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Depression vs. Feeling Depressed PDF  | Print |  E-mail

Depression and feeling depressed are as different as a glass of water is to the ocean. The former is a medical condition and untreated leads in its most benign form to dysfunction and in its most dire form, a life threatening condition. Being sad from time to time is normal and temporary.

Psychiatric consultation helps not only to differentiate between the two but to expertly diagnose the actual causes of medical depression and to recommend the most expeditious and most effective treatment.

The ultimate decision should be reached by a collaborative discussion during which the pros and cons of the many possible medications are discussed in detail.

- Dr. Kenneth Lichtman, M.D.

 
The Future of Psychiatry PDF  | Print |  E-mail

Thomas Insel, the current head of the National Institute of Mental Health at the 2011 May American Psychiatric Association Meeting in Hawaii, stated his view on the future of psychiatry. He opines that at present we are treating patients as if it were the ninth inning of a baseball game. The future is to find the complex gene mutations which cause cellular and later circuitary abnormalities which later express themselves in abnormal chemical and morphological brain states. It is clear from his thinking that the step after finding the faulty genes are to find methods to remedy these faulty genes either by direct gene manipulation or other means to intervene in preventing these cascading downstream abnormalities.

From the Journal of Clinical Psychiatry from Psychiatric News, a series of interesting new ideas are emerging . For example, there are studies which indicate that if a certain hormone level is checked in pregnant woman one can predict with 75 percent accuracy which post partum woman will develop post partum depression. The hormone in question is CRF or Cortical Releasing Hormone thought to reflect stress and in some cases inflammatory responses. This level must be done in the 25th week of pregnancy. An article by Laurie Atschuler M.D. from UCLA measured Cortical Thickness in Bipolar Patients in the Frontal area of the brain and found that there was a thinning compared to normal controls. This points to the growing evidence of actual brain structure changes in mental illness here specifically in Bipolar Disorder. Other authors have shown that Bipolar Patients frontal cortex in a particular part of that region is firing less than normal and that the deep part of the brain, namely in the hypothalamus, there is over firing neurons. These studies were done in patients who were normal for at least 6 months but carried a diagnosis of Bipolar Disorder. There is more to come ie. we know from structural MRI's that the Hippocampus is shrunken during depression but reverts to normal size when depression is cured.

I look forward to sharing new and interesting ideas both already in place and ongoing.

- Dr. Kenneth Lichtman, M.D.