Alan F. Schatzberg, MD, on the state of psychiatry
Dr. Aftab: What do you see as some of the strengths of psychiatry as a profession?
Dr. Schatzberg: Psychiatry as a specialty combines 2 major perspectives—psychological processes and psychobiology—to develop methods for treating patients who suffer from disorders of the mind/brain. It is the most challenging of our specialties because we cannot study the brain directly. We cannot do procedures as we do in cardiology and pulmonology because they may prove dangerously invasive. That hands-off approach limits us, but for the curious it provides an opportunity to begin to unravel the processes that underlie brain functioning. Fortunately, we have therapies—both psychosocial and somatic—that can provide great relief to patients. These can be shown to be effective in sufficient numbers of patients to help many.
Dr. Aftab: Are there ways in which the status quo in psychiatry falls short of the ideal? What are our areas of relative weakness?
Dr. Schatzberg: We need to train our residents in a host of approaches, and not just medications and psychotherapy. They need to understand the basis of brain stimulation approaches (such as repetitive transcranial magnetic stimulation) as well as know how to apply them. We need to train residents more in substance abuse problems and the biology of addiction if they are to better understand the risks of certain new classes of medication. Lastly, we need to train residents in the application of genomics, proteomics, and brain imaging to somatic treatment development.
Dr. Aftab: What is your perception of the threats that psychiatry faces or is likely to face in the future?
Dr. Schatzberg: The biggest threats come from ourselves. We need to do better with our classification approaches, such as the Diagnostic and Statistical Manual of Mental Disorders or the Research Domain Criteria. They need to become more rapidly adaptive to research in the field. We need to be more open to looking at what is a potentially dangerous trend in developing drugs of abuse and mind-altering drugs as therapeutics. We need to be able to demonstrate that telepsychiatry can be as effective as face-to-face treatment and should be reimbursed. Lastly, we need to develop better models for taking care of the psychiatric patient. We have too many patients and not enough psychiatrists.
Dr. Aftab: What do you envision for the future of psychiatry? What sort of opportunities lie ahead for us?
Dr. Schatzberg: I see the future as bright. Over the past 10 years, led by efforts at the APA, some while I was President, reimbursement has increased dramatically. Over the past 10 years, we have done well developing some new drugs and somatic therapies, and these will continue. Less than a decade ago, large pharmaceutical had abandoned psychiatric drug development and investment into biotech start-ups had waned to near zero. However, the last year few years have seen a dramatic surge in investment, and these should yield novel agents and ones that may be combined with innovative biomarkers as companions.
