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Heal Your Brain: Introduction to the New Neuropsychiatry

How neuroscience advances can improve depression treatment...6 key principles

Do you remember Dr. Lewis Thomas, the renowned physician-writer?

Back in the 1970s, Dr. Thomas wrote an elegant book of essays, The Lives of a Cell: Notes of a Biology Watcher, in which he poetically linked the latest advances in biology to the care of patients, to hospitals, to social issues, and even to the state of the biosphere. Lewis Thomas was always an inspiration to me as a young physician and writer, and he has often come to mind over the past decade-a time of incredible advances in neuroscience.

I am a psychiatrist, and I work in the Columbia University Department of Psychiatry, at the New York State Psychiatric Institute in New York City. At Columbia, I teach and do research and run various programs. But I am also a clinical psychiatrist, with an active practice in psychopharmacology and psychotherapy, and a few evenings a week I go to my office on the Upper West Side of Manhattan to see patients-primarily with mood and anxiety disorders.

In recent years I have become what you could call a 'New Neuropsychiatry watcher.' I go to conferences at Columbia and elsewhere, I speak with research colleagues, I run studies that test medications and the effects of therapy, and I work with other doctors doing brain scans of patients with various disorders-especially with chronic depression and anxiety disorders.

More than anything else, I have become fascinated by the torrent of discoveries in neuroscience, from brain imaging studies to genetics to 'animal models' of psychiatric illnesses, as well as innovative treatments such as the implantation of electrodes deep in the brain to treat severe depression, and trials of new medications and types of therapy like 'behavioral activation' therapy.

The world of research is fascinating, and the past decade has brought incredible advances-the beginnings of a true understanding of how the brain functions in health and disease. Every week, I shuttle back and forth between the rarefied world of neuropsychiatry research and the daily realities of work as a psychiatrist who treats people with depression or anxiety disorders-dealing with insurance companies, prescription renewals and the like.

Living this double life, I began to wonder: is it possible to bridge the chasm between cutting-edge science and the busy clinic? Given how complicated the brain is, and how fragmentary our knowledge is at this point, is it possible to come up with basic principles grounded in neuroscience that can help to guide treatment of these disorders? And are there principles that people with depression and anxiety disorders-or their families and loved ones-can use to obtain better results?

I started writing my recent book, Heal Your Brain, over a decade ago, but it was only the past four or five years that I was able to really refine my argument. At a certain point it seemed that every week there was a new advance linking the latest research in the neuroscience laboratory with what we psychiatrists see in our offices.

Eventually, I came up with six key concepts for the New Neuropsychiatry. Each of these is supported by research findings, and each has relevance to people whose lives have been affected by depression and anxiety disorders. Specifically, each principle can help us-doctors as well as patients and their families-to better manage these disorders, and I believe they can help researchers to work more effectively to bridge the chasm between the laboratory and the doctor's office.

6 Key Concepts for the New Neuropsychiatry

As I describe in Heal Your Brain, and as I will discuss in future postings, these concepts include the following:

1) neuroplasticity, the ongoing remodeling of brain structure and function throughout life, which can be affected by biological agents, behavior, exercise, and thought patterns;

2) the damaging impact of clinical depression and anxiety disorders on brain structure and function;

3) the importance of achieving "remission" of disorders, and its potential effects on limiting or even reversing brain injury occurring as a result of psychiatric disorders;

4) the importance of behaviors such as learning, psychotherapy, and exercise as well as somatic treatments (medications, etc.) on changing brain structure, connectivity and function, and on alleviating disorders;

5) the impact of physical health on the brain and the course of psychiatric disorders; and

6) the possibility of enhancing resilience as a means of alleviating chronic stress and improving the long-term outcome of mood and anxiety disorders.

The purpose of this blog is to explore the ways in which what I call the New Neuropsychiatry can improve the treatment of people with psychiatric disorders. But it is also to explore the ways in which patients' experience can inform research, and help us researchers to do better studies in order to improve treatment. One thing I have realized as a 'New Neuropsychiatry watcher' is that this communication is a two-way street. Insights from the research lab and the doctor's office-not to mention from the experiences of people with depression and anxiety disorders-can help bridge the chasm between research and practice, and lead to true advances in care.

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