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> a growing body of literature suggesting that the immune system is involved in psychiatric disorders from depression to bipolar disorder

> Austrian physician Julius Wagner-Jauregg developed a method of deliberate infection of psychiatric patients with malaria to induce fever. Some of his patients died from the treatment, but many others recovered. He won a Nobel Prize in 1927.

Julius Wagner-Jauregg specifically treated neurosyphilis, an infectious disease, not just any ”psychiatric” disorder. That makes it perhaps less surprising that activating the immune system should have an effect. Today neurosyphilis is treated with antibiotics.
I've long suspected that my depression & OCD were caused by some immune response. It all started very suddenly when I had a very bad illness. Unfortunately I have yet to find a doctor that believes me and is willing to do anything other than giving me the standard medications.
If you haven’t tried the Wim Hof method, please give it a go. It might not work for you as well as it has for others, but it won’t cost you anything to try it.
I found it quite helpful if practiced regularly.
To heal depression or OCD or both?
Personally I believe it’s helpful for both. I don’t know what the mechanism is, but it has been effective for me. It feels something like distilled meditation (vipassana) ...
Technically mental trauma could have done so as well - which you probably heard dozens of times. Even if a doctor believed you I am not sure what they could do that wouldn't be extremely ill advised. Immunosuppressants would be tough to justify even if it was a certain cure instead of a highly tentative one.

I know it is a frustrating situation to be in. Like I know that oral general anesthesia would help me for bloodwork given a severe phobia (multiple panic attacks while maxed oral dose and too tranqed to walk normally bad) but even without asthma and weight the risk would be too off-kilter to do without qualifying as malpractice. Let alone insurance and expenses. Unfortunately the field seems to select for people who see it as a nonissue.

Yes, there are likely multiple factors here, both physical and learned behaviors. I've had some access to cutting edge treatments since I live in Boston, which is probably the #1 place in the world for psychiatry research. Over the years I've cobbled together a regimen that sort of works, but it's basically a band-aid solution and I can tell that it's not 100% effective.

Nowadays I feel normal ish about 15% of the time, meh about 50%, and somewhat depressed 35%. I've tried multiple medications from pretty much every category of medications, including many off-label treatments.

I treat my treatment resistant depression by inducing 101+ fever for half an hour each day. I started when I had to stop an allergy to the EMSAM patch.

There are also medications that you might not have heard of. If you want, I can write more when I'm not on mobile.

How do you induce a fever?
I'm guessing he uses a sauna.
Pretty much. I use IR lights and a pair of space heaters in an enclosed space. The IR lights do most of the job.

Going to a sauna with a thermometer would probably be the easiest route for many who want to try this. It was easier for me to buy a bunch of lights on amazon and do it at home. Cheaper, too.

You can easily induce a 102 degree fever with a very hot bath.
Not for half an hour, unless you have someone patient with a kettle.

I have seen one journal abstract where that that was used, but I don't know the details. There are better methods though, if you have the budget of a hospital or research center, such as IR lights filtered through water. There's also a article outlining various methods of inducing hyperthermia.

Well, perhaps not by itself .

I used to take an ear thermometer in the tub with me, dunk my head, check temp in both ears to make sure I hit 102, then wrap up in bedding, fully covered, for 20 minutes or so.

Edit in reply to your edit:

Yes I also preheated water on the stove and had assistance from a family member, though technically no kettle was involved.

There are no doubt better methods if you have scads of money. If you don't, a bathtub and big pot on the stove, plus blankets, can readily get you there for cheap.

If you have an instant gas hot water you have fairly unlimited hot water. You could position the bath plug to leak at a set rate and continually add hot water to maintain an appropriate water temperature.
What are these alternative meds?
I was thinking specifically of Pramiplexole.

Pramipexole in Treatment Resistant-Depression, Possible Role of Inflammatory Cytokines:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5143506/ https://www.nature.com/articles/npp2016217.pdf?origin=ppub

Antidepressant-like effect of pramipexole in an inflammatory model of depression.

https://www.ncbi.nlm.nih.gov/pubmed/27825895

Anti-inflammatory treatment for major depressive disorder: implications for patients with an elevated immune profile and non-responders to standard antidepressant therapy

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5606303/

I would like to know more.
I learnt about it from this interview of about depression inflammation research:

> Charles Raison, M.D. is a professor at the School of Human Ecology at the University of Wisconsin-Madison and Founding Director of the Center for Compassion Studies in the College of Social and Behavioral Sciences at the University of Arizona. Dr. Raison’s research focuses on inflammation.

https://www.youtube.com/watch?v=6DtJGJWjDys

While the protocol he is implementing (and most hyperthermia protocols I have seen) involve temperatures reaching 104-105 degrees, in the interview they discuss a possible connection to hot yoga and sauna use, which would not involve such high temperatures.

I would assume that it would easiest to try something like this at a sauna in a gym for a few week or so - all else you would need would be a thermometer. I picked up a bunch of IR lamps and a couple of space heaters, and set them up in a space just big enough to do push-ups in. The entire setup cost ~$200.

http://i.imgur.com/aM3BCbE.jpg

I have been getting my temperature to 100 degrees via the lights and the heaters, spending another ten minutes trying to increase it from there (it is usually close to 102 by the time I stop), then resting for another 20 minutes with the heaters and lights not quite as overbearingly close. I've also started incorporate pushups and planks and drink a quart of hot tea (watch out with this and the thermometer :) )

At first I thought it wasn't doing much for depression, but continued to use it due to dramatic and unexpected improvements in my other immune conditions. After skipping it a few times, it became very obvious what effect it was having on my mood, which noticeably and reliably lifts around 20 minutes or so of reaching 100 degrees.

Overall, it takes an hour a day. The process is tiring, and once your temperature starts getting above 100, you can't concentrate or do very much: even watching TV becomes a chore. And while it hasn't alleviated my depression, it's had enough of an effect that I'm no longer willing to go without it.

Have a way to contact you directly?
Another one person data point:

I've had OCD since childhood, and even when I was a kid I noticed that sometimes my symptoms would flare up for a few days, right before I came down with the flu.

As an adult, I contracted Lyme Disease, and one lingering symptom was that my OCD got a lot worse. After 1 month of IV antibiotics (rocephin), my OCD went from a "10" down to maybe a 7 in severity.

There is an autoimmune theory of schizophrenia. Excess histamine can also cause OCD-like symptoms.

Look into megadose vitamin D3 (+ K2 MK-4 + magnesium). Memantine + selank. Lowering inflammation.

I tried prescription memantine, both the generic and XR formulations. The brain fog startup side effect never went away for me, so I had to quit. I've never found a supplement that has actually done anything.
Did you taper 2.5 mg at a time every 3-4 days until taking 5-10 mg? Also add selank. Have you ever tried chelated/TRAACS magnesium? What else have you tried?

Do you have any nutrient deficiencies? Ever looked into nutrient tests like NutrEval? A comprehensive hormone panel? Thyroid panel? Genetic testing?

I also tried Memantine, my verbal fluency took a serious nose dive, I was unable to follow simple instructions. I slowly tapered up, much slower than 2.5 mg at a time.

It helped in some other areas, but not being able to do simple tasks nixed it for me.

I don't know enough to evaluate this advice, but the word "histamine" caught my eye.

There are antidepressants that, as I understand it, are antihistamines. For example, imipramine. I wonder what it means if you have an adverse reaction to such a drug, and something resembling schizophrenia as well.

You need to find a doctor like late Oliver Sacks and Ramachandran. Basically, a research oriented doctor.
There’s an illness called PANDAS in children that is very much like that, a key symptom is the OCD. The Cunningham panel test is used for diagnosis and can also be used by adults although there are no established diagnosis from this in adults. The test costs about $900. Treatment in children requires a smart doctor who is aware of the illness and who will get IVIG and/or plasmapheresis for the child. Both are incredibly expensive treatments.

There are also a number of very expensive autoimmune panels from Quest and Mayo Clinic for neurological stuff which can be worth running through, but only do these if your insurance will cover them, they’re up to 10k each, and the results aren’t necessarily going to help you in any way.

Diseases such as Lyme and mononucleosis are also known to cause a number of different autoimmune problems. Unfortunately doctors aren’t very good at recognizing this and it can take a long stressful odyssey to get properly diagnoses.

For some types of autoimmune illness there are some options such as Low Dose Naltrexone which work well for some people, but not others. In cases like Lyme, properly treating the illness and clearing the Lyme can eventually lead to the autoimmunity going away also.

(Note: in your case LDN has a big warning that in some people it can cause depression, I tried LDN and the depression it triggered was no joke, but it came on fairly shortly after starting and passed after stopping thankfully, and when I tried it again the same happened so it was clear what was happening. I just say this so if you do try it you are very aware and monitor yourself.)

Actually I already take naltrexone, but in ultra low doses. I'm combining it with low dose buprenorphine, which is basically the only medication that has done anything for my depression. I will see if I can get an appointment with a specialist about PANDAs. I have known about PANDAs for a while, but it was dismissed very early since I'm an adult. Now that I've failed pretty much every treatment it might be worth it to take a second look.
Curious. Was it Epstein Barr virus? I never felt quite right since my mid 20's. Mononucleosis (glandular fever) and then a couple incidents of really bad food poisoning. On occasion, when I get the flu my cognition temporarily gets better.
I used to participate in an alternative medicine community. Their explanation would be your illness "settled in the brain" and has never been fully cleared.
Reminds me of the surprising cause of narcolepsy - not anything sleep cycle related, energetic as one might expect but auto-immune causing the body to periodically attack its own wakefulness hormones producers.

Unfortunately all of our immune system tools are very coarse even when doing something groundbreaking as cancer immunotherapy which is basically farming ones we know attack the cancer and reinserting them - very labor intensive for something individualized with highly educated workers.

It almost makes one wish for reverse vaccination to specify things as harmless - until you realize how horribly exploitable it would be by nature - let alone anybody twisted enough to use it for biological weaponry.

Just a friendly reminder not to get medical advice from anonymous strangers on the internet. There are some pretty serious interventions described in the comments below as things you could try at home.
Also don’t use webmd :)

See an actual clinician

Just a friendly reminder to also not confuse conversation on the topic with a recommendation that "You should do X!"

Some of us are just talking and that's it.

When penicillin was first used to treat syphilis, thousands of cured schizophrenics were released from mental asylums.

https://www.newsweek.com/diseases-mind-133263

I've apparently submitted this article three times, the last time 18 days ago. It's never gotten traction.

I have a long history of viewing mood issues and the like as somatopsychic side effects of medical issues. I tend to ask my sciency son to "Look up X" when I'm having an issue. I'm talented at asking the right questions. He's talented at getting back to me within an hour with the info I need, plus supporting links. Then I typically go eat a thing and stop being such a fruitcake.

Some things I've done:

Consumed foods containing rosemary or sage to calm extreme anxiety because I was clear it was brought on by withdrawal.

Consumed beef with potatoes to mediate the salt-lithium connection and prevent both woke bi-polar like mood swings and suicidal tendencies.

Consumed oranges for the vitamin c to put a stop to out of the blue rage.

See also:

https://news.ycombinator.com/item?id=16607422#16608139

https://news.ycombinator.com/item?id=16140867

Not to be rude, but it seems fairly likely the changes you observed from your change in diet are a result of placebo.

The levels of rosemary and sage found in most foods probably aren't going to have much effect one way or another, let alone being an extremely potent anxiolytic. Beef and potatoes probably aren't going to reliably treat bipolar swings and suicidal ideation. Vitamin C probably isn't going to stop spontaneous rage, and oranges are even less likely to since they only contain 70 - 120mg of vitamin C. Diet is certainly important to physical and mental health, and anything's possible, but I'm skeptical that there's a direct cause and effect between those specific foods and relief from those specific symptoms.

I am really burned out on hearing "It's placebo effect!" from people who firmly believe diet cannot possibly have a significant effect on (mental) health, but the power of believing it will make a difference absolutely can. So I'm just going to leave these two resources and quotes pulled from one of the blog posts I did about mediating the salt-lithium connection with diet:

http://www.webmd.com/bipolar-disorder/guide/bipolar-diet-foo...

Which Foods Should I Avoid if I Have Bipolar Disorder?

•Watching your salt if you have high blood pressure but not skimping on salt if you are being prescribed lithium since low salt intake can cause higher levels of lithium in the blood

http://www.collectivewizdom.com/Lithium-LithiumRichFoods.htm...

Lithium Rich Foods

In 1971, a Texas biochemist named Dr. Earl Dawson noticed that the murder and suicide rates around El Paso were significantly lower than the rest of the state.

After investigation, he discovered that the lower rates of suicide, murder and admissions to mental hospitals were linked to the high levels of lithium found in El Paso’s water supply.

The parent did not dispute that diet can have a significant effect on health, including mental health, only the particular examples you mentioned. Lithium in particular is a well known case that's been researched and has plenty of supporting literature. I have not seen comparable studies supporting the use of rosemary or Vitamin C for the indications you mentioned and the latter in particular seems unlikely unless you had a specific deficiency. Have you seen any literature for those examples?
This is one of the links in my original comment: https://news.ycombinator.com/item?id=16140867

I've already stated that these decisions are based on research. I don't plan to try to "prove" anything here to people being dismissive of me rather than genuinely interested in what I know. I deal with far too much of that and it never, ever goes good places.

The parent did not dispute that diet can have a significant effect on health, including mental health, only the particular examples you mentioned.

Which boils down to claiming that my consistent observations of my experience over many years can be explained by the power of me believing it will work, but cannot be explained by actual chemistry. This is an incredibly tedious argument. To my mind, it is on par with advocating that we should all clap to bring Tinkerbell back. And I cannot comprehend how anyone who sees themselves as scientific can genuinely insist in earnest that the power of belief has more influence over my physical body than the power of food chemistry.

For the record, I have a genetic disorder that predisposes me to become rapidly deficient in various nutrients, among other things.

I will add that "placebos" are typically sugar pills and sugar has chemical impact on the brain akin to an opiate. So there is zero reason to believe that "placebo effect" is actually due to the power of belief and not due to food chemistry impacting brain activity.

https://breakingmuscle.com/healthy-eating/the-science-and-su...

> And I cannot comprehend how anyone who sees themselves as scientific can genuinely insist in earnest that the power of belief has more influence over my physical body than the power of food chemistry.

It would appear belief can have an extreme severe acute impact on our bodies. It follows then belief can also have chronic affects.

People can die simply because they've given up, life has beaten them and they feel defeat is inescapable, according to new research.

The study, by Dr. John Leach, a senior research fellow at the University of Portsmouth, is the first to describe the clinical markers for 'give-up-itis', a term used to describe what is known medically as psychogenic death.

https://m.medicalxpress.com/news/2018-09-people-die.html

HN discussion here https://news.ycombinator.com/item?id=18083509

It appears you didn’t comment on that one, so perhaps you missed it?

Also, it stands to reason the affect of foods, herbs, essential oils, what have you, on people probably follows a bell curve distribution and therefore there are likely to be extreme outliers. This may explain why some people experience significant clinical effects from, say, Rosemary and Sage, while others not.

This brings me to something I like to highlight: the difference between public health policy and individualised medicine. It might not be sound public health policy to put essential oils in the water, although I’m not aware of any rigorous studies, but may be sound advice for a component of individualised wholistic care.

Disclosure: I’ve dabbled in nutritional and herbal medicine, with four years of formal study and the resultant certifications, here in Australia. For what it’s worth.

Thank you. It's a reasonable comment. Unfortunately, in the context of multiple people being incredibly dismissive, it somewhat comes across as just another dismissal, though I sincerely believe you don't mean it that way.

For context, my official diagnosis is atypical cystic fibrosis. I was diagnosed a bit over 17 years ago. I had been bedridden for several months and had a hole in my left lung.

Classical CF accounts for about 1/3 of all adult lung transplants and 1/2 of all pediatric lung transplants in the US. It has a very low life expectancy and you typically take about $100k worth of drugs annually to manage it with no hope of actually getting well.

So I have a lot of baggage from internet strangers insisting that the hole in my lung closing and my ability to get off multiple prescription drugs etc is obviously due to placebo effect and couldn't possibly be due to extensive dietary and lifestyle changes, nor could I possibly actually know a fucking thing of any value at all, what with being a woman and former homemaker.

I'm leaving this discussion now. Nothing personal against you. I'm just fed up with people attacking my personal anecdotes in a way that doesn't automatically get done to other people who say "I have X diagnosis and I do Y thing for it." Other people can talk about their health and how they manage it without everyone piling on to inform them they are a nutcase who imagined the entire thing.

Other points I make are consistently ignored in order to focus on what I said about my firsthand experience and tell me that I don't know what I experienced. Some internet stranger has more expertise in my life than I have.

Ugh.

Yeah, sorry, didn't mean it as a dismissal at all. Was actually trying to support your claims. Good evening.
For what it's worth, the placebo effect is such a strong effect, sugar or no, that the immediate reaction of most skeptics is to attribute most things to it. HN is full of skeptics. I feel you've done a fine job defending you position though.

My take on food and mental health is that we are omnivores, and as such we need a wide veriety of foods to be healthy. I have noticed time and again that certain foods smell and taste absolutely heavenly to me one week, and I can't be bothered to eat a spoonful a month later. This is most common for me with high nutrient low calorie foods like salads and soups (though if you pay attention it's there with various sweets as well). All of which makes me very suspicious that it has to do with my body trying to regulate it's nutrient balance.

And god forbid you fall out of normal working parameters for certain nutrients, you can end up in a positive feedback loop. There was a study I saw some years ago linking anorexia and a lack of some common metal (zinc or magnesium I think). Not being hungry means you're not likely to get this metal, means you're not hungry...

Lithium (or rather Li+) is widely used to help manage mood disorders. From my experience with people on it, it seems to be pretty effective.
Diet has a big effect on mental health, but any one given food usually won't create a big difference. Lithium is definitely very beneficial for people with bipolar disorder, but the amount of bioavailable lithium in food is usually pretty low. It's really hard to know just how much of a certain substance you're getting when it's solely by diet; it's much more measurable and replicable when you're taking an exact, concentrated dose of something on a consistent schedule. When you're eating food, you just can't reliably know what you're getting, and how much.

It's certainly possible you found some food with particularly high concentrations of bioavailable lithium and then consumed enough of it to have an effect, but unless you were tracking it pretty closely or were into some really unusual foods, my guess is your overall lithium absorption probably didn't increase much.

Regarding lithium and salt: lithium does have a relationship with sodium and there can be a higher requirement for sodium when you take lithium, but this is typically only ever going to be relevant for people who are prescribed lithium medication or are consuming an unusually high level of lithium in their food.

It's the same thing with stuff like curcumin. Curcumin (one of the components of turmeric) definitely reduces inflammation, but eating food with turmeric once per day is probably only going to have a tiny marginal effect, even after a year. But consuming curcumin (ideally theracurmin) in capsule form could have an effect within hours or days, and you can judge exactly what it is and isn't doing for you.

These things are important for averages; if people in a certain culture eat 500x more turmeric on average over their lifetime than another culture, then on average their rates of inflammation may be lower. But a random person saying "I want to reduce my inflammation" probably should try the pills first.

Same with lithium in water supplies. It's an cumulative thing that can affect a population over generations, but the concentration is usually too low to drink tap water with lithium in it for a month and actually notice changes.

Trying to treat serious psychological symptoms with rough approximations of potentially biounavailable versions of substances in food that you consume in inconsistent quantities and at inconsistent intervals really isn't a scientific way to address issues. I think if you want to see if vitamin C might help you with something, you should just take vitamin C supplements for a few weeks or months (at the same dose and roughly the same time every day). Same with lithium or anything else (though lithium treatment probably shouldn't be undergone without a doctor and a prescription). This can be complicated because sometimes substances work differently or more effectively when taken with other things that modulate or potentiate them (like coffee vs. caffeine pills), so sometimes consuming food or consuming multiple substances that mimic the ratios found in food can give a better outcome. But in general, I think diet is just too blunt an instrument for this kind of thing.

And I'd go even further and say that concentrated rosemary/sage oil and vitamin C supplements probably aren't going to help most people (unless they were already deficient in vitamin C, which is pretty rare in developed countries) in general. Of the things you listed, lithium is the only substance I think would have a significant effect. If you really did consume more lithium from the change in diet (though I still think it's unlikely for you to know if you actually did or didn't consume significantly more bioavailable lithium), it's plausible all of your symptom changes could be explained by that. Lithium has been shown to reduce mood swings (including anger), anxiety, and suicidal thoughts.

I would say one of the most significant effects of diet on physical and mental health (once you're already getting the right nutrients)...

It's certainly possible you found some food with particularly high concentrations of bioavailable lithium

Or, alternately, it is entirely possible I have a genetic disorder, as already stated, and this disorder impacts how my body processes salt. So when going through a period of rather extreme mood swings that reminded me somewhat of what bipolar friends dealt with, I stopped to wonder if there was any connection between salt and lithium in the body. Low and behold, there actually is.

So we looked up high lithium foods, which includes beef, and paired it with a food I know from experience helps my body hold onto salt (and made sure I had salt at the same time) . Voila! Problem solved. I was able to stabilize my mood and put a stop to the wild mood swings.

I will add that I don't normally eat a lot of beef.

It seems that high amounts of salt are "bad for you" only in the context of low potassium. But most doctors either aren't aware of the fact that there needs to be a certain proportion of salt and potassium, or they don't bother telling patients because the doctors know most people won't eat anymore potassium-rich foods, so they just tell them to "eat less salt."

This video has some references to studies backing this:

https://www.youtube.com/watch?v=amJ-ev8Ial8

There's also this book that argues for the importance of salt in our food, of which I heard good things but haven't read:

https://www.amazon.com/Salt-Fix-Experts-Wrong-Eating-ebook/d...

My official diagnosis is atypical cystic fibrosis. CF medical clinics routinely include a dietitian on the medical team and the standard medical treatment includes prescribing a high fat, high salt, high calorie diet due to malabsorption and how it impacts salt processing and fat.

So a medical specialist whose official specialty was pulmatology prescribed me a high salt diet years ago.

> When penicillin was first used to treat syphilis, thousands of cured schizophrenics were released from mental asylums

Syphilis itself produces psychosis and those "schizophrenics" were most likely never schizophrenics in the first place (shame on you Newsweek)

https://www.ncbi.nlm.nih.gov/pubmed/11186166 https://www.ncbi.nlm.nih.gov/pubmed/1521109

If those diet based treatments work for you then that's great but, respectfully, I think everyone should take those statements with a serious pinch of salt (no pun intended)

Edited 2x for brevity, grammar

(comment deleted)
Anecdotally, I've heard of and seen nursing home patients and other elderly people that have seriously altered mental states, with anger and/or disorientation, that recover immediately with antibiotics, where the medical people describe the infection as a UTI. And also in my experience, even once it's repeated a couple times, they can be obtuse about inferring the mental changes are a sign that they should treat with antibiotics.

I've also seen a cancer patient on chemo with symptoms that resemble some forms of psychosis, and of course that is someone who is immuno-compromised and susceptible to opportunistic infections.

So I think that probably syphilis is only one example of an infection that leads to an altered mental state, and there's no reason to assume that because something is treatable with penicillin, that is is necessarily syphilis.

> So I think that probably syphilis is only one example of an infection that leads to an altered mental state, and there's no reason to assume that because something is treatable with penicillin, that is is necessarily syphilis.

I don't doubt this at all however:

> I've also seen a cancer patient on chemo with symptoms that resemble some forms of psychosis, and of course that is someone who is immuno-compromised and susceptible to opportunistic infections.

this might simply be due to the stress of a life changing, life threatening event. Couldn't it be?

No. I'm not talking about something like shock moments after being diagnosed, I'm referring to cognitive issues that developed later, in someone who was terminally ill and suffering the effects of both the cancer and the chemo. And, you know, people get worse and better and then worse so the contrast is clear. Especially when the treatment is massive amounts of antibiotics, vancomycin among others, I think?
> where the medical people describe the infection as a UTI

Very interesting. Are you suspecting that the medical diagnosis of a UTI wasn't totally accurate?

Not particularly suggesting it was incorrect. I don't have any other hypothesis, but neither do I know what the mechanism would be for it to cause mental symptoms. It might be that the diagnosis is technically correct but misleading. See: blind men and the elephant.

The main issue was just that it recurred and the medical people did not have an overarching theory about what was going on. They seemed to regard the test results and symptoms as just random disconnected facts without a pattern. The belief among some of the relatives of the patient was that the mental symptoms were a harbinger of the UTI and therefore treatment should start sooner.

Of course, that's what happens with elderly patients, doctors just don't try that hard, because being old is explanation enough for anything that goes wrong and if you fix one problem another will occur.

Is anyone else interested in crowdfunding a scientific study to explore this link? This is not my area of expertise but as someone affected by this I would like to contribute to finding some answers even if it is at the home lab level.
Something I ran across in a newsletter about medical research recently was that a doctor examining patients with treatment-resistant depression determined that there were (treatable) metabolic abnormalities apparent in cerebrospinal fluid. Normally, blood tests are all that is done to rule out such things, but that may not show the problem.