From Chaos to Consilience: Using the New Mind-Body Science to Improve the Diagnosis and Treatment of Major Depression

Chaos – definition [from wordnet.princeton.edu]: a state of extreme disorder or confusion Consilience – definition [from Wikipedia]: literally a jumping together of knowledge by the linking of facts and fact-based theory across disciplines to create a common groundwork for explanation Lecturing around the country has left us with the powerful impression that both primary care physicians and psychiatrists are hungry for new ways to think about and manage depression and the myriad symptoms and syndromes with which it is associated— including attention-deficit disorder, insomnia, chronic pain conditions, substance abuse, and various states of disabling anxiety. Primary care physicians also seem especially excited to learn that depression is not just a psychiatric illness but a behavioral manifestation of underlying pathophysiological processes that promote most of the other conditions they struggle to treat—including cardiovascular disease, diabetes, cancer, and dementia.^1,2 In hopes of simultaneously quelling and stimulating this hunger and excitement, we have developed a 3-part 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 Jain is director of adult and child psychopharmacology research at R/D Clinical Research, Inc, in Lake Jackson, Tex. Dr Maletic is clinical professor in the department of neuropsychiatry and behavioral sciences at the University of South Carolina School of Medicine in Columbia. Dr Draud is medical director of psychiatry and addiction medicine at Baptist Hospital in Nashville and at Middle Tennessee Medical Center in Murphreesboro. 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 on speakers’ bureaus for Lilly, Takeda, and Novartis, and serves on advisory boards for Lilly and Takeda. Dr Draud is on speakers’ bureaus and serves as a consultant for Lilly, Pfizer, Cephalon, Forest, Takeda, AstraZeneca, and Sanofi- Aventis. Dr Jain is on speakers’ bureaus for Jazz, Lilly, Pfizer, Takeda, and Shire; he serves as a consultant for Addrenex, Impax, Lilly, Shire, Takeda, and Pfizer. series that sets forth a new view of major depression that synthesizes multiple converging lines of scientific evidence from an array of fields relevant to mind-body neurobiology. While this new science is fascinating in its own right, our emphasis in this series is to clearly enunciate the promise these new findings hold for improving our ability to diagnose and treat depression and its many comorbidities. We also hope to show that an integrated mind-body view of depression helps explain many aspects of mood disorders that have long been enigmatic. We believe this view can enhance our ability to provide our patients with an honest prognosis for their longterm functioning and survival. You will find the first article in our series online at www.psychiatrictimes.com. We begin the series with a general discussion of how a mind-body neurobiological approach to depression is an improvement over our current diagnostic understanding of mood and related disorders. In Part 2, we will detail the primary elements of a mind-body view of depression. In part 3, we will describe treatment implications that arise from the new science. Throughout, we will highlight ways in which a neurobiological understanding of mood disorders can help us move toward a personalized approach to the treatment of depression and its multiple comorbidities, both psychiatric and medical.

Editor’s note: The concept of a mind-body neurobiological approach to depression will be explored in detail at this year’s US Psychiatric and Mental Health Congress, which will be held in Las Vegas on November 2-5, 2009.