Clinical Psychopharmacology
Alexander H. Glassman, M.D., Chief of Psychiatric Research
B. Timothy Walsh, MD, Psychiatrist II
Steven P. Roose, MD, Psychiatrist Research II
Lirio S. Covey, Ph.D., Research Scientist V
Michael J. Devlin, MD, Psychiatrist II
Juli A. Goldfein, Ph.D., Project Coordinator I
Rene P. Laje, Ph.D., Research Scientist II
Evelyn Attia, M.D, Psychiatrist II
Janel Carino, M.D., Psychiatrist I
Laurel Meyer, M.D., Assistant Professor of Clinical Psychiatry
Stuart Seidman, M.D., Assistant Professor of Clinical Psychiatry
Ellen Zimmerli, Assistant Clinical Professor
We have focused our research efforts in the following major areas: biological
concomitants and treatment modalities in patients with late-life depression;
the effect of depression on mortality/morbidity in heart attack, unstable angina,
and coronary artery bypass patients; pharmacological and psychological treatment
of eating disorders; psychological concomitants of and risk factors for eating
disorders; cardiovascular effects of tricyclic antidepressants in children and
adults; and smoking dependence, with special interest in the relationship between
nicotine addiction and depression, as well as the prevention of smoking relapse.
Late Life Depression Center
The Late Life Depression Center was established in 1991 by the Departments of
Clinical Psychopharmacology and Biological Psychiatry to focus on the study
of the phenomenology, biology, and treatment of depressed older adults. The
Center is the only research clinic focusing on depression in the elderly in
New York City. Depression is a common illness in this growing segment of the
population and research efforts have not been commensurate with the public health
significance of the disorder. Studies have demonstrated that a mild, chronic
type of depression, called dysthymia, occurs in older patients, and initial
trials have suggested that medication may be of help to these patients. One
of the unique studies conducted at the Center compared the efficacy of a tricyclic
antidepressant to a serotonin reuptake inhibitor in elderly patients with ischemic
heart disease. This study established that for these patients, an SSRI is equally
effective and a safer treatment than a TCA. Current federally funded projects
in the Center include studies of the effectiveness of antidepressant medications
in older adults; cerebrovascular abnormalities in late-onset depression; elderly,
depressed cognitively impaired patients; cerebral blood flow in elderly depressed
patients; and the effectiveness of testosterone replacement as a treatment for
depression in men. The Center is also the lead site in the first multi-center
study of treatment of depression in the old-old, i.e., patients over 80. The
Center has received a NIMH grant to train clinical researchers in geriatric
psychiatry.
Ongoing projects that began in 2000 include a treatment study of atypical depression
in late life; sildenifil treatment for SSRI induced sexual dysfunction; and
treatment of patients with depression and mild cognitive impairment. Major administrative
changes include the opening of a Spanish-speaking clinic to treat late-life
depression.
Antidepressant Studies In Patients With Ischemic Heart Disease
There are significant data to support the observation that depression dramatically
increases the risk of a recurring cardiac event in the months following a myocardial
infarction or unstable angina. What is uncertain is the safety of antidepressant
drugs after a heart attack and their efficacy in reducing the risk of depression
and the associated increase in mortality. We have been funded to look at the
safety and efficacy of sertraline immediately following an infarction or unstable
angina. We completed an open label pilot study to test the safety of sertraline
in post-MI patients and are have now completed a randomized double-blind controlled
trial in both heart attack and unstable angina patients hospitalized at CPMC.
We are conducting 6, 12 and 24 month follow-up calls to ascertain medical and
psychological states on these patients after the study. This study has been
submitted for publication.
Study and Treatment of Nicotine Dependence
We are continuing our work in drug development and extending our research to
better understand genetic and other biological factors that contribute to nicotine
dependence. Advances in tobacco dependence treatment have resulted in a number
of efficacious therapies for smokers who wish to stop smoking. These treatments,
however, which are typically four to eight weeks in duration, have not solved
the problem of a high relapse rate associated with tobacco cessation. Through
a 5-year grant funded by the National Institute on Drug Abuse (NIDA), we are
entering over 700 moderate-to-heavy smokers in a 12-month study to determine
the efficacy of maintenance pharmacotherapy for reducing the rate of relapse
to smoking. This study will enable us to determine which combination of pharmacotherapy
(bupropion, nicotine replacement, or the combination) will best reduce the relapse
rate. In addition, we are studying the demographic, psychological, personality,
and psychiatric factors that influence cessation and relapse, and measure the
cost-effectiveness of each type of maintenance treatment.
Most of the available information regarding nicotine dependence and treatment
has been obtained from predominantly Caucasian populations. To extend the knowledge
base to other racial/ethnic groups, we have applied for and obtained supplementary
funds from NIDA to study: a) the nature of nicotine dependence, b) those factors
influencing successful cessation using bupropion, nicotine patch, and counseling,
and c) the efficacy of long-term use of pharmacotherapy with Hispanic, African-American,
and Asian smokers. In addition, the NIDA-funded parent maintenance study will
be replicated in the Philippines, one of the countries in Asia that has an extraordinarily
high rate of smokers compared with the United States.
With researchers from the Medical Genetics Department, we are continuing a 5-year
study funded by the National Institute on Drug Abuse to conduct a genetic linkage
study to identify and locate genetic risk factors for persistent smoking.
Treatment and Psychobiological Concomitants of Bulimia Nervosa, Anorexia Nervosa,
and Binge Eating Disorder
Bulimia Nervosa We recently started a study examining the effectiveness of Prozac
in the treatment of adolescents with bulimia nervosa. We have completed a controlled
treatment study to compare the relative effectiveness of three treatments for
women with bulimia nervosa: guided self-help, antidepressant medication, and
guided self-help + antidepressant medication in a primary care setting, and
we are currently analyzing the results. In addition, we are continuing studies
that examine some of the psychobiological concomitants of bulimia nervosa: eating
behavior, stomach functioning, and levels of CCK, a hormone that is released
into the blood after eating to signal "fullness." We have begun work
on a translational research grant which is a collaboration among several groups
studying various aspects of eating regulation: researchers studying drug abuse/dependence
(Dr. Richard Foltin), researchers studying peripheral controls of appetite and
satiety in animals (Dr. Gerard Smith), and CNS reward mechanisms involved in
eating (i.e. “sugar addiction”) in animals (Dr. Bart Hoebel). The purpose of
this grant is to apply the concepts and methodology used by these other groups
to study dysregulation of eating in humans.
Anorexia Nervosa We are conducting a controlled study comparing the efficacy
of CBT to nutritional counseling in preventing post-hospitalization relapse
of anorexia nervosa. We are beginning a study examining the effectiveness of
family therapy for adolescent girls with anorexia nervosa. In addition, we are
conducting studies that examine some of the psychobiological concomitants of
anorexia nervosa. One study aims to measure serotonin activity in women with
anorexia nervosa undergoing re-feeding. Another study examines changes in body
composition, metabolic rate, and hormone levels in women with anorexia at low
weight and after weight has normalized. The above mentioned translational research
grant is examining the phenomenon of exercise dependence in women with anorexia
nervosa.
Binge Eating Disorder We have completed the initial treatment phase and are
conducting the follow-up phase of a controlled treatment study to determine
the relative and additive efficacy of two contrasting treatments for women and
men with binge eating disorder who participate in standard group behavioral
weight-control treatment: individual CBT and antidepressant medication. We are
participating in a multicenter study of the efficacy of sibutramine in treating
binge eating disorder. We are continuing to conduct laboratory studies of eating
behavior in obese women with and without binge eating disorder. Finally, we
are studying the phenomena of binge eating and weight gain in patients with
schizophrenia who are being treated with novel antipsychotic medications.
Training
The unit staff is active in a broad range of training programs. The educational
objectives for all residents are to learn how to recognize and treat major depression
and eating disorders and the principles of pharmacology that govern the use
of psychotropic medications.
Patient Care
The 5th Floor Clinical Service is a research unit devoted to, among other things,
the study and treatment of eating disorders. Treatment modalities include antidepressant
medication and cognitive behavior therapy.
Special Activities
In addition to regional seminars in psychopharmacology, the department administers
a statewide psychopharmacology "Hotline." This is a service offered
to NYS DMH facilities across the state through which physicians may, by phone,
get immediate expert advice on any drug related psychiatric problem. It functions
to improve the level of patient care throughout the New York State psychiatric
system.