The Inflamed Mind: A Radical New Approach to Depression

by Edward Bullmore

Worldwide, depression will be the single biggest cause of disability in the next 20 years. But treatment for it has not changed much in the last three decades. In the world of psychiatry, time has apparently stood still... until now. In this game-changing book, University of Cambridge Professor Edward Bullmore reveals the breakthrough new science on the link between depression and inflammation of the body and brain. He explains how and why we now know that mental disorders can have their root cause in the immune system, and outlines a future revolution in which treatments could be specifically targeted to break the vicious cycle of stress, inflammation and depression. The Inflamed Mind goes far beyond the clinic and the lab, representing a whole new way of looking at how mind, brain and body all work together in a sometimes misguided effort to help us survive in a hostile world. It offers insights into the story of Western medicine, how we have got it wrong as well as right in the past, and how we could start getting to grips with depression and other mental disorders much more effectively in the future.

Genres: Nonfiction, Psychology, Health, Science, Mental Health, Self Help, Neuroscience

224 pages, Hardcover

First published April 26, 2018

Reviews

[Dr Neil MacFarlane MRCPsych · Rating 2 out of 5]

I am a psychiatrist and have not only seen hundreds of patients with depression, but also experienced it for several years. Dr Bullmore belongs to the same professional organisation as myself: the Royal College of Psychiatrists. He has worked half-time for a large British pharmaceutical company since 2005.

I think the starting point about interventions for depression is that most people just need good support. One problem has been that 'support' is often seen as a low-cost option, while different brands of therapy (whether 'talking' or drugs-based) market themselves, often dubiously, both within the NHS and in private practice. In recent years it has become clear that fewer than 1 in 10 people who are prescribed current 'antidepressants' have a real drug-based response. There are also more serious problems, with side effects and withdrawal, than patients are usually informed about.

We should keep an open mind about whether some people have 'inflamed' depression, but for me the way Dr Bullmore outlines it reduces his credibility. He gives a distorted account of current 'anti-inflammatory' drugs, highlighting aspirin rather than those with fewer side effects such as ibuprofen. His account of the reasons why such drugs have not been tested, and of the pharmaceutical industry, is not convincing.

I have written a longer review (900) words on my Blog at https://drnmblog.wordpress.com/2018/0...

[DMackD · Rating 5 out of 5]

Pre-ordered this on Amazon and it arrived at 10am this morning.
I've just completed it.
This is the book I've been waiting for and this is the book I hoped it would be when I pre-ordered it.

Everyone should read this book... as everyone will be touched by depression/anxiety at some point in their lives - either personally or themselves know someone else with mental health issues.

Everyone should read it... including GPs.


Anyone reading this who has at some point battled with depression themselves (and on average that will be 1:4 of us) will be struck I think, by page 72.

GPs still "test" you for depression or MDD with a basic tick box list... DESPITE you perhaps presenting chronic or even acute physical symptoms.
This is infuriating at best for the patient... and deeply, deeply flawed at worst.

In my own case I certainly became exasperated and depressed by a "grumbling" chronically-inflamed appendix and doctors passing it off soley as 'stress'.

The worst question to answer in my own MDD test was the "Are you taking less pleasure in activities that you previously found pleasurable?"

I looked at my GP and said "It's not that I'm taking less pleasure from my physical hobbies... it's that I'm taking NO pleasure from them... as I CAN"T do them (golf, running etc) as I double up in physical pain when I do."

But I had no 3rd option on my test. I had to put "I take less pleasure..."

2 months later and I had an emergency appendectomy.

I'm sure our hard-working GPs know the basic MDD test is very flawed. I hope so.

Another horrible revelation for readers will be Bullmore's insistence that physiological scientific knowledge of mental health issues hasn't really moved on since the late 80s with the introduction of Prozac.

I remember speaking to two GPs a good few years ago now about my reluctance to go onto SSRI antidepressants as I didn't think the resulting chronic feeling of low level despair, the probable impotence and the balloon in weight would be worth any mild improvements that the pharmaceutical might (repeat MIGHT) make.

I am a scientist by qualification myself and didn't see any huge leaps in antidepressant effectiveness (or reduction in horrible side effects) in a couple of decades.

The GPs insisted all antidepressants HAD come on over those 20 years... but Bullmore confirms otherwise.
We're still basically probing around in the dark.
That's... so.... well.. for want of another word... depressing.

The worst revelation of all in the book though comes on page 184 - but it's a revelation that many of us that either have been troubled with depression or know family members who have, know all too well.

It's a fact that if you have (or have had) a chronic mental health issue, you're likely, on average to live at perhaps 10 or 15 years LESS than if you've not managed a mental health issue in your life....and no... this is NOT because of suicides skewing the figures.

It's because of something far more alarming than even that.

Even when suicides are taken out of the "life expectancy equation", your average mental health "battler" still, on average, lives 10 years less than someone who hasn't battled a chronic mental health issue (be that depression/anxiety etc).

This is basically because once you are even tentatively diagnosed with something like depression by your GP - you card is well and truly marked -or at least it feels like that to many, many patients.
Dare to go again to your GP and complain of real physical symptoms - and the standard position (often) from your GP will be "it's all in your head".

You're FAR more likely to die of a treatable, physical illness or disease if you have "depression" in your medical records.
You could argue (with some fortitude) that is actually because the your GP truly believes your physical symptoms really ARE "all in your head".
Or... they don't actually believe you at all when you dare to say "Doc... I really do think I may have something very wrong with my liver/gut/lung/joints/thyroid..." etc etc.

This, I think, is a NATIONAL DISGRACE.

I say "National" as I think even our European neighbours do better at this sort of thing than we do.

Our entire health system needs to join-up mental and physical health issues, diagnosis and treatment - but even now we basically treat them as completely separate things.
And that is something that the rest of the world does seem to be streets ahead of us in.

Now.
I'm not saying GPs don't care (although some of mine I'd suggest could benefit from a course in "listening to" (or even "looking at"!) their patients).
And I am aware that some GPs DO look to "prescribe" exercise or a change in diet etc to look to any physical roots of mental ill health - rather than immediately reach for the Prozac prescription form.

But very often one is pushed towards a bit of a box tick such as CBT - even when that COULDN'T work for some physical inflammatory symptoms - and then the chain of trying out SSRIs if CBT has no lasting effect.

I also know (very well indeed) that some "traditional" or "accidental" antidepressants such as SSRIs DO work for many people and enable them to function. (Without which they couldn't).

But they simply don't work for many other people because they CAN'T... and we STILL don't have a clear picture about the importance of serotonin (or adrenaline or noradrenaline) in this complicated field... despite what many GPs (blindly) insist.

The well-qualified Bullmore makes such a lot of sense in this book, at least to me.

I hope this book and others like it kick off a new wave of prolonged, REAL clinical research into things other than a chemical imbalance of serotonin, adrenaline or noradrenaline possibly causing what seems to be the most-pressing health issue of our times -

Perhaps this will go some way to begin to eradicate any stigma of mental ill health too.

I hope so.

Even if you're on (or have been on) an SSRI and thought it DID make a difference to you or you know someone who is (or was) - I'd certainly HIGHLY recommend this book.

Thanks

[Peter Tillman]

This one comes under the category of "books I won't read", but you have to say you're going to, to post at Goodreads. So.
Carol Tavris at the WSJ didn't think much of this one:
https://www.wsj.com/articles/the-infl... [paywalled]
"The cover of “The Inflamed Mind” should immediately arouse a reader’s suspicions about the reliability of what lies within. The subtitle promises “a radical new approach to depression,” and the front flap of the dust jacket claims this is a “game-changing” book that “reveals the breakthrough new science on the link between depression and inflammation of the body and brain.” In science, the words “radical,” “game-changing” and “breakthrough” apply to vanishingly few developments. Scientists despair of the way language like this excites the public ...
'
'
My mind was further inflamed, so to speak, when I saw a cover endorsement by the CEO of “Mindstrong Health,” a company aiming to develop ways of measuring biomarkers for mental illnesses. On the back flap, we learn that the book’s author, Edward Bullmore, a professor of psychiatry at the University of Cambridge, is “currently leading an academic-industrial partnership for the development of new anti-inflammatory drugs for depression.” ... Even “Listening to Prozac” did not have a cover endorsement from the CEO of Eli Lilly.
'
'
The idea that inflammation is involved in some mental illnesses is not an improbable hypothesis. But the evidence that it’s a significant cause of most kinds of depression comprises a relatively small part of Dr. Bullmore’s narrative, which is puffed to book length with chapters on how the immune system works [etc]"

Really, need you read more? Avoid, avoid. At least at this stage.
Reviewer Carol Tavris is best known for her classic "Mistakes Were Made (But Not by Me)," which I liked a lot.

[Joy D · Rating 3 out of 5]

Bullmore asserts that certain types of depression are caused by inflammation in the body that can penetrate the blood-brain barrier. He believes this causal relationship has been missed over time due to the ongoing acceptance of the views of René Descartes, and contends these views are still influencing medical professionals today. He calls this a “Cartesian divide.” This divide splits mind and body into separate and distinct parts. He hopes to prove that treatment for inflammation will help some patients who are not responding to traditional psychiatric treatments. He describes the experiments that have been conducted in support of his ideas.

He starts by describing the immune system and how inflammation arises. He suggests measuring cytokines and macrophages as indicators (biomarkers) of inflammation. It appears there is some evidence for “inflamed depression,” which is presented in this book, but (as the author admits) his claims are far from proven. He contends anti-inflammatory drugs could, once studied and approved, help a substantial number of people. My overall impression is that further study of the “inflammation theory of depression” is warranted but I remain skeptical until more testing is completed.

This book will appeal to those with a specific interest in depression and the mind-body connection. I thought (from my previous reading) that the idea of the mind and body as an inseparable whole was more pervasive in the medical community than is depicted in this book. It is a bit jargon-laden in places but is easily consumed by someone with a basic knowledge in this field. I will be keeping an eye out for further research into “inflamed depression.”

The author is a neuroscientist, Professor of Psychiatry at the University of Cambridge, and Vice-President of Experimental Medicine at the pharmaceutical company GlaxoSmithKline.

[Beth · Rating 2 out of 5]

I wanted to like this book. Bullmore is right, at least, in noting that “therapeutic progress [in psychiatry] has stalled in the last 30 years”, and that doctors still have little to offer other than SSRIs and talking therapies, helpful though they are to many people.

The book is, however, full of contradictions and unsubstantiated claims. That bodily inflammation might cause a lowering of mood is an interesting enough theory but that is all it is. Bullmore fails to back this claim with any kind of solid evidence and falls into the trap of making the facts fit the theory, which will never pass muster under scientific scrutiny. He points to a statistically significant correlation between depression and a raised CRP (marker for inflammatory proteins) in the blood and goes on to describe this as “robust evidence” but it is nothing of the sort. Correlations say nothing of cause and effect or of variables, of which there are a great many when it comes to raised levels of CRP.

Bullmore rightly emphasises that depression has many causes – it is a symptom rather than an illness in its own right – yet he goes on to say that it really all boils down to inflammation in the end, including responses to minor events such as dental treatment or vaccination. To be clear, Bullmore is referring to clinical depression here and not just a bout of everyday fed-upness. But this claim leads to strange consequences. He states, for example, that older people are more prone to depression because of the inflammatory effects of ageing but this is not true. Depression generally lessens with age, which is why suicide rates are far higher in younger age groups. He states that it is not a diagnosis of chronic illness that causes depression but the inflammation, as if one is not quite reasonably cast down by this on psychological and emotional grounds. Finally, he claims that it is not major life events such as bereavement or redundancy that cause depression but some hidden inflammation due to stress. And this, I’m afraid, is just nonsense.

Besides, if it were the case that inflammation caused clinical depression, we would have noticed it within the context of everyday life right across human history. There would have been a strong pattern of pronounced low mood following every cold, cough, infection, injury or surgical procedure. There is no such pattern. It is true that those who enjoy good physical health are less prone to depression, especially if they exercise regularly, but this cannot be extrapolated to an inflammatory theory of depression. This book is a red herring.

[Alicia Bayer · Rating 4 out of 5]

This is an excellent book by a psychiatrist who has compelling reasons to suggest that for many people, inflammation in the body (and then the brain) leads to depression. Bullmore started his career as a doctor on the medical side of things before switching to psychiatry (medical doctors who specialize in mental disorders). He talks about the fact that the two fields really have an Apartheid-like relationship to each other and never treat patients as a whole. He was trained as a medical doctor that his patients with illnesses like arthritis were very depressed just because "you would be" under the circumstances, never that the illness might actually have a physical trigger for depression. He also writes of his time working for Glaxo Smith Kline trying to work on new antidepressants and the fact that nobody has been looking at anything but SSRI medication for 20 years, despite the fact that the main premise behind them has never actually been proven and that depression is very unlikely to only have one cause. GSK ended up shutting down their entire antidepressant section, saying it was too expensive and most of the drugs they were trying failed. He also gives insight into the process they use, and it's no wonder they all fail. All of the new drugs were in the same SSRI field and they have a ridiculous model for developing them that involves first hanging mice by their tails and seeing if the drug makes them give up struggling in more or less time, and then moving on to badly designed trials in humans.

The book goes deeply into the history of psychiatry, antidepressants, inflammation and the immune system. It's fascinating for those who are science nuts but is very long. He does an excellent job of convincing the reader that inflammation is almost certainly linked to depression in many people, and in showing you what causes inflammation and how to find out if you have it. Where the book is less promising is in telling you how to help it. He's a psychiatrist who worked in developing medications, and that's his sole focus. There is almost no talk of anything other than prescription drugs for treating inflammation, though he does acknowledge that lifestyle changes make a huge difference (he says it's too hard to make those lifestyle changes when you're depressed). He also says that an implant that sends electrical charges to the vagus nerve has shown very good results in treating depression in people. That has been approved as a treatment for years but it's expensive and invasive, and nobody knows why it works. He ends the book with a sort of hopeful plea for doctors and pharma companies to quickly get on board so we can help people.

I really wish he had talked about the many ways that you can decrease inflammation -- supplements like garlic, turmeric and ginger; mindfulness training and meditation; movement and exercise; and so on. I also just read a book by another medical doctor about the effects that grounding have on inflammation and I looked up studies after reading that book and that's a really fascinating method that has shown remarkable effects on inflammation and wound healing (here's one fascinating study published in the Journal of Inflammation Research that also has images of the dramatic effects on three patients: https://www.dovepress.com/the-effects...). Bullmore is single minded in his focus on pharmaceutical interventions though.

The book is well supported with a full 1/4 of the pages devoted to references. It's a great read for anyone interested in learning more about depression, inflammation, and the history of the two.

I read a digital ARC of this book for review.

[Tahmineh Baradaran · Rating 4 out of 5]

به عنوان کسی که سالها دربرابرمصرف داروهای ضدافسردگی و اضطراب مقاومت کرده ام (که البته افتخاری برای من نیست)
دیدگاه و نظرمتفاوتی از ارتباط دوسویه ذهن و التهابات بدن به من داد و فصلی هم به دلایل عدم سرمایه گذاری شرکتهای دارویی برا ی ساخت داروهای جدید درحوزه روان پزشکی می پردازد که آ ن هم جالب بود.
از نوعی سندرم افسردگی پس از "عصب کشی " دندان نام برده می شود .من به شوخی به دندان پزشکم گفتم اگر هر عصب کشی به افسردگی منجر شود و هرکدام چندسالی طول بکشد ، دلیل تام و کافی برای افسردگی سالیان من وجود دارد :D
کتاب بسیار جالب و خوش بیانی است . توصیه میکنم .

[Richard · Rating 4 out of 5]

Our knowledge of immunology has exploded during the past twenty years; two decades ago it was a more self-contained field, today there are few serious medical disorders that aren’t either complicated by, or directly the result of, our immune system. And the author’s thesis here is this: “inflammation” is an essential part of our immune system’s response to attack; inflammation can affect any organ of the body—including the brain, causing many of those changes in mood, thinking and behaviour characterised as “depression”. The case he’s making is that in many people depression is directly caused by an inflammatory disease: in rheumatoid arthritis, for example, depressed mood can be as much a symptom as swollen and painful joints. Rheumatoid arthritis is itself an auto-immune disorder in which the immune system attacks its own body, flooding it with hostile antibodies and inflammatory proteins, and Bullmore is extending this to include effects on the brain as well.
    The reason this seems to most of the medical profession such a revolutionary—even nonsensical—idea is that it brings together two realms medicine usually prefers to keep apart: body and mind. Terms such as “neuro-immunology” and “immuno-psychiatry” reflect the orthodox dualistic view that what goes on in the brain is separate from what goes on in the rest of the body, and to many the idea that inflammation can cross the supposed “blood-brain barrier” (what the author calls the Berlin Wall) is unthinkable.
    Body and mind: although an ancient way of dividing us in two, medically and scientifically speaking we largely have Rene Descartes to thank or curse for this, and Bullmore fills in the background because it’s also the background to the case he’s making. As he says, even four centuries after Descartes our medical services are still organised along Cartesian lines: two completely different sets of hospitals, two kinds of doctor, two types of treatment.
    Just to add: this is no “pop” medical book written by a journalist or someone unqualified altogether. Edward Bullmore himself crossed his “Berlin Wall”, having originally trained in medicine at Oxford, then Bart’s Hospital in central London, later retraining in psychiatry where he is now Professor and Department Head at Cambridge University. And just to emphasise: The Inflamed Mind isn’t orthodoxy. If he’s right though the result might be, not only a fuller understanding of certain debilitating mental disorders, but a more unified view of human beings.

[Bookworm Ava · Rating 5 out of 5]

This book should be added to the set reading list for all trainee doctors and clinicians with immediate effect. It should also be available at all mental health charities. All libraries both university and public. It should be made available to anybody who works with children whether as a support worker or teacher, but more importantly for anybody who is a sufferer of mental health issues or who is a carer of one (I am both) please read this book. For all those who sit on charitable commissions, House of Lords and Commons Mental Health Committees, Mental Health Hospital Trysts, CEO’s of Hospital Trusts and anybody who has a voice or any say in this country’s current care/treatment of those suffering from mental health issues my plea to you all is please read this book. GP’s, Home Treatment teams for Mental Health please read this book but to those psychiatrists coming through their training now to you most of all please please read it and think outside of the box.
Mental health continues to be a topic where those that suffer and those that have been lucky enough to come through depression are still in the shadows but we too have a voice and it’s one that should be listened to.
If you buy one non fiction book this year please consider this one. Thank you Professor Bullmore for being brave enough to speak out.
I hope my daughter will finally get the help she so badly needs and your book has given me that hope!

[Literary Redhead · Rating 5 out of 5]

🧠 🧠 🧠 🧠 🧠

THE INFLAMED MIND: A RADICAL NEW APPROACH TO DEPRESSION shares groundbreaking research into the role of the immune system and inflammation in the development of depression. Edward Bullmore, among the first animmunopsychiatrists, shares the pioneering work being done in clinical neuroscience that impacts not only depression, but also schizophrenia and Alzheimer's disease. He describes the significant link between systemic inflammation and mental illness, heralding a new field of personalized psychiatry, much in the way personalized therapy has revolutionized cancer treatment. He also identifies new anti-inflammatory treatments for depression, projected to be the single biggest cause of disability in the next twenty years. As Jeremy Vine of the BBC says, “Suddenly an expert who wants to stop and question everything we thought we knew…This is a lesson in the workings of the brain far too important to ignore." Highly recommended!

Pub Date 31 Dec 2018   

Thanks to Macmillan-Picador and NetGalley for the review copy. Opinions are fully mine.

#TheInflamedMind #NetGalley

[Louise · Rating 5 out of 5]

Phenomenal. I wanted to pull my hair at times over the descriptions of psychological explanations of depression, but, big but - the most satisfying book on depression I have ever read. Very uncomfortable reading this on the tube to work and then having to use CBT to treat depression when I got there. It's not enough.

A must read for anyone interested in depression, for anyone who has or loves someone with a long term health problem.

I think I need to read it again.

Please, someone I know, read it now so we can talk about it! Right now!!

[Emily · Rating 4 out of 5]

What I gained from the book was not only how depression might be approached from an immunological perspective, but also a greater understanding of the history behind how we approach things in medicine and the limitations of the traditional Cartesian dualistic view, which is so inherent to the field that it may not be questioned by those practising medicine. I liked his honesty regarding the implications of what he has written about - that there is scepticism about the link between inflammation and depression, but that evidence does exist and research is ongoing, and that this could lead to new approaches for treatment of such a prominent mental health disorder.

[Hannah · Rating 4 out of 5]

Overall I found this book fascinating. The military metaphors for the immune system early on were a bit much, but I appreciated the accessibility of the content for non-medical readers. Most of all, I enjoyed seeing someone look at mental illness (and specifically depression) from a different angle. My family has a history of depression going back generations, and I'm being treated with the same therapies that my mother was (and is still) treated with when she was first diagnosed. So whether the immune link proves to be useful or not, I agree wholeheartedly that we need to be looking differently and creatively at depression--its causes, its symptoms, and its treatments.

[Sam · Rating 3 out of 5]

An intriguing discussion of how depression is potentially caused by inflammation in the body. Bullmore argues that in response to infection our immune system is designed to inflame and send macrophages, which release cytokines into the blood; these then signal to lymphocytes to produce needed antibodies. People with inflammation, indicated by higher levels of cytokines, have been more likely to display symptoms of depression. Bullmore takes pains to argue the evolutionary benefit of this which personally I found was somewhat obvious. It is not difficult to surmise that symptoms, such as lack of appetite and increased sleep, means that an individual can fight off potential infection and social withdrawal means there is less chance to infect the rest of the tribe. Bullmore did also suggest that disturbances in sleep and anxiety are perhaps explained by infected ancestors sleeping apart from the tribe and therefore were more at risk from predators and thus needed to sleep lighter and be anxious to survive. Thus depression is an evolutionary advantage for us to repair from trauma to the body which Bullmore argues now includes social stress. I was interested by the discussion of how SSRIs such as Prozac rose to fame on the back of little scientific evidence for their credence and the incredulous use of mice held upside down by their tales to indicate a suitable drug in trials. The use of Alzheimer’s as a contrast and the discussion of genetics and inadequate technology to observe the levels of neurotransmitters in the synapses of neurons was illuminative of how much research is still needed in this area and with such a lack of financial backing is unlikely to develop any time soon. Even with inflammation of the body as an adequate explanation, with no way to measure it there is still no advantageous treatment but what Bullmore hopes for is a holistic view of medicine which incorporates the mind and body rather than usual dualism. All this said I found myself getting bored towards the second half as it felt like Bullmore was trying to pad out his argument and was less to the point as he had been earlier.

[John Riley · Rating 2 out of 5]

As a new Psychiatric PA I was excited to read something on the “cutting-edge” of psychiatry to try and get a better understanding of where the field is heading theoretically and what the future of mental health practice may hold. While Dr. Bullmore does an excellent job of presenting his hypotheses regarding immunology and various medical disorders (chiefly MDD), his ideas seem better suited for a journal article than a book. The same ideas/clinical examples/history lessons are repeated over and over and the first 3-4 chapters (out of 7) are basically history lessons that explain why his ideas are still medically misunderstood or refuted today. Overall, I did get what I was looking for out of this book, which is a “cutting-edge” psychiatric hypothesis that I can take with me and keep in the back of my head while I practice psychiatry and begin to treat patients with MDD. Even though this is a very short book, I think the important ideas could have been said in far fewer pages, as well as repeated less, and the level of detail in both psychiatry and immunology could have been much greater. I am most excited about the predictions he makes regarding new psychotropic medications and I hope his ideas and those of others like him receive the attention, both financial and academic, that they deserve.

[Darnell · Rating 2 out of 5]

The author has some interesting proposals, but he overreaches. Though I think he makes a decent case that inflammation is involved in depression, he pushes for it to have a central role on thin evidence. The book is also padded with tangents on Descartes, the immune system, and evolution - fairly basic stuff, as in white blood cells drawn as Pac-Men. I was uncertain whether to lean toward the good parts or the weaker parts, but if Carol Tavris rated it two stars, I'll go with her.

[Jordon · Rating 3 out of 5]

Darn you Cartesian divide

[Charles · Rating 4 out of 5]

"if we could completely cure depression in the UK from the start of the next financial year it would be roughly equivalent to adding 4% to GDP, or tripling the projected growth rate of the whole economy from 2% to 6%" p3
1. Mental Health Foundation 2015

"It is now clear that a lot of what I was taught in medical school is wrong." p10

"If a rat is experimentally injected with infectious bacteria, ... It withdraws from social contact with other animals, it doesn't move so much, its sleeping and eating cycles are disturbed. In short, infection reliably causes a syndrome in animals – called sickness behaviour – that is roughly recognisable as akin to the human experience of depression. In fact ... It is enough to inject a rat with cytokines, proving that it is not the germ itself that causes sickness behaviour but the immune response to infection. Inflammation directly causes depression-like behaviours in animals – that is beyond doubt.³" pp12-13

"...the inflammatory response to injury dilated the local blood vessels, allowing more blood to flow into the wounded area, causing ... heat. ... inflammation makes makes blood vessel walls leakier, allowing more fluid to leave the circulation and accumulate in the muscles and other tissues ... causing ... swelling" p24

"... beautifully detailed knowledge ..." p42 such modest

"... it is difficult to think of a disease that isn't caused or complicated by inflammation or auto-immunity." p60

"Pretty much whatever their physical health disorder, patients with long-term medical conditions have increased risk of mental health symptoms, most often depression or fatigue." p61

"For about 15 years after they first met in 1887, Fliess and Freud corresponded extensively and conspired to develop a naso-genital theory according to which neurotic or hysterical symptoms originating in the female genitals could be treated by applying cocaine to the nose, or even by a surgical operation on the nose." p79

"... the French disease, as the ongoing plague of syphilis was then known by German-speaking people." p88

"When I started specialist training as a ... psychiatrist ... in 1989, it was recommended we study a couple of standard textbooks that covered all the major theories and therapeutics that were then considered important for psychiatry. To this day, in 2018, I could still safely and acceptably treat most patients with mental health disorders based solely on what was written in those textbooks." pp102-3

"... between 1992 and 2014, immuno-psychiatrists have reported cytokine measurements on thousands of MDD cases and healthy controls.⁴² Collectively, these data show that the blood concentrations of CRP and some cytokines are increased in patients with depression. The probability of seeing differences this big by chance is in the order of one in 10,000." p116

"... people who are located towards the more severe end of the depressive spectrum tend to have higher blood levels of inflammatory markers ..." p116

"... the auricle, the flexible collagen ridge in their shell-like outer ears, just above the opening that lets sound pass through to the inner ear. Rubbing your auricle is good first aid for indigestion and anxiety ..." p131

"We know that depression is common in patients ... who have a major inflammatory or auto-immune disorder such as rheumatoid arthritis, diabetes or atherosclerosis ..." p146

"... adipose tissue, is inflammatory. About 60% of the cells in adipose tissue are macrophages ... one of the principal sources of inflammatory cytokines ..." p148

"Age ... is ... a cause of increased inflammation and a risk factor for depression. As we grow older, our bodies tend to get more inflamed." p148

"... about 80% of all episodes of depression have been preceded by a stressful life event.⁶⁷ The most depressing stresses are events that involve both loss of an important relationship and social rejection. So a man who has initiated divorce proceedings against his wife will be at 10 times greater risk of depression, because of the loss of the marital relationship; but a man who is being divorced by his wife will be at 20 times greater risk of depression ..."

In the discussion on natural selection and why depression exists he fails to address the argument that a genetic mutation that doesn't immediately decrease a being's ability to pass on its DNA but also has no real advantage either could be an inherited trait.

"... the innate immune response of social withdrawal reduces the risk that currently uninfected but genetically related members of the tribe will also become infected." p170

quantum - a required or allowed amount, especially an amount of money legally payable in damages
• a share or portion

"Even if you take out all deaths by suicide, the life expectancy of people with serious mental illness is still cut by a decade. So-called mental patients are dying younger from physical disorders – like diabetes, heart and lung disease." p184

"There is no solid evidence that aspirin or any other anti-inflammatory drug already in medical use has anti-deoressant effects. The clinical trials that would be needed to provide such evidence have simply not been done. There is strong but circumstantial evidence that some anti-inflammatory drugs... have anti-depressant effects ... . But no anti-inflammatory drugs are officially licensed for treatment of depression." p187

swingeing /ˈswɪn(d)ʒɪŋ/ - severe or extreme in size, amount, or effect
swinge /swɪn(d)ʒ/ - strike hard; beat
"did she not swinge the dragon of ripsnorting inflation?"

"Recent studies ... have shown that the anti-inflammatory drugs tested had an anti-depressant effect size of about 0.4, on average. ... the average effect of SSRIs is only about 0.2 ..." p202

"The story goes that at a psychiatric conference in 1907, where Alzheimer first presented his findings, his lecture was immediately followed by a more keenly awaited presentation of a case of compulsive masturbation, and he faced no questions from the audience." p208

Here are some commas from Oxford pls use them ,,,,,,,,,,,

Also, stop starting sentences with conjunctions.

This is really well-written in terms of how easy it was to read as a non-medical non-professional. It could use a bit of an edit for grammar in some places but there were only about 2 or 3 places where the meaning was too obscured.

He says right up front that he's a corporate sellout working for GlaxoSmithKline. I respect that honesty, and it's clear throughout the book that he leans heavily in favour of the pharmacological solution. I feel like I say this a lot but; sugar feeds inflammation. I kept coming back to What The Fat by Schofield, Zinn, and Rodger and thinking about all the conditions a low-carb diet helps. Bullmore even mentions schizophrenia in the final chapter, I know there's a diet associated with that.

From one perspective this could have been a sort of pamphlet explaining what's known about the role inflammation plays in mental conditions, but from another the context and speculation of an experienced medical professional, and educator, is really valuable and helps better seat the idea and its repercussions in the mind.

I'm fairly ignorant of medical history tbh so the historical detours might be less entertaining to someone who reads a lot of this sort of stuff.

[Jonna Higgins-Freese · Rating 4 out of 5]

It seemed plausible to me as a line for further research. Inflammation seems to be a culprit for any number of things.

Though overall, let me just go on record that within 50 years, I predict we are going to figure out the reasons for depression, obesity, and various increasing mental conditions: ADHD, autism, etc. I think we are with them where we were with tuberculosis in 1900: floundering around talking about "consumptive constitutions" and various quasi-effective remedies (in the case of tuberculosis: rest, decreasing overcrowding), but in the end -- it was a bacterium. And depression, ADHD, autism, obesity will turn out to have been: a virus, a prion, the preponderance of hormone mimicking chemicals in the environment, etc.

"If my arm is broken I can at least count on the cheerful support of people around me. There will probably be an entertaining story to tell about how it happened, perhaps some thrillingly gory details to share, and other people will generally be happy to listen, to sympathise, to tell in return their own war stories, and to pass on their nuggets of medical advice. But if my mind is broken I can count on none of this. if I am depressed -- joyless, hopeless, sleepless and plagued by an incessant sense of worthlessness -- I am also much more likely to find myself on my own" (74).

In study in Cophenhagen, those with highest CRP levels were also most depressed.

Shocks to the vagus nerve to inhibit cytokine production by macrophages in the spleen, thus decreasing inflamation (132).

Gene most highly associated with depression is also (olfactomedin 4) known for its role in "controlling the gut's inflammatory response to dangerous bacteria" (174).

[Ada · Rating 5 out of 5]

Professor Edward Bullmore is Head of the Department of Psychiatry and the Director of the Wolfson Brain Imaging Centre in the Department of Clinical Neurosciences at the University of Cambridge and a part-time consultant for GlaxoSmithKline.

His book is a summary of the most recent research linking depression to physical inflammation.
I found it absolutely fascinating. Bullmore’s suggestion is that patients are not simply depressed because of their physical symptoms, but that their depression is part and parcel of their physical symptoms. He is excellent at explaining scientific terms to a lay audience, and there are a lot of helpful diagrams illustrating what is going on inside the human brain. For me, this was a page-turner.

The only thing that amused me somewhat is Bullmore’s insistence that the divide between mind and body in medicine is due to Descartes. Perhaps he bears a share of the blame, but the dualist position has been in existence at least since Plato’s time, and it seems rather harsh to place all the blame on Descartes’ shoulders.

[Paul Bard · Rating 4 out of 5]

Superbly argued and clear cut single issue clarification of an important medical topic - inflammation and depression.

Well worth a read.

Here’s my money quote:

“A lot of what I was taught in medical school was wrong… inflammatory proteins in the blood, called cytokines, can send signals across the blood brain barrier… creating powerful inflammatory effects. What does an inflamed mind look like? A 2014 study of 15,000 children found children who were slightly inflamed at the age of nine were significantly more likely to be depressed 10 years later. Infection reliably causes sickness behavior in animals roughly akin to the human experience of depression. Injecting the rat with cytokines… causes sickness behavior… proving inflammation directly causes depression-like behavior in animals - that is beyond doubt.”

[hb · Rating 2 out of 5]

This was a 2/5 versus a 1/5 simply based on the author’s writing, which is overall fluent. Readers studying depression or psychiatry in general should beware that contrary to its summary, this book is largely anecdotal with little factual evidence of its claims. While there is indisputable evidence that inflammation has a relationship with depression, this novel does a poor job of explaining why or giving any context into how scientists have achieved this understanding. Much more could be done in a book whose introductory claims are as strong.

[Betsy · Rating 3 out of 5]

Great info but so dry. I struggled to get through it. It reads more like a dissertation or long journal article, so be prepared if you start it. But I do agree with the author- depression and inflammation are wildly intertwined and that can’t be ignored.

[Fatemeh Mehrasa · Rating 5 out of 5]

Die Behandlung und das Management von Patienten führen manchmal zu kaum einem Ergebnis. Einer der zahlreichen möglichen Gründe ist die cartesianische Trennung von Körper und Geist. Es wird kaum ein interdisziplinärer Austausch zwischen Psychiatern und anderen Ärzten gefördert. Ebenso wenig wird von einem Allgemeinmediziner erwartet, die psychische Verfassung eines Patienten in den Behandlungsverlauf einzubeziehen, wie von einem Psychiater, die entzündlichen Ursachen einer Depression, wie z. B. rheumatoide Arthritis, zu untersuchen.

Genau dieses Thema greift Professor Edward Bullmore, Psychiater und Mitglied des Royal College of Psychiatrists in Edinburgh sowie Direktor des Wolfson Imaging Center, in seinem Buch auf. Bullmore leitet derzeit ein wissenschaftlich-industrielles Forschungsprojekt zur Entwicklung neuer entzündungshemmender Medikamente zur Behandlung von Depressionen.

In dem Buch beschreibt Professor Bullmore eine persönliche Erfahrung aus seiner Praxis: Als Psychiater diagnostizierte er bei einem Patienten mit Atemnot nach Alkoholgenuss eine alkoholische Kardiomyopathie – einfach durch das Abhören von Herz und Lunge. Der Patient war zuvor wegen erhöhter Atemfrequenz, ausgelöst durch Angstzustände nach Alkoholkonsum, behandelt worden. Obwohl seine Herangehensweise beeindruckte, wurde er von seinen Vorgesetzten ermahnt: „Ein Psychiater geht nicht mit einem Stethoskop auf Station!“

Das Buch widmet sich der noch jungen Wissenschaft der Neuroimmunologie und beschreibt eindrucksvoll, wie bei entzündlichen Erkrankungen freigesetzte Zytokine die Blut-Hirn-Schranke überwinden (eine Barriere, die zeitgleich mit dem Fall der Berliner Mauer eingestürzt zu sein scheint) und Depressionen auslösen können. Dies zeigt auf, dass bei Patienten mit Depressionssymptomen mehr als nur die Verschreibung von Sertralin und eine Wiedervorstellung in ein paar Wochen notwendig sein könnte. Ein erhöhter CRP-Wert kann die Herangehensweise an einen depressiven Patienten grundlegend verändern.

Das Buch versucht, die beiden Welten von Geist und Körper zu versöhnen und eine ganzheitliche Behandlung voranzutreiben, die psychische und körperliche Aspekte kombiniert. Geist und Körper waren nie wirklich getrennt – diese Spaltung scheint erst seit Descartes entstanden zu sein.

Dies sind meine Gedanken zu diesem Buch, das ich in den letzten Minuten des Jahres 2024 in der Notaufnahme gelesen habe. Ich bin froh, dass ich es trotz aller Schwierigkeiten geschafft habe, meine Goodreads-Challenge für 2024 abzuschließen. Allerdings zeigt der Vergleich mit den Vorjahren, dass ich in meinen nicht-beruflichen Lektüren deutlich nachgelassen habe – ein Umstand, den ich hoffentlich ausgleichen kann.

[LuisJ · Rating 3 out of 5]

This was a tricky book to rate because it's not 2-stars but there were issues with it, not least that it really didn't know what it wanted to be. On the one hand one can think of it as an overly long book on the topic of the role of inflammation in human health or, on the other hand, as an overly short book on the philosophy of medicine.
In the first case there is an awful lot of supposition and hand-waving over empirical-evidence which is absent. However, I do think that it has value and constitutes an important jumping off point for future research.
In the second case, there are the constant references to "Descartes" and "dualism", which wear thin very quickly. While the author (eventually) makes the point that many doctors are too specialised and that there is still too much of a bifurcation of medicine vs psychology/psychiatry, I find that too often he fails to recognise that the issue is not so much that practitioners are falling into Cartesian dualism and then choosing the


He often re-uses the refrain "but you would too if [such-and-such]" when talking about things like being depressed when experiencing a disease. His point is that the automaticity of that sort of reply stops other causes of depression being considered. In his case he wants experts to consider the inflammatory or immunological cause but, of course, the point is valid insofar that there can be many causes of depression; moreover, conditions like depression are often self-reinforcing conditions- e.g. perhaps you get sick and this causes you to feel depressed; because you are depressed you get more sick than you would have otherwise, around and around in a vicious circle.
The philosophical/methodological approach is a good one but it turns up empty precisely because the story he's telling has so little to recommend it from an empirical point of view; enough to intrigue and invest in research but not enough to constitute a reason for belief.

Finally, I find that too often the author conflates depression with being depressed.
Being depressed is a normal state to be in in certain circumstances. After all, if you're happy as a lamb that your parents have died then there's probably something seriously wrong. Being depressed or feeling sad is often the appropriate (even healthy) state to be in given your circumstances. Suffering from depression as a condition is very different.
What you end up with is a sense that the author is trying to swing the needle too far the other way; away from saying that depression if just the normal result of coping with a bad situation to the other extreme of saying that it's mostly to do with inflammation.

[Ashley Peterson · Rating 3 out of 5]

The Inflamed Mind: A Radical New Approach to Depression is written by psychiatrist Edward Bullmore, and presents inflammation as a new frontier in tackling depression.  The author's bio at the beginning of the book reveals that he works at pharmaceutical giant GlaxoSmithKline.  He doesn't try to be subtle about disclosing this, and I didn't pick up any sense of bias.  He explains that in 2010 GSK shut down its mental health research and development (R&D) programs, and this was what prompted him to start thinking seriously about neuro-immunology and the role of inflammation.

The author refers multiple times to an anecdote of his experience of social withdrawal and morbid rumination immediately following root canal surgery.  It was gone by the next day, but he wrote "you could say I had been a bit depressed", and attributed this to inflammation related to the surgery.  While I understand the point he was trying to make, as a person living with depression myself I couldn't help but roll my eyes.

Cartoon drawings are used effectively to capture neuro-immunology concepts.  Explanations are given in simple terms, without making the mistake of sacrificing accuracy for metaphor.  Scientific terms are used, such as the immune cells known as macrophages, and the signalling molecules they release, called cytokines.  While it's somewhat difficult for me to judge, as I was familiar with many of these concepts before reading the book, I think it was pitched to a level that a reasonably intelligent person could understand without having a science background.

A patient referred to as Mrs. P. makes frequent appearances throughout the book.  The author encountered Mrs. P. during his medical training.  She had rheumatoid arthritis as well as depressive symptoms, but her treating physician insisted that the depression was a normal psychological reaction to her physical disease.  It was a relevant example, but it struck me as a bit over-used.

There was what initially felt like a bit of a detour to philosopher René Descartes to explain the persistent idea of separation between mind and body.  However, Descartes ended up appearing even more often than Mrs. P. did, to the point that it got to be a bit much.  The author writes "I can fondly imagine that Descartes himself might have agreed with me, but I can't be sure."  Oh my.  He did make the interesting point, though, that the mind/body divide is a sort of "medical apartheid", and I very much agree that a more holistic approach will better serve patients.

Bullmore argues that placing depression solely within the mental domain actually serves to increase shame and the likelihood that people will think the illness is their fault, which is in many ways what the idea of a "chemical imbalance" tries to counteract.  He goes on to explain the shortcomings of the serotonin hypothesis, which was used as the  basis for the development of selective serotonin reuptake inhibitor (SSRI) antidepressants.  He also explained that approaching depression with a focus on serotonin and related neurotransmitters has stalled out, and there have been no major advances in the treatment of depression since around 1990.  He writes: "To this day, in 2018, I could still safely and acceptably treat most patients with mental health disorders based solely on what was written in those those textbooks" that he used when he started his specialty training in 1989.  While I understand the underlying point that there haven't been any revolutionary advances in psychiatry, the notion of seeing a psychiatrist whose knowledge base is rooted in 1989 is unpalatable, to say the least.

The book explains that according to the DSM: "According to the official diagnostic criteria of the American Psychiatric Association, depressed patients can only have a diagnosis of [major depressive disorder] if they do not also have a bodily disease."  Based on this, he concluded that Mrs. P. who had rheumatoid arthritis couldn't have a depression diagnosis.  To me this interpretation seemed a bit odd.  The exact wording in the DSM-5 is: "The episode is not attributable to the physiological effects of a substance or another medical condition."

The possible relationship between depression and evolution is discussed.  The author explained that back in the caveman days social withdrawal could have been a form of quarantine to prevent infectious disease, adding that: "One might even wonder if the stigmatization of depression in 2018 is somehow related to the isolation of ancestral tribe members who were behaving as if they were inflamed."  That seems like a bit of a leap, and is followed by yet another leap: "Could the common feeling that 'we don't know what to say' to our depressed friend conceal an ancient inherited instinct to recoil from close contact with people who are behaving as if they are inflamed and infectious?"  By that argument, though, why is there not such a social recoil from people with type I diabetes or Crohn's disease?  Or the oft-referred-to Mrs. P. with rheumatoid arthritis?

While there is a strong argument that inflammation is a factor in depression and an important target for research, there isn't much yet in practical terms.  The book describes the "Remicade high" that some clinicians have seen in patients who rapidly cheered up while getting an infusion of that anti-inflammatory medication.  There have been some small studies with anti-inflammatories that have had positive results, but there isn't a clear indicator of something particularly effective that's available right now.

Vagal nerve stimulation is also mentioned as a possible intervention  to target inflammation.  Cytokine receptors on the vagus nerve respond to high levels of inflammation by signalling to the spleen to deactivate macrophages in order to maintain homeostasis.

I started this book quite prepared to buy what the author was selling, given my prior knowledge of some of the research in this area.  I was a bit surprised by the book's presentation of the idea as though it's something that everyone is denying, because it's sufficiently accepted to have made its way into the mainstream continuing medical education activities that I've viewed.  Bullmore writes that "we could be on the cusp of a revolution", and I know personally I'm hoping that advances in anti-inflammatory treatment approaches will end up being able to help with my own depression.

The book makes a strong argument that further research into inflammation is going to open new doors in depression treatment.  However, the fact that we don't have keys to those doors yet limits its practical usefulness.  Still, this book is worth reading if you're interested in finding out more about a new way of looking at the biology of depression.

[MediSN · Rating 4 out of 5]

Dr. Bullmore's new approach to depression is advertised as "radical"- yet it is only radical in some ways, and a long time coming in others. It is radical in the sense that neither depression, nor any other mental health illness, has ever been proposed to be treatable with anti-inflammatory medication. The research that implicates systemic inflammation as a causal factor in these diseases is definitely promising enough to be explored in clinical trials, as Dr. Bullmore suggests. I found the pharmacological aspect of this groundbreaking, and in this sense, Dr. Bullmore's book is an essential read for all current and future pracitioners of psychiatry and mental health. The current expensive and time consuming method of seeking out the next "blockbuster drug" is prone to failure; thus, focusing on inexpensive medication that already exists is a very new and interesting place to steer antidepressent research.

While the scientific aspect of this was definitely novel, I found certain concepts of his narrative actually quite dated. For one, all multifactorial diseases are moving towards an individualized approach in their treatment. He mentions this himself, while refering to the treatment of cardiovascular disease and cancer. Thus, I understand his reluctance to focus too much on this in the book, as it goes against his claims of "a radical new approach". He only really emphasizes in the last chapter that this approach would only work for a subset of "inflamed depression" patients, assuming that this subset exists. The lack of this explanation felt like a huge plot hole to me, and had me questioning the impact of inflammatory research in depression for the majority of the book.

Overall, while I am not entirely convinced that inflammation plays a distinct causal role in the development of depression, I am able to look past that, when accepting that Dr. Bullmore was not trying to convince anyone of this. He is simply putting forth the research that exists, and establishing the importance of further pharmacological research in this direction. If he is right, then in 5-10 years, a subset of mental health patients will be treated for an incredibly debilitating disease that was once thought incurable. For this reason alone, this book is an important read, and I would recommend this to all medical students and practitioners.

[Alex Delogu]

I was initially enthused by this book. The (very) basics on immune response have me wanting to learn more. The connection between the immune system and consciousness is very intriguing. I was happy to see a fleeting mention of meditation and tai chi as inflammation reducers. Some of my criticisms were confirmed upon reading some other reviews. The insistence that the solution to inflammation lies in some medication, while holding some promise, never addresses the problems raised in the book itself. Reducing stress in one's life, engaging in more activities that might reduce inflammation (like tai chi or meditation). They seem like the answers to the problem that a new medication cannot substitute. My intuition at this time is that the work of people like Stephen Porges, Dan Siegel, Bessel Van Der Kolk, and the likes, already indirectly work at the level of immune response.

[Chad Manske · Rating 3 out of 5]

Depression is on track to becoming the single highest disability in the coming years. Yet treatments have not changed much over the past 30 years, because it’s root and symptoms have not been clearly understood—until now. A University of Cambridge professor, in this groundbreaking book, details his findings grounded in the connections between physical body, the immune system, and the mind that conspire to rob people of joy. “Professor Edward Bullmore explains how and why we now know that mental disorders can have their root cause in the immune system, and outlines a future revolution in which treatments could be specifically targeted to break the vicious cycle of stress, inflammation and depression.” If his hypothesis is correct, it could be a game changing turnaround afflicting so many people young and old.

[Mia Billingham · Rating 3 out of 5]

I found this book a really interesting new perspective on an alternative explanation of the biological mechanisms that cause depression. Bullmore presents a convincing argument that inflammation provoked by our immune system is associated with depression using anecdotal data from his own experiences as well as patients he has treated. However, I found that in the second part of the book I started to lose interest as I found it quite repetitive as he hammers the same points home a lot. Despite that, I think with further research exploring the link and further clinical trials of drugs and therapeutics targeting the inflammatory response for depression, this idea could be groundbreaking for clinical neuroscience.
Considering this was published 5 years ago also, I wonder if there has been any significant developments on this idea since.