The Osteopathic Psychiatrist and Depression

Osteopathically informed psychiatry recognizes the biopsychosocial principle that the body is able to affect the mind. Consider for example the phenomenon of chronic disease-related depression that asserts when depression is analyzed in the context of preexisting disease, its prevalence is much higher than the typically stated 5% of the world’s population. Interestingly, 8-27% of patients with diabetes mellitus, 20-30% of cardiac patients, and 40-50% of patients with oropharyngeal or pancreatic cancer manifest a depressive disorder.(1)

Of course, a thorough analysis of this phenomenon reveals that depression may be the result of something other than a bodily disease process. In fact, virtually every class of medication includes some agent that can induce depression.” (2) For example, anti-hypertensive medications such as calcium channel blockers and to a greater extent, beta-adrenergic blockers tend to elicit depressive mood changes. Another possibility is that a depressed mood may result simply from psychological stress as a part of the coping process. These two etiologies however,are outside the scope of this post and will be dealt with in detail at a later date. Today we focus on how the body affects the mind.

It is instructive to begin our study by focusing on the hormone cortisol. Cortisol is produced in the adrenal glands that sit atop the kidneys on both sides. A few of its many uses include upregulating glucose metabolism and regulating blood pressure. So it is easy to see why the body boosts cortisol production during “flight or flight” situations because of the increased need for energy and blood circulation. Blood levels of cortisol typically peak around 8:00 a.m. (waking us up) and fall continuously throughout the day.

So, what does this have to do with how our body affects our mind? Well, many people suffer from a condition of constantly elevated cortisol levels called hypercortisolism. This condition has a variety of causes, but the resultant high cortisol levels often manifests in signs like hypertension and mental changes. An example of the mental changes would be increased anxiety, that is, a low level but continuous “fight or flight” state due to high cortisol levels. So here we have a direct body-mind relationship-increased cortisol leads to increased anxiety.

Interestingly, Eric Kandel, the Noble prize winning psychiatrist cites a correlation between depression and increased evening cortisol levels. In other words, the typical depressed patient that feels worse in the morning and better at night is really experiencing a perversion of the normal diurnal cortisol pattern. Further, the characteristic insomnia, early morning rising and agitation can all be attributed to the same cortisol abnormality. In fact, Kandel asserts that over 40% of depressed patients may be diagnosed by simply measuring their cortisol levels.

References

1. Kasper DL, et al (ed). 2005. Harrison’s Principles of Internal Medicine. New York McGraw-Hill, 2551-2552

2. Ibid.

3. Kandel, ER, et al (ed). 2000. Principles of Neural Science. New York McGraw-Hill, 1220