Changing the Paradigm for Patients With Treatment-Resistant Depression

Mar 14, 2019 | Featured, Psychiatry, Research

Dennis S. Charney, MD

The U.S. Food and Drug Administration on March 5 approved SPRAVATO™ (esketamine) CIII nasal spray for the treatment of treatment-resistant depression. Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, is a co-inventor of a method of treatment, which is patented and part of the drug application for SPRAVATO, a product of the Janssen Pharmaceutical Companies of Johnson & Johnson.

“As a researcher, you strive to come up with new treatments for the patient, especially in terms of finding answers to the most debilitating diseases,” says Dr. Charney, who is also President for Academic Affairs, Mount Sinai Health System. “To know that you oversaw the early development of an approach that can make a difference in the lives of countless individuals is extremely rewarding.”

Esketamine represents the first new mechanism of action in decades to treat major depressive disorder. Delivered in the form of a nasal spray, esketamine works differently than the three classes of antidepressants that are currently on the market. The drug works on the N-methyl-D-aspartate (NMDA) receptor, an ionotropic glutamate receptor in the brain. In contrast, widely used antidepressants target different neurotransmitters—serotonin, serotonin and norepinephrine, and norepinephrine and dopamine—and can take weeks or even months to work.

An estimated 30 percent of people who are treated for depression do not respond to therapies. Treatment-resistant depression (TRD) is a devastating disease that is associated with greater morbidity, higher health care costs, and various comorbid conditions.

“We commend Dr. Charney and his colleagues for their work in changing the paradigm for patients with treatment-resistant depression,” says Kenneth L. Davis, MD, President and Chief Executive Officer of the Mount Sinai Health System. “Through his commitment to innovation and science, Dr. Charney has inspired countless researchers to leverage new technologies and create discoveries to benefit the lives of patients around the world—while at the same time leading the Icahn School of Medicine to unparalleled growth and high national rankings.”

In his role as Dean of the Icahn School of Medicine, Dr. Charney says that many younger researchers look to him for advice. “I tell them that in science you’ve got to keep trying, to keep pushing,” he says. “There is a lot to be gained by working in a small group that is engaged in the give and take of scientific interaction. Researchers should understand that failure is going to happen, but they can use that failure as a stepping stone to discovery.”

Conflicts of Interest Disclosure: Dr. Charney is named as co-inventor on patents filed by the Icahn School of Medicine at Mount Sinai (ISMMS) relating to the treatment for treatment-resistant depression, suicidal ideation, and other disorders. ISMMS has entered into a licensing agreement with Janssen Pharmaceuticals, Inc., and it has and will receive payments from Janssen under the license agreement related to these patents for the treatment of treatment-resistant depression and suicidal ideation under this agreement. Consistent with the ISMMS Faculty Handbook, Dr. Charney is entitled to a portion of the payments received by the ISMMS. Since SPRAVATO has received regulatory approval for treatment-resistant depression, ISMMS and thus, through the ISMMS, Dr. Charney will be entitled to additional payments, beyond those already received, under the license agreement.

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Consortium Sheds New Light on Brain Disorders

Updated on Jun 30, 2022 | Featured, Neuroscience, Psychiatry, Research

From left: Kristen Brennand, PhD, Associate Professor, Neuroscience, Genetics and Genomic Sciences, and Psychiatry; Prashanth Rajarajan, MD/PhD candidate; and Schahram Akbarian, MD, PhD, Professor, Psychiatry, and Neuroscience.

Reprinted with permission from AAAS.

More than two dozen researchers at the Icahn School of Medicine at Mount Sinai are advancing brain science by mapping the complex molecular underpinnings of autism spectrum disorder, schizophrenia, and bipolar disorder through their work in the National Institute of Mental Health’s (NIMH) PsychENCODE Consortium. Since this work began in 2015, their contributions—and that of their PsychENCODE colleagues from 14 other U.S. institutions—have helped identify several hundred new risk genes for mental disorders. The research has also revealed critical time windows during brain development when these genes can influence the disease process.

In December, the Consortium published its initial findings in 10 studies that appeared in Science, Science Translational Medicine, and Science Advances. The researchers analyzed more than 2,000 postmortem brain samples from people with no psychiatric conditions and those with schizophrenia, autism, and bipolar disorder. They created and then integrated data sets that included information on DNA variations and gene expression for about 32,000 cells from major regions of the brain. Then the investigators employed machine learning to create a predictive model of risk for the psychiatric disorders.

Their seminal findings received an enthusiastic response from the NIMH. “The PsychENCODE project came through,” said Thomas Lehner, PhD, MPH, Director of the Office of Genomic Research Coordination at the NIMH. “We’re at the beginning—I cannot overstate how early we are. But I can confidently say that for the first time we have a beginning of an understanding of the biology—the molecular pathophysiology of mental disorders—of schizophrenia, and bipolar and autism spectrum disorder.”

Unraveling the Complexity of the Human Brain

“Exploring how the human genome is folded and packaged into the nucleus of each of our billions of brain cells was both awe-inspiring and humbling at the same time,” says Prashanth Rajarajan, MD/PhD candidate at the Icahn School of Medicine at Mount Sinai, who was first author on seminal brain research that was published in the December 14, 2018, issue of Science.

The scientific team discovered that early development is associated with major changes in the spatial organization of DNA inside of brain cells. These changes in how the chromosomal material is packed seem to disproportionately affect DNA sequences linked to schizophrenia heritability risk and provide new insights into the genetic causes underlying this disease.

The study, which was conceived and executed at the Icahn School of Medicine, included senior authors Schahram Akbarian, MD, PhD, Professor, Psychiatry, and Neuroscience; and Kristen Brennand, PhD, Associate Professor, Neuroscience, Genetics and Genomic Sciences, and Psychiatry. Colleagues at the New York Genome Center and the University of Massachusetts also contributed to the study.

According to Mr. Rajarajan, “There is so much more to the genome than just the four-letter DNA code (A, T, C, G)—such as its folded architecture, which is a highly organized and regulated process. Eighteen years after fully sequencing the human genome, we still understand very little about how it actually comes to life. Our study, and the others that were published, are beginning to unravel more nuances than previously imagined, making it a really exciting time to be in the field of neuroscience and psychiatry research.”

NIMH Program Director Geetha Senthil, PhD, added that the massive scope of the project required a “concerted effort. Many investigators had to come together and do this collectively.” While the mental disorders in the studies are distinct, Dr. Senthil said, “There are some aspects where the biology is similar. The genes interact with each other in a way to influence the disease process. If we can find biological clues early on, we can intervene early on. While we are building and generating more data, analyzing this data to find basic mechanisms, there’s an opportunity also for drug discovery.”

The 10 papers published by the PsychENCODE Consortium were dedicated to the late Pamela Sklar, MD, PhD, former Chair of the Department of Genetics and Genomic Sciences at the Icahn School of Medicine, and a pioneer in genomic brain research, who was an early leader of the NIMH effort. The Icahn School of Medicine last year renamed the division she created the Pamela Sklar Division of Psychiatric Genomics.

Mount Sinai laboratories within The Friedman Brain Institute, The Seaver Autism Center for Research and Treatment, the Department of Psychiatry, The Mindich Child Health and Development Institute, the Department of Genetics and Genomic Sciences, the Department of Neuroscience, and the Icahn Institute for Data Science and Genomic Technology were involved in the PsychENCODE Consortium.

“Mount Sinai serves as one of the lead sites in this national consortium. The discoveries that are being made by our scientists and their colleagues at other major institutions are moving us closer to understanding and finding treatments for these devastating brain disorders,” says Eric J. Nestler, MD, PhD, Nash Family Professor of Neuroscience, Director of The Friedman Brain Institute, and Dean for Academic and Scientific Affairs, Icahn School of Medicine at Mount Sinai.

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Innovations in Psychiatry: New Treatments for Depression

Updated on Jun 30, 2022 | Psychiatry

A slide from Dr. Charney’s introduction, showing that depression is the leading cause of disability worldwide.

The Department of Psychiatry’s seventh annual symposium took place on Friday, February 8. The speakers covered emerging treatments for depression including ketamine, deep brain stimulation, and personalized treatment.

“This symposium was an opportunity for researchers, clinicians, and individuals from the community to come together to take stock of the magnitude of the problem of depression, and discuss the latest in treatment innovations,” said James Murrough, MD, PhD, who organized and presented at the event. “Despite the large scale problems of depression and suicide in our country, the research presented at the symposium is cause for great optimism. We believe that we will have breakthrough treatments for patients suffering for depression in the near future.”

The Depression and Anxiety Center

Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System, opened the symposium by announcing Mount Sinai’s new Depression and Anxiety Center for Discovery and Treatment (DAC), headed by Dr. Murrough. DAC will build upon its previous iteration, the Mood and Anxiety Disorders Program, via its mission to advance the treatment of depression, anxiety, and related disorders through innovative clinical and translational research, and to provide exceptional evidence-based clinical care to patients.

“To come up with a breakthrough is not easy—to do so requires intelligence that involves not just memory, but creativity,” Dr. Charney said. “There are only a few places in the country that have the resources and scientists that make discoveries that change the lives of patients, and we’re fortunate to have that here at Mount Sinai.”

Stress and epigenetics

The first keynote was delivered by Bruce McEwen, PhD, of The Rockefeller University, on the role of stress and epigenetics in the causes and treatment of depression. Epigenetics refers to the study of differences in gene expression that come as a result of environmental factors throughout the course of an individual’s life. Experiences change the brain, and a history of chronic stress can alter the brain’s physical structure. Dr. McEwen said that “gene expression is a one-way street, and we can’t turn back the clock; we must focus on resilience and redirection, as opposed to reversal.”

Translational neuroscience driving novel antidepressant development

Dr. Murrough moderated the first panel: Scott Russo, PhD, on immune mechanisms, Ming Hu Han, PhD, on hyperpolarization-activated cyclic nucleotide-gated (HCN) channel targets, and Gerard Sanacora, MD, PhD, from the Yale School of Medicine, on glutamate and GABA.

Dr. Russo discussed his research into how the immune system plays a causal role in stress vulnerability, specifically the pro-inflammatory cytokine interleukin 6. He showed that individual differences in the inflammatory response to stress can lead to social avoidance in animal models, and he is investigating these differences. Similarly, Dr. Han is exploring why some people are stable after experiencing stress and others are not, and his lab is exploring HCN channels for potential drug discovery, as HCN channels are involved in mediating ketamine effects. Dr. Sanacora discussed how glutamate and GABA contribute to depression on the molecular and cellular level. He highlighted a new drug in development, brexanolone, that binds to the GABA receptor, as well as various ketamine studies.

Biosignatures for personalized treatment

Madhukar Trivedi, MD, from UT Southwestern Medical Center, presented the second keynote talk on biomarkers for diagnostic purposes.

“We need to look at the interaction of an array of clinical, EEG, neuroimaging, and serum markers,” he said. “This approach can lead to customized treatments for individuals.” His research underscores the importance of tracking physiological biomarkers based on neuroimaging, neurophysiology, genomics, proteomics, and metabolomics measures to understand depressive symptoms and treatment effects.

Therapeutic innovations for treatment resistant depression

Manish Jha, MD, moderated the second panel: Dr. Murrough on rapidly acting antidepressants including ketamine, Corey Keller, MD, PhD, of Stanford, on the mechanisms of antidepressant response to transcranial magnetic stimulation (TMS), and Helen Mayberg, MD, on deep brain stimulation (DBS).

Dr. Murrough brought the backstory on ketamine as the first drug to show rapid antidepressant effects within hours, and noted that Mount Sinai conducted the first experiments on repeated dosing, the first study of intranasal ketamine, and the first randomized controlled trial of ketamine for suicidal ideation. Dr. Keller discussed his aims for maximizing clinical response to TMS by enhancing specificity and plasticity. Regarding “metaplasticity,” he notes that “previously induced plasticity can modify a synapse’s ability to induce future plasticity,” and hopes to use computational models to predict changes in the brain. Dr. Mayberg spoke about her DBS work, which involves implanting electrodes into the subcallosal cingulate near the center of the brains of patients whose depression “couldn’t be drugged down, talked down, or shocked down with ECT.” Her pioneering work takes place in collaboration with other Mount Sinai researchers at the new Center for Advanced Therapeutics.

A slide from Dr. Murrough’s presentation.

Take-home message

The consensus? When you make a change, you create a new version of the brain. “The brain is flexible and plastic, which is cause for great optimism in the future of treating depression.”

This symposium was made possible thanks to a generous gift from Dr. Karen Davis and the Elkins Foundation.

 

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APA 2019: Mount Sinai’s Presentations

Updated on Jun 30, 2022 | Psychiatry

This year’s American Psychiatric Association (APA) conference takes place May 18-22 in San Francisco. The schedule of sessions presented by faculty from the Department of Psychiatry is listed below.

Veerle Bergink, MD, PhD, will speak on psychiatric illness during and after pregnancy on Tuesday, May 21.

Saturday, May 18

Computers and Psychiatry: How Might Our Practice Change?
Chair: Cheryl Corcoran, MD
When: 8:00-9:30 am
Where: Room 158, Upper Mezzanine, Moscone South

Creating and Implementing a Program for the Mental Health and Wellbeing of Medical Students and Trainees: The Mount Sinai Health System Experience
Chairs: Jeffrey Newcorn, MD; Paul Rosenfield, MD
Presenters: Sabina Lim, MD, MPH; Daniel Safin, MD; Jonathan Ripp, MD, MPH
When: 10:00-11:30 am
Where: Room 151, Upper Mezzanine, Moscone South

Sunday, May 19

Sex, Drugs, and Culturally-Responsive Treatment: Addressing Substance Use Disorder in the Context of Sexual and Gender Diversity
Presenter: Faye Chao, MD
When: 8:00-9:30 am
Where: Room 24, Exhibition Level, Moscone North

Advances in the Understanding and Treatment of Treatment Resistant Depression
Chair: James Murrough, MD, PhD
Presenter: Martijn Figee, MD, PhD
When: 8:00-9:30 am
Where: Room 156, Upper Mezzanine, Moscone South

Imminent Suicide Risk Assessment in High-Risk Individuals Denying Suicidal Ideation or Intent
Director: Igor Galynker, MD, PhD
Faculty: Paul Rosenfield, MD
When: 8:00 am-12:00 pm
Where: Room 7, Exhibition Level, Moscone South

The Multiple Faces of Deportation: Being a Solution to the Challenges Faced by Asylum Seekers, Mixed Status Families, and Dreamers
Presenter: Gabrielle Shapiro, MD
When: 10:00-11:30 am
Where: Room 308, Third Level, Moscone South

Disrupting the Cycle of HIV Transmission: The Role of Mental Health Providers in the Inclusive Use of PrEP to Address Disparities
Chair: Kenneth Ashley, MD
When: 3:00-4:30 pm
Where: Rooms 310/311, Third Level, Moscone South

Transitioning from Methadone to Buprenorphine At An Urban Opioid Treatment Program
Chair: Timothy Brennan, MD
Presenters: Annie Levesque, MD; Prameet Singh, MD
When: 3:00-4:30 pm
Where: Room 25, Exhibition Level, Moscone North

Monday, May 20

Trauma Inflicted to Immigrant Children and Parents Through Policy of Forced Family Separation
Chair: Gabrielle Shapiro, MD
When: 8:00-9:30 am
Where: Room 303, Third Level, Moscone South

Medical History Mystery Lab
Presenter: Kenneth Ashley, MD
When: 8:00-11:00 am
Where: Room 22, Exhibition Level, Moscone North

A Blueprint for Providing Free, Comprehensive, Integrated Adolescent Health, Transgender Services and Mental Health Care in NYC for $1,000 per Patient
Chair: Kashmira Rustomji, MD
Presenter: John Steever, MD
When: 8:00-9:30 am
Where: Room 314, Third Level, Moscone South

Facing the Challenges of Misuse and Abuse of Stimulant Medications for ADHD: From Neurobiology to Clinical Care
Chair: Jeffrey Newcorn, MD
Presenters: Iliyan Ivanov, MD; Jeffrey Newcorn, MD
When: 8:00-9:30 am
Where: Room 25, Exhibition Level, Moscone North

Rebels With a Cause: Nurturing the Provider for Successful Program Evolution
Chair: Shilpa Taufique, PhD
Presenter: Brandon Johnson, MD
When: 8:00-9:30 am
Where: Room 206, Second Level, Moscone South

Diagnostic Categories or Dimensions? How Studying the Neural and Genetic Bases of Dimensional Traits Can Help Us Find New Treatments
Chair and presenter: Maria de las Mercedes Perez-Rodriguez, MD, PhD
When: 8:00-9:30 am
Where: Room 213, Second Level, Moscone South

Walking the Walk: Resident Roadmap to Leadership in Psychiatry
Presenter: Adjoa Smalls-Mantey, MD, DPhil
When: 10:00-11:30 am
Where: Room 208, Second Level, Moscone South

No Blacks, Fats, or Femmes: Stereotyping in the Gay Community and Issues of Racism, Body Image, and Masculinity 
Chair: Kenneth Ashley, MD
When: 3:00-4:30 pm
Where: Room 214, Second Level, Moscone South

Training the Next Generation of Community Psychiatrists: Science and Recovery
Chair: Paul Rosenfield, MD
Presenters: Joy Choi, MD;  Tomas Felipe Restrepo Palacio, MD
When: 3:00-4:30 pm
Where: Room 210, Second Level, Moscone South

Tuesday, May 21

Scaling Behavioral Health Integration: One Academic Health Care System’s Approach
Chair: Sabina Lim, MD, MPH
Presenters: Hansel Arroyo, MD; Kimberly Klipstein, MD; Rajvee Vora, MD
When: 10:00-11:30 am
Where: Room 314, Third Level, Moscone South

Management of Psychiatric Illness During Pregnancy and Postpartum: What Every Psychiatrist Needs To Know
Chair: Verlee Bergink, MD, PhD
When: 1:00-2:30 pm
Where: Rooms 201/209, Second Level, Moscone South

Typical or Troubled?®: Program Update and Further Development Discussion
Presenter: Gabrielle Shapiro, MD
When: 1:00-2:30 pm
Where: Room 308, Third Level, Moscone South

A Patient-Centered Approach to School Refusal: A Day Program’s Guide to Tackling One of Child and Adolescent Psychiatry’s Most Difficult Problems
Chair: Brandon Johnson, MD
Presenter: Shilpa Taufique, PhD
When: 3:00-4:30 pm
Where: Room 158, Upper Mezzanine, Moscone South

Separating Parents and Children: Impact on Mental Health and Resilience
Chairs: Adriana Feder, MD; Rachel Yehuda, PhD
When: 3:00-4:30 pm
Where: Room 204, Second Level, Moscone South

From Genetics to Stress Response to Treatment of Personality Disorders
Chair: Maria de las Mercedes Perez-Rodriguez, MD, PhD
When: 3:00-4:30 pm
Where: Room 153, Upper Mezzanine, Moscone South

Wednesday, May 22

New Onset Psychosis: What Trainees, Residents and Early Career Psychiatrists Should Know
Presenters: Cheryl Corcoran, MD; Iliyan Ivanov, MD; Dolores Malaspina, MD, MS, MSPH; Gabrielle Shapiro, MD
When: 8:00-9:30 am
Where: Room 156, Upper Mezzanine, Moscone South

Training Physician-Scientists in Psychiatry: A Road Map to Academic Success
Chairs: Antonia New, MD; Maria de las Mercedes Perez-Rodriguez, MD, PhD
Presenters: Kenechi Ejebe, MD, PhD; Rene Kahn, MD, PhD; Drew Kiraly, MD, PhD
When: 3:00-4:30 pm
Where: Room 208, Second Level, Moscone South

NARSAD Awardees

Updated on Jun 30, 2022 | Psychiatry

The 2018 NARSAD Young Investigator grantees from the Brain and Behavior Research Foundation include four faculty members from the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. Their research aims are listed below.

 

Michael Sean Breen, PhD, will leverage an established cohort of mothers and infants to investigate the effects of maternal PTSD. Using samples of the newborns’ umbilical cord blood, Dr. Breen will examine the patterns of gene expression in babies born to mothers with and without PTSD. The study will also include analysis of gene expression in samples from the babies at two years of age, providing measurements of the effects of maternal PTSD on children over time.

 

Alexander William Charney, MD, envisions a future in which it is possible to assess mental illnesses via a routine blood draw, and will search for cues from immune system that may aid to make this concept feasible. These cues, Dr. Charney believes, may be found in genetic messages floating around patients’ cells, presumably in transit to help accomplish immune-related tasks. To find them, Dr. Charney will draw genetic information from single cells in blood and brain samples in psychiatric patients, revealing additional insights into whether certain cell subtypes regulate interactions between the brain and the rest of the body.

 

 

Rebecca Sue Hofford, PhD, hopes to lay the groundwork for a drug to treat addiction to cocaine and other psychostimulants. She previously found a link between cocaine-induced behaviors and the activity of granulocyte-colony stimulating factor, or G-CSF, which is a cytokine—a signaling protein released by the immune system. Her team now hopes to identify which neurons are affected by G-CSF in the nucleus accumbens, a brain region that is associated with reward processing and involved in addiction. They will study how affected neurons change their activity in response to G-CSF.

 

Eva Velthorst, PhD, will explore how parental genes that are not passed on to the child may nevertheless help explain the link between childhood adversity and the development of psychosis. It is theorized that such non-inherited genes are able to affect the child through their parents’ contribution to the child’s environment. This phenomenon, called “genetic nurturing,” has been largely ignored in genetic studies but may point to preventable exposures, Dr. Velthorst suggests. Leveraging the Avon Longitudinal Study of Parents and Children study, the team will integrate genetic and developmental data on 3,000+ individuals followed from birth up to age 24, and their parents. This will provide the opportunity to examine the effect of non-transmitted genes of the mother and father separately (accounting for the transmitted genes) in the childhood adversity-psychosis relationship.

CARES: A Unique Program for Teens

Dec 9, 2018 | Psychiatry

CARES at Mount Sinai Morningside offers high school students mental health and substance abuse treatment plus academics—all in one setting.

For more than three decades, the Comprehensive Adolescent Rehabilitation and Education Service (CARES) at Mount Sinai Morningside has been helping high school students with mental health and/or substance abuse issues turn their lives around. The program integrates intensive psychological treatment with a complete high school education through the New York City Department of Education’s ReStart Academy (District 79), and it is the only one of its kind in the country, according to Shilpa Taufique, PhD, the program’s director.

Adolescents experiencing emotional problems and/or or dabbling in substance use are at extreme risk of adverse effects on their brain development, along with decreased academic performance and lifelong domino effects. CARES seeks to mitigate these effects with its educational and therapeutic components, including substance abuse treatment.

Therapy

The team of psychiatrists, psychologists, social workers, creative arts therapists, and substance abuse clinicians provide individual therapy (twice a week), group therapy (five times per week), family therapy (once a week), medication management, crisis intervention, case management, and academic achievement services. The program uses dialectical behavior therapy, motivation enhancement therapy, cognitive behavior therapy, and the Transtheoretical Model for Change, among others. Alcoholics Anonymous, Narcotics Anonymous, and community meetings are also part of the program.

Academics

CARES provides a full-time, diploma-granting high school education curriculum through the New York City Department of Education. Students attend daily academic classes taught by Department of Education teachers, and clinical staff work closely with the teachers to ensure that students are attending their classes, working well with teachers and peers, and participating. Some students have the option to opt for a High School Equivalency Diploma based on their needs and preferences. Following New York State Education Department mandates, the diploma program enables students to earn and accumulate credits, as well as prepare for Regents exams.  In addition to academics and therapy, CARES provides students with extracurricular activities such as a talent show, spelling bee, field trips to museums, yearbook club, music club, holiday parties, and prom.

Two Tailored Tracks

CARES branches into two programs: one for mood and anxiety issues, and the other for substance abuse.

AADP: The Adolescent Alternative Day Program (AADP) addresses problems with social skills, anxiety, and/or mood changes. “Alternative” refers to the more focused, individualized, safe, and respectful school environment that students are seeking when they apply from regular high school settings. AADP uses a milieu treatment model integrating therapeutic and educational components, and provides a unique opportunity to treat students aged 14-18 with severe emotional problems and school truancy.

CAPA:  The Comprehensive Addiction Program for Adolescents (CAPA) serves teens aged 14-19 who are struggling with substance abuse. Co-occurring problems may include depression and other mood-related disorders; mild to moderate behavior problems (angry outbursts, disrespect, breaking family rules, lying, truancy, early run-ins with the police); school problems;  and/or legal problems. A combined substance abuse/mental health model helps identify and treat all related issues. The program uses a harm-reduction model to help students reduce and ultimately abstain from substance use. CAPA is run in collaboration with the Addiction Institute of Mount Sinai and provides an alternative for teenagers who have just started abusing substances or who have already been in significant substance-related trouble.

CARES is located at Mount Sinai Morningside. For more information or to make a referral, please call (212) 523-3083. The application can be found here.

Shilpa Taufique, PhD, is the director of the Comprehensive Adolescent Rehabilitation and Education Service (CARES) at Mount Sinai Morningside. She is also the Director of the Division of Psychology for the Mount Sinai Health System and Chief Psychologist at Mount Sinai Morningside.