Pies wanted more, so he and a resident colleague started a monthly newsletter discussing psychopharmacology.
Much of Pies' subsequent career has included psychopharmacology. He wrote
the Handbook of Essential
Psychopharmacology (2005, 1998; American Psychiatric Association), and he authored
the Handbook of Geriatric
Psychopharmacology (2002; American Psychiatric Publishing, Inc.) with
Sandra A. Jacobson, M.D., and David J. Greenblatt,
M.D. He has been director of psychopharmacology and research at
For more than a decade, Pies operated a private psychopharmacology consultation service where he "saw some very sick individuals," most of whom were not getting better even under psychiatric care. "It certainly taught me a great deal about very refractory cases," he said. Those refractory cases and others taught him much about the humanity of the patients he treats.
"My patients have taught me how generous people who are suffering can be and how strong people are. That may seem surprising, because these were often very severely impaired folks, people with psychotic-level disorders and so on," he said.
"What I remember most about some of the patients I saw early in my career was their generosity and kindness, particularly when I would make mistakes, and, of course, we all do. Sometimes, a patient would almost be in the position of comforting me by saying ‘There, there doctor, it is OK that the medication really didn't help me. I'll get through this.'"
Despite his expertise in psychopharmacology, Pies doesn't consider himself a psychopharmacologist.
"I consider myself a general adult psychiatrist who has always had--and this goes back to college--a very strong interest in the biological functions that underlie thinking and feeling," he explained. "Even as a freshman and sophomore at Cornell ... I was very interested in neurotransmitters, how the brain works and how that fits in with broader ideas about the mind, which, I think, leads one almost naturally to have an interest in how medications can work for mood disorders and other psychiatric conditions."
Asked about the direction of psychopharmacology, Pies said he found it fascinating that some of the medications being used and tested work not so much by increasing neurotransmitters but by actually improving neuronal growth and development. He disagrees with those who criticize medication use as being "cosmetic" by covering up patients' root problems.