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Reexamining the Definition of Depression

July 10, 2017

A newly published book, authored by 2 members of the Psych Congress Steering Committee, challenges many widely held assumptions about depression by telling an overarching story about the disorder.

The New Mind-Body Science of Depression, by Vladimir Maletic, MD, MS, and Charles Raison, MD, explores topics ranging from bodily inflammation to human evolution to encourage a broader perspective on the nature of depression.

“We challenge this prevailing idea that mental disorders are brain disorders,” said Dr. Raison, co-chair of Psych Congress. “We say no, they’re brain-mind-body disorders.”

The pair decided more than 5 years ago to write the book. In their work educating mental health clinicians, they realized new viewpoints and information on depression were emerging, but an overall conceptual view of the advancements was missing.

“The pieces were all there but people hadn’t organized them in ways that perhaps would give us the most clarity,” Dr. Raison said. “It really seemed like a useful thing to try to put in print.”

Listen to Dr. Raison's interview about the book with Shrink Rap Radio:

In hour-long conversations on the symptoms of depression and the underlying neurobiology, “we more and more realized that depression is not a single condition,” Dr. Maletic said. He noted there is no agreement on the descriptive nomenclature regarding depression.

Vladimir Maletic
    Vladimir Maletic, MD, MS

“In STAR*D, a large, national trial using the DSM-based criteria, they noted that there are about 1000 or more different depression profiles. So, 3000 participants, 1000 different profiles. No single profile was seen in more than 2% of the patients,” he said. “DSM-5 rater agreement rates were about 30%, meaning 70% of the time they couldn’t agree what major depressive disorder is.”

In biological studies, he noted, 30% to 35% of depressed patients will have a certain biological marker, while the remainder will not. “A summary of the literature would suggest that major depressive disorder as a single entity does not exist,” he said.

Using agreed-upon findings in scientific literature, the authors present the concept of an “intermediary phenotype” related to depression, which 16% of the population suffers from at some point in their lifetime.

“It’s not going to be in every single depressed patient, but there will be a probabilistic relationship between certain underlying neurobiology and symptomatic expression of depression,” Dr. Maletic explained.

Research on Brain-Body Connections Poised to Transform Mental Health Treatment

Charles Raison
    Charles Raison, MD

Dr. Raison described the concept as a cloud. “The cloud tends to form over certain landscapes and those landscapes have a lot to do with where certain genetic vulnerabilities meet environmental conditions,” he said.

The authors hope the 640-page hardcover book, which was published in June, will appeal to trained clinicians and researchers. Three case studies are included to show how the concepts can intersect with clinical practice. Parts of the book, they said, may also be of use for members of the general public who are simply interested in learning more depression.

In addition, the authors hope the book will be used as a textbook in the United States. It can be read all the way through, but for readers interested in just a specific topic, the chapters can each stand alone, they said.

Understanding Inflammation and the Microbial World

“If one is interested in learning about immune-brain interface, no matter what they’re studying, the basics will be in the book,” Dr. Maletic said. “If one is interested in organizing one’s thinking about serotonin, norepinephrine, dopamine, glutamate, cannabinoid signaling, that information is in the book.”

There’s also a possibility that it will be translated into other languages and used in educating mental health professionals, Dr. Maletic said.

“We really hope that it contributes to taking this broader scientific perspective,” Dr. Raison said. “If we can contribute to people—both clinicians and scientists—taking that sort of perspective, we think we will have made quite a significant contribution.”

Dr. Maletic agreed, adding “in a subtle, and sometimes not so subtle, way we’re trying to foster a paradigm shift.”

—Terri Airov

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