Explore the fascinating realm between the mind and body…and the common cold.
“Why do I seem to get every infection going around?” Margery asked as she came to see me with an upper respiratory infection for the third time in four months. “If my kids get a cold, so do I, every time! Is something wrong with my immunity or something?”
Seldom do serious immune deficiency diseases show up primarily with recurrent colds. (More likely appearing with such immune disorders would be unusual bacteria, fungal or parasite infections.) “What else has been going on in your life?” I asked. “Any unusual pressures or problems?”
Margery’s eyes began to fill with tears. “Does it show?” she asked. She proceeded to tell about some difficult problems with one of her children, and on further specific questions, she revealed some strong evidence of clinical depression.
Are the old wives’ tales about getting more infections when stressed true? Folklore often arises out of personal observation, which, while not always consistent in everyone’s experience, often suggests some good research opportunities. Dr. Sheldon Cohen and his colleagues decided to scientifically check out the impressions about colds and stress. I’m not sure their experiment would get past the research review boards in this country, but in Great Britain, they recruited a substantial number of people willing to find out.
The Study
The recruits were studied for the amount of stress, anxiety and depression they were experiencing. Both their situational stressors and their response to it were measured, as also were some criteria for clinical depression or anxiety. These items were combined into a “stress index”, a number relating to the magnitude of how stressed the person was at the moment.
Then (this is the questionable part), they received nose drops containing small amounts of various common cold viruses– not enough to make everyone sick, but low levels somewhat comparable to what one might pick up from the environment during a viral cold season. Sure enough, the old wives were right. Those with a high stress index got sick at a much higher rate than those with a low index.
A few years ago, just as the Asian influenza was beginning to move around the world in an epidemic, some researchers at Fort Dietrich in Maryland wondered what effect being depressed would have on a person’s ability to handle influenza. Having a patient population essentially obligated to come into their clinic when sick, they screened a large group of them for depression, before the coming influenza epidemic hit. Then, every one who got the flu was brought back to the clinic 3 and 6 weeks later, to see whether or not they got well in the expected length of time. Those still sick with influenza at six weeks were largely those who were depressed before their exposure to the flu virus.
How could this be? What would thinking in a stressed way have to do with difficulty with viruses? One obvious biochemical answer would involve the release of cortisol, an adrenal hormone like cortisone that rises with stress and suppresses immune responses. But it’s more complicated than that. The immune suppression occurs even if the adrenal gland that secretes the cortisol is absent, and also when cortisol-type hormones are not elevated. It’s now known that the same part of the brain that regulates emotions also modifies immune responses, with the same neurochemicals involved in creating depression or anxiety mediating some of the brain’s effects on immunity. This, for example, is part of why stress is the most common precipitant of cold sores caused by a herpes virus.
Helping a person regain a sense of control over stress tends to help normalize the immune response. This has interesting implications for someone like Margery who has recurrent colds, and also feels excessively stressed or depressed. We can offer limited acute treatment when the cold is already present (see some suggestions in the box below), but far more useful for Margery would be to do some things to prevent the recurrent infections in the first place. For example, we thought that since her depression and stress seem to be major players, some interventions to improve stress resilience and bring back some sense of control to dealing well with her situation may go a long way toward better immune responses when exposed to cold viruses. Another important part for her was treating the depression, which often requires re-regulating the disordered brain chemistry causing both the depression and inadequate immune response.
Margery agreed. She participated in an experiential group program proven to improve both physiological and emotional response to stress. After two months, Margery found that she not only felt much better and more at peace overall, but also was not getting the colds anymore, even when her kids brought them home from school. These benefits continued in the months that followed.
Some behavioral medicine interventions that have been proven effective in altering immunity in some studies to date include the following:
- Clinical biofeedback
- Meditation
- Autogenic training
- Progressive muscle relaxation
- Visualization
- Hypnosis
- Behavior modification
All of this may seem like an unusual approach to dealing with colds, but Margery’s pattern is very commonly seen when it is considered. And with much that can be done to help overall, perhaps we need to consider going into this fascinating realm between the mind and body more often.
What About Treatment of a Cold Already Started?
A cure for the common cold is likely a long way off, mainly because there is no such thing as the common cold. It’s actually a group of common symptoms caused by many different viruses (as many as 200): rhinoviruses are the most common. Meanwhile, other than the usual hot gargles, decongestants, cough suppressants and chicken soup, a few studies suggest some benefit from using zinc topically. Zinc attaches to and blocks some of the ICAM receptors in the nose and throat to which the virus and inflammatory white blood cells attach, and if used early, can sometimes shorten the duration of the cold. Scientific studies are mixed on this issue, but several show shortening of colds by 1-3 days using zinc gluconate lozenges, and possibly by 7 days for longer colds using a zinc nasal spray (Zicam) in the first few hours of symptoms. Other forms of zinc don’t seem to work. Only one controlled study of the nasal spray has been published, so that awaits confirmation from other investigators.
Zinc is also a nervous system stimulant that could have a stimulating effect on immune responses. However for colds, the benefit appears more related to binding those receptors in the respiratory lining cells. This effect is lost if the zinc is mixed with Vitamin C (which is often added to some lozenge brands to also diminish the bad taste). Adding Vitamin C and other agents may account for the varied results with the lozenges. On the other hand, in high doses, Vitamin C has antihistaminic-like effects that may improve nasal symptoms somewhat.
