Depression as Physical Disorder : THE NEW SCIENCE OF MIND


Dr. Philip John MD (NIMHANS) 

The Mind is generated by the Brain. Exponential research in neurobiology using the sophistication of functional neuroimaging techniques has made it possible today to ‘peep’ into live brain cells as they go about performing functions of the mind. Now we know that specific neural circuits are acted upon by specific neuro chemicals to produce attention, memory, thoughts, emotions or any of our mental functions. Today, therefore, we can ‘see’ the mind. Neurology and Psychiatry explore the biology of one and the same neuronal tissues; psychological disorders are today understood as disorders of the Brain. Psychiatry is the application of basic neuro sciences to man’s day-to-day problems. Psychiatry, therefore, is a pure branch of medicine, and not psychology. By that token, Psychiatric disorders are Physical disorders. Psychiatrists are primarily Physicians. Just as firing of neurons moves a limb, firing neurons produce pain or pleasure. What we all called as ‘Functional’ in medical school is therefore “Real” today. Psychogenic symptoms are not just thonnal 
- functional deficits reflect structural deficits. In the neuronal structures that are visible today through functional neuro imaging. Neurology and Psychiatry share the most complex object in the universe, the brain. Every mental function is generated by billions of neurons and regulated by trillions of neural circuits that are shared by neurology and psychiatry. The current concepts about disorders in Psychiatry and their treatment are based on this knowledge and evidence-base. Malfunctioning neural circuits mediate malfunctioning of the mind. As in Depression or in Schizophrenia. Therefore, restoring these circuits involves targeting specific neurotransmitters and their neurons - through therapy, manipulation and medications. This is why, we understand psychiatric disorders as having a physical basis in the neurons. Depression is quintessentially a neuropsychiatric disorder and therefore a ‘Physical Disorder’. The symptoms involve loss of pleasure, depressed mood, fatigue, lethargy and a plethora of physical symptoms. 69% of diagnosed depressed patients report at primary care purely for physical symptoms like headache, backache, autonomic (ANS) arousal symptoms of palpitations, gastrointestinal symptoms etc. This also results in an error of diagnosis or fallacy of treatment; many primary care physicians treat these patients with anti-anxiety agents and they feel better initially. But the unaddressed Depression goes on to become chronic and treatment-resistant. The cutting-edge in treating psychiatric disorders today is to hypothetically identify the culpritneural- circuit and choose the corresponding circuitcorrecting Antidepressant. This application of the basic neuroscience of biochemistry to behaviour has marked the evolution of Psychiatry as a Neuroscience, as an absolute branch of Medicine.