Dual Focus: Biological And Psychological Therapies
The lead author of the study Dr. Andreas Walther conducted the research while working as a postdoc to Clemens Kirschbaum, the chair of biopsychology at TU Dresden. Dr. Walther feels it is essential to advance biological and psychological therapies to treat depressive conditions more efficiently and sustainably in the long term.
He explains:
We are working in parallel on research into pharmacological therapies to improve dysfunctional biology as well as psychological therapies to improve dysfunctional cognitive and emotional processes. Indeed, in my opinion, only a holistic approach can understand and efficiently treat this complex disorder and hopefully prevent much suffering in the future.
The study included 69 pre-screened individuals at high risk for depressive disorders and 70 matched healthy controls. The participants underwent clinical evaluation using a globally recognized clinical interview process for diagnosing mental health conditions, called the Composite International Diagnostic Interview.
An artificial intelligence method of deep learning scanned over 16 million blood cell images. These images were then classified into main blood cell types and measured using parameters such as cell size, in addition to their ability to change shape and exhibit cell membrane deformability.
The scientists discovered that
leading causes of disability worldwide.
When Should I Go To The Emergency Department
Go to the emergency department if any of the following autoimmune disease symptoms get severe:
- Trouble breathing/shortness of breath. Remember that some people with an autoimmune disease can experience this when theyre pregnant.
- Severe chest pain/pressure to your chest.
- A headache that starts suddenly and feels like the worst headache youve ever had.
- Sudden weakness, especially if you cant move.
- Dizziness that doesnt stop.
- Pain so severe that you cant stand it.
A note from Cleveland Clinic
Living with an autoimmune disease can be complicated. Diseases like lupus, rheumatoid arthritis and multiple sclerosis are complex and serious. Although there are no cures for these diseases, many of their symptoms can be treated, and sometimes they go into remission. Stay in touch with your healthcare provider about any advances in understanding and treating autoimmune diseases.
If you think you may have an autoimmune disease, see your healthcare provider as soon as possible for diagnosis and treatment. Your symptoms will be easier to control if the condition is treated promptly.
Last reviewed by a Cleveland Clinic medical professional on 07/21/2021.
References
Uncertainty Leads To Depression Anxiety In Patients With Systemic Autoimmune Diseases
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Patients with systemic autoimmune rheumatic disorders who show evidence of illness-related uncertainty also tend to experience depression, anxiety and increased sickness impact, according to data published in the Journal of Rheumatology.
From my clinical experience, I have observed that our medications for rheumatic disease often work very well to address some of the diseases manifestations joint pain, renal failure, inflammatory eye disease, for instance but patients often continue to struggle with their diagnosis and what it means for their day-to-day life and functioning,Zachary S. Wallace, MD, MSc, of Massachusetts General Hospital, told Healio. We dont have a great understanding of illness-related uncertainty in these conditions, its associations with mental health, and what patients need from us besides pharmacologic treatments.
To examine the connection between illness uncertainty and certain mental health conditions, Wallace and colleagues first identified patients with ANCA-associated vasculitis , lgG4-related disease and systemic sclerosis at Massachusetts General Hospital. These conditions were selected because they prototypic systemic autoimmune rheumatic disorders that feature distinguishing factors which may play into patient uncertainties, the researchers wrote.
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Depression Autoimmune Disease And What You Can Do
Our culture has recently made strides in learning how to better discuss mental health and emotional well-being in ways that our parents and grandparents could never have done.
And yet, as individuals, many of us remain far away from a place of deep understanding and acceptance of what it means to be emotionally healthy, safe and proactive.
Depression remains one of the most common conditions of emotional ill-health and, sadly, both pregnancy/post-partum and having an autoimmune disease increase the risk of developing depression.
Awareness of this risk and education about depression can help prepare you to recognize symptoms and access early effective treatment.
While medication is often helpful and necessary, it is best used as one component of a comprehensive plan that also includes developing healthy, supportive relationships, coping strategies such as:
- Exercise, meditation, and hobbies
- Rejuvenating activities such as quality sleep
- Talk-therapy or personal retreat
- Nourishing food
Theres no time like the present to start working toward some of these skills so that if depression strikes, you will have some tools to get yourself on the road to recovery. If depression has already entered into your life, working on the above is a difficult but worthwhile endeavor.
Why is depression so common in pregnancy and autoimmune disease?
How do I develop resilience when Ive got children, a job, a partner, bills and aging parents to worry about?
Questions for your doctor
Symptoms By Autoimmune Condition
There are more than 80 autoimmune conditions. There is an overlap in symptoms among many of these conditions, and distinctive symptoms can help differentiate between them.
If you have one autoimmune disease, you have a 25% chance of developing other autoimmune conditions. This can make sorting out diagnoses more difficult. It can also cause some symptoms to be compounded.
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Infections As A Common Risk Factor
It is thought that one of the most important triggers for developing autoimmune diseases is infection , and it is known that infectious encephalitis, specifically with herpes-simplex virus, markedly increases the risk of developing NMDA-receptor encephalitis . As it was shown in a large Danish nationwide study, prior infection increased the risk of developing schizophrenia in a dose-response fashion , and this finding has been repeated in other large studies . The effect of infection on risk of schizophrenia was present regardless of autoimmune diseases, but additionally, a significant synergy was found in those with both a history of autoimmunity and infections . For many of the individual autoimmune diseases, it was seen that the effect on the risk of schizophrenia increased when a prior hospital contact due to infection was also present .
It has also been found that infections during pregnancy increases the risk of schizophrenia in the offspring . On the basis hereof, it has been considered whether infections during the prenatal phase might prime the immune system, making it more vulnerable and perhaps more likely to produce abnormal responses to later infections, resulting in increased inflammation. However, a new study have shown that even maternal infections before and after pregnancy increases the risk of mental illness , which could also indicate a genetic susceptibility for infections associated with mental illness.
What Are Autoimmune Diseases
Your immune system is made up of organs and cells meant to protect your body from bacteria, parasites, viruses and cancer cells. An autoimmune disease is the result of the immune system accidentally attacking your body instead of protecting it. It’s unclear why your immune system does this.
There are over 100 known autoimmune diseases. Common ones include lupus, rheumatoid arthritis, Crohns disease and ulcerative colitis.
Autoimmune diseases can affect many types of tissues and nearly any organ in your body. They may cause a variety of symptoms including pain, tiredness , rashes, nausea, headaches, dizziness and more. Specific symptoms depend on the exact disease.
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How Do Autoimmune Diseases Affect You If You’re Trying To Get Pregnant
Some autoimmune diseases can affect your ability to get pregnant and some have adverse effects on pregnancy. You may need fertility treatments to get pregnant. You might also want to wait until your disease is in the remission stage to try to conceive.
There is a higher risk for stillbirth or preterm birth if you have lupus. If you have myasthenia gravis, you may experience trouble breathing.
How Do Autoimmune Conditions Cause Mental Health Problems
Researchers dont fully understand how autoimmune diseases cause mental health conditions, but there are some theories:
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Inflammation: People with autoimmune diseases have higher levels of what are known as pro-inflammatory cytokines in their blood. These chemicals cause inflammation in the body and can also affect brain chemicals that regulate your mood and energy levels. This process can cause symptoms similar to depression, such as fatigue and issues with sleep and appetite.
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Stress: The stress of dealing with an autoimmune condition may lead to mental health problems.
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Medications: Medications used to treat autoimmune conditions, such as steroids, can cause issues like psychosis and sleep disturbances.
As we will discuss later, dealing with these issues may lower your risk of developing a mental health condition.
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Navigating The Social Challenges Of Illness
For many people, life changes significantly after developing an autoimmune disease or other chronic condition. The realities of coping with shifting disease symptoms, energy levels, and overall needs might leave you feeling like a burden to others.
Additionally, many people see their social options diminished as a result of their changing health and energy levels, which can be difficult to adapt to.
Other social challenges of autoimmune disease can include:
- Social isolation due to decreased mobility, low levels of energy, or frequent hospitalizations.
- Avoiding others as a means to avoid being judged or having to explain your illness.
- Anxiety around talking about your illness and explaining your accessibility needs or dietary restrictions.
- Distancing yourself from others because you are tired of hearing hurtful comments or receiving unsolicited advice about your illness.
What you can do:
- Try your best not to isolate yourself. Come up with a list of activities that feel safe and feasible for you. Ask your friends, family, and members of your household to help you come up with ideas. On your toughest illness days, remember that you dont have to be physically present in order to enjoy human connection. Try using a video calling app to stay connected with loved ones. Even something as simple as watching a movie with a friend via Facetime or Skype can be enormously comforting.
Additional Effects On The Body
MNT also spoke with Dr. Sheldon Zablow, a child, adolescent, and adult psychiatrist and a voluntary assistant professor of child psychiatry at the UC San Diego School of Medicine.
Chronic inflammation as well as chronic depression produces a wide variety of chemicals, such as cortisol, which deforms the structure of the white blood cells of immunity, said Dr. Zablow.
This deformability of white blood cells reduces their capacity to fight infection or repair damage and increases the risk of a wide variety of illnesses besides depressionchronic inflammation causes or worsens obesity, heart disease, dementia, diabetes, and autoimmune illnesses. Dr. Sheldon Zablow
Dr. Zablow said that in the future, testing the deformability of blood cells could become standard for people with chronic inflammation or those at increased risk of long-term depression.
Dr. Kim called the findings interesting but said more research was needed to understand the wider implications.
Although the full clinical meaning and implications of this proxy for immune cell deformability remain unclear, what the various results mean, in terms of what stage/severity of depression can do to the immune system and why/how, , she said.
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When To See A Healthcare Provider
If you’re worried you may be experiencing symptoms of an autoimmune condition, or if you have a strong family history of autoimmune disease, see your healthcare provider. They can give you a comprehensive evaluation and a physical exam to help provide a diagnosis.
Your doctor may also order blood tests such as:
- The antinuclear antibody test, which checks for specific antibodies to see if your immune system is attacking itself
- Complete blood count , which measures your blood cells
- Erythrocyte sedimentation rate, which checks for inflammation
If your healthcare provider thinks that you may have an autoimmune disease, you will likely be referred to a specialist. This might include a rheumatologist or an endocrinologist .
How Do You Treat Mental Health Problems When You Have An Autoimmune Disease
Often, treating the underlying autoimmune disease is enough to treat the associated mental health condition. In some cases, if the medications you take could be making things worse, then working with your provider to make some changes may be all that is needed.
If the autoimmune disease is well treated but you are still experiencing mental health symptoms, there are several treatment options available, including seeing a mental health specialist. Speak with your healthcare provider so you can decide what works best for you.
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Major Depressive Disorders Accompanying Autoimmune Diseases Response To Treatment
Inflammation is well-known factor in depression pathophysiology.
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Autoimmune diseases are frequently accompanying depression.
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Inflammatory markers are associated with poorer response to antidepressant treatment.
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Depressive symptoms are reduced by agents used in autoimmune diseases treatment.
Why Does The Immune System Attack The Body
Doctors dont know exactly what causes the immune system to misfire. Yet some people are more likely to get an autoimmune disease than others.
According to a 2014 study, women get autoimmune diseases at a rate of about 2 to 1 compared to men 6.4% of women versus 2.7% of men. The disease often starts during childbearing age .
Some autoimmune diseases are more common in certain ethnic groups. For example, lupus affects more African American and Hispanic people than white people.
Certain autoimmune diseases, such as multiple sclerosis and lupus, run in families. Not every family member will necessarily have the same disease, but they inherit a susceptibility to an autoimmune condition.
Because the incidence of autoimmune diseases is rising, researchers suspect environmental factors like infections and exposure to chemicals or solvents might also be involved.
A Western diet is another suspected risk factor for developing an autoimmune disease. Eating high fat, high-sugar, and highly processed foods are thought to be linked to inflammation, which might set off an immune response. But this hasnt been proven.
BOTTOM LINE: Researchers dont know exactly what causes autoimmune diseases. Genetics, diet, infections, and exposure to chemicals might be involved.
When your immune system is weakened, you may be at a higher risk from COVID-19. Be sure to get tested quickly if youre experiencing symptoms.
There are more than 80 autoimmune diseases. Here are 14 of the most common ones.
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Exploring The Mental Health Needs Of Persons With Autoimmune Diseases During The Coronavirus Disease 2019 Pandemic: A Proposed Framework For Future Research And Clinical Care
University of Toronto and Toronto General Hospital, Toronto, Ontario, Canada
Address correspondence to Kathleen Bingham, PhD, Toronto General Hospital, 200 Elizabeth Street, 8 Eaton North Room 241, Toronto, Ontario, M5G 2C4, Canada. Email:
University of Toronto and Toronto General Hospital, Toronto, Ontario, Canada
Address correspondence to Kathleen Bingham, PhD, Toronto General Hospital, 200 Elizabeth Street, 8 Eaton North Room 241, Toronto, Ontario, M5G 2C4, Canada. Email:
How Are Autoimmune Diseases Treated
There are no cures for autoimmune diseases, but symptoms can be managed. Everyones immune system, genetics and environment are different. That means that your treatment must be unique.
Some examples of medications used to treat autoimmune diseases include:
- Painkillers.
- Limiting processed foods from your diet.
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Effects On Depression And Fatigue By Treatment Targeting The Immune System
Overall, there is strong evidence that changes in the immune system may be one of the pathways through which antidepressant therapies act. Many of the pharmaceutical antidepressant agents reduce inflammatory activation in immune cells and lower circulating inflammatory cytokine levels. Other treatments such as ECT, tDCS, psychotherapy, and exercise also result in decreases in inflammatory cytokine levels. Lower baseline inflammatory cytokine levels are also shown to predict better efficacy in most types of antidepressant treatments, except for exercise. Anti-inflammatory treatments have also been shown to be effective, with medications such as NSAIDS and anti-cytokine drugs having antidepressant effects. While the anti-fatigue drug amantadine has not been shown to have immunomodulatory effects, drugs targeting of TNF and B cells both lead to decreased fatigue, suggesting potential targets for drug discovery for anti-fatigue therapies.
Immune Activation Is Associated With Depression And Fatigue
Higher rates of depression and fatigue have been shown across a broad range of conditions associated with activation of the immune system such as allergies, autoimmune diseases , and infections . Patients with both atopy and asthma have a roughly 50% increased rate of depression . Du et al. found that 35.9% of asthmatic patients suffer from depression and that TNF levels were significantly higher in the depressed cohort, with IFN being significantly lower.
In diabetes, activated inflammatory immune response is implicated in its pathogenesis, with immune activation being involved in the development of both type 1 and type 2 diabetes . Meta-analyses have found that the prevalence of depression in patients with diabetes is up to twice that of people without the disease . Associations have been shown between depression and serum levels of CRP, IL-1, IL-1RA, and MCP-1 in type 2 diabetes patients, with all serum levels being significantly higher in those who are depressed .
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Inflammation And Changes In The Brain
The role of inflammation in depression and fatigue has led researchers to examine the effects that peripheral inflammation has on the CNS. Some changes occur at the level of the blood brain barrier , which separates the CNS parenchyma from the peripheral blood circulation. TNF cause changes in the endothelial cells constituting the BBB, resulting in reduced tight junction protein expression, larger extracellular gaps and increased permeability in animal models and in vitro, all of which are restored by treatment with anti-inflammatory drugs . An increase in proinflammatory cytokine levels including TNF have occurred in patients who have suffered from a myocardial infarction and is associated with disruption of the BBB integrity in animal models and elevated rates of depression . CNS inflammation has also demonstrated that it disrupts the BBB in both MS and its animal model, experimental autoimmune encephalitis , allowing for easier entry of both cytokines and immune cells into the brain . This increased permeability of the BBB may be one of the reasons why patients with immune-mediated diseases like MS have worse psychological symptoms compared to those with other chronic disorders.