Bipolar depression can feel a lot like a physical illness, such as the flu, because it is a lot like a physical illness. Here is a physiological explanation.
You’re pretty much laid up in bed, or at least significantly limited in your capacity to perform daily duties. Your concentration is off, and you’re not expected—nor welcome—at work. It feels like the flu. But is it?
My body aches all over. Why does a mental illness feel so much like a physical one?
Depression can feel a lot like the flu because it is a lot like the flu. It feels a lot like a physical illness because it is a lot like a physical illness.
The way we feel when we are physically sick is caused by the products of inflammation that result from the interaction between the flu virus and the body’s defense mechanisms. Markers of inflammation, called cytokines, are elevated in times of stress, such as when the body is fighting an infection. The result is a feeling of malaise, poor energy, lack of appetite, and general all-over body aches. The decreased energy and accompanying psychological features are driven to a significant degree by the cytokines and related products of the inflammatory process.
“Sickness behavior” is the term used to describe the emotional feelings of the flu. From an evolutionary perspective, sickness behavior is important, as it is nature’s way of pulling an ill person out of action and giving him or her time to get well. In the days of early humankind, developing an infection affected the capacity to participate in the daily activities necessary for survival, and the pattern of sickness behaviors provided the basis for the individual to rest and (hopefully) recover. Sickness behaviors are very much like depression.
Not a lot has been written or discussed on the topic of sickness behavior, as it is a term that emerged from veterinary medicine. Sick animals are assessed based on observations of behavior: when ill, they become lethargic and socially withdrawn, and their appetite is decreased. Sounds a lot like depression, doesn’t it?
How is inflammation related to illness? What’s going on in my body?
Although cytokines and other markers of inflammation are related to infection, there are numerous factors that can cause the inflammatory markers to increase, such as tissue injury; increased inflammatory markers are also associated with various chronic disorders. There are many different types of cytokines that associate with different types of viral disorders, and they appear (and can be measured) in the blood over the course of illness. Cytokines are broad markers of distress and indicate that the body is trying to accommodate disruption. Simply put, increased cytokines are the result of stress—whether from a physical or an emotional cause.
Theories abound on what causes the elevated cytokines found in individuals with depression. Diet (excess processed sugars cause increased cytokines), and sleep and physical activity (low levels of either can result in increased cytokines) are common culprits; even the stressors of everyday life can boost these inflammatory markers.
What should I do to feel better?
Even if one has been vaccinated, one can still get influenza; the vaccine confers approximately effective protection approximately 60 percent of the time. Unfortunately, there is no vaccine to decrease the incidence or severity of depression. But just as “rest and plenty of fluids” is good advice for people with the flu, individuals with depression would do well to follow a healthy diet low in processed sugars, and maintain a consistent routine of good sleep and regular exercise.
Taking care of your health—both physical and psychological—involves collaboration with your health-care provider. If you feel flu-like symptoms that interfere with your daily routine, talk with your doctor. Malaise, lethargy, social withdrawal, decreased appetite, and body aches could be signs of the flu—or it could be a depression that’s dragging you down. Both are treatable.
Printed as “Ask the doctor: I’m sick, I ache all over”, Spring 2016
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