Looking to the Future of Mood Disorders Treatment

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CLINICAL CONVERSATIONS

With an increasingly robust pipeline for new medications and a plethora of nonpharmacological options to address mood disorders, it can be difficult to stay up to date on the treatment strategies that will best help your patients. To support readers in that endeavor, Psychiatric Times is pleased to welcome Gus Alva, MD, to our editorial board as Mood Disorders Section Editor.

In addition to his private practice and keen interest in clinical research, Alva is an assistant clinical professor at the University of California, Riverside Medical School in the Department of Psychiatry and Neuroscience. He is a Distinguished Fellow of the American Psychiatric Association and he is board certified by the American Board of Psychiatry and Neurology and the American Board of Geriatrics.

Alva was the recipient of the first Senior Care Humanitarian Award as Outstanding Physician in Dementia Care and the Physician’s Recognition Award by the American Medical Association.

Psychiatric Times chatted with Alva about his love of psychiatry, interest in mood disorders, and new role.

Psychiatric Times (PT): When did you discover you wanted to be a psychiatrist?

Gus Alva, MD: During medical school I had a natural affinity toward surgery, specifically, orthopedics. However, I discovered I wanted to be a psychiatrist when a mentor suggested that the area in which there was a need for additional understanding and investigation revolved around the mind.

I was about to start residency training, and the University of California, Irvine [UCI] happened to be at the forefront of innovation and discovery. Having a cyclotron and being able to whip up radioligands set up UCI at the forefront of neuroimaging.

In addition, because they brought in talent from the National Institute of Mental Health, including top geneticists, neuroanatomists, and researchers, the psychiatry and human behavior division was perfectly poised as an attractive target for me. Ultimately, that made me seek out matching a psychiatry slot with UCI.

Beginning my psychiatry residency training at UCI also saw me promptly get started with the clinical research division as an intern. Over the years, I have never looked back with regret.

PT: What do you enjoy most about being a psychiatrist?

Alva: I love the plethora of activities that I am involved with being a psychiatrist. I have been deeply involved with investigational research in the CNS space for more than 27 years. I love educating peers and speaking about the latest interventions in the field. But above all, I love the fact that I get paid to help heal those in need.

PT: What most interests you in the field of mood disorders?

Alva: The field of mood disorders, as in the rest of psychiatry, continues to evolve; we have better ways of diagnosing and treating our patients. Constant work is afoot to gain a better perspective as to the cause and effect of psychopathology, but also how to best intervene. Constant work in educating peers and the public helps in bashing bias, ignorance, and stigma.

PT: What has changed the most since you entered psychiatry?

Alva: Psychiatry has evolved enormously since I started down this road. The prevailing treatment when I got started was psychodynamic psychotherapy, and it’s morphed into more of an interventional state. I think that is because of my background; I love being able to have better tools to make meaningful change for patients in a more precise manner.

The advent of additional interventional aids such as repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS) have helped us quite a bit, and soon we will have better markers to guide better treatment for our patients.

PT: What are the biggest challenges in the field of psychiatry in general and mood disorders, specifically?

Alva: The biggest challenges facing general psychiatry and the biggest challenges in mood disorders align. We still need to educate the public about the pitfalls associated with a lack of recognition and the ability to intervene with conditions that cripple people in many ways. Fostering better literacy, particularly now with the advent of technology, is important.

People still lack a full awareness of what certain conditions entail and will self-diagnose erroneously. There is still stigma and denial about psychiatric conditions being like any other medical problem and the importance of being proactive, rather than reactive, in addressing them.

PT: What is something you wrote this year that you are particularly proud of?

Alva: The last article I wrote revolved around the importance of achieving rapid treatment response in major depressive disorder, first published online on March 27, 2023, by Cambridge University.¹

PT: What are you currently working on?

Alva: At the present time I’m involved with a plethora of clinical research trials that are important in the field: a fair amount of work with novel agents and interventions, including the RECOVER study of VNS in mood disorders, rTMS work in conjunction with nootropics and cannabidiol, and psychedelics and their potential role in mood disorders.

I have also started doing a weekly videocast on YouTube called The Gus Alva Perspective, which has been a fun project; I put out 2 topics a week. I continue to lecture nationally and internationally and publish on these themes, and I will have much to share with readers, including the latest and best revolving around mood disorders.

PT: What are you most excited about in joining Psychiatric Times?

Alva: What I enjoy most about the Psychiatric Times is the contemporary nature of the topics. There is an easy prose to the articles, and a richness presented in a pithy manner. The publication is germane to our field and a wonderful tool for professionals in the psychiatric space.

What I hope to share with readers is a better understanding of mood disorders through the lens of advances in our understanding of the psychopathology and interventions earmarked to enhance our clinical acumen. There is a constant fluidity associated with medicine, and our psychiatric specialty is particularly notable for having evolved in such a manner that we become better in tackling serious mental disorders.

However, to be able to take advantage of all these changes, one has to remain up to date. My aim then is to help foster this link between what’s novel and the readers of the Psychiatric Times.

I am honored and humbled to have a part of this wonderful publication and join the luminaries who help educate our peers on regular basis.

Reference

1. Alva G. Importance of achieving rapid treatment response in major depressive disorder. CNS Spectr. 2023;28(5):521-525.