Roger McIntyre, MD, Discusses Mood Disorders, Psychopharmacology
More Emphasis Needed on Early Prevention, Treatment
Psychiatry Advisor Editorial Board member Roger McIntyre, MD, head of the Mood Disorders Psychopharmacology Unit at the University Health Network, in Toronto, Canada, speaks about his interest in mood disorders and medical comorbidities, and most recently, cognitive decline associated with depression.
Psychiatry Advisor (PsychAd): Your major research interest is in mood disorders and psychopharmacology. Why does this area interest you so much?
Roger McIntyre: The area around mood disorders and psychopharmacology that captured my attention was really the opportunity to better understand disease models that support mood disorders. Also, the ability to use very novel, innovative pharmacological approaches that are not based on serendipity, but gathered from disease modeling exercises.
In the last seven decades of psychiatry, we have had a number of different treatments available to us. But we've not had that treatments discovered that are based on a disease mode. The reality is we've reached a bit of a plateau of sorts in psychiatry. In order for us to get better outcomes, we need to think very differently.
We have had tremendous advances in science — cognitive science, neuroscience — that really [has provided] excitement and inspiration. We've had decades of incremental changes, but what's going to happen in psychiatry that is going to be large-scale?
PsychAd: Medical comorbidies (e.g. smoking, obesity) are a key part of your research. Do you think psychiatrists treating patients should do more to help decrease such comorbidies?
McIntyre: Yes, I do. Psychiatrists are physicians and key members of the medical health team. The diagnosis has to look at the neck up and neck down. Psychiatric disorders have a high prevalence rate of chronic medical disorders as well as many complications secondary to taking medications, like metabolic changes and weight gain. It's unacceptable for clinicians not be attending the neck down. Chronic medical disorders have their own morbidity and mortality. This can often also exert a direct effect on the brain.
Also, obesity and diabetes can have negative effects on cognition. At the very least, a clinician should help orchestrate the circle of care for the patient.
PsychAd: You've also done a lot in cognitive decline associated with depression. Can you describe some of your research in this area and what you have found?
I've done research with others that will be published in the journal Comprehensive Psychiatry soon on this. We determined for people who have a job and also have depression, their performance in the workplace is not a function of how depressed they area. It's a function of how cognitively impaired they are. What's more deterministic [on their job performance] is the extent to which they are cognitively impaired. This is an extremely important observation.
PsychAd: Much has been written about treatment-resistant depression (TRD). What are some of the ways you believe TRD treatment can be improved?
McIntyre: Ketamine has received a heck of lot of attention, but its safety needs to be sorted out. Our first job for any patient is not to hurt them. Ketamine will likely help some people, but it can also hurt a lot of people.
There are some other potential alternatives. There's a whole host of very novel treatments that focus on inflammation, metabolism, oxidative stress. There are also old drugs we might be able to repurpose.
For example, the antibiotic minocycline has anti-inflammatory properties. There's some data in schizophrenia that it can improve cognitive symptoms. It's not a panacea, but it's an interesting proof of concept in a very old drug that we might apply to a brain disorder.
PsychAd: What is a key problem or area of psychiatry that you believe needs improvement and why?
McIntyre: Research and development needs to be refined into a more strategic direction. I'm very concerned by the retreat of very large pharmaceutical companies away from developing treatments for central nervous system disorders. It's concerning for drug discovery. How can we make advances if people are walking away?
Also, during the last five or six decades, there's been an emphasis of treatment, but little emphasis on prevention. We can prevent mental illness and maybe even cure some disorders. We need to go further upstream. Ideally, we don't wait until someone has a heart attack to treat the symptoms behind it. We need to do the same thing in psychiatry. Start treatment when we first see signs. Stop waiting before we do something.