Clinical
Psychopharmacology
Alexander H. Glassman, M.D., Chief
of Psychiatric Research
Evelyn Attia, M.D., Psychiatrist
II
Lirio S. Covey, Ph.D., Research
Scientist V
Michael J. Devlin, M.D., Psychiatrist
II
Steven P. Roose, M.D., Psychiatrist
(Research) II
B. Timothy Walsh, M.D., Psychiatrist
II
We have focused our research efforts in the following major areas: 1) biological concomitants and treatment modalities in patients with late-life depression; 2) the effect of depression on mortality/morbidity in heart attack, unstable angina, and coronary artery bypass patients; 3) pharmacological and psychological treatment of eating disorders; 4) psychological concomitants of and risk factors for eating disorders; 5) cardiovascular effects of tricyclic antidepressants in children and adults; 6) 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 (TCA) to a serotonin reuptake inhibitor (SSRI) 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 multicenter study of treatment of depression in the old-old, i.e., patients over 80. The Center has received an NIMH grant to train clinical researchers in geriatric psychiatry.
New projects that began in 2000 include: 1) a treatment study of atypical depression in late life; 2) sildenifil treatment for SSRI-induced sexual dysfunction; and 3) 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 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.
Treatment and Psychobiological Concomitants of Bulimia Nervosa, Anorexia Nervosa, & Binge Eating Disorder
Bulimia Nervosa We recently started a study examining the effectiveness of Prozac in the treatment of adolescents with bulimia nervosa. We are continuing 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. 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."
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.
Binge Eating Disorder We are continuing 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.
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 five-year grant funded by the National Institute on Drug Abuse, we will examine the efficacy of maintenance treatment which will consist of extending tobacco dependence treatment to six months for reducing the rate of relapse to smoking. We will also determine which combination of pharmacotherapy (bupropion, nicotine replacement, or the combination) will best reduce the relapse rate, measure the demographic, psychological, personality, and psychiatric factors that influence cessation and relapse, and measure the cost-effectiveness of each type of maintenance treatment. We are also continuing to work in multi-site clinical trials of cessation aids. We completed the follow-up phase for two studies. One examined the efficacy of bupropion, the only FDA-approved non-nicotine pharmacotherapy as a re-treatment aid; the other examined the safety and of a MAO-A inhibitor for helping smokers. We completed the treatment phase of a multi-site Phase 2 trial of a partial agonist of nicotinic acetylcholine receptors and are conducting the follow-up phase.
With researchers from the Medical Genetics department, we received a five-year grant from the National Institute on Drug Abuse to conduct a genetic linkage study to identify and locate genetic risk factors for persistent smoking.
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 Department of Mental Health 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 NYS psychiatric system.
Dr. Lirio Covey was appointed to the Smoking Cessation Advisory Panel and Dr. Alexander Glassman was appointed to the Emergent Science Advisory Panel with the American Legacy Foundation.
Dr. Alexander
Glassman, left, conferring with Dr. Stephen Rayport