Charles L. Raison, MD, Rakesh Jain, MD, MPH,
Vladimir Maletic, MD, and Jon W. Draud, MD, MS
A PDF of this article will be provided on request; please contact Dr Charles Raison at
craison@emory.edu
The concept of a mind-body neurobiological approach to depression will be explored in detail at "Treating The Whole Patient: The Mind-Body Connection." This new meeting will be held November 1-2, 2009 in conjunction with the US Psychiatric and Mental Health Congress, which will be held in Las Vegas on November 2-5, 2009. For information about that conference and to register, please call (800) 447-4474 or visit
www.psychcongress.com
But is this the correct approach? Are all these tumors really of separate origin with distinct etiopathologies, disease courses, and prognoses? Or are they perhaps the same disorder, presenting with varying manifestations in different individuals, despite shared genetic and other risk factors?
What’s wrong with this scenario?
We suspect almost everyone would agree that the government scientists and clinicians are not thinking as clearly as they might be about the situation in Tumor Town and that, indeed, they have missed a number of very important clues about what’s going on. First, the high rate of tumors in this one town strongly suggests a huge environmental component to the problem. However, because some families are affected and others not, it is also likely that genes play an important role. In fact, because family members in other towns don’t come down with these tumors, disease genes may only pose a risk in the context of environmental risk factors unique to the town. Here is the most important point of all. Whatever the environment is doing to people’s bodies is almost certainly related directly to processes that are causing the cancers, regardless of the specific endocrine organ they are in. Also, it’s a good bet that genetic risk factors are related to the same pathophysiological pathways that are activated by the risk factors in the environment.
What are we to make of the striking comorbidity between tumors in different endocrine organs? Are you more interested in understanding why some people have a tumor in the pancreas and others have a tumor in the thyroid…or do you suspect that it is more important to ask what is causing the larger phenomenon of all these multiple endocrine neoplasms? Wouldn’t you guess that the shared, underlying factors that cause any one of these tumors are probably more central to the cause of the problem than whatever exigencies lead a particular tumor to sprout up in the pancreas or the adrenals—especially given that most people have tumors in multiple endocrine organs, which suggests that the specific locale is not essential to the underlying pathological process?
What mind–body neurobiology tells us about depression and related conditions
Conditions characterized by sadness, loss of pleasure, anxiety, fatigue, irritability, nonspecific aches and pains, sleep disturbances, appetite alterations, and difficulties in thinking and concentrating share important similarities with the cancers in our mythical Tumor Town. We psychiatrists have often behaved like those benighted government researchers who failed to see the importance of some very simple facts and figures. Fortunately, scientific discoveries in psychiatry itself, as well as in fields ranging from neuroscience and psychoimmunology to cardiology and evolutionary psychology are taking approaches more like what we would take were we to commit ourselves to solving the riddles of Tumor Town.
Thus, recent research suggests why:
• Depression has the genetic and environmental risk factors that it does. (These risk factors dysregulate activity in brain–body pathways in ways that produce depressive symptoms.3,4)
• Depression typically co–occurs with other symptoms, such as anxiety and pain, and with syndromes. (These symptoms/syndromes share similar pathophysiological abnormalities.5)
• Depression is so strongly associated with such conditions as cardiovascular disease, diabetes, and dementia. (Depression reflects the same type of wear and tear on body and brain that causes or contributes to the development of these medical illnesses.6,7)
• Remission of symptoms matters greatly to long–term outcomes. (This is not because symptoms somehow cause brain damage but because symptoms reflect states of brain–body function that are damaging over time and are inimical to optimal functioning in the modern world.8)
Pathophysiological and treatment implications of these propositions will be covered in greater detail in parts 2 and 3 of this series. Here we turn instead to a discussion of what recent findings in the arena of mind–body neurobiology tell us about issues of diagnosis and comorbidity involving major depression.
