Depression and Autoimmunity: The Biological

Connection
August 21, 2013
Comorbid depression is common with chronic inflammatory illnesses such as rheumatoid
arthritis and psoriasis. The cycle of symptoms even appears to track simultaneously: For
instance, it has been known for some time that depression accompanies psoriasis flares, and
resolves when the flares subside.
New research suggests that this depression is no mere reactive consequence of the
"frustration and discouragement associated with the illness," as Andrew J. Cutler MD puts
it in this recorded interview. It is a "true, underlying biological process" recognizable by measuring mediators
of inflammation.
Here Dr. Cutler sheds light on the relationship between neurotransmitters, mediators of inflammation,
depression, and chronic disease. He is board certified in internal medicine and psychiatry. Dr. Cutler is on the
clinical faculty in the . He is also CEO and Chief Department of Psychiatry at the University of Florida
Medical Officer of the in Bradenton. Florida Clinical Research Center
Managing Physical Illness and Depression
Managing Physical Illness and Depression
Key quotes:
Depression is not only an illness that is seen by psychiatrists. All physicians need to be aware of this,
especially as we learn more about the common underlying biologies and the relationships between some very
common illnesses and depression.
People who have chronic medical conditions such as ... rheumatoid arthritis or autoimmune conditions ...
are at risk for depression. What's been under-appreciated is that this is not just a reactive depression ... We
now know that the same biologic conditions that are causing the primary condition ... can cause changes in
the brain that induce depression.
The brain is loaded with hormone receptors and also cytokine receptors, and we know that some of these
inflammatory cytokines have a negative effect on the brain's ability to make ... the neurotransmitters
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serotonin, norepinephrine, and dopamine. ... involved with the pathogenesis of depression. We also know that
inflammation can prevent neurogenesis and be toxic to nerve cells.
Charles Raison ... treated a group of patients with depression with infliximab. ... He found that overall the
drug did not beat placebo at treating depression. However, he found that when markers for inflammation
were elevated, those patients did respond and the depression got better. This is the first time we have a
biologic treatment rather than the standard antidepressants. .

REFERENCE:
Raison CL, Rutherford RE, Woolwine BJ et al. A Randomized Controlled Trial of the Tumor Necrosis
Factor Antagonist Infliximab for Treatment-Resistant Depression: The Role of Baseline Inflammatory
. (2013) 70:31-41 Biomarkers JAMA Psychiatry

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