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ADAA 2018 Opening Session and Keynote Address

Thursday, April 5, 2018
5:45 - 7:00 pm (includes Q&A session)

Keynote: Update from the NIMH

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Dr. Gordon received his MD/PhD degree at the University of California, San Francisco and completed his Psychiatry residency and research fellowship at Columbia University. He joined the Columbia faculty in 2004 as an Assistant Professor in the Department of Psychiatry where he conducted research, taught residents, and maintained a general psychiatry practice. In September of 2016, he became the Director of the National Institute of Mental Health.

Dr. Gordon’s research focuses on the analysis of neural activity in mice carrying mutations of relevance to psychiatric disease. His lab studies genetic models of these diseases from an integrative neuroscience perspective, focused on understanding how a given disease mutation leads to a behavioral phenotype across multiple levels of analysis. To this end, he employs a range of systems neuroscience techniques, including in vivo anesthetized and awake behaving recordings and optogenetics, which is the use of light to control neural activity. His work has direct relevance to schizophrenia, anxiety disorders, and depression.

Dr. Gordon’s work has been recognized by several prestigious awards, including the The Brain and Behavior Research Foundation – NARSAD Young Investigator Award, the Rising Star Award from the International Mental Health Research Organization, the A.E. Bennett Research Award from the Society of Biological Psychiatry, and the Daniel H. Efron Research Award from the American College of Neuropsychopharmacology.

Jerilyn Ross Lecture

Friday, April 6, 2018
3:30 - 4:30 pm (includes Q&A session)

Pharmacological Strategies in the Treatment of Resistant Depression (TRD): The Past, The Present, and The Future

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In major depressive disorder (MDD), a substantial proportion of depressed patients show only partial or no response to standard antidepressant therapies, and, even among responders to antidepressant treatment, residual symptoms are rather common. When patients with MDD do not respond adequately to treatment with an antidepressant, clinicians are faced by critical clinical decisions. The typical pharmacological strategies for treatment resistant depression (TRD) are switching to a different antidepressant, or using a pharmacologic agent that is not considered to be a standard antidepressant to boost the effect of an antidepressant that is continued (augmentation), or combining the antidepressant that did not produce adequate response with another antidepressant, typically of a different class (combination).  Augmentation strategies of variable efficacy dominated the TRD literature in the early years, partly because of the modest differences in efficacy across antidepressant classes. More recently, there has been an emergence in practice of switching and combination strategies, reflecting the introduction of antidepressant compounds with marked differences in both efficacy and tolerability from standard therapies. In particular, with respect to the augmentation and combination strategies, there are a number of placebo-controlled clinical among patients with treatment-resistant depression, showing the efficacy of various pharmacological tactics. The best studied augmentation strategies involve the use of atypical antipsychotic agents, ketamine and other glutamergic compounds, dopaminergic agents, anti-inflammatory psychotropic drugs, and opioid modulators. The best studied combination strategies involve the use of SSRIs or SNRIs with bupropion or mirtazapine. On the other hand, clinicians' decisions are often guided also by anecdotal reports, case series, and by some relatively smaller, uncontrolled clinical trials. All these augmentation and combination strategies appear to be relatively safe and effective approaches to treatment-resistant depressions. While drug-drug interactions may limit the use of some of these strategies, the potential loss of partial benefit from the failed drug inherent in switching may increase the acceptability of augmentation and combination strategies among partial responders.

Learning Objectives:

  • Participants will learn about the typical pharmacological strategies used in the treatment of resistant depression.
  • They will also learn about the changes in approaches to resistant depression over time in both practice and research.

They will also become familiar with the evidence of efficacy of these various strategies.

Dr. Maurizio Fava is Director, Division of Clinical Research of the Massachusetts General Hospital (MGH) Research Institute, Executive Vice Chair of the MGH Department of Psychiatry and Executive Director of the MGH Clinical Trials Network and Institute, and Associate Dean for Clinical and Translational Research and the Slater Family Professor of Psychiatry at Harvard Medical School.

Dr. Fava is a world leader in the field of depression. He has authored or co-authored more than 800 original articles published in medical journals with international circulation, edited eight books, and published more than 50 chapters and over 500 abstracts.  The citation impact of Dr. Fava’s work is extremely high, as his articles have been cited more than 55,000 times in the literature, with an h index of over 115.

Dr. Fava obtained his medical degree from the University of Padova School of Medicine and completed residency training in endocrinology at the same university. He then moved to the United States and completed residency training in psychiatry at the Massachusetts General Hospital. He founded and was Director of the hospital’s Depression Clinical and Research Program from 1990 until 2014. In 2007, he also founded and is now the Executive Director of the MGH Psychiatry Clinical Trials Network and Institute (CTNI), the first academic CRO specialized in the planning and coordination of multi-center clinical trials in psychiatry.

Under Dr. Fava’s direction, the Depression Clinical and Research Program became one of the most highly regarded depression programs in the country, a model for academic programs that link, in a bi-directional fashion, clinical and research work.

Dr. Fava has been successful in obtaining funding as principal or co-principal investigator from both the National Institutes of Health and other sources for a total of more than $95,000,000. Dr. Fava’s prominence in the field is reflected in his role as the co-principal investigator of STAR*D, the largest research study ever conducted in the area of depression, and of the RAPID Network, the NIMH-funded series of studies of novel, rapidly-acting antidepressant therapies.

Dr. Fava has received several awards during his career and is on the editorial board of five international medical journals. Since 1990, Dr. Fava has also mentored more than 50 trainees who have gone on to become lead investigators in the area of psychiatry. He has developed with Dr. David Schoenfeld a novel design (with over five patents) to address the problem of excessive placebo response in drug trials and to markedly reduce sample size requirements for these trials.  In 2009, Dr. Fava received the A. Clifford Barger Excellence in Mentoring Award from Harvard Medical School, and in 2013 the John T. Potts, Jr., MD Faculty Mentoring Award from Massachusetts General Hospital. 

Dr. Fava is a well-known national and international lecturer, having given more than 300 presentations at national and international meetings.

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