“Defianda me Dios de mi ! ” God save me from myself ( Spanish Proverb)
“Man dies from the wound in his soul” (BALZAC)
What is really going on in the human body? How do we prove all this?
In the late fifties and early sixties everything seemed so clear and certain that many deaths could be prevented with vaccines and antibiotics. However, after the eighties, death from infectious diseases in the USA, which is one of the most technologically advanced countries in the world, rose to the 5th rank and rose to 58%. Even gene technology, the latest invention of the age, could not result in an effective treatment for any disease.
“When I was a kid, I thought nature was magical. Later I learned that everything can be expressed with mathematical formulas. This has been my biggest disappointment. When you take the magic out of science, you’re left alone with technology. But I still want to believe that there is magic that bends the DNA helix”
The first book published in the field of Psychoneuroimmunology was published by Robert Ader in 1975. Robert Ader and Nicolas Cohen repeated the classical Pavlov experiments on rats and demonstrated that the immune response changed in relation to behavior. These researchers injected rats with cyclophosphamide after happy events (fresh water), then tried to create an antigenic reaction by injecting sheep erythrocytes and found that fresh water, which was used together with cyclophosphamide in the past, could suppress the immune system alone. It seemed that something formed in the rats’ brain was generating this response. However, classical immunology was based on many dogmas that were proven in test tubes outside the human body.
It should be said that no matter how detailed we work on the parts, we will never be able to understand the whole. This leads us to the first question, can we really believe data from any isolated system? Or how much can we trust cadavers, from which a large part of our anatomical knowledge is obtained, in this context? For example, the information that the cranial bones do not move is an anatomical information valid only for cadavers. Did you know that the movements of the cranial bones can be measured and are of vital importance? At first glance, the immune system and nervous system do not seem very similar. However, in both systems, they are related to the situation of the organism against the external environment. Both have roles of resistance and adaptation.
It also has memory on both systems. Nerve cells not only communicate with the solid organs of the immune system, but also with the nervous system, thanks to the free-circulating immune system cells, Peyer’s plaques and bone marrow. Endorphins and neurotransmitters, which are the communicative molecules of the nervous system, hormones of the endocrine system, cytokines of the immune system are from the peptides group of chemical substances. These peptides act as intermediates between these systems.
After all, these systems are extensions of the same network system. If we consider how interconnected the ecological systems on the planet are for natural life, perhaps we can change our view of human biological systems. One day we will stop seeing the disease as an invasion medical science as war, because as we gain victory over the old ones, the new diseases we encounter will refute the doctrine of war
. In addition, autoimmune diseases in which the body is damaged by its own immune system are increasing. In this case, when we see the enemy, we will understand that it is us. This is the case with all degenerative diseases.
Quantum theory reveals that all elements contain energy fluctuations (vibration). Is the quantum current detected between seas absent between cells? What is the use of microtubules, which are resistant to the frequencies of UV light, between cells? Fritz Popp argues that the cell communication system is dependent on a continuous light, such as a laser. Danah Zohar’s work, Quantum Model of Consciousness, was supported by the work of Herbert Frolich. Brian Josephson’s idea, as a result of his research on psychoneuroimmunology, is that a quantum computer, supported by the brain, operates in the body.
BASIC CONCEPTS
The Immune System has to resist countless foreign antigens in almost every part of the body. For this reason, the ability of immune system cells to travel between blood, lymph and tissues and to settle in areas exposed to antigen is called HOMING. This feature is very valuable for the immune response. Immune responses protect the individual against infection, autoimmune diseases and cancer. The normal immune system has the ability to recognize and eliminate tumor cells that differ from normal before tumor development, this is called Immune Control (Immune Control). The mechanisms that protect the individual from potentially dangerous agents and that exist in the organism before most agents encounter it are called NATURAL Immunity.
Innate Immunity:
Physics Barriers (skin mucous membranes)
Phagocytosis ( macrophages neutrophils eosinophils)
Natural Killer Cells (NKC)
Acute Phase Proteins and
· Consists of the Complement System.
SPECIFIC Immunity is the system that enables the development of a specific response only when a foreign antigen is encountered and creates a stronger response when the same antigen is encountered again.
Specific Immunity:
· Lymphocytes
· Antibodies produced by Plasma Cells
· It consists of lymphokines released from lymphocytes
There are two types of specific immunity.
1- Humoral Immunity: With B lymphocytes and antibodies (extracellular)
2- Cellular Immunity: Developed by T lymphocytes (intracellular)
Macrophages take the antigen they find and break it into their peptides. They bind to MHC (Major Histocompatibility Complexes) and transport them to the cell surface. Each of the T lymphocytes
has specific receptor molecules on their surface that can recognize only one MHC. These are called T Cell Receptors. It is thought that the mammalian immune system is capable of recognizing 9 over 10 different antigens
. This is called the LYMPHOCYTE REPERTOIRE. All of the lymphocytes derived from a lymphocyte are called a LYMPHOCYTE CLONE. All cells in a clone have the same antigen-recognizing receptors. T cells that are activated by recognizing the specific antigen presented with MHC Class 2 on the macrophage surface divide and secrete lymphokines.
Cells that secrete lymphokines are called T helper (Th). With the secretion of lymphokines:
1- Macrophages become active and digest the antigen in them
2- B lymphocytes become plasma cells and begin to secrete antibodies
3- Cytotoxic T lymphocytes enter the form to kill cells showing Tc antigen characteristics.
All normal immune responses are self-limiting after antigenic stimulation. Many mechanisms play a role in this stage. One of these mechanisms is NEUROENDOCrine MODULATION. To give examples of this modulation;
Lymphocytes and blood vessels of most lymphoid organs have sympathetic innervation: There are receptors for many hormones, neurotransmitters and neuropeptides on lymphocytes. Lymphocytes can make their own adrenocorticotropic hormones by responding to corticotropin-releasing factor, which leads to the production of corticosteroids
. Under stress, the in vitro mitogen response of lymphocytes is impaired and the healing of infections is delayed. A person is immune competent when the immune system can perform its functions in the body. In cases where the immune functions are not sufficient, there is an immune-compromised situation.
CAUSES AND EFFECTS OF STRESS
In recent years, many studies have been conducted to measure the effects of stress on society. For example, in a study conducted on internal medicine patients, it was revealed that the symptoms of the patients were mostly related to stress
. 36% of them complained that they did not take good care of themselves, 26% of them about their mood, 25% of them about their emotions, 25% of them working overtime, 24% of them having a mental breakdown.
Stress is the initiator or main cause of many diseases. Stress is an organism’s response to an unexpected situation. For example, someone standing next to a snake urgently needs to escape. This is the organism’s fight-or-flight response. Stress can cause our behavior to be in the form of haste or laziness. Weak stimuli provide insensitivity at rest, minimizing unnecessary attacks.
Stress is an unhealthy aspect of modern life. The mind isn’t always focused on the real source of stress, it’s filled with a lot of unrealizable images. For example, fears about the future, catastrophic thoughts, habitual anxieties. These are not yet true stressors.
It is difficult for the body to distinguish between what is a real stressor and what is just an imagined stressor. If it receives a message on the way to take action in a stressful way, it will be activated in that direction. For example, when a person perceives a stick as a snake, the body reacts according to this perception. When the person perceives the snake as a stick, he makes a dangerous mistake.
Stress reduction is a relaxation response that serves to reduce the harmful effects of unrealistic stressors. This answer can be done in many different ways . For example, when sitting on a chair. This is aimed at deep physical and conditional relaxation and focus on a clear object with the mind. The state of the body in this state is called rest insensitivity.
Although it is known that stress has negative effects on the immune system, it is not easy to prove this objectively. The interplay of the nervous system, endocrine system and immune system is very important in the execution of homeostatic mechanisms. A person’s mood or the way he responds to stress can change that person’s fight against infectious diseases or cancer, as well as affect the course of autoimmune diseases. It has been shown in the study of Cohen et al. that stress is associated with infectious diseases. In this study, volunteers were administered one of 5 different cold viruses or placebo, and it was observed that both respiratory tract infections and clinical colds increased with psychological stress. In another study, it was reported that stress adversely affected the antibody response to the hepatitis B vaccine.
It is known that stress is a risk factor for diseases caused by various infectious agents, especially human herpes viruses, and has an effect that increases the severity of the disease. In a study conducted with medical students, it was shown that there was a relatively low level of stress with the immunological tests performed on the blood samples taken from the exam period, which lasted for 3 days, and when the results of similar tests 1 month ago, which were considered basic, were compared, there was a significant decrease in NK activity during the exam period (Kiecot-Glaser 1984, p. 1987) During these studies, it was also found that the levels of interferon gamma measured during the exam period were significantly lower than the levels of the samples in the control groups (Glaser, Rice1987). In studies conducted on a group of people whose natural killer cell activity was consistently low, it was observed that the best determining factors for this group were age and the degree of daily stress (Levy, Herberman 1989).
As a result of a 6-month study examining the changes made by daily stresses on the immune system, it was observed that daily stresses caused an increase in Ts, and the Th/Ts ratio decreased, and it was reported that the expectation of stress was associated with a decrease in the number of Th (Kemeny Cohen 1989). In a study conducted with homosexual men, they were first told that they were HIV + and the measurement was made, and then it was explained that this was not correct and the measurement was made. In these measurements, it was found that the proliferative response of lymphocytes to phytohemagglutin doubled within a week after the real situation was reported (Antoni, Schneiderman 1991)
It has been reported that marital problems can cause physical and psychological disorders as well as disorders in immune parameters. In a study comparing women who were divorced less than a year ago with appropriate control groups, it was found that marital problems go along with depression and immunocompetence deficiency (Kiecolt-Glser, Fisher 1987).
In a similar study conducted in men, similar results were obtained, but it was observed that these disorders were relatively mild on the side who wanted and initiated the divorce (Kiecolt-Glaser 1988) In a study conducted by Mayne et al. Afterwards, blood pressures, heart rates were measured, and blood samples were taken for immune changes: women found elevated blood pressure and a slight decrease in lymphocyte proliferation, indicating a decrease in cellular immune system functions. (Mayne 1997).
It has been reported that cellular immunity is impaired in stereotypes with primary depressive illness (Kronfol, Silva 1983). While there are publications stating that depression is associated with low Th count and more frequent herpes recurrence (Kemeny Cohen 1989), there are also studies suggesting that there is no significant difference in immune function between depressed and non-depressed patients (Darko, Gillin 1991).
Norman Cousins in 1979 put forward the idea that personality traits, behavior styles, ways of coping with events and emotional state may affect the course of diseases with some known or predicted disorders in immune functions. Cousins reported that remission was achieved with psychological intervention in ankylosing spondylitis. The effects of coping with stress and ways of coping with stress on immune system changes are being studied more and more. These studies are especially carried out on university students, the elderly, cancer patients, people with HIV virus, those with chronic rheumatic diseases and voluntary control groups.
In this context, especially hypnosis, relaxation, exercise classical conditioning, assertiveness and cognitive studies have been summarized by Glasers (Kiecolt-Glaser 1992). It is very difficult to plan and carry out these studies, and it is not always easy to evaluate the results objectively.
It has been published that the use of psychotherapy, psychological counseling services and participation in support groups positively affect the prognosis of cancer patients. Such methods have been reported to prolong survival in patients with metastatic breast cali (Spiegel, Bloom 1989) and malignant malanoma (Fawzy, Hyun 1993). After all these explanations, the thought that stress alone will definitely cause diseases by making changes in immune functions should be removed: Stress and unhappiness can push people to some risky behaviors and lifestyles.
Such people may be more prone to alcohol and drug use, their sleep and nutrition levels are often disrupted, and they may become less active in sports. It should not be forgotten that all of these are factors that negatively affect the general health as well as the immune system. As the ways of coping with stress are better understood and applied, it is expected that many pathological conditions that are thought to be directly or indirectly related to the immune system will be positively affected.
Physiological Benefits of Stress Reduction:
· Significant reduction in oxygen consumption and metabolic rate, even below sleep level. This is a sign of great economy and efficiency.
Decrease in minute ventilation and respiration rate
Decrease in heart rate and blood pressure,
A greater reduction in serum cholesterol than can be achieved with diet alone
A significant increase in skin resistance (low skin resistance is an indicator of stress response)
A decrease in blood lactate level, which is a sign of anaerobic metabolism, which is high in stressful situations,
Detected in resting state in EEG ( alpha ) and ( tetra) waves, ensuring coordination of EEG waves
Decreased epileptic seizure frequency
Detection of high serotonin production seen during recovery from depression,
Decreased catecholamine metabolite levels ,
Reduced TSH and T3 levels
Improved reflexes and response time
Auditory Increased sensitivity of breast and other senses,
· Strengthening of immune function. In chronic stress, the immune system is suppressed or excessively activated, which leads to the emergence of autoimmune and inflammatory diseases
Melatonin levels increase
Calcium loss and osteoporosis risk decreases (This is probably due to a decrease in cortisol levels)
Some of the Diseases where Stress Reduction is Beneficial:
o Heart diseases,
o Cancers,
o Chronic Pain,
o Asthma,
o Diabetes,
o Spastic Colon,
Psychological Benefits of Stress Reduction:
· Reduction in Anxiety,
· Decreased depression (through induction of increased serotonin levels)
Greater optimism,
Greater self-awareness and self-actualization,
Improved coping skills, (
Feeling of non-situational happiness
Decreased tendency to alcohol with prescription or nonprescription drugs
Improved quality of sleep (more restful sleep, decreased insomnia, less sleep over time) need development)
· Reduction of aggression and criminal tendencies,
· Increased IQ, increased learning capacity, development of personality and intellectuality,
· More efficiency and productivity in business life
Administrative positivity,
Increase in concentration ability and memory,
· Reduction of tendency to unwanted personality problems and personality disorders
PSYCONEUROIMMUNOLOGY:
In this term, psycho intelligence represents neuro nervous system and immunology represents immune system. In simple words, we create powerful effects on the immune and nervous systems with our thoughts and emotions. Nerves are like telephone wires. Neurotransmitters work like a mail system. This is related to the immune response for two reasons. The nervous system provides the transmission of each element, and the white blood cells give messages back to the nervous system. Therefore, this communication is two-way. The feedback mechanism of this system in the brain is in the lobe of the limbic system.
So it is very related to emotions. More than 60 neurotransmitter receptors have been identified on white blood cells. Such receptors have also been detected in areas of the body such as the gut. This situation reveals how stress, anxiety and depression can cause events such as immune suppression and bowel spasm. In addition, it has been determined that drugs such as sedatives with psychoactive properties have effects on immune cell functions. Because these cells also have the same receptors. It can even be said that the blood-brain barrier becomes more permeable under stress. Although the number of white blood cells is affected under stress, the main effect occurs in functions. This effect is caused not only by emotional factors but also by factors related to lifestyle. The table below reveals which factors affect Natural Killer Cells, which are very important in Cellular Immunity.
Table:1 Effects on Lifestyle and NKCell Activity
|
BEHAVIOR |
In NKcell Activity Increase |
|
Exercise |
47% |
|
Stress Management |
45% |
|
Adequate Sleep |
44% |
|
Balanced Nutrition |
37% |
|
No Smoking |
27% |
|
Breakfast |
21% |
|
Regular and U Suitable Working Hours |
17% |
|
Alcohol abstinence |
% 0 |
It is a well-known situation based on many sources that unhealthy lifestyles are easier to emerge due to stress. Appropriate stress management, meditation, psychological interviews, positive attitudes and habits are powerful immune stimulants. They reduce the immunosuppressive effect or reduce the effects of some hormones such as adrenocorticoid hormones caused by stress. The concept that the mind affects body resistance is not a new concept in Public Health. “There is no reason to panic. Fear is low and does a lot of harm. Being cheerful increases resilience and prevents complications.” Meta-analyses reveal that increased antibody titrations and interleukin2 receptors in lymphocytes are affected by stress. The strong link between the relapse of herpes viruses and stress is well known.
PERSONAL STRUCTURE AND DISEASE:
Our personality structure is a factor that affects our physical health for a lifetime. Ancient medical teachings also support this view; “There is no disease, there is a patient” Hippocrates Personality traits of people affect the appearance of the disease. The person is generally aware of most of the positive and negative personality traits in himself. For this reason, it should be possible to review the personality traits objectively and to discuss the illness. The person should be encouraged to try himself, develop his personality, and be free from fatal feelings such as self-blame. Although personality is one of the most important factors, other factors that are effective are factors such as environment, lifestyle, genetic predisposition. In Eyenstock’s research, three of the four personality types identified by the researcher were related to some diseases. These;
Type 1: people who are hopeless, do not accept help, suppress their emotions. Cancer is common among them.
Type 2: People who are prone to anxiety, aggressive, ambitious, expressing their emotions in inappropriate ways. Heart diseases are common in these people.
Type 4: People who are in tune with themselves and other people . They communicate well, are optimistic, sensitive, and try to remain calm under stress.
In a study in which personality types were followed for 10 years, the relationships between causes of death and personality types are shown in the table below.
Table: Relationships Between 2 Personality Types and Causes of Death
|
Personality Type |
Number( n) |
Causes of death |
Survivors (n) |
Survivors % |
||
|
Ca |
CHD |
Other |
||||
|
Type 1 |
901 |
347 |
61 |
155 |
338 |
38 |
|
Type 2 |
818 |
36 (9 800709) |
208 |
221 |
353 |
43 |
|
Type 3 |
570 |
8 |
21 |
80 |
346 |
81 |
|
Type 4 |
946 |
3 |
9 |
39 |
895 |
95 |
In another study, 490 people with predisposition to cancer and heart disease were taught ways to cope with stress. In this study, the groups were randomly formed and the control group was not taught ways to cope with stress. While the mortality rate was 76% in the control group, it was 20% in the study group. Deaths due to CHD in the study group were 6 times higher than in the control group.
Table: The Effect of Coping Training on Deaths in 3 Types 1 and 2 Personalities: ( 17 people could not be heard from)
|
Groups |
Number |
Ca Deaths |
Ca Incidence |
CHD Deaths |
CHD Incidence |
Other Deaths |
|
Control |
234 |
111 |
129 |
36 |
45 |
33 |
|
Work |
239 |
18 |
75 |
10 |
29 |
20 |
In this study, a 7-year follow-up was made and 17 patients could not be reached. The most important result of this research was that it revealed that personality patterns are quite flexible, no matter how unchanging they seem. Behavioral patterns and habits that have become habits are unlearned. The only positive aspect of illness and stress is that they are a very important motivator for structural changes when wisely directed.
Eysenck’s 13-year follow-up work is as follows. In this study, people prone to Ca and CHD were trained in self-compassion, relaxation techniques, improving communication skills, group support, and finding new ways to cope with stressful situations. 192 people with an average age of 50 were followed for 13 years. Sonuçlar aşağıdaki tabloda belirtilmiştir:
Tablo 4: Eğitim Verilen ve Verilmeyen Kronik Hastalarda İzlem
Sonuçları
|
Tip |
sayı |
||||
|
Tip 1 |
100 |
Ca ölümleri |
Ca insidansı |
Diğer ölümler |
Yaşayanlar |
|
Kontrol |
50 |
16 |
21 |
15 |
19 |
|
Çalışma |
50 |
0 (980070 3) |
13 |
5 |
45 |
|
Tip 2 |
92 |
CHD Ölümleri |
CHD insidansı |
Diğer Ölümler |
Yaşayanlar |
|
Kontrol |
46 |
16 |
20 |
13 |
17 |
|
Çalışma |
46 |
3 |
11 |
6 |
37 (9800 709) |
Başka bir kişilik sınıflandırmasına göre D tipi kişilik olarak tanımlanan kişilik tipinde CHD için atfedilen risk 4.7 bulunmuştur. D tipi kişilik iki ana bileşenden oluşur:
1-Yüksek oranda negatif etkilenme ( anksiyete, sinir, endişe)
2-Duygularını bastırma eğilimi
Bu tip sınıflandırmada A tipi kişiler aceleci, dost canlısı, uyumlu kişilerdir ve kalp hastalıklarına daha fazla eğilimleri vardır. Tip B bu özelliklerin tam tersi özellikler taşıyan kişilerdir. Tip C kansere eğilimi olan kişilerdir. Bunlar kötümser uyum sağlaması güç duygularını açıklamaya dirençli soğuk ve kızgın kişilerdir.
GÜLMENİN TERAPÖTİK ETKİSİ:
· Stresi azaltır,
· Ağrıyı azaltır, ağrıya dayanıklılığı artırır,
· İmmuniteyi güçlendirir,
· Kan ve Lenf akımını artırır,
· Oksijenizasyonu artırır,
· Kan basıncını düşürürür,
· Kasları hareket ettirir.
MELATONİN ETKİSİ:
Son zamanlarda ilgi çeken mediatörlerden biri melatonindir. Melatoninin antitümör etkileri araştırılmaktadır. Melatonin aynı zamanda antiproliferatiftir. İntranükleer gen transferini baskılayarak düzenler. Büyüme faktörlerinin salınımını ve aktivitesini inhibe eder. Melatonin endojen olarak stimüle edilir. Fizyolojik sınırlarda birçok yararlı etkisinin yanısıra yüksek farmakolojik dozlarda insanlarda oldukça olumsuz etkileri saptanmıştır. Bu olumsuz etkilerden biri immunsupresyondur.
Melatonini stimüle eden durumlara göz attığımız zaman destek tedavi programlarında kullanılan yaşamtarzı etkilerinin bu durumlardan olduğunu görürüz. Düşük melatonin düzeyleri de genellikle işyeri koşullarından kaynaklanan aşırı yorgunluk gibi durumlarda karşımıza çıkar.
Şekil: 1 Melatonin Salınımını Etkileyen Faktörler:
|
ARTIRAN DURUMLAR |
İNHİBE EDEN DURUMLAR |
||||||||||||||
|
|
SOSYAL FAKTÖRLER VE SAĞLIK:
Koruyucu sağlık programlarında kişilerin sosyal integrasyonları ve ilişkilerinin hastalığa yakalanmadaki önemi ortaya konmuş ve bilinen yaşamtarzı faktörlerinin önemi vurgulanmıştır. CHD etiolojisinde işyerinde meslekten tatminsizlik ve mutsuzluğun genelde kabul edilmiş risk faktörlerinden daha güçlü bir risk oluşturduğunu destekleyen çalışmalar vardır. Evli olmak geniş bir arkadaş çevresine sahip olmak, kiliseye üye olmak, grup etkinliklerine katılmak gibi bazı faktörler sağlık üzerinde koruyucu etkisi olan faktörlerdir. Bunun yanısıra marjinallik birçok hastalığa predispozandır. Kişinin hayatında kurtarıcı olan sosyal destek şu soruyla sorgulanmaktadır: ” Sana duygusal destek sağlayan bir yakının var mı? Yani problemlerin üzerinde konuşabileceğin ve sana zor kararlarında yardım edecek biri var mı?” Kişilerin sosyal yapıları tıbbi özgeçmişlerinden çok daha önemlidir. Bu onların sağlıkları açısından diğer bütün terapotik potansiyellerden daha güçlü ve merkezi bir faktördür.Bu nedenle destek grupları bu denli yararlıdır.
DEPRESYONDA İMMUN SİSTEM:
Nöral immun ve psikolojik sistemler arasındaki etkileşim immunsistem, hipotalamik hipofizer ve adrenal aks ile otonom sinir sistemini içeren rotaları izler. Vücut patojenle karşılaştığında immun sistem sensor organ gibi rol oynar. İmmun sistem ve beyin arasındaki iletişim sitokinlerce sağlanır. Sitokinler çok çeşitli ve geniş biyolojik aktiviteleri sağlayan peptidlerdir. Aynı zamanda immun yanıtı da yönetirler. İmmunstimulasyon sırasında interlökinler ve interferonlar gibi sitokinler periferde ve beyinde üretilerek etki edebilecekleri nöral nöroendokrin, ve davranışsal fonksiyon gören özgün reseptörlere
taşınırlar.
Hipolalamo pituiter adrenal aks HPA ateş gibi fizyolojik yanıtlar yanı sıra hormonal yanıtlara da sebep olur, bu arada beyin dokusundaki sitokinler davranışsal değişiklikler meydana getirebilirler.Bu durum
fiziksel hastalığı olan kişilerdeki depresif mod, anoreksi, kilokaybı, uykusuzluk ya da değişik uyku kalıpları, güçsüzlük ve motor aktivitenin gerilemesi gibi durumlar ile fiziksel ve sosyal çevreye karşı ilgisizlik, bozuk bilinçsel durumlar gibi olguları açıklayabilir. Akut hastalık sırasındaki bu davranışsal semptomlara ” hastalık davranışı” denir. Kronik hastalıklara eşlik eden immun aktivasyon durumunda hastalık davranışı depresif epizodda gelişebilir.
Depresyon yaygın yıpratıcı tıbbi bir durumdur. Fiziksel olarak hastalıklı kişilerde major depresif epizodların prevalansı %5 den %40 ların üstüne çıkmaktadır. Prevalansın bu durumu, depresyona genellikle tanı konulamamasından yada tedavi edimemesinden kaynaklanmaktadır. Depresyonla ilgili tıbbi süreçler sadece ağrı, güçsüzlük, fizik hastalık nedenli birtakım kayıplar değil direkt immun sistemin aktivasyonuna neden olan süreçler olabilmektedir. Viral enfeksiyonların özellikle respiratuar sistemde hastalık yapma nedenlerinin depresif mod yada diğer depresif semptomlar gibi nörofizyolojik bozuklukluklar olduğu deneysel olarak gösterilmiştir. Benzer bulgular; kronik herpes infeksiyonlarında, CMV, EBV,gastroenterit, Borna Disease Virus ve HIV enfeksiyonları için gösterilmiştir.
İmmun sistemin kronik aktivasyonu nedeniyle sekrersyonu sağlanan sitokinler birçok enfektif olmayan duruma neden olurlar. Bu tür hastalarda depresyon insidansı yüksek bulunmuştur. Yapılan çalışmalar depresyonun immum sistemin disregulasyonuna neden olduğunu göstermiştir. Bu durum hastalığa eşlik eden depresyonun immun aktivasyon sonucu meydana geldiğini desteklemektedir.
Hastalığa Eşlik Eden Depresyonda Sitokinlerin Rolü: Sitokinlerin psikolojik etkileri kanser yada hepatit C li hastalara egzojen sitokin verildiğinde ortaya çıkan psikolojik ve nöroendokrin semptomlar nedeniyle anlaşılmıştır. İnterferon alpha, interlökin 2 veya Tümor Nekroz Faktörü ( TNF ) gibi sitokinlerin egzojen verilmesi maskeli depresyon yaratmıştır. Bu depresyonun semptomları sitokin verilmesini takiben başlamış ve
sitokin tedavisi sonunda belirginleşmiştir.
Yapılan başka bir deneysel çalışmada düşük doz pürifiye lipopolisakkarit (LPS) enjekte edilen kişilerde ilk yanıt enfeksiyon bulguları olmuştur. Bu kişilerde hastalık ortaya çıkmamış, Kalp Hızı ve kan basıncı normal kalmış ancak ateş yükselmiş, sitokinler ve kortizolün kan düzeyi yükselmiştir. Bunu izleyen süreçte bu kişilerde anksiyete ve depresif mod saptanmış verbal venonverbal hafız fonksiyonlarının bozulduğu görülmüştür.
Hayvan çalışmaları sitokinlerin davranışsal etkilerini de ortaya koymuştur. Bu etkiler anoreksi, kilo kaybı, uyuklama, psikomotor retardasyon, güçsüzlük, yorgunluk, lenf bezlerinin hipertrofisi, bilinçsel bozukluklar gibi durumlardır. Bunların IL-1 ve TNF ile ilgili olduğu düşünülmektedir.
Antidepresanların Rolü: Hastalıklara eşlik eden depresyon antidepresanlarla tedavi edilmektedir. Bu amaçla trisiklik antidepresanlar ve selektif serotonin reuptake inhibitörleri önerilebilir. Antidepresanların
birçok immundüzenleyici etkileri gösterilmiştir. Uzun süreli tedeavi sonunda immun fonksiyonda ve sitokin sekresyonunda baskılanma yada sitokin düzeylertine hiç etkinin olmaması şeklinde etkiler gözlenebilir. Deney hayvanlarında LPS ile oluşturulmuş hastalık davranışı ve nöroendokrin etkiler imipramin ve fluxetine kullanılarak azaltılmıştır.
Malign Melanoma hastalarına interferon tedavisi sırasında yapılan çift kör bir çalışmada tedaviden 2 hafta önce paroxetin verilmiş grupta olguların 1/3 ünden azında depresyon gelişmiş ve tedaviyi terk olmamıştır. Ancak, plasebo grubunda hastaların çoğunda major depresyon görülmüş ve interferonun toxik etkileri nedeniyle tedavi 3 hafta erken kesilmek zorunda kalınmıştır.
Özet:
· Sitokinler; antijenlerle temas eden hücrelerden salınan ve hücre içine etki eden antijen olmayan proteinlerdir,
· Hastalık sırasında immun sistem duyarlı organ olarak çalışır, beyinle iletişime geçerek sitokin salınımını uyarır,
· Yüksek sitokin düzeyleri ve depresyon gibi psikolojik bozukluklar arasında ilişki mevcuttur,
· Deneysel immun aktivasyon depresif mod ve diğer psikolojik bozukluklara neden olmuştur,
· Antidepresanlar olası immundüzenleyici etkileri nedeniyle hastalıklara eşlik eden depresyonların tedavisi ve önlenmesinde klullanılabilirler,
· Hasta kişilerdeki depresif semptomlar hastalığın neden olduğu rahatsızlık ve yetersizliklerden ziyade immun aktivasyon ve sitokin salgılanımının sonucu olabilir.
Sitokin Sekresyonu ve İmmun Sistem Aktivasyonuna Eşlik Eden Enfektif Olmayan Durumlar
• Otoimmun hastalıklar: MS, RA,SLE, Allerji
• İnme ( Stroke)
• Travma
• Alzheimer HSt
• Diğer Nörodejeneratif Hastalıklar
• Kanser
Kanser ya da Hepatit Hastalarına Sitokin Verilmesinin Neden Olduğu Depresif Semptomlar:
• Depresif Mod
• Disfori
• Anhedonia( Zevk alma kapasitesinin azalması)
• Umutsuzluk,
• Ilımlı ya da aşırı yorgunluk,
• Anoreksi ya da kilo kaybı,
• Hipersomni,
• Psikomotor Retardasyon,
• Azalmış Konsantrasyon,
• Konfüzyon
Antidepresanlara Yanıt Veren Depresif Sendromlarla Birlikte Görülen Hastalıklar:
• MS,
(980 0702) • Stroke,
• Alzheimer Hst.
• Kanser,
• AIDS,
• İnterferon Kullanımı ( Hepatit C yada MS)
Depresyonla ilgili yapılan son çalışmalar major depresyonun sadecekoroner arter hastalıklarını gelişmesinde bir risk faktörü olmadığını MI li hastaların mortalitesini etkileyen bir faktör olduğunu ortaya koymuştur.
BÜTÜNSEL TIP:
Mind- Body Medicine yada Akıl Vücut Tıbbı olarak bilinen Bütünsel Tıp birçok konuda işbililiğini gerekli kılmaktadır. Bu alanlar psikologları, immunologları, psikiyatristleri, onkologları, davranış bilimcileri, ve kardiyologları içeren alanlardır. Sağlığın Geliştirilmesi ( Health Promotion) açısından mind body medicine gelecek vadeden bir alandır. Bunun nedeni de maliyetinin nispeten düşük olması ve yan etkilerinin genellikle iyi olmasıdır.
Bu açıdan klinik tıptaki geleneksel yöntemlerin yeniden gözden geçirilerek yeni bir açılım oluşturulması iyi bir tutum olacaktır. Batı Tıbbının babası Hipokrat ” insan sadece bir bütün olarak anlaşılabilir” demişti. Birçok tanımdan ve aradan geçen asırlardan sonra WHO aynı tanımı neredeyse yakalamak üzeredir. “Kişinin vücudu, aklı ruhu ve çevresindeki sosyal ve kültürel etkileşimlerin dinamik bir uyumu” tanımı WHO nun son sağlık tanımıdır. “Vucut ruhun gölgesidir”
Bu basit cümle holistik düşünceyi kapsayan birçok anlam içermektedir. Holistik ilişkiyi açıklamakta kullanılan bir analoji araç ve sürücü analojisidir. Sürücü aracın gittiği yolu, aracın yeterli motor gücüne ulaşmasını ve bu gücün sürdürülmesini, hatta kazaların olup olmaması durumunu etkiler. Dikkatli sürücüler araçlarına iyi bakarlar, daha az kaza yaparlar ve en azından bir tamirciye ihtiyaç duyarlar.
Diğer analoji de orkestra ve şefi analojisidir. Orkestra ve şef arasındaki iletişim iyi ise bir harmoni mevcuttur. Eger aksi söz konusuysa bozuk ses çıkar. İnsan vücudunun şaşırtıcı bir iyileşme eğilimi vardır. Bu yaşatıcı güç yaşamı büyük bir zeka, gözetim ve koordinasyonla hazırlar. Einstein doğanın sahip oldugu bu zekayı şöyle açıklamıştır. ” Bilimin kovalamacası içine ciddi biçimde giren her kimse bilirki doğanın kanunlarında bir ruh vardır. Kişi alçakgönüllü ve mütevazi gücüyle üzerindeki bu gücle yüzyüze gelince dini duygulara yüklü bir anlam atfeder. Din kişinin oldukça deneyimsiz olduğu farklı bir alandır.” “Mucizeler doğa ile çelişmez bizim çelişki diye bildiğimiz doğanın içinde zaten vardır”
Bütünsel Tıp Teknikleri:
· Doğu Hint Ajurvedası,
· Akupunktur,
· Biofeedback,
· Çin’in Herbal Tıbbı,
· Egzersiz,
· Herbalizm,
· Homeopati,
· Hipnoz,
· Masaj,
· Kas iskelet Sistemi Manipulasyonları,
· Meditasyon Ayinleri,
· Psikoterapi
· Refleksoloji,
· Relaksasyon,
· Tai Chi,
· Terapötik dokunma,
· Yoga
HALK SAĞLIĞI AÇISINDAN ÖNERİLER:
· Bütünsel ve Alternatif Tıp teknikleri ile ilgili araştırmalara önem verilmelidir.
· Psikonöroimmunoloji ile ilgili araştırmalara önem verilmelidir.
· Tıp Eğitimi Müfredatına Modern Tıp dışındaki diğer tıp uygulamaları ile ilgili yeterli bilgi eklenmelidir.
· Sağlığın Geliştirilmesi İle İlgili Programlarda Stres Azaltılması ve Gevşeme Teknikleri yer almalıdır
· Depresyon tanısı ve tedavisi konusunda eğitim ve uygulamada ki eksiklikler giderilmeye çalışılmalıdır
