Psychopharmacology research in clinical psych vs. psychiatry?

[goatcrossing]

Hey all, this is my first post on here so feel free to beat me senseless if I break any rules.

I am a college student currently on a pre-med track, aiming for psychiatry. I'm struggling to choose between psychiatry and clinical psych partially because I have a strong interest both in the psychological functioning of the mind on a cognitive level and the biology/psychopharm aspects. I like that clin. psy. is a bit "deeper" on the cognition side, not to mention it seems a bit more "holistic", but don't know if that's worth losing the RxP and physiological knowledge of psychiatry.

I was wondering, as a clinical psychologist, how likely is it that I would still be able to conduct psychopharm research? While I like the interplay of biology & psychology as a whole (gut-brain connection gets me going!) my main interest is where it overlaps with therapy. For example, I've read about the use of MDMA in treating PTSD patients or couples' therapy, as well as ketamine infusions for MDD or PTSD. Heck, even more basic stuff like the effectiveness of therapy on or off SSRI's is interesting to me. Things like this, investigating augmented cognition for the purpose of making therapy more effective, seem really exciting. Seems like it could be a breakthrough for people who currently haven't gotten much out of therapy.

My problem is, it sort of seems to fall between the domains of psychiatry and clinical psychology. Depending where this kind of work is by the time I'm practicing, I'd like to either work on investigating it via research or incorporate it into my practice. It seems like if I go the clinical psych route, I won't really have the medical chops to be able to do this kind of thing either in research or in practice (unless RxP passes in my state, but can't choose a career path on a "maybe" like that). But then, as well, as a psychiatrist it seems more likely I'd be in a health & safety role, and less likely I'd be providing therapy, not to mention the relative lack of research training.

Any thoughts on the merits of these two paths?

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[szymk1sm]

With either avenue, you'll need collaborators.

I'm a neuropsychologist and work with a psychiatrist on pharmacological and non-pharmacological interventions for mood and cognition (as I obviously can't prescribe any medication so my colleague handles that, but I can "prescribe" and administer anything non-pharmacological).

If you're a psychiatrist and want to do good therapy studies, then you'll want to consider having psychology collaborators to administer the intervention.

The main point of what I'm saying is that you can't do it all, but you'll create relationships with colleagues to assist you in the areas where you're lacking (especially for research, but also for practice - there are multidisciplinary treatment clinics out there).

 

[WisNeuro]

With either avenue, you'll need collaborators.

I'm a neuropsychologist and work with a psychiatrist on pharmacological and non-pharmacological interventions for mood and cognition (as I obviously can't prescribe any medication so my colleague handles that, but I can "prescribe" and administer anything non-pharmacological).

If you're a psychiatrist and want to do good therapy studies, then you'll want to consider having psychology collaborators to administer the intervention.

The main point of what I'm saying is that you can't do it all, but you'll create relationships with colleagues to assist you in the areas where you're lacking (especially for research, but also for practice - there are multidisciplinary treatment clinics out there).

Not so obvious Depends on the state(s) in which you practice.

 

[PsychPhDone]

Hey all, this is my first post on here so feel free to beat me senseless if I break any rules.

I am a college student currently on a pre-med track, aiming for psychiatry. I'm struggling to choose between psychiatry and clinical psych partially because I have a strong interest both in the psychological functioning of the mind on a cognitive level and the biology/psychopharm aspects. I like that clin. psy. is a bit "deeper" on the cognition side, not to mention it seems a bit more "holistic", but don't know if that's worth losing the RxP and physiological knowledge of psychiatry.

I was wondering, as a clinical psychologist, how likely is it that I would still be able to conduct psychopharm research? While I like the interplay of biology & psychology as a whole (gut-brain connection gets me going!) my main interest is where it overlaps with therapy. For example, I've read about the use of MDMA in treating PTSD patients or couples' therapy, as well as ketamine infusions for MDD or PTSD. Heck, even more basic stuff like the effectiveness of therapy on or off SSRI's is interesting to me. Things like this, investigating augmented cognition for the purpose of making therapy more effective, seem really exciting. Seems like it could be a breakthrough for people who currently haven't gotten much out of therapy.

My problem is, it sort of seems to fall between the domains of psychiatry and clinical psychology. Depending where this kind of work is by the time I'm practicing, I'd like to either work on investigating it via research or incorporate it into my practice. It seems like if I go the clinical psych route, I won't really have the medical chops to be able to do this kind of thing either in research or in practice (unless RxP passes in my state, but can't choose a career path on a "maybe" like that). But then, as well, as a psychiatrist it seems more likely I'd be in a health & safety role, and less likely I'd be providing therapy, not to mention the relative lack of research training.

Any thoughts on the merits of these two paths?

I work with several psychologists who do psychopharm research. Like as has been said, you work with collaborators.

 

[goatcrossing]

With either avenue, you'll need collaborators.

I'm a neuropsychologist and work with a psychiatrist on pharmacological and non-pharmacological interventions for mood and cognition (as I obviously can't prescribe any medication so my colleague handles that, but I can "prescribe" and administer anything non-pharmacological).

If you're a psychiatrist and want to do good therapy studies, then you'll want to consider having psychology collaborators to administer the intervention.

The main point of what I'm saying is that you can't do it all, but you'll create relationships with colleagues to assist you in the areas where you're lacking (especially for research, but also for practice - there are multidisciplinary treatment clinics out there).

This is a good point, thank you for this insight. It won't be just me on a research team.

I suppose my major concern is that I'd like to be able to provide these kinds of interventions to my patients if/when they are eventually available for clinical use, and I don't want to get walled off from that because of the degree path I chose. I like the strong biological background I'd receive from a psychiatry program, but I would hate to be gutterballed into only prescribing these kinds of interventions without being able to conduct them for anyone myself. It's that way for therapy, and I imagine the restriction is even moreso for this kind of very sensitive pharmacologically-active therapy. However, I guess that's the reality of collaborative medicine.

 

[psych.meout]

This is a good point, thank you for this insight. It won't be just me on a research team.

I suppose my major concern is that I'd like to be able to provide these kinds of interventions to my patients if/when they are eventually available for clinical use, and I don't want to get walled off from that because of the degree path I chose. I like the strong biological background I'd receive from a psychiatry program, but I would hate to be gutterballed into only prescribing these kinds of interventions without being able to conduct them for anyone myself. It's that way for therapy, and I imagine the restriction is even moreso for this kind of very sensitive pharmacologically-active therapy. However, I guess that's the reality of collaborative medicine.

It's not just about what your scope of practice is, it's also about economics. Psychiatrists could do more therapy, especially if they get additional training, but that's not where the money is in mental health. Why would your employer want you to do therapy as a psychiatrist when a mid-level could provide therapy, but much, much cheaper?

Also, why do you have to do it all? Yes, pharmacologic and psychotherapeutic interventions are both good, but why is it that you, personally have to do both? Why can't you provide one and let a specialist from another discipline provide the other?

 

[goatcrossing]

Also, why do you have to do it all? Yes, pharmacologic and psychotherapeutic interventions are both good, but why is it that you, personally have to do both? Why can't you provide one and let a specialist from another discipline provide the other?

It's just an interest/personal fulfillment thing for me. It's not that I have to be Superman and do it all for every patient, but in my future as a mental health clinician it seems like it'd be gratifying to do at least some work where you're helping patients actually work through & resolve issues psychologically, not just writing 'scripts all day. If I tried to work out something like that down the line, it wouldn't be for the economics of it.

In the matter at hand, a pharmacologically-active psychotherapeutic intervention even seems to play to a psychiatrist's strengths moreso than average therapy, since I assume you'd have to have some kind of medical personnel overseeing it anyway.

 

[AcceptingUncertainty]

Medication/psychedelic-augmented psychotherapies are in a realm of their own and in the pre- to post-approval phases require specialized trainings and collaborative research teams. If your goal is to end up being a PI on related clinical trials, go the psychiatry route in case you need a Schedule I license, gives you more maneuverability than clinical psychology.

 

[psych.meout]

It's just an interest/personal fulfillment thing for me. It's not that I have to be Superman and do it all for every patient, but in my future as a mental health clinician it seems like it'd be gratifying to do at least some work where you're helping patients actually work through & resolve issues psychologically, not just writing 'scripts all day. If I tried to work out something like that down the line, it wouldn't be for the economics of it.

In the matter at hand, a pharmacologically-active psychotherapeutic intervention even seems to play to a psychiatrist's strengths moreso than average therapy, since I assume you'd have to have some kind of medical personnel overseeing it anyway.

No, I meant the economics of your future employer. If you are a psychiatrist, they will want you to be writing scripts all day, not doing therapy that their far less paid masters level counselors or trainees could be doing.

 

[goatcrossing]

Medication/psychedelic-augmented psychotherapies are in a realm of their own and in the pre- to post-approval phases require specialized trainings and collaborative research teams. If your goal is to end up being a PI on related clinical trials, go the psychiatry route in case you need a Schedule I license, gives you more maneuverability than clinical psychology.

Thanks, that's what my thought was too. The MD is more maneuverable of a degree altogether it seems. I just don't want to get walled off from being able to do those augmented therapies myself if I want to seek that out, and if psychiatry is going to make that near impossible, it would be a significant con for me to weigh.

 

[goatcrossing]

No, I meant the economics of your future employer. If you are a psychiatrist, they will want you to be writing scripts all day, not doing therapy that their far less paid masters level counselors or trainees could be doing.

This is a very valid point. I figure that it'd have to be in PP, either fulltime or between the gaps of an employed position, similar to the way some psychiatrists do it in order to offer normal therapy, no?

 

[szymk1sm]

There are psychiatry residency programs that place higher emphasis on therapy training, so there's that. The breadth and depth of therapy training that psychiatrists receive is less than that of a clinical psychologist (IMO), but it seems like those residency programs may fulfill what you're trying to get at....

 

[Therapist4Chnge]

You'll probably be better served going the MD route, mostly bc of demand and wider scope that will allow easier earning potential. Better compensation allows you more flexibility to do research. It will likely still require collaboration across multiple disciplines: MD, PharmD, Ph.D./Psy.D, depending on what area(s) of pharma research.

Most people think of "pharma research" as the ppl who are doing clinical trials for a new potential medication, which are pre-FDA approval. I haven't worked in this area, so I'll defer to others.

There are more treatment focused options (post-FDA), which tend to focus on specific patient populations. These can recruit specifically (e.g. Alzheimer's) to study a certain medication (e.g. donepezil) or recruit from a diagnosis type (e.g. major depressive disorder) and study a range of medications like the Star*D study.

There are also options for post-FDA approval comparison studies like instant release (IR) v. extended release (ER)....which are more like the pre-FDA studies bc you are looking at a specific medication's efficacy.

I've been approached numerous times to do studies for various pain medications, like the above IR v. ER study. Those are almost always drug sponsored bc they want evidence to show why their patented med w. proprietary delivery system is better than the existing (generic) IR.

I've also done studies w. an existing population (e.g. post-CVA rehab) and the medication component is a carve out. There are more limitations bc your subjects will likely be a subset of the existing group being studied, but it's more "real life" than the typically very narrow protocols used by drug company sponsored studies.

Studying illicit drugs (LSD, MDMA, etc) are it's own area and typically *very* niche. I don't know the particulars, I just know they are a PITA bc of using Schedule I substances.

Hopefully that was coherent. These aren't all of the options, but some more things to think about. My background is neuropsych + psych RxP training. Doing psychiatry would have been the better choice.