Can neurologists treat depression? (A basic investigation)

From the article, below, we will answer the question “can neurologists treat depression?” and thus gather some useful information about a neurologist’s and a psychiatrist’s approach to treating depression. 

Can neurologists treat depression?

No. A neurologist cannot treat depression completely. They can diagnose and detect depression but cannot treat it from its roots.

What does a neurologist do? 

A neurologist is specialized to diagnose and treat pathological abnormalities in the brain, spinal cord and the peripheral nervous system. 

The neurologist treats disorders that affect the brain, spinal cord, and nerves, such as:

  • Cerebrovascular disease, such as stroke
  • Demyelinating diseases of the central nervous system, such as multiple sclerosis
  • Headache disorders
  • Infections of the brain and peripheral nervous system
  • Movement disorders, such as Parkinson’s disease
  • Neurodegenerative disorders, such as Alzheimer’s disease, Parkinson’s disease, and Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease)
  • Seizure disorders, such as epilepsy
  • Spinal cord disorders
  • Speech and language disorders

Understanding depression

Depression is a mental illness which is quite common but may be serious enough to hamper one’s daily lifestyle.It is a state of feeling sad and low accompanying the following symptoms: 

  • Loss of interest or pleasure in activities once enjoyed
  • Changes in appetite — weight loss or gain unrelated to dieting
  • Trouble sleeping or sleeping too much
  • Loss of energy or increased fatigue
  • Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable by others)
  • Feeling worthless or guilty
  • Difficulty thinking, concentrating or making decisions
  • Thoughts of death or suicide

It is estimated that 5.8% of men and 9.5% of women will experience a depressive episode in any given year.

Causes of depression :

Biological factors: Imbalances in certain neurotransmitters are estimated as the probable causes of depression. Less or excess supply of neurotransmitters like serotonin, dopamine and norepinephrine are accounted as the biological factors in causing depression. 

Genetic causes : 

twin studies have revealed that genes play an important role in depression, but lack of research and evidence has failed to detect which genes or genes are exactly responsible.  

Environmental factors : The experiences and lifestyle of an individual can contribute to an individual’s predisposition to depression such as poor nutrition, stress, grief and loss,substance use etc. 

Treatment 

A mental health professional  ( a psychiatrist or a psychologist) treats depression as it is associated with mood and thought.

It is usually treated with proper medications(antidepressant) and psychotherapy or a combination of both. Brain stimulation therapy is another treatment option.

What is the root of mental illness?

It is not so easy to diagnose mental illness because it does not have a bounded or restricted set of symptoms nor are the causes and effects predefined. Chronic diseases like cardiovascular disease are easily detectable through blood tests and ECG(electrocardiogram) which isn’t the case while detecting mood disorders or any mental health conditions. We cannot detect depression or bipolar through any sort of tests. 

A professor of brain science at the columbia university commented, “ all disorders of the mind are biological”. His explanation was based on the idea that just like dysfunction of any organ has its predisposition in behaviour as well as molecular roots, the brain can also be considered the organ of the mind. Whatever symptoms we show up is an abnormality that has its root in the biology of the brain. Recent research has also suggested that various functions and dysfunction of areas of the brain are related to psychological abnormalities. Schizophrenia, PTSD and autism are areas of research which shows evidence that certain brain regions and chemicals can be considered responsible for causing these mental disorders.

Helen Mayberg, a professor of psychiatry and neurology at Emory University studied about a brain region – Brodmann area 25 – that is active in people suffering from depression.She further added that this area of the brain is responsible for interacting with other brain regions involved in mood, emotion and thinking. (Neuron, 2005).

The biggest issue in detecting and treating mental illness is the uncertainty and lack of a one-size-fits-all approach interventions. Depression does not have a pattern nor a particular intervention.Mayberg says. “The caveat is that different cohorts of patients clearly have different patterns” — The treatment has to be specific depending on what the person’s experiences and symptoms are.

On the other hand, a group of researchers at the New York University, believes that too much emphasis has been laid on the biology of mental illness since quite a long time which has in no way helped facilitate intervention methodologies nor uncovered useful clues that could be translated to improvements in both diagnosis and treatments.

Our brain – the computer

What if we think of our brain as a computer? The computer has a hardware and a software just like our brain and mind. The physical and biological components of the brain : neurons, neurotransmitters, gray matter etc, comprises the hardware. Our cognition like learning, memory, perception, emotion, our software. Just as software dysfunction is often the cause of computer problems, even when everything else is working perfectly, mental disorders can also be explained likewise. If we focus on just the biology we may eventually miss out on the other behavioral and environmental factors.

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The danger in placing too much attention on the biological is that important environmental, behavioral and social factors that contribute to mental illness may be overlooked.

A study by Steven Marcus, PhD, and Mark Olfson, MD, that found the percentage of patients who receive psychotherapy for depression declined from 53.6 percent in 1998 to 43.1 percent in 2007, while rates of antidepressant use stayed roughly the same (Archives of General Psychiatry, 2010).

Epigenetics can bridge the gap : 

Epigenetics is the study of how genes express themselves in the influence of environmental factors. Epigentics studies the phenotypic changes of the genes that do not involve changes to underlying DNA sequence.  epigenetics, meanwhile, could help provide a link between the biological and other causes of mental illness.

 Since ages psychologists have focused on the behavioral level of mental illness not giving attention to the physical and biological aspects. Suicide rates have touched peaks and prevelance of these disorders have also taken a rise. This tells us our mode of treating and understanding mental illnesses may not be adequate and enough. 

Epigenetics is a blooming research area to understand mental illness from interconnected levels of behaviour, biology and environment. 

To successfully understand the brain and mind and decipher the true nature of mental illnesses, we have to do a lot more studies and research and dig in its various levels this coming down to an efficient way of treating it.

What Is the Difference Between Neurological and Psychiatric Disorders?

Neurological disorders are characterized by the problems in the central and peripheral nervous systems- lesions, tumors, malfunction or damage. Disorders like  Parkinson’s disease, Huntington’s disease, epilepsy, multiple sclerosis, and Alzheimer’s disease can be clustered together because they all involve malfunction of or damage to the nervous system. 

These disorders are diagnosed and detected through various tests and investigations and treated with medicines or surgery. 

Psychiatric disorders are those disorders which encompass symptoms like mood fluctuations, behavioral abnormalities, emotional flings and so on. Neurological causes can underpin these disorders such as difference in levels of neurotransmitters, problematic communication between neurons. Neuronal communication has been implicated in depression, behavioral problems, posttraumatic stress disorder, attention deficit hyperactivity disorder, and schizophrenia. 

Psychiatrists detect and treat mental disorders keeping in mind both the physical and behavioral aspects which serve as contributors to mental illness.

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Should Neurologists manage Psychiatric Symptoms?

When asked this question, Andrew  N. Wilner, MD, a Neurohospitalist, Lawrence and Memorial Hospital, explains that “From a neurologist’s and psychiatrist’s perspective, problems of the brain and mind differ primarily in the strategy of investigation and management.”

How neurologists and psychiatrists manage illnesses and symptoms can be understood from the following case study.

A 27 year lady comes to a neurologists with the following symptoms  :

Visual hallucinations – “I think I’m going crazy. I keep seeing things that aren’t there.” followed by nausea, vomiting, photophobia, phonophobia, and irritability. When she is asked to draw what she hallucinates, the patient sketches an exact copy of the fortification spectra( a pattern resembling old forts).

The neurologist diagnoses migraine after making the patient go through various tests and examinations(magnetic resonance imaging (MRI)), the results of which were normal.

If the same patient goes to a psychiatrist with auditory symptoms which commanded her to jump off a window, followed by a headache and irritability, migraine won’t be the diagnosis.

A neurologist would perform a series of tests to rule out any autoimmune, endocrine, infectious, metabolic, paraneoplastic, structural, or other “medical” problems responsible for this patient’s auditory hallucinations and headache before categorizing the problem as psychiatric.

After ruling out the possible neurological predictions, the neurologist will send the patient to a psychiatrist for the symptoms suggestive of schizophrenia.

One may argue that depression being a mood disorder has its root in neurological causes like imbalance in neurotransmitters that can be treated by a neurologist. But these disorders fall in the domain of psychology and psychiatrists are trained to treat them. A neurologist can detect and predict the presence of a psychiatric disorder but he or she is usually not trained to manage them in a nonmedical way. They can, if they have interest, expertise and the availability of psychiatric support. Usually when symptoms are non neurological they recommend patients to go to a psychiatrist who is adept to treat diseases of the mind and not the brain.

Conclusion 

It can be concluded from the above discussion that neurologists cannot treat depression until and unless they have interest, expertise and psychiatric support. 

Faqs : Can neurologists treat depression?

How does peanut butter detect Alzheimer’s?

Researchers at Florida University found that those who suffered from Alzheimer’s had an impaired sense of smell in their left nostril. They noted that the participants who had alzheimers had to smell peanut butter from a closer distance with their left nostril as compared to their right nostril.

Is depression a neurological disorder?

The root of mental illness lies in neurological abnormalities but depression is not a neurological disorder. It is a mood disorder and can be treated by a psychologist or a psychiatrist.

Can a neurologist detect mental illness?

A neurologist can detect mental illness by ruling out all possibilities of any neurological abnormality that can prevail in a patient through tests and investigations. They may then refer the patient to a psychiatrist or psychologist. 

Do neurologists prescribe antidepressants?

Antidepressants are used by neurologists to treat depression of patients with neurological disorders, chronic pain syndromes and neuropathic pain, panic attacks, eating disorders, premenstrual syndrome and for migraine prevention.

Can a neurologist diagnose anxiety and depression?

They may diagnose anxiety and depression which is associated with neurological disorders.

What we recommend for depression

Professional counselling

If you are suffering from depression then ongoing professional counselling may be your ideal first point of call. Counselling will utilize theories such as Cognitive behavioural therapy which will help you live a more fulfilling life.

References :

https://www.urmc.rochester.edu/highland/departments-centers/neurology/what-is-a-neurologist.aspx

https://www.medscape.com/viewarticle/727530

https://www.researchgate.net/publication/340234992_The_Role_of_Neurologist_in_the_Assessment_and_Treatment_of_Depression

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