Inflammation of the Small Intestine
On June 7, 1956, President Eisenhower suffered severe stomach pains that sent him to Walter Reed Army Medical Center. He had experienced stomach problems for years, but this time, doctors determined that the cause was ileitis (an inflammation of the ileum, part of the small intestine) and that surgery was needed immediately. The President, upon being told he needed surgery, had said simply, “Well, let’s go.”
Historian Clarence G. Lasby, in Eisenhower’s Heart Attack: How Ike Beat Heart Disease and Held on to the Presidency (University Press of Kansas, 1997) described the President’s recovery from the surgery:
“The first five days of Eisenhower’s postoperative convalescence at Walter Reed were especially “rough” . . . . The doctors had him walking on the second day and eating on the fifth, but they could not get rid of a troublesome infection around the incision.”
Recovery Includes Depression
Thereafter the recovery was uneventful, although the president never escaped from depression about what he perceived to be the slowness of his improvement. His impatience at the end of the first week prompted Mamie to write;
“I am going to put the ‘Slow me down Lord’ prayer in the president’s mirror when he gets home as a daily reminder, and I think it is most apropos.“
The doctors decided to release the President on June 30 because they thought a change of scenery, namely his home at Gettysburg, Pennsylvania, would expedite his recovery. The President was uneasy about the decision, according to Lasby, but deferred to the doctors.
Infection and General Feelings of Sickness
Anyone who has experienced a viral or bacterial infection knows what it means to feel sick. The behavior of sick people changes dramatically; they often feel feverish and nauseated, ignore food and beverages, and lose interest in their physical and social environments. They tire easily and their sleep is often fragmented. In addition, they feel depressed and irritable, and can experience mild cognitive disorders ranging from impaired attention to difficulties in remembering recent events.
Despite their negative impact on well-being, these symptoms of sickness are usually ignored. They are viewed as uncomfortable but banal components of infections.
President Eisenhower’s Recovery – In Hindsight
Finally, on the scheduled day of the President’s hospital departure, The President and First Lady walked carefully down the stairs before saying goodbye to Brigadier General Jack W. Schwartz, acting commander of the hospital. The President said he had enjoyed the past few weeks and was told by the General, “We are certainly going to miss you around here.”
Still, the recovery to full strength took longer than expected. The infection in the incision continued to bother the President, as did a lingering depression. John Eisenhower “never saw his father look worse until the last days of his life.”
As for the patient, his goal was to be at full strength for a trip to Panama that had been postponed until July 20th because of the surgery.
On July 15, the President returned to the White House, but was still “terribly depressed” and in some pain and discomfort from gas and soreness in his lower abdomen. Nevertheless, the President made the trip. (Read the full story of President Eisenhower’s surgery here.)
Connection to Depression
Today, researchers believe there is strong evidence for a link between inflammation and depression. Inflammatory processes can be triggered by many things – infection as well as negative cognitions or their consequences, such as stress, violence, or deprivation. Thus, negative cognitions can cause inflammation that can, in turn, lead to depression.
In addition there is increasing evidence that inflammation can cause depression because of the increase of cytokines, setting the brain into a “sickness mode“.
During the last five years, it has been established that pro-inflammatory cytokines induce not only symptoms of sickness, but also true major depressive disorders in physically ill patients with no previous history of mental disorders.
Symptoms of Depression
Classical symptoms of being physically sick, like lethargy show a large overlap in behaviors that characterize depression, including:
- deep sadness
- weight loss or gain
- loss of interest in activities
- insomnia or oversleeping
- feelings of worthlessness or guilt
- appetite changes
- decreased energy
- difficulty concentrating
Levels of cytokines tend to increase sharply during depressive episodes in manics and drop off during remission. Furthermore, it has been shown in clinical trials that anti-inflammatory medicines taken in addition to antidepressants not only significantly improves symptoms but also increases the proportion of subjects positively responding to treatment.
Inflammations that lead to serious depression could be caused by common infections such as those caused by a virus, bacteria or even parasites.
These recent advancements in connecting inflammation, sickness and depression underscore the importance of a holistic, ‘Team’ approach to diagnosis and treatment of depression.