Bullmore - The inflamed mind: a radical new approach to depression

Praise for The Inflamed Mind

Psychiatrists are re-thinking depression. Is depression due to trauma, a chemical imbalance, brain circuits misfiring? In this beautifully written book, Professor Edward Bullmore shows us why we need to look at the immune system if we want to understand depression. This approach not only bridges the mind and body, it suggests new approaches to treatment. The Inflamed Mind is an important book, a hopeful book, for anyone who wants to think about depression in a new way.

Tom Insel MD, Co-founder and President, Mindstrong Health

The Inflamed Mind confronts the reader with the converging revolutions in neuroscience and immunology that give rise to a new perspective about depression and its treatment. It traces the roots of dualism, the tendency to view mind dissociated from body, and then calls for moving beyond dualism in order to understand how inflammation in the body affects brain and mind. In an erudite, enjoyable, and accessible way, Professor Bullmore conveys the profound impact of this new perspective by helping us to appreciate the links between traditional medical and psychiatric syndromes and it identifies new anti-inflammatory treatments that may cross the boundary from general medicine to psychiatry.

John H. Krystal, M.D., Robert L. McNeil, Jr., Professor of Translational Research; Chair, Department of Psychiatry, Yale University School of Medicine

The Inflamed Mind is not only a dramatic breakthrough in our understanding of depression. It is an extraordinary exploration of what it is to be human.

Matthew dAncona, author of Post Truth

A compelling and highly readable argument that some forms of mental illness, especially depression, are really diseases of the immune system. If Ed Bullmore is right, psychiatry is on the brink of a revolution - the reunion of body and mind.

Sir Colin Blakemore, Professor of Neuroscience and Philosophy, School of Advanced Sciences, University of London

Not so long ago neuro-immunology was regarded with derision within medical circles. Professor Bullmore has been a leading figure in highlighting how wrong that was. As one of the first people to brand themselves as an immunopsychiatrist, he has led us out of the dark ages and shone the light on the crucial link between systemic inflammation and mental illness. This set of insights is creating a paradigm shift in psychiatry which heralds a new field of personalised psychiatry in the same way that we are seeing personalised therapy in cancer.

Sir Robert Lechler, President of the Academy of Medical Sciences

Here is a narrative that tells of exciting new approaches to reducing mental illness while capturing the essence of a powerful strand in fundamental brain science. Even better: it is easy to read without overly simplifying its subject.

Sir Philip Campbell, Editor-in-Chief, Nature

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.

Jeremy Vine, BBC

To my family

Original illustration by Helena Maxwell.

One of the things that first attracted me to psychiatry, many years ago, was that it tries to deal with the most personal human afflictions: clinical disturbances of our selves, our emotional balances and imbalances, our states of mind and memories, our ideas about the world and its relationship to us. As a young doctor, the richly individual content of mental health symptoms seemed much more interesting to me than physical health symptoms, like ankle swelling or skin itching. It was also attractive to me, from a scientific perspective, that all these mental symptoms must originate from the brain; but it was not yet known how. It seemed likely to me then, and it still does today, that if we could understand more about how mental health disorders are generated by brain mechanisms we would be in a much stronger position to do something about treatment and prevention. We would probably also feel less ashamed or afraid to talk about mental health issues if we knew more certainly where they came from, or what caused them.

So, when I was about 30, finding out more about how mental symptoms originated from the brain became a professional research mission for me. At this time, about 1990, many psychiatrists were focused on how brain chemicals like dopamine and serotonin could cause disorders like psychosis and depression. But it was clear there was an enormous amount more still to understand. I realised that I would need to become a scientist as well as a clinical psychiatrist.

For several years in the 1990s, I was supported by the Wellcome Trust to do a PhD, supervised by Professor Michael Brammer, at the Institute of Psychiatry in London. The first functional magnetic resonance imaging (fMRI) scanners were just starting up, in a few places around the world, and I got involved in mathematical analysis of these newfangled fMRI data, to make maps of human brain function in healthy people and patients with mental health disorders. I started writing and co-writing many scientific papers on neuroimaging, neuroscience and mental health. This was a very exciting transition for me. I was lucky enough to be in the right place at the right time to catch the first wave of fMRI research, which has since expanded massively into a global science ecosystem. I thought it could only be a matter of time, perhaps a few years, certainly by the time I was 50, before the irresistible flood of new discoveries from brain scanning, and brain science generally, must force radical improvements in how we think about and treat mental health disorders.

It was in that spirit that I started as a Professor of Psychiatry in the University of Cambridge in 1999. At first, I carried on with my brain imaging research, trying to find new ways of measuring and analysing the complex network organisation of the human brain. I am probably most well-known as an academic scientist for my work on network neuroscience or the connectome. But that is not the topic of this book.

As I approached my mid-40s, I couldnt help noticing that, despite what seemed like a tremendous amount of progress in neuroscience internationally, there was no sign yet of any great change in what was happening day-to-day in local NHS clinics and hospitals. I became restless about the prospect of making any difference to psychiatric practice simply by writing more papers about brain scans. I recognised that the most powerful lever of change in the history of medicine was always the advent of a new treatment. I found myself wanting to know more about how new drug treatments were being discovered for depression, psychosis and other disorders.

Thats why, in 2005, I took an unusual chance to start working part-time for GlaxoSmithKline, also known as GSK, one of the UKs biggest pharmaceutical companies. Half the week I spent working in my University lab on the fascinating esoterica of network analysis and the other half I spent working as the director of GSKs clinical research unit, conveniently located about 200 yards down the hall in Addenbrookes Hospital. In the GSK unit, we did a lot of studies to test the effects of new drugs that were in clinical development for psychiatry, neurology and other areas of medicine. It felt exhilarating at times to be inching closer to the promise of new treatments; but then, in 2010, GSK abruptly closed down all its research and development programs in mental health. I realised I was a 50-year-old psychiatrist working for a company that didnt want to do psychiatry any more. And if a company as big and strong as GSK didnt see an opportunity to make therapeutic progress in psychiatry, what did that mean for the prospects of those radical improvements in treatment that I had been confidently expecting to witness for the last 20 years? That is the moment I began to start thinking seriously about the ideas that this book is about.