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Stress and immune-related disease. Stress has a ripple effect on your biology. Dr. Sheldon Cohen (2007) published a review of the relationship between stress and disease, confirming that stress is a contributing factor to the development and worsening of many chronic diseases, in particular depression, HIV/AIDS, cardiovascular disease, and possibly cancer. Social stressors seem to influence depression, and depression is common among those diagnosed with these illnesses. Daily stressors seem to contribute most to cardiovascular disease. In addition, the progression of AIDS has been linked to an increased perception of stress.

Inflammation as a component of the immune response, if experienced in excess, is another contributor to many chronic diseases. Often, stress causes inflammation in the body, connecting inflammation to chronic disease. For example, those with rheumatoid arthritis experience more flare-ups during stressful times. Herpes virus outbreaks are more common during periods of high stress. Those with chronic fatigue syndrome have lower levels of morning cortisol and deplete their stress responses more quickly. Those experiencing stress may reduce their ability to fight and remove viruses, which in turn may increase vulnerability to other disease processes such as multiple sclerosis.

Stress, depression, and the immune response. Being stressed or chronically ill can be depressing in itself. Because depression has many different possible contributors, it must be considered holistically. These contributors to depression likely include genetics, resiliency, current internal and external resources, brain neurotransmitters, hormones, diet, environment, and stress.

Stressful events are known to be one of the triggers for depression. Stress can also lead to overactivity of the body’s stress-response system. The failure of the body to stop the rush of hormones related to stress is also known to influence depression. If sleep is poor, the immune system does not repair and replenish itself in deep sleep. When individuals are stressed or depressed they neglect self care, diet, and exercise, and engage in lifestyle practices (like smoking, drugs, or alcohol) that further contribute to depression. As a result, depression causes even further stress and life crisis. Do you see the circular nature of depression?

One of the new ways of thinking about depression also includes the immune system in the equation. When an injury or infection happens, the immune system directs inflammatory agents to rush through the blood to the wound. Cytokine (interleukins) signal for help and trigger sickness behaviors (fatigue, appetite changes, reduced motivation, fever). White blood cells arrive to kill any invading bacteria. Red blood cells bring extra oxygen for the healing tissue. Clotting factors arrive in case there is bleeding. The result is swelling and redness that is uncomfortable enough to require rest so the body can heal, further contributing to the sickness behavior those who are depressed exhibit.

Depression accompanies inflammatory response, which results in higher levels of cytokines in the blood. Stress hormones (like cortisol) tend to be higher in people with depression. Cytokine levels are also influenced by stress. You need tryptophan in your diet to make serotonin, which supports sleep, appetite, and mood, and is one of the brain neurotransmitters that is associated with depression. When the body breaks down tryptophan, some of the remaining chemicals further influence cytokine levels. Again, this refers to the circular nature of depression.

However, with all of these bidirectional contributing factors, it is unlikely that there is one contributor to depression. Again this is a reminder to think holistically; it all matters.

Chronic illness. It is not hard to imagine that an impaired immune system caused by depression would lead to common ailments such as colds and the flu. However, the prolonged presence of depression can lead to far more serious and lasting diseases. These long-lasting or chronic diseases, which usually cannot be cured, are expensive for sufferers and the health care systems. These diseases may include diabetes, heart disease, arthritis, liver disease (hepatitis), asthma, cancer, chronic viral infections such as HIV/AIDS, and cancer. Years ago people usually died from these diseases, but more recently, medical care has improved and people are living longer. These diseases are also effectively managed by improving diet, exercise, and reducing risky lifestyle practices such as smoking. Due to its life impairment, chronic illness often brings about episodes of depression. Depression is seen in over one third of all people with chronic disease and is more likely to occur if the illness is accompanied by pain, social isolation, fatigue, or disability.

Autoimmune disease. As you move about your life, different systems within your body work together for the health benefit of your entire body. New cells generate and old cells expire, while hormones and chemicals provide the electrical reactions required to keep everything functioning to its specific design without any active influence or interference from you. Imagine if these cells, hormones, and chemicals did not function without your prompting. What if you had to identify a foreign cellular invader and prompt your white blood cells to respond? Thanks to your immune system, though nearly imperceptible to you, these activities happen on autopilot. The immune system is a network of special cells and organs that defend the body from both external forces such as foreign invaders (bacteria, viruses, allergens, and trauma) and internal cell mutations. When your immune system has a reduced ability to differentiate between self and non-self, or native cells and foreign cells, you are experiencing the onset of an autoimmune disease. An autoimmune disease exists when antibodies that would normally kill foreign tissue (such as a heart transplant from a donor that does not match) begin to attack normal, healthy cells by mistake. When T-cells fail to keep the immune system in line, it results in a misguided attack on the body’s healthy tissues. To illustrate this point, look at the image of the worn-out car on the following page:

The car represents a biological system within the body. If your immune system confuses a part of the body with a foreign invader, T-cells are releases to defend the body. In the case of the picture above, the car represents a component of the body. If your T-cells were to attack it as shown above, you have the onset of an autoimmune disease, because the body is attacking itself. The component of the body being attacked becomes worn and does not function properly. The body part that the immune impairment affects determines the type of autoimmune disease. There are more than 80 known types, including rheumatoid arthritis (RA), lupus, Type 1 diabetes, Guillain-Barre syndrome, Hashimoto's disease, celiac disease, Crohn's disease, ulcerative colitis, and multiple sclerosis. Autoimmune diseases are often accompanied by high levels of inflammatory factors and depression.

References

Cohen, S., Janicki-Deverts, D., & Miller, G. E. (2007). Psychological stress and disease.

Journal of the American Medical Association, 298(14), 1685–1687.

© 2012 Laureate Education, Inc. 1