Chris Kresser: This is really interesting, actually, because viral infections are a trigger for many different chronic inflammatory conditions. If you look in the scientific literature, you’ll see viral infections associated with everything from IBD to neurological and cognitive disorders to cardiovascular issues to depression, which is now considered to be a chronic inflammatory disorder, at least for many patients. So I wonder if the mono, the Epstein-Barr virus, actually triggered and exacerbated the preexisting depressive condition in this case. Mono, or Epstein-Barr, is supposed to be self-limiting, and the immune system just takes care of it on its own, but it’s also now recognized that it can linger and become reactivated, and during those reactivated periods, it can cause symptoms basically that are related to chronic low-grade inflammation. So you might consider doing a viral panel through a lab like Immunosciences and see if that infection really passed or if she’s still producing IgM antibodies and there’s a reactivated Epstein-Barr situation there that’s contributing to the rest of her symptoms, but other than that, you would still do the full workup that we’re talking about now. You’d want to test her gut because of the gut-brain axis. We know that changes to the gut microbiome and things like parasites and SIBO and H. pylori are all associated with depression, and so you’d certainly want to do some of the tests that we’ve already been talking about in the gut unit. You’d want to test her HPA axis, which you’ll learn to do shortly. You’d want to look at her cortisol and DHEA levels and the diurnal cortisol rhythm. We know that in depressed patients cortisol tends to be high, and particularly evening cortisol tends to be high, so you’d want to look at that on the DUTCH test, for example.
With diet, there are a lot of considerations, mostly an anti-inflammatory diet, and in the nutrition part of the course we have, actually, a whole section where we talk about dietary modification for depression and anxiety and other cognitive and mood disorders. We’ll also be talking about lifestyle modifications in that section. Some of them include bright light therapy in the morning, which has mostly been studied in seasonal affective disorder, but can be helpful even in major depressive disorder. Ensuring adequate sleep. Physical activity is huge. We know that in the scientific literature, on average—we’re just talking about averages here—exercise is typically as effective or more effective than antidepressants for mild to moderate depression.
There are a lot of considerations. Hopefully that’s enough to point you in the right direction.