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Ask the Holistic Psychiatrist: How do you measure inflammation?

An image depicting a serene, natural scene (like a tranquil forest or a person meditating) blended with scientific elements such as molecular structures or a representation of the hsCRP molecule. This would symbolize the connection between mental well-being, natural healing, and scientific analysis.

As a holistic psychiatrist, I often encounter questions about how physical health intersects with mental well-being, particularly regarding inflammation. This is a great question that we recently received from a colleague last week who wondered if there were other ways to measure inflammation besides obtaining cerebral spinal fluids through an invasive lumbar puncture. Fortunately, there is!

One of the key ways we measure systemic inflammation in our practice is through a biomarker known as high-sensitivity C-reactive protein (hsCRP). I'll mention that there are other labs that can give us a better understanding of the cause of inflammation, but this is where we often start.


What is hsCRP and Why is it Important?

hsCRP is a substance produced by the liver in response to inflammation. Elevated levels of hsCRP in the blood can indicate various underlying conditions, such as infections, mold toxicity, and long COVID.


However, it’s crucial to understand that hsCRP is a marker of inflammation, not a specific diagnosis. It signals that there is an inflammatory process occurring in the body, but the exact cause can vary. There are several factors can cause elevated hsCRP levels. This is why we get a careful history and cast a very wide net through screening questions in our initial appointment. Levels of hsCRP greater than 3 are considered elevated and levels between 1-3 are considered borderline elevated.


The Causes Behind Elevated hsCRP Levels

In my experience, elevated hsCRP can be triggered by several factors. Common causes include infections, where the body releases inflammatory chemicals to combat the illness, thus raising hsCRP levels. Exposure to mold can also trigger a similar inflammatory response. Additionally, patients recovering from COVID-19, particularly those experiencing long COVID symptoms like fatigue and brain fog, often show elevated hsCRP levels. Other conditions such as autoimmune diseases, COPD, heart disease, kidney disease, and rheumatoid arthritis can also influence hsCRP levels.


Depending on someone's symptoms and their history, we can consider additional diagnostic testing to investigate causes and determine a personalized treatment plan. For example, if someone has significant gut issues such as constipation, diarrhea, bloating, we may consider an elimination diet to assess for food triggers/intolerances/sensitivities that may be causing downstream inflammation. We can also test for autoimmune conditions like celiac disease as well as ordering biomarkers that are specific markers of inflammation, dysbiosis, and/or infection in the gut through a stool sample.


What about Measuring Cytokines

There are other inflammatory markers like cytokine biomarkers, which are molecules that are produced by immune cells and serve as messengers to communicate with other cells and regulate immune responses. Some examples of these include IL-6, IL-1, IL-2, and TNF-alpha.


There are several studies that have investigated the role of inflammatory cytokines in psychiatry:


  • A 2022 study published in the journal "Translational Psychiatry" found that elevated levels of IL-6 and TNF-alpha were associated with an increased risk of developing major depressive disorder (MDD) in older adults.

  • A 2021 study published in the journal "Neuropsychopharmacology" found that individuals with MDD had significantly higher levels of IL-1β and IL-6 compared to healthy controls.

  • A 2020 study published in the journal "Molecular Psychiatry" found that cytokine levels were associated with symptom severity in individuals with anxiety disorders.

  • A 2019 study published in the journal "Frontiers in Psychiatry" found that cytokine levels were not associated with symptom severity in individuals with post-traumatic stress disorder (PTSD).


While research suggests a potential link between inflammation and mental health conditions, the clinical utility of measuring inflammatory cytokines to guide treatment is still under investigation. However, for individuals with mental health symptoms that may be attributable to underlying conditions like long COVID, measuring inflammatory cytokines can provide objective evidence to support diagnosis and treatment. This helps validate people's suffering in ways that are useful in real life such as getting employers to believe an individual's symptoms, school/work accommodations, and greater empathy and care from healthcare professionals.


Implications for Treatment from a Holistic Psychiatrist Perspective

When I see elevated hsCRP levels in my patients, it guides our treatment approach. For instance, if the elevation is due to an infection, gut imbalances, or mold toxicity, we focus on addressing and treating these specific underlying causes. In cases where inflammation is a significant factor, treatments may include anti-inflammatory strategies like low dose naltrexone, higher dose omega-3 fatty acids or L-methylfolate supplementation. We also consider lifestyle interventions, such as sauna therapy, which can help reduce inflammation and complement other treatments.


The Impact of hsCRP on Psychiatric Medications

Research, including studies highlighted by psychiatrist Dr. Charles Raison and others, reveals that hsCRP levels can significantly influence the effectiveness of psychiatric medications. For instance, studies suggest that individuals with higher hsCRP levels might respond better to certain antidepressants. One particular study found that individuals with a CRP level greater than 1 had a more favorable response to nortriptyline compared to escitalopram.


Moreover, a study examining the effectiveness of combining SSRIs with bupropion (Wellbutrin) showed that patients with higher hsCRP levels responded better to this combination. This suggests that for some patients, particularly those with elevated hsCRP, a treatment approach that includes medications like Wellbutrin, which have dopaminergic and noradrenergic properties, might be more effective.


Ultimately, the goal in holistic psychiatry is to not only treat the mental health symptoms but to delve into and address the physical health aspects, ensuring a comprehensive approach to each patient's health and well-being.


If you're interested in exploring how inflammation impacts your mental health through holistic psychiatry in Wisconsin, Iowa, or Minnesota, complete our patient inquiry form at Driftless Integrative Psychiatry and start your journey here.


A kind reminder: This blog post is designed as a general guide. This is not a substitute for personalized medical advice, nor is a patient-physician relationship established in this blog post.


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