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-of-grounding-earthing-on-inflammation-the-immune-response--peer-reviewed-fulltext-article-JIR). 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.

The concept was interesting and was well-written. However, the book felt like a drawn out academic paper in need of additional research.

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 he 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.

Edward Bullmore's book is both amazing and disappointing. It's amazing because his writing is refreshingly clear as he lays out his thesis about inflammation's role in depression. He explains the nascent field of psycho-immunology and how much has been learned about the immune system 30 years. He also documents the weaknesses inherent in contemporary mental health-care, which is based on the ages-old Cartesian separation of mind and body.

The book is disappointing, however, because any treatment based on the role of inflammation in the brain is still years away. Unfortunately, he also has virtually nothing to say about any other approach to lowering inflammation in the body. For instance, there are a variety of anti-inflammation diets out there, but Dr. Bullmore has no guidance to give. No doubt that is because there is no inflammation-reducing diet verified as effective through research. (At least to my understanding.) But it would have been helpful if he at addressed it.

Regardless, any lay person interested in inflammation and the brain should find Dr. Bullmore's overview both accessible and educational.

I didn't know what to expect in reading this book, the ideas of neuro-immunology were new to me. I enjoyed his easy to consume writing that touched on evolution, psychology, the nature of belief and Descartes. This was a great description of the duality of medicine and psychology that really clicked with me and helped me understand neuro-science more.

The Inflamed Mind is an engrossing look at how our bodies work as interconnected systems. This book is eye opening and informative. I highly suggest this read for anyone looking for more information about how our mental health is affected by all the systems of the body and the connection between the inflammation within our bodies and the effects on our mental states.

Edward Bullmore's book "The Inflamed Mind" is a cutting-edge book that examines the connection between inflammation and the epidemic known as depression. As a mental health advocate and author, I particularly appreciated Dr. Bullmore's informed approach to such a complex topic. Although the material at times borders on being difficult for a layperson to follow, the reader is helped along the way thanks to Dr. Bullmore's conversational writing style and logical progression "The Inflamed Mind" is a fascinating book written by one of the most brilliant minds of our time. I definitely recommend it to anyone interested in mental health.

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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.

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