Separate no more

We often make a clear distinction between “mind” and “body”. But when it comes to mental and physical health, I no longer regard the two as separate. We know that poor physical health can lead to an increased risk of developing mental health problems, and similarly, poor mental health can negatively impact on physical health, leading to an increased risk of some conditions. However, in most healthcare systems the two have largely been disconnected.

I read with interest a recent meta-analysis looking into the role of oxidative stress in depression. In simple terms, oxidative stress occurs when the system is unable to detoxify the increasing levels of production of byproducts of the metabolism of oxygen, and this leads to significant damage to cell structures. The brain has a high oxygen consumption and a lipid-rich environment, and is therefore highly susceptible to oxidative stress. Therefore, the fact that oxidative stress is implicated in several mental disorders including depression, anxiety disorders, schizophrenia and bipolar disorder, is not surprising. However, although several studies have established a link between oxidative stress and mental health disorders, the causal relationship has not yet been fully determined.

This is why metaanalyses (i.e. statistical analyses bringing together results from multiple studies internationally) like this paper – published in the Journal of Clinical Psychiatry – are important sources of evidence. The authors here looked at almost 2,500 patients with depression from 29 studies and saw that the balance of key antioxidants is disturbed in this group, and is moving towards being restored after treated with antidepressants (all compared to healthy controls). We have championed the value of evidence coming from systematic reviews and meta-analysis since the inception of the Society of Junior Doctors.

Pooling evidence is becoming increasingly important. Despite the fact that antidepressant drugs have been used for more than 50 years, the mechanism of action for some is still not fully understood. Equally, we haven’t fully explained the relationship between depression and physical conditions like cancer, even though we know that up to 1 in 4 people with cancer have clinical depression. Interconnected system imbalances, such as the one that emerges in the results of this research, could go a long way towards explaining some of these associations.

Overall, results such as this are important for us to build the evidence base for questioning the long standing (costly and dysfunctional) separation between physical and mental health, towards an integrated approach to prevention of ill-health.


PS. The artwork is “The Scream” by Edvard Munch.

You can read the paper here.

My comment in The Independent.

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