How the Progressive Nature of Neuropsychiatric Illnesses Bridges the Brain and Body

Question:

"Could you please comment further on the quote you cited by Dr. Charles Mayo and how the concept of the progressive nature of neuropsychiatric illnesses bridges the brain to the body?"

Jon W. Draud, MD, MS:

This is an excellent question that gets to the heart of our evolving concept of the mind-body science. Dr. Mayo’s astute quote was from 1898 and underscores that for over 100 years physicians have suspected a strong link between the brain and the body. The quote reads: "Worry affects the circulation, the heart, the glands, the whole nervous system. I have never known a man who died of overwork, but many who died from doubt." We clearly see that Dr. Mayo was an early adopter of how profoundly disturbances of the mind could impact bodily functions in the periphery. This is particularly salient given that Western medicine has spent years artificially disconnecting psychiatry and the brain from general medicine and the body.

This concept was explored in my presentation from the 2009 U.S. Psychiatric and Mental Health Congress (USPC). Carney and colleagues1 showed that depression is an independent risk factor for death in a 5-year, follow-up study that examined survival in patients without depression versus patients with depression post-myocardial infarction. The results are impressive and show that the presence of either major or minor depression increases one’s risk for all-cause mortality.

The concept of disease state progression and how this fits into the overall mind-body science is explored in several studies from my presentation delivered at USPC. First, Keller and Boland2 presented clinically compelling data on recurrence of depression becoming increasingly likely with each successive episode over a 5-year period. This data is a clinical pearl in my mind and reminds us as clinicians that a patient’s risk of recurrence is 50% after episode 1, 70% after episode 2, and 90% after episode 3. As clinicians, we also know that our patients suffering third and fourth episodes are much more difficult to treat to remission than those presenting with a first episode of depression.

Part of the rationale for this clinical finding is presented in data from Frodl and colleagues.3 This 3-year, prospective study compared healthy controls to patients with major depression. Patients with major depression had significant differences in the volume of gray matter density in several brain regions, including the hippocampus, amygdala, anterior cingulum, and dorsomedial prefrontal cortex. This is very compelling data for us as daily clinicians and essentially warns us that depression seems to be a disease that results in neuronal degeneration.

There is further evidence of the same basic pattern of brain volume loss in patients with insomnia as well as patients with fibromyalgia. If we examine the data by Riemann et al.,4 we see that patients with primary insomnia have significant volume loss in both the right and left hippocampus when compared to good sleepers. Kuchinad and colleagues5 found that patients with fibromyalgia lost 10.5cm3 of gray matter annually since the year of their diagnosis. In addition, there seemed to be greater loss related to advancing age of the patients and the time since their diagnosis.

This brings us full circle to Dr. Mayo’s observation over 100 years ago and should serve as a daily reminder to us as clinicians that the mind and body are inextricably linked in our patients. There seems to be increasing evidence that under- or untreated neuropsychiatric illnesses may similarly lead to brain volume reductions in our patients. This should re-awaken us to our mission of aggressively and comprehensively treating these conditions in our patients to help stave off the sequelae.

1. Carney RM, Freedland KE, Steinmeyer B, et al. Depression and five year survival following acute myocardial infarction: a prospective study. J Affect Disord . 2008;109(1-2):133-138.
2. Keller MB, Boland RJ. Implications of failing to achieve successful long-term maintenance treatment of recurrent unipolar major depression. Biol Psychiatry . 1998;44(5):348-360.
3. Frodl TS, Koutsouleris N, Bottlender R, et al. Depression-related variation in brain morphology over 3 years: effects of stress? Arch Gen Psychiatry . 2008;65(10):1156-1165.
4. Reimann D, Voderholzer U, Spiegelhalder K, et al. Chronic insomnia and MRI-measured hippocampal volumes: a pilot study. Sleep . 2007;30(8):955-958.
5. Kuchinad A, Schweinhardt P, Seminowicz DA, et al. Accelerated brain gray matter loss in fibromyalgia patients: premature aging of the brain? J Neurosci . 2007;27(15):4004-4007.