Article by Sonja Elsaid
Graphic design by Michie (Xingyu) Wu
“Never give up!” This is Dr. Peter Giacobbe’s recipe for achieving almost the impossible. We interviewed Dr. Peter Giacobbe, an Associate Professor at the Institute of Medical Science (IMS) and Department of Psychiatry at the University of Toronto, and the Associate Scientist at Sunnybrook Research Institute, to learn about his motivation for researching and treating patients with treatment-resistant depression. Dr. Giacobbe is one of the very few psychiatrists in the world with expertise in delivering Electroconvulsive Therapy (ECT), Deep-brain Stimulation (DBS), MRI-guided Focused Ultrasound Treatment, and repetitive Transcranial Magnetic Stimulation (rTMS). As an Interventional Psychiatrist, he provides the entire care continuum to his patients, including psychotherapy, various pharmacological treatments, and more invasive device-based regimens.
Some patients do not get better, even after being repeatedly treated for their symptoms of depression. For many mental health workers, treatment-resistant depression is one of the most challenging psychiatric conditions to remedy. Only a few are up to the challenge of coming face-to-face with the almost impossible. When asked about his motivation to accept the challenge of treating persistent depression, Dr. Giacobbe responded: “I was always interested in the world around me and ‘how people work.’ To answer this question, I pursued a Bachelor’s in Science (BSc) degree in Neuroscience at the University of Toronto—a topic that helped me understand brain development, human personality, and behavior. That curiosity led me to the next level—the decision to become a psychiatrist. So, I went to medical school at the Western University in London and subsequently entered the psychiatric residency program at U of T. During the clinical rotations, I worked with patients who were very depressed. They repeatedly failed to respond to pharmacological treatments, but then they, all of a sudden, significantly improved with the ECT. I was fascinated! How could a non-esthetically pleasing procedure, such as ECT, performed at the basement of a hospital, produce such great results?”
Thus, Dr. Giacobbe began exploring the biological paradigm that explains the physiological causes of depression. “We know that the brain is an electrochemical organ. Pharmacological treatments are only half of the equation. The electrical properties of the brain could also be changed by delivering electricity or magnetic pulses. We now know, that the brain is very responsive to externally delivered energy, which explains why patients with depression who show little respond to other treatments can respond to the ECT or rTMS.”
Nevertheless, Dr. Giacobbe’s desire to help patients went beyond learning to use all the available tools in his treatment kit. He wanted to improve the quantity and quality of life of his patients and destigmatize depression. By demonstrating that psychiatric illnesses are products of the brain, Dr. Giacobbe hoped that psychiatric disorders, like depression, would get the same level of acceptability as Parkinson’s disease and epilepsy.” Device-based treatments have the unique capability to destigmatize these illnesses. They [psychiatric disorders] are not illnesses of willpower or personality; they are illnesses of the brain. If we can alter the brain functioning of psychiatric patients therapeutically, then we can make people see that psychiatric illnesses are similar to neurological disorders.”
Dr. Giacobbe also pointed out how obtaining his Master’s degree at the IMS was crucial for his career. “I did not only want to use all the treatments available, but also play a role in finding new ones. In my quest for discovery, I needed to learn how to pursue a hypothesis and choose the best methodology to test the questions I am passionate about.”
According to Dr. Giacobbe, given that psychiatric diagnoses are very heterogeneous, a way forward is to deconstruct the inherent heterogeneity through the application of innovative technologies. Blood tests and brain scans hold the promise of helping to stratify different depression subtypes. Thus, similar to how breast cancer gene identification leads to specific treatments, Dr. Giacobbe wants to do the same for depression. “Brain imaging and eye-tracking tests could supplement the clinical wisdom and help us make the essential decisions about treatments for our patients. This is the way forward! One-size-fits-all treatments may not work for everyone, therefore by adding these technologies to our diagnostic toolbox, we can personalize treatments for depression based on the subtypes.”
For some working in clinical research and recruiting human subjects, Dr. Giacobbe reminded us that the study participants might have a tremendous fear of the unknown when enrolled in clinical studies. “We must partner with them and treat them as collaborators, whose medical situation we are trying to understand so that we could enhance their outcomes.” As graduate students, Dr. Giacobbe suggested that we give back to the scientific enterprise by participating in clinical studies ourselves. Only by becoming research participants, we can begin to understand how it feels to be a subject in a research study. “To be successful in recruiting participants,” Dr. Giacobbe added, “be personable, develop good communication skills, and be open to being wrong. Be honest in revealing to potential participants that the treatment offered in a clinical trial may not work. Instead of overpromising and under-delivering, openness and honesty go a long way.”
When asked “how to become a good researcher?” Dr. Giacobbe encouraged students to be open to feedback, continue to perserve, and develop resilience to rejection. “Good feedback is supposed to make you better, not bitter. You have to develop good communication skills to be able to work with multidisciplinary teams.”
Furthermore, Dr. Giacobbe advised about the essence of cultivating our questions and, most notably, being passionate about our research. “It is important to pursue your own intellectual freedom and be in the research environment that supports your curiosity and the development of your path. Thus, it is vital to find a supervisor who will challenge you, drive you, and guide you. The relationship should be a dialogue with the openness to feedback. The strength of being an IMS student is that it is a large department where students can always find a scientist who researches the topic that interests them.”
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