Mood and Anxiety
Head: Dr. Sidney Kennedy
Genetics
Members of the Mood and Anxiety Program are actively involved in three
main areas of genetic research. Obsessive-compulsive disorder (OCD) is
a common psychiatric condition characterized by anxiety-provoking thoughts
and the need to perform rituals. Throughout the past six years, Dr. Peggy
Richter has consistently held peer-reviewed funding to study the genetics
of OCD related to the serotonin and dopamine systems. Dr. Robert Levitan
has established a research program to study genetic polymorphisms across
the mood disorders spectrum, particularly as they relate to seasonality
and the regulation of energy balance. Publications are beginning to appear
from both groups. Drs. Sagar Parikh and Robert Cooke have been collaborators
in a series of studies on people with bipolar disorder, concentrating
their efforts on genetic abnormalities in second messenger systems and
the genetic profile of the disorder. This work is being done in partnership
with the labs of Drs. James Kennedy and Jerry Warsh.
Epidemiology and Health
Systems
Developing and evaluating optimal methods of treatment delivery to patients
and education to community physicians has been a priority. In collaboration
with the Health Systems Research Unit at the CAMH, Dr. Sagar Parikh continues
to evaluate shared care models of health care deliveries in the treatment
of bipolar disorders. Dr. Roger McIntyre has recently received funding
from the CAMH Foundation Wolfond Fund to evaluate genetic causes of weight
gain with bipolar medications and quality of life issues in people with
bipolar disorder. Dr. William Gnam continues his research on the economics
of mental health issues, with special emphasis on the impact of psychiatric
disorders on the workplace and the labour market. Dr. Robert Cooke has
continued to investigate "quality of life" issues faced by people
who have bipolar disorder and other forms of mental illness.
Functional Imaging
Since 1995, the Mood and Anxiety Program has made functional imaging
a priority research initiative. Drs. Greg Brown and Jeff Meyer initially
carried out a series of studies using FDG/PET technology to examine the
effect of a serotonergic agent, fenfluramine, on neuronal activity in
the prefrontal cortex. Drs. Sidney Kennedy, Franco Vaccarino and Ken Evans
initiated a series of PET studies to examine the effects of antidepressants
on brain activity. Dr. Helen Mayberg joined the group in 1998, and has
extended this work to include investigations in patients who have bipolar
disorder (with Drs. Stephanie Krueger and Sidney Kennedy), the comparative
effects of antidepressants and cognitive therapy on brain metabolic activity
following successful treatment (with Drs. Zindel Segal and Sidney Kennedy)
and the influence of personality dimensions on brain metabolism (with
Dr. Mike Bagby). Since completing his fellowship and PhD in mood disorders
and PET, Dr. Jeff Meyer has continued to use PET to study the relationship
between psychiatric symptoms in depression and abnormalities in serotonin
and dopamine receptors. Using a novel serotonin transporter ligand developed
by Dr. Alan Wilson at the CAMH, Dr. Meyer and collaborators are completing
studies relating optimal therapeutic benefit to optimal brain antidepressant
concentration.
Psychopharmacology
As the main treatment for patients with mood and anxiety disorders, pharmaco-therapy
plays a leading role in many aspects of research in the Mood and Anxiety
Disorders Program. Pharmacotherapy research is ubiquitous across clinical
populations and is interlinked with other research initiatives.
Studies include: influence of personality types on drug response, compliance
and relapse; relationship between clinical response, brain metabolism
and receptor binding; effect of combining pharmacotherapy and psychotherapy
in depression; effect of combining different pharmacotherapies in depression;
testing of novel antidepressants; and pharmacotherapy of comorbid psychiatric
conditions.
In addition, clinicians in the Anxiety, Bipolar and Depression Clinics
have contributed to Phase II, III and IV clinical trials.
Psychological Mechanisms
and Treatments
This area has three major research foci. The first is the identification
of psychological variables that confer risk for the relapse/recurrence
of depression. CIHR has funded Dr. Zindel Segal to evaluate the role of
mood-linked cognitive changes in predicting prospective relapse/recurrence
of depression following either cognitive therapy or pharmacotherapy. Dr.
Segal is also collaborating with colleagues in the UK in an NIMH-funded
randomized trial to evaluate a prophylactic intervention designed to reduce
mood-linked negative cognitive processing.
The second research focus is the assessment of psychological mechanisms
associated with response to cognitive therapy for depressive or anxiety
disorders. CIHR has funded Drs. Mark Lau and Neil Rector to study the
roles of cognitive inhibition and rumination in mediating the patient's
ability to benefit from treatment. In addition, Dr. Rector and colleagues
Drs. Peggy Richter, Michael Gemar and Eilenna Denisoff were awarded a
CIHR grant to examine cognitive factors that predict successful treatment
response and relapse potential in OCD. Dr. Martin Katzman continues to
draw industry support for researching novel pharmacological interventions
for anxiety.
Studies of personality and psychopathology as they pertain to people
with depression are reported in the Personality
and Psychopathology Section.
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