Between 1 and 5 percent of the American population suffers from “chronic rhinosinusitis” (CRS), a condition in which the nose and sinuses are inflamed for at least 12 consecutive weeks. It can result in a plugged nose, facial pain, loss of smell, or nasal mucus—or all of the above. As much as 11.6 percent of U.S. adults have sinusitis—inflamed sinuses—and 8 percent of U.S. adults and 7 percent of U.S. children have seasonal allergic rhinitis, or hay fever, which can also be characterized by sinus inflammation.
Now researchers believe that the conditions can be linked to depression, anxiety, and even suicide, although it isn’t clear whether the mental health issues precede or follow the sinus issues.
A study published in the American Journal of Rhinology & Allergy found that almost a third of patients with CRS also had depression that occurred “independent of other chronic illnesses associated with CRS.” A study published in 2019 in the Journal of the American Medical Association (JAMA) Otolaryngology—Head & Neck Surgery, looked at 16,224 South Korean patients who had CRS and 32,448 who didn’t. It found that patients with CRS were more than 50 percent more likely to have developed depression or anxiety after an 11-year follow-up.
And a study published in the International Forum of Allergy & Rhinology found that the severity of patients’ CRS—called their “Rhinosinusitis Disability Index”—was correlated with their anxiety and depression score and that the more depressed the patients were, the worse they said their CRS was.
Lifestyle, Medication Considerations
Chronic rhinosinusitis can affect the whole body and cause such comorbid conditions as cognitive dysfunction, diabetes, and sleep disorders caused by nasal obstruction and drainage, researchers wrote in the American Journal of Rhinology & Allergy. Facial and sinus pain and “impaired olfactory function could impact pleasurable social activities,” the authors wrote, noting that work productivity can also suffer.
Depression is also linked to comorbid conditions such as rheumatoid arthritis, cancer, coronary heart disease, stroke, and diabetes.
“Patients with depression may have physiologic effects due to their mental illness or maladaptive behaviors, which increase their risk for developing some conditions, such as Type 2 diabetes,” American Journal of Rhinology & Allergy researchers wrote.
“Comorbid depression has also been shown to impact treatment outcomes in other diseases. Patients with depression have increased death and rehospitalization rates after coronary artery bypass grafting. Within this context, it is not surprising that CRS would be associated with a higher prevalence of depression compared with a group of individuals without CRS.”
There are also similarities in the medications that people with depression or sinus problems may be taking—as well as special risks when psychiatric patients are treated, researchers noted in the journal Allergic Rhinitis.
“Psychotropic medications may affect diagnosis of allergies [and] medications used to treat allergies impact mood and behavior,” they wrote.
What are some of the risks?
“Systemic corticosteroids are associated with depression, mania, and psychosis,” and “antihistamines may act additively or synergistically with certain psychotropic medications in beneficial (treatment of insomnia, potentiation of anxiolytic effects) or detrimental (worsening of sedation- elevating risk of accidents) [ways].”
Insomnia, seen in both diseases, exacerbates depression, and “systemic decongestants with alpha-Adrenergic agonist mechanism of action can precipitate hypomania or mania, and exacerbate insomnia and anxiety in vulnerable individuals,” the researchers wrote. Antidepressants and ADD medications can also have additive effects when sinus medications are used, according to the researcher.
Researchers writing in the BMJ echoed the concerns.
“The side effect of some antiallergic medications (systemic decongestants, antihistamines, leukotriene inhibitors and corticosteroids) may worsen prosuicidal factors such as night-insomnia, day-somnolence, agitation, anxiety, depression and cognitive disturbance,” they said.
Pollen, Ragweed May Be Dangerous for Some
Several scientific papers have noted an increase in suicides when pollen and ragweed counts rise.
“Based on the influence of cytokines [substances secreted by immune cells] on mood, cognition, and behavior in healthy individuals and patients with medical and psychiatric conditions, the reciprocal immune–brain interactions, and the cytokine expression during allergic reactions, we hypothesized that tree pollen (which peaks in spring) and ragweed pollen (which peaks in late summer/early fall) may act as environmental triggers for suicide in vulnerable individuals,” researchers wrote in the journal Molecular Psychiatry as early as 2005.
Their hypothesis is strengthened at the end of their paper.
According to research published in the BMJ, those with a history of mood disorders were more at risk of suicide when pollen rises, but even those without such a history were seen to be at risk. Pollen-linked suicides affected men more than women, according to the research published in BMJ, but a study in Japan published in the journal Environmental Research found the opposite to be true.
“Our results indicate that pollen is associated with female suicide mortality in Tokyo,” the researchers wrote.
What mechanisms could explain such a morbid consequence from ubiquitous substances that most believe to be an annoyance but not a danger?
“There are several possible mechanisms underlying the link between pollen and suicide,” BMJ researchers wrote. “One possibility is that air pollen triggers episodes of seasonal allergic rhinitis, a relatively common condition affecting more than 20 percent of adults with deterioration in their quality of life. In seasonal allergic rhinitis, pollen induces allergy-related cytokine (i.e., Th2 cytokine) production in the nose of individuals who are sensitive to tree pollen.”
The cytokines in the nasal cavity can find their way to the brain, “where they may induce an amplified production of Th2 cytokine that can result in the impairment or inhibition of the limbic structures involved in impulsivity, aggression, anxiety, and especially depression. A recent study of suicide victims found an increased expression of Th2 cytokines in a region of the prefrontal cortex previously implicated in suicide,” according to the researchers.
Depression in Those With Sinus Problems
It’s likely that similar mechanisms are at play in those with non-hay fever sinus conditions.
“A systemic inflammatory hypothesis has been proposed, which links inflammatory cytokine levels to depression severity,” researchers wrote in the American Journal of Rhinology & Allergy.
“The proinflammatory cytokines interleukin-1beta, interleukin-6 and the neutrophil-chemoattractant interleukin-8 may play a major role in acute sinusitis, as shown in viral and allergic rhinitis,” researchers wrote in the Journal of Korean Medical Science. “In chronic sinusitis interleukin-3 dominates the cytokine profiles, giving support to a variety of inflammatory cells.”
Similarly, inflammatory cytokines are often behind the development of depression (a cause that was obscured by the now-discredited “chemical imbalance” theory of depression). Even food allergies can lead to depression-related inflammation.
Still, there’s a ray of hope for those with sinus issues who are also experiencing depression.
“CRS treatment does seem to improve depression,” researchers wrote in the journal Current Opinion in Otolaryngology & Head and Neck Surgery while noting that “depressed patients have a significantly larger economic burden because of their increased healthcare utilization and productivity losses.”
Getting treatment for a mood disorder might help alleviate allergy symptoms since the two conditions have related biological actions according to some researchers.
And it’s also important to remember that depression can be a natural and expected reaction to many environmental and social conditions that exist today. Despite drug ads that imply the normal human emotional state should be gleeful and ecstatic, there are valid reasons for sad and depressed moods, from job and economic stresses to family problems to the diminished human dignity occurring in many political, social, and medical spheres today.
Natural Treatments for Sinus Problems
According to the Mayo Clinic, there are several at-home and natural treatments you can try to relieve sinus conditions and hopefully any depression you might have with them.
The Mayo suggestions include: rinsing your nasal passages including nasal lavage; breathing in vapor from a bowl of hot water; a hot shower, the steam of which can help; applying a warm compress to your nose and forehead to reduce sinus pressure; drinking plenty of fluids; and rest, which speeds recovery from infections.
Sinus conditions may also benefit from the symbiotic bacteria found in probiotics. These bacteria play an important role in digestion, immune function, and more. We pick these helpful bacteria from our environment and food. Some research suggests that sterile environments that are too “clean” cause our immune systems to overreact to substances, including weeds and trees that we encounter less frequently. Researchers believe that the “good” bacteria found in probiotics offer an effective treatment option for many such conditions.
Research published in 2021 in the journal Healthcare states that “probiotics may induce the inhibition of adhesion of pathogens to the mucous membranes, the stabilization of tight junctions in the epithelial layer with a reduction in the permeability of the mucosa, the competitive inhibition of pathogens, modulation of the immune system, and the production of various substances toxic to pathogenic microorganisms.”
Probiotic treatment for sinus conditions is especially promising, according to the researchers, because the nasal microbiome or microbiota has its own unique characteristics different from other parts of the body.
The researchers note that animal studies have shown the ability of probiotics to “reduce the inflammatory phenomena of CRS on the mucosa” and say that studies of the nasal microbiota should continue. Many sufferers would welcome further research.