Advancing Mental Health Research, Psychiatry and Behavioral Sciences at Northwestern with Sachin Patel, MD, PhD

Erin Spain, MS [00:00:10] This is Breakthroughs, a podcast from Northwestern University Feinberg School of Medicine. I'm Erin Spain, host of the show. Mental health problems are common in the U.S., according to the CDC, one in five Americans will experience a mental illness in a given year. The Department of Psychiatry and Behavioral Sciences at Feinberg has been accelerating research in mental health and translational neuroscience in recent years and is well-positioned to advance this work under the leadership of Dr. Sachin Patel. He is the new chair and Lizzy Gilman, professor of psychiatry and behavioral sciences at Feinberg and the psychiatrist-in-chief at Northwestern Memorial Hospital's Norman and Ida Stone Institute of Psychiatry. He joins me to talk about the current mental health crisis in this country, his research and vision for the department. Welcome to the show, Dr. Patel.
 
Sachin Patel, MD, PhD [00:01:04] Thank you so much for having me.
 
Erin Spain, MS [00:01:05] What was it about this field that drew you into it and made you want to be a physician scientist to both study the science and treat patients?
 
Sachin Patel, MD, PhD [00:01:13] I've always been very interested in the brain, the reason why you know, people do the things that they do, and these ultimately arise from the brain. I thought about several avenues, including clinical psychology, psychiatry and ultimately settled on medical school and entering the field of psychiatry. During that same period where I was developing those clinical interests, I was exposed to neuroscience at a variety of levels, starting in my undergraduate institution, and became just even more fascinated by the fact that we could potentially understand why people do the things they do, behave the way they do feel, the way they do by understanding how the brain works. And so those two things I think developed in parallel very nicely over the past 15 plus years for me and really represent a very natural and quintessential blending of my interest in neuroscience and clinical practice.
 
Erin Spain, MS [00:02:03] Tell us about your background and what brought you here.
 
Sachin Patel, MD, PhD [00:02:05] My background is as a psychiatrist and neuroscientist, I've spent the past 10 plus years at Vanderbilt University. I was the director of the Division of General Psychiatry there for several years prior to my move here to Feinberg and have been working on my research program that's focused on understanding how environmental stress affects brain structure and function, and how understanding the impact of stress could potentially reveal new targets for the treatment of mental illnesses affected by stress. So, this could be things like post-traumatic stress disorder or major depression and other illnesses that we know are profoundly affected by stress. Coming to Feinberg was a great opportunity for me. I think the institution as a whole is extremely strong, and the infrastructure and basic and translational neuroscience was exceptional, which allowed me to continue the work in terms of my research here, as well as expand the repertoire of the portfolio of the Department of Psychiatry to include more translational neuroscience, as well as build on existing strengths in health services research, epidemiology and clinical trials, for example. So overall, it was a great opportunity to join an outstanding medical school that was really poised to advance behavioral health research and care in a way that aligned highly with my research interests and visions for my own career.
 
Erin Spain, MS [00:03:21] You are coming to Feinberg at Northwestern Medicine during this time of growth, and also at a time when mental health and the well-being of so many Americans was impacted by the COVID-19 pandemic. Tell me, how do you describe the mental health problems occurring right now in the U.S. and in Chicago? And how is Northwestern poised to meet these challenges?
 
Sachin Patel, MD, PhD [00:03:42] I think most people are acutely aware, certainly over the past few years, that mental health and the need for mental health services is staggering in this country. I think the COVID epidemic certainly has brought that out, but this preexisted COVID, I think this is just something that's been brought to the forefront of people's minds because of the epidemic. And we've seen the impact on all aspects of our population, young children. We've seen the impact of school closures and things like that social isolation, the impact on developing kids. We've also seen the impact on adults in terms of workforce changes, people changing the way they view responsibilities and work, working from home, as well as elderly patients in terms of again, the isolation they've been feeling due to shutdowns and isolation and other types of quarantine situations that we've all experienced over the past several years. Anxiety disorders, depressive disorders, mood disorders are all being brought to the forefront and it's a national epidemic. I think this is riding on top of what we already knew was occurring in many areas, for example, in terms of our substance use disorder epidemic overdose deaths that were already climbing before COVID and have just escalated in the past two years. So certainly, you know, the COVID pandemic highlighted a lot of these preexisting mental health concerns, but they've been there for a long time. And I think one of the benefits of the past several years has been really putting this in the forefront of society and people reducing stigma. Talking more about the mental health impact of the COVID pandemic has been a good thing. I think allowing people the opportunity really to talk more openly about the impact of different types of stress on their mental health and wellbeing has been a good thing. In terms of being poised to tackle some of these major issues, it's difficult all around the country and all around the world. The main thing to consider when we're talking about Feinberg and Northwestern Medicine is the major investments in behavioral health that they're making. Not only with my arrival, but prior to that and ongoing investments in ensuring that behavioral health those incorporated into all areas of health in general. So moving mental health care out more into primary care settings. So collaborative care models which have already been initiated there are going to be expanded, which is a great way to increase access for behavioral health services to people outside of departments of psychiatry, per se. So providing care to folks where they can get it, increasing access at any point of entry within the health system, whether that's the emergency room or pediatrics offices or internal medicine offices. So that's just one example, but there are many others, make me optimistic that Northwestern Medicine and Feinberg are well-positioned to take on these mental health issues that that really are quite staggering and need a substantial amount of attention, as everybody knows.
 
Erin Spain, MS [00:06:33] Community engagement and being involved in community health centers around the city has been a priority. Tell me how you're going to continue doing that and working in our local communities to bring the services of our trainees and students and faculty out into the community.
 
Sachin Patel, MD, PhD [00:06:48] Partnerships with local nonprofit health care and behavioral health care centers is something that's ongoing. Moving behavioral health services into underserved areas and focusing on historically underserved populations is something that we're going to be actively working on. Starting new service lines that address emerging behavioral health needs is also something we're very interested in, and given the diverse population of the region, it's something that I think will help set Northwestern Medicine apart in many ways.
 
Erin Spain, MS [00:07:20] Well, you've mentioned launching a new Center for Psychiatric Neuroscience. Tell me about that and what we can expect.
 
Sachin Patel, MD, PhD [00:07:27] This really stems from my personal career as a psychiatrist taking care of patients, but also being a trained, basic and translational neuroscientist. And it combines, really, I think what what most people are beginning to understand is that, you know, the brain is really one of the final frontiers left in science and understanding how the brain works and deteriorates under certain conditions to really ultimately result in mental health conditions is something we actually really know very little about. We're beginning to learn lots and lots about the brain, and we have over the past 60, 70 years, but it remains largely mysterious in terms of how things break in the brain, how it fix them really at a mechanistic level. And launching this Center for Psychiatric Neuroscience is really aimed at bringing together basic translational neuroscientists that have a goal of understanding and deepening our understanding of the other physiological mechanisms that underlie mental illness with the ultimate goal of being able to reveal new molecular targets, for example, for therapeutics intervention as one particular example. Also understanding the mechanisms by which current therapeutics work, which might allow us to then generate new drugs based on that understanding of existing mechanisms of action. There's a real need to dissect the brain to understand how it works at a very fundamental level. How does the brain and its electrochemical structure result in things like emotion, cognition, memory? I mean a lot of those things are really fundamentally still unknown, and unless we understand that, it's going to be very difficult to understand how those processes get disregulated and result in disorders like PTSD and depression. Bringing together folks that have that common goal, working with clinicians and clinical neuroscientists to come together to address these in a comprehensive ways is really one of the goals of the center.
 
Erin Spain, MS [00:09:14] Tell me about some of the technology you're going to be using in the center, including some brain imaging and other technologies.
 
Sachin Patel, MD, PhD [00:09:20] There's been an unprecedented growth in technological advancement in brain sciences over the past decade. We're doing things today that really weren't even imaginable 15 years ago. And so those include, for example, real time analysis of large-scale neural networks in behaving models systems. These things just could not have been done without the technological revolution, really, that's occurred over the past 10 years in brain sciences. Combining that with rapidly growing computational approaches to really understand the mechanisms by which these, you know, large scale neural ensembles end up coding for and representing really complicated aspects of the environment of the internal states like emotions were really on the cusp of being able to understand these things in ways that have never been able to occur before. And so technological advances in microscopy and cell imaging at multiple levels are really one of the main focuses. And understanding behavioral constructs at a much deeper level, using unbiased approaches and machine learning approaches, have also been rapidly escalating over the past five or six years, and those are also new approaches that are going to be incorporated into the center.
 
Erin Spain, MS [00:10:32] Much of your research involves environmental stress and how it can affect brain structure and function. Tell me about your work and what you've discovered over the years.
 
Sachin Patel, MD, PhD [00:10:41] Early on, it became very clear to me that stress is one of the things that has a substantial impact on mental health. So, all the way from things where it's quite obvious, like post-traumatic stress disorder that involves, of course, exposure to severe stress as sort of a causative agent. But many, many, if not all, other forms of mental illness are also exacerbated by stress. So, for example, patients with substance use disorders can often relapse after long periods of abstinence when they're exposed to stress. Patients with psychotic disorders can often exhibit exacerbations of symptoms under stress. Anxiety disorders and depression get worse when exposed to stress. So, for me, it really seemed like understanding how stress impacts the brain could really have broad implications for understanding a lot of mental health disorders. So, I really have focused on that for the vast majority of my career. And within that area, we've been very interested in understanding how brain cannabinoid systems are involved in how stress impacts the brain. So, brain cannabinoid systems, as some folks may know, are systems that are the target of certain constituents of cannabis, particularly THC, which is one of their primary psychoactive component of cannabis plants, activates a particular receptor in the brain known as the cannabinoid receptor. The brain also produces endogenous molecules that are endogenous cannabinoids that also activate the same receptors. This is very analogous to endogenous and caplan's and endorphins that we make in our own brain that bind to opioid receptors. So, the cannabinoid system is very analogous, and we've been very focused on understanding the role of this system in central stress responses and how we could leverage our understanding of the system to potentially develop new therapeutics for stress related disorders, whether that's anxiety disorders, affective disorders, post-traumatic stress disorder, for example.
 
Erin Spain, MS [00:12:27] How close are you to finding pharmacological target drug development using these systems?
 
Sachin Patel, MD, PhD [00:12:31] Well, we've been working on these systems for, you know, 10, 15 years. Many other groups have also been doing the same. And actually, we're at a point where there are clinical trials that are ongoing with endocannabinoid modulators at various stages. Phase two and some beginning phase three clinical studies for mental health disorders. So, it's been actually wonderful to see a lot of this basic and translational neuroscience and ultimately, you know, end up in clinical trials within a 15-year period. There are two particular classes of cannabinoids that are produced by our brain, and both of them have molecular targets that are amenable to drug treatment. Some of them have been in a few clinical trials. The more recent ones that I believe are going to be a little bit more powerful and fruitful are just beginning phase two and phase three clinical trials for mental illnesses, including anxiety disorders, post-traumatic stress disorder, for example. So, I think we'll have answers to some of these questions within the next two to four years.
 
Erin Spain, MS [00:13:29] Your clinical activity focuses on the treatment of patients with substance use disorders and co-occurring mental illnesses. Tell me about the patients who you see and treat.
 
Sachin Patel, MD, PhD [00:13:38] There's a large comorbidity between patients that have substance use disorders, variety of which with opioid use disorder, alcohol use disorder and others, and major mental illnesses. Bipolar disorder, major depression, trauma related disorders are highly prevalent in folks that have comorbid substance use. Many times, those co-occurring mental illnesses are difficult to treat because of patients ongoing substance use comorbid disorders. So, this is a unique population in which we have the potential to make substantial gains given recent advances in novel treatments for substance use disorders and emerging therapeutics for affective disorders. This is a group that I focused on, primarily in the acute care setting hospitalized patients over the past 10 or 12 years.
 
Erin Spain, MS [00:14:23] What are you most excited about right now in the field? What's happening that just makes you so thrilled to come in and work with your colleagues at Northwestern to tackle these problems?
 
Sachin Patel, MD, PhD [00:14:32] I think the field in general is headed towards an exponential increase in the types of treatments we can provide for patients and believe that within the next 10 years, the repertoire of available therapies, whether that's behavioral therapy, pharmacological therapy or other types of somatic therapies, interventional therapies are going to substantially increase partly because of our understanding and our deepening understanding, but also because of our willingness to try new things to help patients. So, the emergence of novel therapeutics in the forms of things like rapid acting antidepressants, including ketamine, that has been a substantial, really game changer for many patients with difficult to treat mood disorders, including depression and suicidality. Ongoing clinical trials with novel therapeutics including hallucinogenic and psychedelic substances, for example, might hold great promise we'll have to see. Increasing interventional approaches, including magnetic stimulation and continued use of electroconvulsive treatment. All of those make me optimistic that we're really in a phase of rapid growth, both in terms of understanding the causes of mental illness, but also developing novel therapies and also figuring out ways that society really that will enable these therapies to become available to the vast population that need it. So, increasing access to care, understanding barriers to care, figuring out systems level approaches to making sure that behavioral care is accessible to everyone that needs that. Those are all things that I'm interested in working on that we're going to make advancements in as a society and certainly here at Northwestern and Feinberg and makes me optimistic that there are great things to come for the mental health care in this country.
 
Erin Spain, MS [00:16:18] What message do you have for the Northwestern Medicine scientists, clinicians, students and trainees who are working with you to advance research and care in your department? What would you like to say to them?
 
Sachin Patel, MD, PhD [00:16:28] They're in an extremely exciting field that holds great promise and all the work that they're doing, I truly believe, will result in substantial benefit to patients. They're working in an extremely exciting time, at a time when their work is needed more than ever, based on many of the things we've already talked about earlier in the podcast. It's extremely important that people believe that their work and understanding the brain, understanding mental illness will bear fruit in terms of novel treatments, better ways to treat people, better ways to give people the access to care that they need. And all that begins with the research that folks are doing here at Feinberg across the spectrum, all the way from basic neuroscience, all the way to health implementation sciences.
 
Erin Spain, MS [00:17:21] Thanks for listening. And be sure to subscribe to this show on Apple Podcasts or wherever you listen to podcasts and rate and review us. Also, for medical professionals, this episode of Breakthroughs is available for CME Credit. Go to our website feinberg.northwestern.edu and search CME.