting history lesson about René Descartes and that dualist divide between mind and body. However, the purpose of this rather lengthy diversion through medical history is to show that doctors have long been getting mental health wrong. The Cartesian divide between mental and physical has allowed medical professionals, including Bullmore, to develop a blind spot about the relationship between physical inflammation and poor mental health.

The link between the two, he argues, is the immune system. It reacts to physical infection, trauma and mental stress by releasing inflammatory proteins called cytokines into the blood. He believes these cytokines are crossing the blood-brain barrier and inflaming minds as well as joints. What happens when the mind is inflamed? The brain’s immune cells, or microglial cells, pick up inflammatory signals from the body and start pumping out their own cytokines, which can kill nerve cells, damage their ability to connect to one another and disrupt the production of serotonin, which is thought to control mood, appetite and sleep. After that, scientists aren’t yet clear about how the immune system links body and mind. Bullmore thinks it’s worth pursuing.

I must confess that I wondered whether my overactive immune system (responsible for the tiresome panoply of allergies, eczema and childhood chronic fatigue syndrome that gets you disinvited from dinner parties) caused the anxiety and depression that I have struggled with for more than two years after a serious trauma. Perhaps if I just popped fewer vitamin C tablets, I’d suddenly regain full sanity. Of course, it is much more subtle than that. Nonetheless, our immune system’s response to a trauma does seem to lead to depression.

The Inflamed Mind isn’t a pop-science book designed to wow you with quirky facts about the brain. Instead, it is a serious attempt to enlighten not just medics, but also the more dimly lit minds of political journalists, for instance. It does demand that you pay attention and there are a number of passages where it is clearly impossible to simplify the science any further without it becoming a nonsense. You may even need to read them twice, but it rewards you by explaining medical history, the body and advances in medical research in recent years.

Those advances are largely limited to accidental discoveries during trials for physical conditions. Hepatitis B is treated with an inflammatory drug called interferon, which supercharges the immune system. One side-effect is that patients become clinically depressed. So, the author argues, “if inflammation occurs before depression then it could cause depression”.

Conversely, one treatment for rheumatoid arthritis had the surprising side-effect of making patients incredibly happy, to the extent that nurses at one hospital vied to set up drips for patients because they enjoyed witnessing the “Remicade high” of instant gratitude and cheeriness. In both instances the medical world had shown its blind spot by missing the significance of these side-effects; Bullmore writes that the treatments were doing their job in body and mind.

What’s rather more, well, depressing is how little examination there has been of whether conventional treatments for depression are making any difference. “There have been no major new advances in drug treatment, or psychological treatment come to that, for depression or any other mental health disorder, since about 1990,” he writes. And while there is a growing interest in immuno-psychiatry as a serious discipline rather than a slightly eccentric pursuit, Bullmore cannot offer any assurances that drug companies are going to restart their dormant mental health research facilities any time soon.

This brings us back to the lesson that every book in this new generation of writing about mental health teaches us: we don’t even know what we don’t know. This could be the dawn for mental health, but there is going to be a lot more stumbling around in the dark.

Isabel Hardman is assistant editor of The Spectator

The Inflamed Mind: A Radical New Approach to Depression by Edward Bullmore, Short Books, 240pp; £14.99