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Inflammation and Depression

posted on April 12, 2012 | E-mail | |

Question: “I’ve heard you talk about inflammation and depression at the Treating the Whole Patient sessions at the 24th Annual U.S. Psychiatric and Mental Health Congress, and I’m hearing more and more about this topic in psychiatric publications. Is it time we started thinking about major depression as an inflammatory condition?”

Charles Raison, MD:

I’ve bet a lot of my academic career on proving the association between depression and inflammation, so it might surprise you that my answer to your question is “no.” Depression is not an inflammatory condition as we commonly think of these disease states. I’ll discuss this in some detail in this Q&A, but you might also consider listening to my lectures “Reversing the Long Day’s Journey into Night: Mind-Body Perspectives on Treatment Resistant Depression” and “Inflammatory Perspectives on the Future of Psychiatry” presented at the 24th Annual U.S. Psychiatric and Mental Health Congress.

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Role of Default Mode Network in Depression

posted on March 28, 2012 | E-mail | |

Question: “What is the role of the default mode network in depression?”

Vladimir Maletic, MD, MS:

Over the last decade we have seen an important evolution in our understanding of the pathophysiology of depression. A relatively static model focused on identifying an abnormal activity pattern in the individual brain areas has been replaced with a dynamic model evaluating the relationship between major brain networks either in the resting state or in a response to a given challenge. Three networks appear to have an important role in mood disorders: salience network, default mode network, and executive network.

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Understanding Antidepressants’ Receptor Profiles

posted on March 15, 2012 | E-mail | |

Question: “I often treat depression with antidepressants. Why is knowledge about receptors and receptor profiles of the medications I choose important? Is it really important, or is it just interesting stuff, without any clinical value?”

Rakesh Jain, MD, MPH:

Good question! We clinicians are knowledge driven, but even more so, we are practically oriented. Knowledge for the sake of serving our patients even better is what we thirst after. That is where our heart is. Therefore, your question resonates loud and clear with me. What about receptors is important to us? And even more importantly, what about receptor differences amongst medications is of importance to our patients?

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Role of Dopamine in Addiction and Drug Abuse

posted on February 22, 2012 | E-mail | |

Question: “Please elaborate further on the role of dopamine in addiction and drug abuse.”

Jon W. Draud, MS, MD: 

This is a great question and I will approach it by discussing dopamine from a neuroimaging perspective.

Drugs of abuse are known to trigger large surges of dopamine extracellularly in limbic areas, specifically, nucleus accumbens.¹ Volkow et al^2-3 have shown that human imaging studies correlate descriptors of reward, ie, the “high” and euphoria with drug-induced increases in dopamine nucleus accumbens. There is also the issue of saliency of the reward, which seems to be driven by the novelty or unexpectedness of the activity.⁴

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Depression and Fertility

posted on February 09, 2012 | E-mail | |

Question:
"Is there any evidence that depression in the ‘non-infectious’ developed world decrease fertility? Don’t individuals with depression who reach sexual maturity pass their genes on at the same frequency as non-carriers?"

Charles Raison, MD:

For folks like me who often skim the beginning and end of articles or blogs, let me cut to the chase: yes, there is significant evidence that depression is associated with reduced fertility in the developed world, and people who are infertile are more depressed than are fertile individuals, with this effect being especially strong for women. If you want to know the details, and how this might link to adaptive advantages of depression in the ancestral environment (as well as fertility and survival in the royalty of Europe), read on.

Williams and colleagues reviewed the world’s literature on this topic in 2007.¹ At that time a number of studies suggested that people with both bipolar and unipolar mood disorders had reduced fertility, as measured by number of offspring, when compared with matched controls. Importantly, the bulk of the evidence suggested that this effect was seen even prior to the onset of the psychiatric illness, suggesting that the link between mood disturbances and fertility may cut deeper than a simple association between being too unhappy to have sexual relations and reduced number of children.

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Daunting Diagnostic Dilemmas of the Depressive Disorder

posted on December 29, 2011 | E-mail | |

Question: "You were critical of the DSM-IV definition of major depressive disorder. Do we need a new diagnostic classification for psychiatric conditions?"

Vladimir Maletic, MD:

The diagnostic taxonomy that is reflected in the DSM-IV and its predecessors has multiple purposes in psychiatry: a) it is the basis for communication in epidemiological, clinical, and basic scientific research, b) without common language it would be difficult to coordinate care with colleagues and communicate with patients, and last, but not least, c) appropriate diagnosis provides meaningful guidance for treatment.

Useful diagnosis acts as a semantic proxy encapsulating the essence of a medical condition. Usually we envision this essence as some type of physiological and anatomical abnormality (ie, pneumococcal pneumonia is so called because it is caused by the pneumococcus bacterium). Understanding pathophysiological mechanism of a disease invariably helps us seek and find effective treatments. However, this is not the case with depressive disorders. Indeed, the diagnosis of major depressive disorder (MDD) is only a descriptive one, defining it as if it was a singular condition. Unfortunately, abundant research evidence suggests that the category of MDD subsumes genetically and biologically disparate conditions.

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