健康

　　标题：CouldDepressionBeCausedByAnInfection？
　　作者：BRETSTETKA
　　原文链接：http：www。npr。orgsectionshealthshots20151025451169292coulddepressionbecausedbyaninfection
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　　Sometimearound1907，wellbeforethemodernrandomizedclinicaltrialwasroutine，AmericanpsychiatristHenryCottonbeganremovingdecayingteethfromhispatientsinhopesofcuringtheirmentaldisorders。Ifthatdidntworkhemovedontomoreinvasiveexcisions：tonsils，testicles，ovariesand，insomecases，colons。
　　CottonwasthenewlyappointeddirectoroftheNewJerseyStateHospitalfortheInsaneandwasactingonatheoryproposedbyinfluentialJohnsHopkinspsychiatristAdolphMeyer，underwhomCottonhadstudied，thatpsychiatricillnessistheresultofchronicinfection。Meyersideawasbasedonobservationsthatpatientswithhighfeverssometimesexperiencedelusionsandhallucinations。
　　Cottonranwiththeidea，scalpelinhand。
　　In1921hepublishedawellreceivedbookonthetheorycalledTheDefectiveDelinquentandInsane：theRelationofFocalInfectionstoTheirCausation，TreatmentandPrevention。AfewyearslaterTheNewYorkTimeswrote，eminentphysiciansandsurgeonstestifiedthattheNewJerseyStateHospitalfortheInsanewasthemostprogressiveinstitutionintheworldforthecareoftheinsane，andthatthenewermethodoftreatingtheinsanebytheremovaloffocalinfectionplacedtheinstitutioninauniquepositionwithrespecttohospitalsforthementallyill。EventuallyCottonopenedahugelysuccessfulprivatepractice，cateringtotheinfectedmolarsofTrenton，N。J。，highsociety。
　　Followinghisdeathin1933，interestinCottonscureswaned。Hismortalityrateshoveredatatroubling45percent，andinalllikelihoodhistreatmentsdidntwork。Butthoughhisroguesurgeriesweredreadfullymisguidedanddisfiguring，agrowingbodyofresearchsuggeststhattheremightbesomethingtohisbeliefthatinfectionandwithitinflammationisinvolvedinsomeformsofmentalillness。
　　SymptomsOfMentalAndPhysicalIllnessCanOverlap
　　LatelastyearTurhanCanli，anassociateprofessorofpsychologyandradiologyatStonyBrookUniversity，publishedapaperinthejournalBiologyofMoodandAnxietyDisordersassertingthatdepressionshouldbethoughtofasaninfectiousdisease。Depressedpatientsactphysicallysick，saysCanli。Theyretired，theylosetheirappetite，theydontwanttogetoutofbed。HenotesthatwhileWesternmedicinepractitionerstendtofocusonthepsychologicalsymptomsofdepression，inmanynonWesternculturespatientswhowouldqualifyforadepressiondiagnosisreportprimarilyphysicalsymptoms，inpartbecauseofthestigmatizationofmentalillness。
　　Theideathatdepressioniscausedsimplybychangesinserotoninisnotpanningout。Weneedtothinkaboutotherpossiblecausesandtreatmentsforpsychiatricdisorders，saysCanli。
　　Hisassertionthatdepressionresultsfrominfectionmightseemfarfetched，oratleastpremature，buttherearesomedatatobolsterhisclaim。
　　HarkeningbacktoAdolphMeyersearly20thcenturytheory，CanlinoteshowcertaininfectionsofthebrainperhapsmostnotablyToxoplasmagondiicanresultinemotionaldisturbancesthatmimicpsychiatricconditions。Healsonotesthatnumerouspathogenshavebeenassociatedwithmentalillnesses，includingBornadiseasevirus，EpsteinBarrandcertainstrainsofherpes，includingvaricellazoster，thevirusthatcauseschickenpoxandshingles。
　　ADanishstudypublishedinJAMAPsychiatryin2013lookedatthemedicalrecordsofoverthreemillionpeopleandfoundthatanyhistoryofhospitalizationforinfectionwasassociatedwitha62percentincreasedriskoflaterdevelopingamooddisorder，includingdepressionandbipolardisorder。
　　Cbutalsothatautoimmuneactivityorthebodysimmunesystemattackingitselftriggeredbyinfectionmayalsocontribute。TheDanishstudyalsoreportedthatapasthistoryofanautoimmunedisorderincreasestheriskofafuturemooddisorderby45percent。
　　AntibodiesProvideAClue
　　Theideatherecouldbearelationshipbetweentheimmunesystemandbraindiseaseisntnew。Autoantibodieswerereportedinschizophreniapatientsinthe1930s。Subsequentworkhasdetectedantibodiestovariousneurotransmitterreceptorsinthebrainsofpsychiatricpatients，whileanumberofbraindisorders，includingmultiplesclerosis，areknowntoinvolveabnormalimmunesystemactivity。ResearchersattheUniversityofVtheauthorsconcludedthataninterplaybetweenthetwocouldsignificantlycontributetocertainneurologicandpsychiatricconditions。
　　Bothinfectionandautoimmuneactivityresultininflammation，ourbodysresponsetoharmfulstimuli，whichinpartinvolvesasurgeinimmunesystemactivity。Anditsthoughtbymanyinthepsychiatricresearchcommunitythatinflammationissomehowinvolvedindepressionandperhapsothermentalillnesses。
　　Multiplestudieshavelinkeddepressionwithelevatedmarkersofinflammation，includingtwoanalysesfrom2010and2012thatcollectivelyrevieweddatafrom53studies，aswellasseveralpostmortemstudies。Alargebodyofrelatedresearchconfirmsthatautoimmuneandinflammatoryactivityinthebrainislinkedwithpsychiatricsymptoms。
　　Still，forthemostparttheresearchsofarfindsassociationsbutdoesntprovecauseandeffectbetweeninflammationandmentalhealthissues。Theapparentlinkscouldbeamatterofchanceortheremightbesomeanotherfactorthathasntbeenidentified。
　　Dr。RogerMcIntyre，aprofessorofpsychiatryandpharmacologyattheUniversityofToronto，tellsShotsthathebelievesanupsetintheimmuneinflammatorysystemisatthecoreofmentalillnessandthatpsychiatricdisordersmightbeanunfortunatecostofourpowerfulimmunedefenses。Throughoutevolutionourenemyupuntilvaccinesandantibioticsweredevelopedwasinfection，hesays，Ourimmunesystemevolvedtofightinfectionssowecouldsurviveandpassourgenestothenextgeneration。Howeverourimmuneinflammatorysystemdoesntdistinguishbetweenwhatsprovokingit。McIntyreexplainshowstressorsofanykindphysicalorsexualabuse，sleepdeprivation，griefcanactivateourimmunealarms。Forreasonsotherthanfightinginfectionourimmuneinflammatoryresponsecanstayactivatedforweeks，monthsoryearsandresultincollateraldamage，hesays。
　　UnlikeCanli，McIntyreimplicatesinflammationingeneral，notexclusivelyinflammationcausedbyinfectionordirecteffectsofinfectionitself，asamajorcontributortomentalmaladies。Itsunlikelythatmostpeoplewithamentalillnesshaveitasaresultofinfection，hesays，Butitwouldbereasonabletohypothesizethatasubpopulationofpeoplewithdepressionorbipolardisorderorschizophreniaendedupthatwaybecauseaninfectionactivatedtheirimmuneinflammatorysystem。McIntyresaysthatinfection，particularlyinthewomb，couldworkinconcertwithgenetics，psychosocialfactorsandourdietandmicrobiometoinfluenceimmuneandinflammatoryactivityand，inturn，ourriskofpsychiatricdisease。
　　TryingDrugsAgainstInflammationForMentalIllness
　　Theideathatinflammationwhetherstirredupbyinfectionorotherfactorscontributestoorcausesmentalillnesscomeswithcaveats，atleastintermsofpotentialtreatments。Trialstestingantiinflammatorydrugshavebeenoverallmixedorunderwhelming。
　　ArecentmetaanalysisreportedthatsupplementingSSRIslikeProzacwithregularlowdoseaspirinuseisassociatedwithareducedriskofdepressionandibuprofensupplementationislinkedwithlowerchancesofobtainingpsychiatriccare。HoweverconcomitanttreatmentwithSSRIsanddiclofenacorcelecoxibtwootherantiinflammatoriesoftenusedtotreatarthritiswasassociatedwithincreasedriskofneedinghospitalcareduetopsychiatricsymptoms。
　　A2013studyexploredtheantidepressantpotentialofRemicade，andrugusedinrheumatoidarthritis。Overall，threeinfusionsofthemedicationwerefoundtobenomoreeffectivethanaplacebo，butpatientswhosebloodhadhigherlevelsofaninflammatorymarkercalledCreactiveproteindidexperiencemodestbenefit。
　　Thetruthofthematteristhatthereisprobablyasubsetofpeoplewhogetdepressedinresponsetoinflammation，saysleadauthorDr。CharlesRaison，apsychiatryprofessorattheUniversityofArizona。Maybetheirbodiesgeneratemoreinflammation，ormaybetheyremoresensitivetoit。
　　Howinfectionandothercausesofinflammationandoverlyaggressiveimmuneactivitymaycontributetodepressionandothermentalillnessesandwhetherornotitsactuallydepressiondrivingtheinflammationisstillbeinginvestigated，andlikelywillbeforsometime。Butplentyofleadingpsychiatristsagreethatthesearchforalternativepathologicexplanationsandtreatmentsforpsychiatricdisordersiscouldhelpjumpstartthefield。
　　Imnotconvincedthatantiinflammatorystrategiesaregoingtoturnouttobethemostpowerfultreatmentsaround，cautionsRaison。ButIthinkifwereallywanttounderstanddepression，wedefinitelyhavetounderstandhowtheimmunesystemtalkstothebrain。Ijustdontthinkweveidentifiedimmunebasedorantiinflammatorytreatmentsyetthataregoingtohavebigeffectsindepression。
　　ButtheUniversityofTorontosMcIntyrehasaslightlybrighteroutlook。Isdepressionduetoinfection，orisitduetosomethingelse？heasks。Theanswerisyesandyes。Thebottomlineisinflammationappearstocontributetodepression，andwehaveinterventionstoaddressthis。
　　McIntyrenotesthatwhilethescienceofpsychiatryhasalongwaytogo，andthattheseinterventionshaventbeenprovedeffective，numerousapproacheswithminimalsideeffectsexistthatappeartobegenerallyantiinflammatory，includingexercise，meditationandhealthysleephabits。
　　Healsofindspromiseintheworkofhiscolleague：Likemostcasesinmedicine，CharlesRaisonshowedthatantiinflammatoryapproachesmaybenefitsomepeoplewithdepression，butnoteverybody。Ifyoutryonyourfriendseyeglasses，chancesaretheywonthelpyourvisionverymuch。