Thursday, 19.10.2017

Comments (Martin M. Katz)

Martin M. Katz’s comments on Martin Keller’s Clinical Guide to Depression and Bipolar Disorder: Findings from the Collaborative Depression Study

The authors’ description of the inception, results and impact on psychiatry and psychopharmacology of the NIMH Collaborative Depression Study, as presented in this recent book, is sharp and greatly informative. The study was started by the Institute’s Clinical Research Branch in 1970 to deal then, with essential unresolved problems in nosology, genetics and pathophysiology. It was to expand greatly over the years, resulting in major contributions to the understanding of long term course in depression and to the development of the Research Diagnostic Criteria (RDC). The RDC was to serve later as the basis for the radical revision of the diagnostic system, the creation of the operationally defined DSMIII. The Study’s successes resulted in receiving grant support for several decades so that by 2010 it was still in operation recruiting new investigators and producing important findings on the longitudinal course of the disorder, leading to several scientific awards. Notably, it was conducted alongside an equally ambitious Biological Collaborative component, initiated at the same time, to test the then new hypotheses concerning the nature of the disorder, e.g., the “catechol amine hypothesis”, and to uncover the specific relationships of neurochemistry and behavior that are presumed to represent underlying mechanisms of the disorders.

Between them the two Collaborative efforts have resulted in several hundred publications produced by a range of authors representing several disciplines in neuropsychopharmacology.  Keller in his emphasis on description of the book’s content, omits discussion of the contributors who participated over the decades in the conduct of the study. Regarding its initiation as, he states, an outgrowth of the NIMH 1969 Williamsburg Conference (Williams, Katz, Shield (eds), Recent Advances in the Psychobiology of the Depressive Disorders. GPO, Washington DC, 1972) the planning group for the Study includedsuch historical figures as Eli Robins, and George Winokur and was chaired by James W. Maas. Bob Hirschfeld, who was later to become coordinator of the Clinical Study, describes well this history in the Introductory Chapter. Of critical importance to its beginning were the roles of Gerald Klerman, Bob Spitzer, and Jean Endicott. Gerry and I, as Chief of the Clinical Research Branch, co-chaired the Clinical Committee, but it was Klerman who sparked the effort and with his unequalled administrative skill managed to keep it on track for many years. Alongside him, monitoring every element was Jean Endicott, a co-editor of the volume.  The early “young” co-investigators included such notable figures in our fields as Jan Fawcett, John Davis, Nancy Andreason, Bill Coryell (a co-editor}, Tom Williams, Joe Mendels, Robert Shapiro, Jack Croughan, Paula Clayton, Regina Casper, John Rice, Ted Reich.

In addition to its contributions to the research literature and to clinical practice generally, the Collaborative studies made a major contribution to the training of young, primarily, psychiatric investigators in the methodology of clinical research and helped to prepare them for careers in research. Little is more important for advancing the field and elaborating on its history than these kinds of accomplishments.

A word should be said for the contribution of the NIMH to this long term, complex program of research. The Institute is looked to primarily, almost solely, for its financial support of independent research. In the case of the Collaborative Studies, it deserved credit for recognizing that clinical, unlike basic research, requires a more active role, that is, mechanisms to identify critical unresolved obstacles in order to move forward in this important area of research. In that case, having a national conference to identify the problems, it was then able to move ahead and actively organize strategic studies to solve the focal problems. Fortunately, today, the current Director has a comparable vision and has shown his respect for the role of history in their current efforts to resolve similar problems in clinical research.

 

Martin M. Katz                                                                                    J

July 3, 2014