A highlight from Mood, Metabolism, and Cognition: An Interview with Rodrigo Mansur, MD


In one thousand nine hundred eighty. The society for neuroscience began lobbying congress to increase funding for neuroscience research and on july eighteenth nineteen ninety. Their efforts paid off president. George h w bush signed a formal proclamation declaring the nineteen nineties the decade of the brain. At the time i just started working at the national institutes of mental health and the excitement was palpable. You could not go to a meeting or a lecture. Without hearing a reference to the new initiative and the promise at held and by the end of the decade most people judged it a success. Here's a few accomplishments from that decade of the brain the discovery of neuro plasticity before the nineteen nineties. Students were taught in psychology. Wanna one that. The brain was a static organ that became kind of set in its ways by age. Twenty five. now they're given a more empowering message through neuro plasticity the brain changes throughout life. Use it a lose. It is the mantra or is dr arnn. Put it in his bestselling book. Change your brain change your life. Thanks to these ideas. Older adults who taking up usable instruments. Aerobics dexterity games in hopes of reshaping the brain and staving off dementia. The we also learned that some periods of development with critical than others such as early childhood which led many states to launch preschool education programs. Next the discovery of genetic mutations responsible for huntington's disease emmy trophy lateral sclerosis enrich syndrome. Genetic advances like these have now ended clinical practice and no. I'm not talking about could. Genetic testing testing four neuro developmental disorders with a genetic basis is now a routine part of the world cup for autism and intellectual disabilities. If you're not already doing that. Look for it in our upcoming june issue. This year will show you how also from the decade of the brain the discovery of the neural origins of alcohol use disorders and then of course a rush of new anti convulsants and second generation antidepressants and anti psychotics. That decade is long past and if we had to anoint. The research of the current day. I'd call it the decade of the body and brain the assem continues to uphold a firm line in the sand between the brain and the body with the exclusionary clause that the symptoms of most disorders cannot be due to the direct physiologic effects of another medical condition. That line which looks so clean and sensible in the textbook is getting increasingly blurred these days as we learn about the multitude of ways that physical health impacts mental health. It looks like they blurred the line a bit already in the transition from dsm four today esim five in the all day to exclude symptoms that were due to a general medical condition while indecent five. The wording is another medical condition that word another suggests psychiatric disorders are medical conditions as well in reality. I'm hard pressed to think of a patient who psychiatric disorder was not impacted in part by their physical health. It's often said that when a patient has treatment resistant depression that we ought to go back to square one and look at whether any medical conditions like hypothyroidism. Anemia or vitamin deficiencies are causing the depression. And i hope our listeners will diligently run a lab panel like that check out our june twenty eighteen issue on treatment resistant depression for a list of what to include. But i don't think our listeners are very excited to hear this advice. Because they've learned from experience that those tests are fairly low yield in fact. Endocrinologist are currently debating whether we should routinely test for thyroid problems in depressed patients because false positive rates are high and we end up treating a lot of cases of subclinical hypothyroidism. That in the view of our endocrinology colleagues do not need to be treated. I myself am on the fence about the issue. I understand the endocrinology position. But i'm also aware that thyroid supplementation is a valid treatment for treatment resistant depression so you may not find that elusive general medical condition. That explains all your patient symptoms but you can make a big difference by pausing to consider how they physical health is impacting the brain particularly in depression. That boils down to at least three categories all of which overlap and influence each other in some way one that includes the hypothalamus pituitary axes through which so-called stress hormones like cortisol flow as well as reproductive hormones to inflammation on this one we have numbers inflammation contributes to thirty percent of cases of depression. And when it comes to treatment resistant depression that number jumps to fifty percent. The causes of inflammation many. Here's a short-list stress. From childhood trauma to recent stressful life events infection with active or recently like within the past six to twelve months. Chronic medical illness especially arthritis. Autoimmune diseases chronic pain as diabetes cancer and heart disease obesity particularly obama. I of thirty recent chemotherapy or radiation and recent bodily injury all surgery one of those recent infection has become particularly relevant in the kobe. Era this month. A new study found that fifty two percent of covid nineteen patients developed

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