THE INFLAMED MIND

A rousing, straight-from-the shoulder call for a new approach to treating depression.

Mental disorders, writes Bullmore (Psychiatry/Univ. of Cambridge; co-author: The Diagnosis of Psychosis, 2011), the head of the Wolfson Brain Imaging Centre, can have their origin in the immune system. In a book previously published to acclaim in England, he makes the case for a link between inflammation and depression, delineating his argument with a “pioneering new field of research…called immuno-psychiatry or neuro-immunology.” This new field “exists at the boundaries between immunology, neuroscience, psychology and psychiatry.” Forcefully rejecting the Cartesian divide between body and mind—the immune system is now known to communicate across the blood-brain barrier, which was once thought to prevent this communication—the author outlines how the immune system triggers an inflammatory response to stress and how inflammation can cause changes in how the brain works, often leading to changes in mood and behavior. To illustrate, Bullmore refers repeatedly to a former patient with rheumatoid arthritis, an autoimmune and inflammatory condition, and depression, and he adds a personal touch with references to his own temporarily depressed mental state after undergoing a stressful root canal procedure. Besides explaining the biological mechanisms linking stress, inflammation, and depression, the author provides a lesson in medical history that likens present-day thinking about serotonin to the Hippocratic notion of black bile and concludes with the statement, “in short, depression after Descartes is in a sorry state.” Bullmore’s involvement with a research program at the pharmaceutical firm GlaxoSmithKline, an arrangement he is quick to acknowledge, may raise questions about his interest in the development of new anti-inflammatory drugs to treat depression, but his insights into depression and its treatments are impressive and valuable. The black-and-white illustrations vary widely in quality, from woodcuts and engravings to some rather amateurish original drawings.

Aimed at the general public, highly readable, and more than a little provocative.