From Chaos to Consilience

As we’ll discuss in the next 2 parts of this series, understanding these disruptions in danger/adaptation pathways in brain and body is at the heart of what the new science offers. It presents new ways of thinking about how we diagnose, treat, and make prognoses about many of the world’s most vexing behavioral disturbances—which are the primary requirements we ask of any scientifically based disease state.

“So, what’s in it for me?”

If you are a busy practicing physician, you may be asking yourself: “Interesting stuff…but what’s in it for me? How might I benefit from this new mind–body neurobiology? How does it help me be a better clinician?”

This is, of course, an eminently important issue. Our first response is that because the era of looking at depression as a mind–brain–body disease has finally arrived, we practicing clinicians need to be ready for it. Whether we are psychiatrists or primary care physicians, we need to be ready because it will change how we diagnose and treat a range of psychiatric conditions. These changes will likely be reflected—at least to some degree—in the next edition of DSM. We believe the change will be all for the good. We will be able to make diagnoses more efficiently, completely, and realistically, and this will markedly improve our treatment outcomes, as we’ll discuss in part 3.

While parts 2 and 3 of our series will address key treatment implications of the new science, the central point we are trying to make here is that diagnostic yields will improve if we alter our thinking about depression as a primarily mind or mind–brain disorder to a symptom complex that is activated by abnormalities in the whole person: mind, brain, body, and spirit (although we make no claims toward any special understanding of the spiritual realm!).

Increased recognition of the bodily symptoms of depression means we will less often miss the disorder or undertreat patients who present with primarily physical complaints. Indeed, our acknowledgment of the paramount importance of mind and body symptoms in depression will lead us to watch for the resolution in both symptom domains before we declare an individual’s depression to be in remission. Similarly, we will recognize that the treatment of symptoms such as anxiety and pain—which are not currently on the DSM “short list” for depression—is as essential as the treatment of any other symptoms if we are to help our patients achieve optimal long–term outcomes. Finally, the recognition that depression is intimately linked to the risk factors from which it arises provides a strong rationale for developing preventive strategies that are likely to benefit society in general and our patients in particular.

There is of course much else to discuss together. We invite you to continue this dialogue with us in the upcoming parts 2 and 3 of this series of articles.

Dr Raison is assistant professor and clinical director of the Mind–Body Program in the department of psychiatry and behavioral sciences at Emory University School of Medicine in Atlanta. Dr Raison is paid by CME LLC to provide/present this information. The opinions expressed are those of Dr Raison/CME LLC and do not necessarily reflect the views of Emory University or Emory Healthcare. Dr Raison’s participation in this activity does not constitute or imply endorsement by Emory University or Emory Healthcare. Dr Raison is on speakers’ bureaus for Lilly and Wyeth and serves on advisory boards for Lilly and Wyeth. He receives research support from Centocor.

Dr Maletic is clinical professor in the department of neuropsychiatry and behavioral sciences at the University of South Carolina School of Medicine in Columbia. He is on speakers’ bureaus for Lilly, Takeda, and Novartis, and serves on advisory boards for Lilly and Takeda.

Dr Draud is medical director of psychiatry and addiction medicine at Baptist Hospital in Nashville and at Middle Tennessee Medical Center in Murphreesboro. He is on speakers’ bureaus and serves as a consultant for Lilly, Pfizer, Cephalon, Forest, Takeda, AstraZeneca, and Sanofi–Aventis.

 Dr Jain is director of adult and child psychopharmacology research at R/D Clinical Research, Inc, in Lake Jackson, Tex.  He is on speakers’ bureaus for Jazz, Lilly, Pfizer, Takeda, and Shire; he serves as a consultant for Addrenex, Impax, Lilly, Shire, Takeda, and Pfizer.