講演情報
[LS-01]Rethinking Depression and Anxiety: Mind, Body, and the Paradoxes of Everyday Reasoning
*Takeo Kimura1 (1. Department of Psychiatry, Tokushukai, Yokohama Hino Hospital (Japan))
As a practicing psychiatrist, I frequently encounter patients with depression and anxiety, and I am consistently confronted with unresolved questions regarding these conditions. Although psychiatric classification systems have gradually shifted—from traditional distinctions such as exogenous, endogenous, and psychogenic depression, to operational criteria like the DSM-5-TR—depressive disorders remain highly heterogeneous with complex and multifactorial etiologies. The persistence of mind-body dualism continues to complicate both clinical reasoning and explanatory models within psychiatry.
Recent studies suggest that psychological stress can induce neuroinflammatory responses, blurring the line between psychological and biological factors. Moreover, growing evidence on the gut-brain axis and the role of the microbiome highlights the need for integrative perspectives in understanding psychiatric disorders.
In clinical practice in Japan, pharmacological treatment is commonly selected for the management of depression. Nevertheless, some studies have indicated that serotonin may not be directly responsible for mediating antidepressant effects. While it is almost certain that monoamines are involved in the pathophysiology of depression in some capacity, if their involvement is not direct, it is highly likely that the underlying biological processes of depression are even more complex. Psychotherapeutic interventions, such as cognitive-behavioral therapy, have demonstrated strong efficacy and may even surpass pharmacotherapy in preventing relapse, indicating that both approaches influence brain function through distinct mechanisms. This raises fundamental questions about what is actually occurring in the brain.
Depression and anxiety often coexist, prompting further inquiry into their shared and unique biological underpinnings. When providing explanations to patients—especially when drawing on biological frameworks such as immunology—clinicians inevitably encounter philosophical challenges.
Ultimately, I argue that establishing a strong therapeutic alliance, characterized by clear communication and mutual understanding between clinician and patient, is essential for enhancing placebo effects and optimizing treatment outcomes. Expanding our explanatory frameworks allows us to provide more meaningful support to those in our care.
Although the themes discussed in this lecture reflect my personal interests, I hope that sharing these insights will help you deliver clearer, more meaningful explanations to your patients, thereby improving clinical practice and patient well-being.
Recent studies suggest that psychological stress can induce neuroinflammatory responses, blurring the line between psychological and biological factors. Moreover, growing evidence on the gut-brain axis and the role of the microbiome highlights the need for integrative perspectives in understanding psychiatric disorders.
In clinical practice in Japan, pharmacological treatment is commonly selected for the management of depression. Nevertheless, some studies have indicated that serotonin may not be directly responsible for mediating antidepressant effects. While it is almost certain that monoamines are involved in the pathophysiology of depression in some capacity, if their involvement is not direct, it is highly likely that the underlying biological processes of depression are even more complex. Psychotherapeutic interventions, such as cognitive-behavioral therapy, have demonstrated strong efficacy and may even surpass pharmacotherapy in preventing relapse, indicating that both approaches influence brain function through distinct mechanisms. This raises fundamental questions about what is actually occurring in the brain.
Depression and anxiety often coexist, prompting further inquiry into their shared and unique biological underpinnings. When providing explanations to patients—especially when drawing on biological frameworks such as immunology—clinicians inevitably encounter philosophical challenges.
Ultimately, I argue that establishing a strong therapeutic alliance, characterized by clear communication and mutual understanding between clinician and patient, is essential for enhancing placebo effects and optimizing treatment outcomes. Expanding our explanatory frameworks allows us to provide more meaningful support to those in our care.
Although the themes discussed in this lecture reflect my personal interests, I hope that sharing these insights will help you deliver clearer, more meaningful explanations to your patients, thereby improving clinical practice and patient well-being.