Psychiatry | Mount Sinai Today

Sharely Fred Torres, MD: Fostering Culturally Sensitive Therapy

Updated on Nov 14, 2025 | Engagement, Inside Mount Sinai Psychiatry, Psychiatry

Sharely Fred Torres, MD, with her grandfather in Puerto Rico.

The racial and ethnic disparity in mental health care is a critical issue facing psychiatry—and health care as a whole. Lack of access, a dearth of racially and ethnically diverse providers, and increased need across the board due to ripple effects from COVID-19 have intensified the need for minority providers. The Substance Abuse and Mental Health Services Administration (SAMHSA) launched the APA SAMHSA Minority Fellowship Program to address this. Sharely Fred Torres, MD, a rising second-year resident at The Mount Sinai Hospital, was just awarded this year-long fellowship, which begins in October 2021.

“One reason I knew I wanted to go into psychiatry is that there are so few minority providers, which is not a problem that is unique to psychiatry,” she said. The Mount Sinai Hospital is at the border of two socioeconomically distinct neighborhoods of East Harlem and the Upper East Side, so the inpatient psychiatry unit sees very diverse patient populations. “In my medical training at Mount Sinai, I would say that more than 50 percent of my encounters are in Spanish. I feel really lucky that I can talk to many of my patients in their native language as a bilingual person. They’re much more comfortable with a doctor they can relate to, and more likely to be honest about topics they would otherwise keep hidden.”

The path to psychiatry

Dr. Fred Torres was born and raised in Puerto Rico, and has been interested in pursuing a career in psychiatry since she was young.

“I realized that working in medicine could allow me to work with all kinds of populations and help people in the most fundamental way possible, which is their health,” she said. Regarding her interest in psychology, she said, “I really liked thinking about what drives people’s behaviors and decisions. It applied to so many interactions I’d had.” Dr. Fred Torres’s psychology course at Harvard was taught by Professor Dan Gilbert, who inspired her to pursue psychology as her college major with an emphasis on social and cognitive neuroscience. She joined Harvard Medical School’s Family Van program, which provided disadvantaged neighborhoods in Boston with preventative health screenings such as blood pressure, cholesterol, and blood sugar levels, as well as medications.

“I loved the medical aspects, like learning how to take someone’s blood pressure, but I also loved listening to their stories,” she said. “When the patients spoke about loss and trauma, it really became clear that the lack of access to mental health services was a huge problem in this community.” It was during these years that she also realized that many of her college peers were navigating emotional stressors in school. “I noticed mental health issues affect everyone. But not everyone seeks care.” This led her to join Harvard’s Student Mental Health Liaisons program to advocate for mental health services for college students. She worked with the director of Harvard University Health Services to ensure that freshman orientation at Harvard featured workshops on mental health services so that freshmen had the information early on, rather than waiting for a crisis to seek help.

In medical school, she became one of the first students at the Icahn School of Medicine at Mount Sinai to be accepted to the Primary Care Scholars Program launched in 2015. Through this four-year scholarship for students interested in providing primary care to underserved communities, she provided longitudinal care for patients in a variety of primary care settings. Her medical school tenure was five years, because she took a scholarly year to research under the mentorship of Adriana Feder, MD, and Mercedes Perez-Rodriguez, MD, PhD. “That year really grounded my interest in psychiatry,” she said.

Research and APA SAMHSA Minority Fellowship Program

Dr. Fred Torres is grateful that she is able to take advantage of the APA SAMHSA Minority Fellowship Program for psychiatry residents who are committed to addressing mental health disparities through a scholarly project. She plans to research cultural components that shape post-trauma trajectories within the World Trade Center (WTC) first-responder cohort that Dr. Feder has been studying for many years as the associate director for research at the WTC Mental Health Program.

“When Hurricane Maria hit Puerto Rico in 2017, I was in the beginning of my scholarly research year. Being directly impacted by that experience made me realize I wanted to shift my learning to focus on trauma-based research,” she said. “I saw how in the face of trauma, despite much loss and hardship, there was also a sense of support growing in the community in Puerto Rico with people at home coming together to support one another through this shared experience. I was proud and inspired by my community.” Dr. Feder let her know that she could learn about trauma by working with the WTC cohort, a unique population affected by the same traumatic event, in which there is a significant Hispanic population as well.

Dr. Fred Torres wants to explore culturally unique resilience factors within this group. “In much of the Hispanic community, no one talks about anxiety or depression,” she said. “Instead, there is a tendency to go to church and pray when faced with life stressors.” She hypothesizes that depending on the individual, the religious factor and other culturally specific variables can serve both as a barrier to and enhancement of resilience, strength, and meaning after a traumatic incident.

Via qualitative individual interviews during her fellowship, she plans to compare the Hispanic WTC cohort to other minority and non-minority counterparts to identify culturally specific factors that contribute (or detract) to resilience. She hopes the findings from her fellowship research are ultimately incorporated into culturally sensitive therapy for trauma. The Mount Sinai Hospital’s psychiatry residency allows time for research projects in the second year, and Dr. Fred Torres’s mentors, Dr. Feder and Dr. Perez-Rodriguez, will guide her in her scholastic work.

Career plans

Once she finishes residency, Dr. Fred Torres hopes to focus on outpatient therapy for many psychiatric conditions such as personality disorders, depression, anxiety, and trauma. “I like the idea of longitudinal, years-long relationships with patients,” she said.

After residency, she hopes to continue to pursue research and academic interests in order to better inform the care she provides patients. “In this career, you can help anybody,” she said. “There’s nobody who doesn’t need health care. I feel privileged to be in a position to help someone on such a fundamental level. But within the field of psychiatry, we face unique challenges to providing care. Our practices are not as clear-cut—you can’t draw someone’s blood and with a biomarker determine that they have depression or anxiety, in the same manner that you can measure someone’s cholesterol level for example. We rely on the psychiatric interview. I enjoy this challenge of working with patients through that subjective space together.”

Furthermore, as she did in medical school and her residency with the Admissions Committees, Dr. Fred Torres hopes to continue efforts to ensure the diversity of the medical field by recruiting diverse medical trainees and increasing academic support for students who are underrepresented and/or disadvantaged in medicine.

Mount Sinai’s Department of Psychiatry is one of the largest and most prolific in the world. With our new series, Inside Mount Sinai Psychiatry, we showcase stories from every corner of our Department including our training programs, patient care teams, and scientists. We believe psychiatry and mental health are the building blocks to fulfilling lives and thriving societies; via these stories about our faculty, trainees, and staff, this series shows the myriad ways we work toward that. Whether it’s manning the front desk of an opioid treatment clinic, researching how psychedelics work in the brain, or training future clinician-scientists, our team is relentlessly pursuing the best for those suffering from mental health issues.

Learn more about the psychiatry residency at The Mount Sinai Hospital

How Can You Tell if Someone You Know May Have PTSD?

Updated on Jun 30, 2022 | Featured, Mental Health, Psychiatry, Your Health

Many people think post-traumatic stress disorder (PTSD) is something that occurs mostly in soldiers returning home from war. Not so. In fact, PTSD affects millions of people throughout the United States, and the numbers are no doubt rising due to the pandemic.

In this Q&A, Jonathan DePierro, PhD, Assistant Professor, Psychiatry, and Clinical and Research Director, Center for Stress, Resilience and Personal Growth at the Icahn School of Medicine at Mount Sinai, explains how PTSD develops, what some of the warning signs are, and why having symptoms of PTSD is not a sign of weakness.

What is PTSD?

PTSD is a mental health condition that can develop after someone goes through a life-threatening event, like a car accident, combat, or a serious illness; or when sudden life-threatening events happen to a loved one. Seeing and hearing about human suffering and death at work over and over, like medics, nurses, and 911 dispatchers do, can also contribute to PTSD.

Jonathan DePierro, PhD

What are the symptoms of PTSD?

PTSD involves four types of symptoms that happen at the same time.

Intrusions – reliving the event with upsetting memories, nightmares, or flashbacks where it truly feels as if the event is happening all over again
Avoidance – trying very hard to avoid any reminders of the trauma, including talking about what happened
Negative thoughts and emotions – feeling depressed, angry, numb, mistrustful, guilty, or ashamed
Hyperarousal – feeling on edge, irritable, having difficulty concentrating, being easily startled, and having poor sleep

These symptoms also need to last for more than a month, be distressing, and/or cause problems for you in your life. Some people may notice changes in their mood, behavior, or relationships right after a trauma; but for others who develop PTSD, symptoms might not develop for many months.

What causes PTSD?

One of the important things to keep in mind about PTSD is that it is the result of a person being exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in one or more of the following ways:

Experiencing it yourself
Witnessing the event(s) firsthand
Learning it happened to a loved one
Indirect exposure to aversive details of the trauma, usually by nature of one’s job

The American Psychiatric Association estimates that about 7 percent of adults in the United States will develop PTSD during their lives. People who do develop PTSD are not “weak.” They have experienced an event that they struggle to understand, and their bodies and brains are “stuck” replaying the event and all the upsetting emotions that come along with it.

How can you recognize the signs of PTSD in someone you know?

People with PTSD struggle to make sense of what happened to them or what they witnessed. They might have upsetting images or memories of the most upsetting parts of the trauma, even though they spend a lot of time trying to avoid anything that might remind them of what happened. The events feel too overwhelming to think or talk about. Spending time with others feels like a lot of work and more stressful, so people with PTSD might withdraw and spent a lot more time alone. Sleep and attention problems are common, because the body is so “on edge” and still reacting as if the trauma is still happening in the present moment.

We also know that people with PTSD tend to see themselves, the future, and other people in their lives through certain “mental filters.” One example is that people with PTSD often blame themselves for things that happened during the trauma, even though that does not make sense. Some of our health care workers experience “moral injury” – blaming themselves all the time for something they did or did not do during the worst of the pandemic.

How is PTSD diagnosed and treated?

If you are concerned that you may be experiencing symptoms of PTSD, speak with your health care provider. They may refer you to a mental health clinician, who can review your symptoms and make a treatment plan. You should also know that depression and PTSD often co-occur, so mention any symptoms of depression you may be experiencing to your providers so they can better understand your needs. If you are concerned about a friend or loved one, speak to them and encourage them to seek help.

Treatment for PTSD directly address avoidance, fear, and negative thoughts. Catching negative thoughts and trying to change them, to make them more realistic and helpful, is a key part of many treatments. Treatment also involves rebuilding a sense of safety that often feels so absent in people with PTSD. Some people with PTSD also find antidepressant medications to be helpful.

Get more information from Mount Sinai about PTSD

Learn more about PTSD from the National Institute for Mental Health

Find additional resources at the National Center for PTSD

How to Cope With Post-Pandemic Anxiety

Updated on Jun 30, 2022 | COVID-19, Mental Health, Psychiatry, Your Health

Young woman sits in window sill while looking at phone

With vaccination efforts ramping up across the United States, people are looking forward to a sense of normalcy. However, for many, the thought of things returning to normal brings a paralyzing sense of anxiety. Shannon O’Neill, PhD, licensed psychologist and Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, discusses the post-pandemic anxiety you may be experiencing and how to overcome those complicated feelings.

Why are people feeling anxious as we see signs of the pandemic easing?

It makes a lot of sense that people are feeling anxious and unsettled right now. Just when we were finally adjusting to a new normal with some predictability and flow, the world is preparing to change all over again. Future uncertainty and a sense of not knowing what to expect can fuel anticipatory anxiety. There is even a diagnosis for this feeling: adjustment disorder.

What does that mean?

Adjustment disorder is described as an emotional or behavioral reaction to stress or change in a person’s life. As vaccinations tick up and warmer weather approaches, there will likely be a significant readjustment of phasing normalcy back into our lives, similar to the adjustments made to social distancing or quarantining at home. This can, naturally, cause feelings of anxiety, as well as depression.

In most circumstances, beginning to reintegrate a ‘normal’ routine can enhance ones confidence. So, having the extra protection of the vaccine amongst ourselves and within our community may offer added physical and emotional security for those who are feeling anxious about things going back to normal.

How can I overcome the new feelings of anxiety I’ve developed during quarantine?

A classic treatment approach for an anxiety diagnosis is exposure. Rather than avoiding what is feared, it is important to lean into those activities.

Technology has been a wonderful and very helpful incentive for us to stay home when it was important to do so. Whether enabling us to receive a grocery or pharmacy delivery or attend a virtual happy hour, technology has allowed us to obtain resources and socialize from a distance. However, for some, this adaptation can turn into over accommodation and avoidance.

Thankfully, through repeated exposures to feared stimuli, while also following CDC guidelines, you should eventually become more comfortable. However, this may mean that you will need to ease in with smaller social commitments that have time limits before expanding out to larger outings. For instance, if attending an extended outing with your larger—hopefully fully vaccinated—social group sounds too much, try connecting with a friend you haven’t seen in a year with an hour-long picnic in the park. Once you feel comfortable with these smaller interactions, you can begin to safely expand your social network.

Another good rule of thumb is to know your boundaries and limits ahead of time as this will allow for some predictability and certainty. Ask yourself, what are you willing to tolerate? Is it the group size, rules around mask wearing, or the amount of time you are present? Acknowledging your boundaries and sticking to a plan can offer a good sense of confidence when you leave your home.

How can I tell if my anxiety about leaving the house is agoraphobia? What are the symptoms?

Agoraphobia is a clinical diagnosis under the umbrella of anxiety. This entails marked fear or anxiety across a number of situations whether that is going outside alone, using public transportation, standing in line, or being in large crowds or within closed spaces.

When there is fear of leaving the home, significant avoidance or behavioral modifications can develop. This can be turning down invitations, starting to self-medicate before leaving the home, or engaging in ‘safety behaviors’ such as only leaving the home with a trusted loved one.

How do I know if I should seek care for these feelings?

If current behaviors and emotions cause significant distress, impact daily functioning, or affect interpersonal relationships, it would be a good time to seek help from a trusted provider. Additionally, if self-medication—via drugs, alcohol, or even food—is necessary to white-knuckle your way through a task, seeking help would be important.

Telehealth services have expanded throughout the Mount Sinai Health System during the pandemic and this can be a wonderful way to begin psychotherapy for those with anxiety or agoraphobia. Working towards even just meeting in person with your provider is a great treatment goal at the start of these sessions.

Learn more about Behavioral Health at Mount Sinai

Psychiatry Residents Win Multiple Awards

Updated on Jun 30, 2022 | Psychiatry

Psychiatry residents at the Icahn School of Medicine at Mount Sinai have been awarded several prestigious prizes and fellowships this year in recognition of their exceptional patient care, outstanding leadership, and remarkable research prowess.

Top row, left to right: Tim Becker, MD, PhD, (PGY-3); Sharely Fred-Torres, MD, (PGY-1); and Young Jung Kim, MD, PhD, (PGY-4). Bottom row, left to right: Isobel Rosenthal, MD, MBA, (PGY-2); Andrew Smith, MD, PhD, (PGY-3); Brian Sweis, MD, (PGY-1); and Genevieve Yang, MD, PhD (PGY-3).

Tim Becker, MD, PhD, (PGY-3) was selected as a 2021 American Psychiatric Association Foundation (APAF) Child and Adolescent Psychiatry Fellowship Program and won third place in a New York State Psychiatric Association Poster competition

Sharely Fred-Torres, MD, (PGY-1) was selected as a 2021-22 SAMHSA Minority Fellow through the APA Foundation.

Young Jung Kim, MD, PhD, (PGY-4) won second place in a New York State Psychiatric Association Poster competition.

Isobel Rosenthal, MD, MBA, (PGY-2) won an APA leadership award and a Group for Advancement of Psychiatry fellowship.

Andrew Smith, MD, PhD, (PGY-3) was admitted to the competitive Research Colloquium for Junior Psychiatrist Investigators through the APA.

Brian Sweis, MD, (PGY-1) won second place in the New York County Psychiatric Society Research Awards.

Genevieve Yang, MD, PhD (PGY-3) won an Outstanding Resident Program award from the NIMH and received a pilot grant from the ANRP at Mount Sinai.

Please join us in congratulating our exceptional residents!

Pregnancy and Antidepressants: Should You Avoid Taking Them?

Updated on Jun 30, 2022 | Featured, Mental Health, OB/GYN, Psychiatry, Research, Women's Health, Your Health

Approximately half of women who use antidepressants before pregnancy decide to discontinue use either before or during pregnancy due to concerns about the negative consequences for their child.

Those who are pregnant or who may be thinking of getting pregnant may wonder if taking antidepressants could affect the heath of the child. New research from Mount Sinai offers some potentially important findings and shows that the underlying mental health of the parents is more of a concern than the medication itself.

The study shows that while there is a link between maternal antidepressant use during pregnancy and affective disorders in the child later in life, the link also exists between paternal antidepressant use during pregnancy and child mental health.

The data suggest the observed link is most likely due to the underlying mental illness of the parents rather than any “intrauterine effect,” which means any effect the medication could have on the fetus developing inside the uterus. These affective disorders include depression and anxiety.

“Our study does not provide evidence for a causal relationship between in-utero exposure to antidepressants and affective disorders in the child,” says Anna-Sophie Rommel, PhD, an instructor in the Department of Psychiatry at Icahn Mount Sinai and first author of the paper. “So, while other long-term effects of intrauterine exposure to antidepressants remain to be investigated, our work supports antidepressant continuation for women who would like to continue taking their medication, for example because of severe symptoms or a high risk of relapse. It is important to note that untreated psychiatric illness during pregnancy can also have negative consequences on the health and development of the child. Women and their health care providers should carefully weigh all of the treatment options and jointly decide on the best course of action.”

Anna-Sophie Rommel, PhD

Approximately half of women who use antidepressants before pregnancy decide to discontinue use either before or during pregnancy due to concerns about the negative consequences for their child, according to Dr. Rommel, who is also an expert in epidemiology and has been studying how the COVID-19 pandemic disproportionately affects pregnant women in underserved communities.

Major depressive disorder is highly prevalent, with one in five people experiencing an episode at some point in their life, and is almost twice as common in women than in men. Antidepressants are usually given as a first-line treatment, including during pregnancy, either to prevent the recurrence of depression, or as acute treatment in newly depressed patients. Antidepressant use during pregnancy is widespread and since antidepressants cross the placenta and the blood-brain barrier, concern exists about potential long-term effects of intrauterine antidepressant exposure in the unborn child.

Using the Danish National Registers to follow more than 42,000 babies born during 1998-2011 for up to 18 years, researchers at the Icahn School of Medicine at Mount Sinai investigated whether exposure to antidepressants in the womb would increase the risk of developing affective disorder like depression and anxiety in the child.

In a study published April 5 in Neuropsychopharmacology, the scientists found that children whose mothers continued antidepressants during pregnancy had a higher risk of affective disorders than children whose mothers stopped taking antidepressants before pregnancy.

However, to understand whether the underlying disorder for which the antidepressant was given or the medication itself was linked to the child’s risk of developing an affective disorder, they also studied the effect of paternal antidepressant use during pregnancy and similarly, found that children of fathers who took antidepressants throughout pregnancy had a higher risk for affective disorders. Thus, the research team speculates that rather than being an intrauterine effect, the observed link is most likely due to the parental mental illness underlying the antidepressant use.

A Vaccine Pod Dedicated to Mental Health Patients

Updated on Jun 30, 2022 | Community, Featured, Psychiatry, Vaccines

From left: Raymond Rene, Office of Mental Health (OMH); Ruth Llanos, OMH Psychiatric Nurse; Paul Michael Avellaneda, OMH Psychiatric Nurse; Michelle Izmirly, DO; Gariy Livshits, OMH Treatment Team Leader

Earlier this year, the New York State Office of Mental Health (OMH) launched a program to bring vaccine doses to mental health patients, as many have trouble navigating the internet or don’t have smartphones and need help facilitating appointments. The OMH program was designed for patients to come to state psychiatric centers, but they were also eager to expand their reach and offered to set up vaccine pods at all OMH licensed clinics across the state. Michelle Izmirly, DO, Medical Director of Ambulatory Psychiatry at The Mount Sinai Hospital, reached out to OMH so that The Mount Sinai Hospital’s clinic could be included as a site.

“We see a very vulnerable patient population, and I knew a lot of our patients weren’t comfortable going to places like the Javits Center,” said Dr. Izmirly. “Some were even crying because they were so scared and so frustrated; often, they lacked internet access or cellular service to navigate the New York State vaccine eligibility website. We’re the ones they know. They know our setting and our staff, and they’re more comfortable getting the vaccine with us. They were so grateful that they had this option.”

It was a true team effort to pull it off. OMH scheduled a site visit to make sure the clinic had the appropriate setup: strong Wi-Fi, a comfortable area for injections, and supportive staff. Rajvee Vora, MD, Vice Chair of Clinical Affairs for the Department of Psychiatry, collaborated with Ania Wajnberg, MD, Medical Director of Ambulatory Care at The Mount Sinai Hospital and Site Lead for Vaccine Operations. They engaged the pharmacy and engineering departments to ensure the clinic had the appropriate equipment to safely store the vaccine.

Due to special efforts by Patricia Lamb, Chief of Ancillary and Support Services, Sue Mashni, PharmD, Chief Pharmacy Officer, and Michael Roche, PE, Senior Director of Engineering, the clinic space was converted to a safe and effective vaccine pod in one week. Eva Bayon, Administrative Manager, and Joan Bell, LCSW, Clinical Director of Ambulatory Psychiatry Services, handled the logistics of confirming and scheduling patients. Alicia Hurtado, MD, Associate Dean for Medical Student Wellness and Student Affairs, arranged for medical students to volunteer to monitor the patients for 15 minutes after they received the vaccination.

On April 8, the team vaccinated 72 patients—10 every 30 minutes starting at 9:30 am. And this might only be the beginning. The vaccine pod was such a success that OMH will return May 6 to reach the patients who were unable to attend their appointment that day. If OMH continues to provide the doses, the clinic could continue to offer it to their patients moving forward.

Cassidy Leverett, a care coordinator at the clinic, believes that the stability for these patients is key. “A lot of people find it really difficult to schedule the vaccine because it can be far from where they live or work, so it’s really great that people can go to a place they’re familiar with and see faces that they know. It’s been a very crazy time so it’s nice to have one stable place where you can go get your vaccine.”

Dr. Izmirly hopes this spreads beyond her clinic to other mental health clinics and practices. “You see so many news stories and research studies about people with mental illness contracting and dying from COVID-19 at higher rates than those who don’t suffer from mental illness,” she said. “We’ve even lost some of our own patients, which was completely devastating. This is an opportunity to help our own patients in our own settings, where we know they’ll feel comfortable.”