Are you sure your depression is in your brain?

I’m not. Actually I’m pretty sure that’s not where my depression started. I am quite positive that the encephalitis  – brain inflammation – had developed after several years of chronic gut inflammation. What if my irritable bowel/gastritis was stopped right after it started? What if I had known about celiac disease and stopped eating gluten not two, but ten years ago? My assumption is that I would not have developed brain inflammation then, I would not experience seeing the old women asking me to help them die, I would not feel the walls of my room closing in on me. There would be no primal fear, no encephalitis. Whatever has happened to me, happened, no point to dwell on the past, but I am writing for others, for whom such terrifying experiences may be prevented. It’s important to ask the question – are you sure your depression is only in your brain?

meds

Above is my combination of the psychiatric meds that I was given by my first psychiatrist. She never questioned the origins of my depression – to her it was all a chemical imbalance in my brain, therefore she combined SSRIs, antipsychotics, benzodiazapines, and she failed at treating me. She started treating me in November 2015 and in May 2016 I bought hibachi grills and drove away into a forest with the two grills and a bag of charcoal, police had to track me. In June I could no longer work and became unemployed. Clearly I did not improve in the six months that I was her patient.

I did not improve because I don’t just have some serotonin imbalance, I have autoimmune encephalitis – brain inflammation. I also was diagnosed previously with irritable bowel syndrome (IBS) and chronic gastritis – gut inflammation. Did one lead to another? I believe so. I believe my depression started in the gut and there is research to support this theory.

“Recently, studies have emerged focusing on variations in the microbiome and the effect on various CNS disorders, including, but not limited to anxiety, depressive disorders, schizophrenia, and autism.2,8,9 Therapeutic interventions to treat dysbiosis, or disturbance in the gut, and mitigate its effects on the GBA (gut-brain axis) are only recently coming to the forefront as more is known about this unique relationship. As a result, research has been done on the use of probiotics in treatment of anxiety and depression both as standalone therapy and as adjunct to commonly prescribed medications.”

“When the human microbiome is challenged with changes in diet, stress, or antibiotics, the physiology of the normal microbiome undergoes change. A dysbiotic state leads to increased intestinal permeability and allows contents such as bacterial metabolites and molecules as well as bacteria themselves to leak through the submucosa and into the systemic circulation, a phenomenon aptly named leaky gut syndrome. … Increased intestinal permeability leads to detrimental effects on the host immune system, which have been demonstrated in diseases such as inflammatory bowel disease (IBD), diabetes, asthma, and psychiatric disorders including depression, anxiety, and autism.2,4,10,34,35

“Depressive disorders are characterized by both neuroplastic, organizational changes, and neurochemical dysfunction.42 Illness is thought to begin when there is deregulation of these systems and can largely be attributed to cytokine release secondary to an exaggerated systemic response to stressors.39,41 Endotoxin infusions to healthy subjects with no history of depressive disorders triggered cytokine release and subsequent emergence of classical depressive symptoms. The study established a direct correlation between increased levels of IL-6 and TNF-a with symptoms of depression and anxiety,43 indicating that pro-inflammatory cytokines play a role in the development of anxiety and depression. These effects correlated with a state of chronic inflammation and altered immune cells in the peripheral blood. However, TNF-a administered to healthy subjects resulted in no depressive symptoms,38 suggesting that toxin induced inflammation caused the mood disturbance.”

Gut microbiota’s effect on mental health: The gut-brain axis

There has also been found a link between IBS and depression and recent studies are indicating that probiotics may help with both issues.

“For the new research, scientists from McMaster University in Canada recruited 44 adults with IBS as well as mild to moderate anxiety or depression. They were followed for 10 weeks; half took a daily dose of the probiotic Bifidobacterium longum, and half took a placebo. The probiotics were manufactured and provided by Nestle, which also funded the study. (Nestle was not involved in collection, analysis or interpretation of study data.)

After six weeks, twice as many people who took the probiotic had decreased depression scores compared to those who took the placebo: 64% versus 32%. Results were similar after 10 weeks, as well. When people in the study were given functional MRI scans, the researchers found that improved depression scores were associated with changes in activity of several brain areas involved in mood regulation.”

How Probiotics May Help Depression

If you are suffering from treatment resistant depression – you are not improving with the SSRIs/SNRIs/TCAs/MAOIs/NASSAs/etc., it’s important to ask yourself whether you are also suffering from any other conditions. If I had previously known all the information about the gut-brain axis, inflammation, and autoimmune diseases, it would be more evident to me that the cause of my psychiatric issues was likely gut inflammation. My severe depression started in 2015 but other health problems were starting long before that. I experienced dry and peeling skin since I was 11 years old and after the age of 12 I developed severe acne. When I was 17 I started having strong abdominal pain in the evenings. Sometimes the pain was so severe that I found it difficult to sit up. I also remember difficulties with falling asleep because as I lay down I would feel my stomach grumble and I could not relax. Later on more symptoms were added such as facial swelling, gastric pain, rapid weight gain, and brain fog. Then the depression and psychosis came. A coincidence ? Just a chemical imbalance unrelated to the other health issues? Clearly not and these symptoms were all related. They developed together as I continued to have a diet, unknowingly, that was terrible for me – pasta, bread, pizza, cheesecakes, and the symptoms declined together as I changed my diet, got treated with steroids, and started consuming fermented foods.

Now that I am equipped with all of this information I hope that I will continue to improve. I no longer have a feeling that it will only get worse and worse. I hope this will be useful to you as well and I hope I can help you feel happier again. There is more and more research now on other possible treatments for depression in addition to existing antidepressants, so I am optimistic that something will work for you, there are many things to try, don’t give up!

Probiotics, biome restoration, could it helps with psychiatric issues?

Of course I am hoping that it could. As I have written in my previous posts, I went through a lot of conventional psychiatric treatments with no success. Mirtazapine, Olanzapine, Wellbutrin, Latuda, Cymbalta, Sertraline… you name an antidepressant or an antipsychotic, and I probably tried it. Also benzodiazapines – Lorazepam and Clonazepam. Dangerous little pills, doctors themselves say that you should not be taking benzos for longer than two weeks. Later on, after being diagnosed with Hashimoto’s Encephalitis, I was treated with IV Solu-Medrol and oral prednisone – glucocorticoids for suppressing the immune system. This was in December and I think I am better now, but I cannot say that I have no unwanted or obsessive thoughts. Since the treatment, and selecting that I eat very carefully, my physical symptoms did reduce, these thoughts are the main thing that tortures me. I could not stay on prednisone as it can itself cause psychosis and I experienced violent mood swings, migraines, and severe insomnia. For this reason I continue to look for ways to improve my brain. Or is it my stomach? I am more inclined to think that my main brain is in my stomach, given how sensitive my mood is to ingredients that I eat.

I have experimented a lot with probiotics, but did not find benefits from capsules. Maybe they don’t contain enough organisms or not many of them end up alive in the gut? My gastroenterologist recommended Align brand,  but the capsules contain casein from cow’s milk. I did try it for a while, but did not notice any improvements. After feeling somewhat better since receiving the steroid treatment, I decided to let go of the strict AIP diet and to introduce some foods. I had a craving for black tea with milk and yogurt, so I thought that maybe dairy is what I need. In fact I found it quite difficult to get enough calcium on AIP diet, probably I was lacking some. AIP followers do advise that you can obtain calcium from fish bones and kale, but you would really need to eat large amounts of very salty canned salmon or a whole salad bowl of steamed kale. I found it to be not feasible in practice. Also I have not tried goat milk before so there was no evidence that I would have an adverse reaction to it. I did not find that I do after consuming it. I have been adding goat milk to black tea and I actually found that this way the tea was smoother and felt less acidic, drinking black tea on its own often caused me gastric pain. I have started buying goat and sheep yogurt, turns out it’s now available in plain form at many stores in Toronto. In general, since adding the milk and the yogurt, I have experienced less frequent gastric problems. I have only experienced gastric pain when I ate a lot of bacon (maybe that was too much saturated fat at once?), and when I took naproxen. Gastric/stomach discomfort is a common side effect of naproxen, but unfortunately taking it during my period is unavoidable for me.

I have found several studies indicating positive benefits of goat milk, which also adds a benefit for me when drinking it, even if only a placebo effect.

Anxiety behavior is reduced, and physical growth is improved in the progeny of rat dams that consumed lipids from goat milk

Anti-inflammatory and anti-allergic properties of donkey’s and goat’s milk

I have been reading on the idea that human gut biome depletion could be causing many diseases, included neuropsychiatric ones. With the invention of clean water, sewage systems, hygiene practices, the rate of infections has been greatly reduced in developed countries, but it also led to lower diversity of bacteria and parasites in our intestines. The theory states that we evolved to co-live with these organisms and part of the rise in the number of autoimmune diseases in developed world could be caused by this gut biome depletion. In terms of restoring the biome, fermented milk and vegetable products are advised. There is also an experimental helminthic therapy, but I will post about that later. Kefir is said to be a fermented product that contains a great diversity of bacteria, more than yogurt.

What’s the difference between yogurt and kefir?

About three weeks ago I purchased live kefir grains on Kijiji for $5 and this was a great investment. Making kefir is even easier than buying kefir, it really doesn’t require much action. Place kefir grains into a clean glass jar. Pour milk over the grains, leave one inch at the top. Cover the jar with a coffee filter and tighten with an elastic. Leave it at room temperature for 24 hours and there you go, you’ve got kefir. Then you strain out the grains and drink the resulting liquid, repeat the process.

“The evidence for probiotics alleviating depressive symptoms is compelling but additional double-blind randomized control trials in clinical populations are warranted to further assess efficacy.”

The effects of probiotics on depressive symptoms in humans: a systematic review

How do I feel after three weeks? I think I am calmer. I am hoping this is more than a temporary placebo effect and that there are actually material changes. A few days ago I had a sudden desire to pick up my violin again, which I haven’t touched in years. At the most acute stages of encephalitis I could not stand hearing any music, it all would cause me a feeling of unbearable nostalgia and grief. Since the steroids treatment I have gotten back to creating playlists for workouts and now I even wanted to play music again. That feels like waking up from the dead. I vividly remember a day in the fall of 2015. At that point I had already quit my PhD and I was trying to apply for jobs, sitting in Starbucks. I tried to focus on sending out my resume, but I became overwhelmed with a feeling of grief. It was as if all sounds coming out from the speakers in the corner were trying to cause me pain on purpose, they were reminding me of someone who died, each note was screaming at me. I couldn’t stand it, I packed my laptop and left home. That was when I started to think that I really wanted to die.

I am at Starbucks now again, two and a half years later. I am typing this on my laptop and music is playing from the speakers, as usual. Right now I don’t have a sudden urge to run out, the sounds are not unbearable. I think my brain is healing, knowing that healing is possible gives me a lot of hope.