Fall 2003 Volume 16, Number 2

Why Crossing the Psych-Neuro Line Is More Than Fine

The rigors of med school residency make for quick friendships that can fade as people get posted far and wide. But today, as colleagues in separate departments at Hopkins -- neurology and psychiatry, respectively -- Doug Kerr and Adam Kaplin are still barely a synapse apart. Kaplin spends time in Kerr's laboratory, assaying neuroactive agents; Kerr's made neuropsychiatric testing a staple of his TM clinic. He accurately flags depressed patients for Kaplin's care. Now their departmental border-crossing is paying off. They're tracing the biological basis for TM depression -- studies that stem from Kerr's being alert to his patients' dark moods and from Kaplin's familiarity with work of his Hopkins mentor Peter Rabins, M.D., that linked depression with the pathology of multiple sclerosis. "So far, we've shown brain involvement in TM that we'd not realized was there," says Kaplin. "We picked up on patient depression. That led us to uncover cognitive impairment. And asking what could cause such turmoil led to the idea that cytokines play a role. Our patient studies suggest certain cytokines soar in the disease. And our work with tissue cultures shows such levels can damage rat spinal cords. All seems in sync with what we know of TM. "It's no accident that a neurologist and a psychiatrist may have happened upon a crucial piece of the puzzle for the origins of a disease. It represents the best of what can happen when we poke about in each others' business." The joint research has already shown that: TM patients should be screened for depression when they first visit the clinic. Selected patients can then undergo tests that'll tell if they're also cognitively impaired. Treating TM patients' depression also greatly reduces their fatigue-a major complaint. About 80 percent of depressed patients see a surge in energy when mood's restored. They're far more likely to stick with rehabilitation. TM patients are more willing to see a psychiatrist when they hear their depression is clearly rooted in biology. They're told: You need to do this because it'll help your depression and it could have a bearing on neurologic changes in your brain.