Using biomarkers to predict best treatment for major depressive disorder

. 10 MIN READ

Making the Rounds

Using biomarkers to predict best treatment for major depressive disorder

Dec 8, 2023

In this episode of Making the Rounds, third-year medical student Jack Gomberg from Icahn School of Medicine Mount Sinai, shares about his research submission for the AMA Research Challenge, identifying white matter markers for treatment outcomes in major depressive disorder (MDD). View his poster (PDF).

Learn more about the AMA Research Challenge.

Speakers

  • Jack Gomberg, third-year medical student, Icahn School of Medicine, Mount Sinai
  • Brendan Murphy, senior news writer, American Medical Association

Host

  • Todd Unger, chief experience officer, American Medical Association

Listen on the go to the full episode on Apple Podcasts, Spotify or anywhere podcasts are available.

Student-focused benefits

Become an AMA member to unlock:

  • FREIDA™ residency dashboard
  • Unlimited access to the JAMA Network™
  • Lenovo: Save up to 30% on the latest tech

Unger: Welcome to Making the Rounds, a podcast by the American Medical Association. Today’s interview features one of the finalists for the AMA Research Challenge, which is the largest national research event of its kind. Join us for the main event in February where the five finalists will present their research and compete for a ten-thousand-dollar grand prize, sponsored by Laurel Road. For the full details, visit ama-assn.org/finals. Here’s AMA Senior News Writer, Brendan Murphy.

Murphy: Hello and welcome to Making the Rounds, a podcast by the American Medical Association. I'm Brendan Murphy, senior news writer at the AMA. Today we are continuing our series featuring each of the Research Challenge finalists. The semifinals took place in October and our top five research projects will compete in the final event, which you can watch on February 6.

Visit ama-assn.org/finals to learn more. Joining us is Jack Gomberg, a third-year medical student from the Icahn School of Medicine, Mount Sinai. Thank you so much for being with us today, Jack.

Gomberg: Thank you for having me, Brendan.

Murphy: We are very excited to have you, as we are with all five finalists. Your submission for the Research Challenge is entitled, “White Matter Markers for Treatment Outcomes in Major Depressive Disorder.” I think a good place for us to start is for you to tell us a little bit about this topic, why it appealed to you and how you got involved in the AMA Research Challenge.

Gomberg: Of course. So, this topic has been very near and dear to my heart. I think it's a really exciting combination of neuroscience, psychiatry, neurology and imaging, where we are looking at white matter biomarkers that can predict what treatments will be best for which patients based on their MRI brain scans. This was a really exciting project for me just because it felt so almost sci-fi. The idea that you could scan someone's brain and then say, oh, this is the treatment that they should have and this will do good for them—was really fascinating as just kind of a baseline project. And then beyond that it touches into a lot of academic interest that I have and that I've been exploring over the years in stress, in depression, in neuroscience and this kind of new MRI imaging.

Murphy: So medical students are often fairly new to the research realm. What were some of the challenges you encountered in doing this research?

Gomberg: Great question. So, I was fortunate not to be very new to the research realm, personally. I have been doing research since freshman year of undergrad at Pomona. I worked at a Northwestern lab doing glioblastoma research over the summers in undergrad.

After I graduated from Pomona College with a degree in neuroscience, I went to Israel on a Fulbright research grant to study stress and circus performers for a year. I came back to the States, joined a lab at UCLA looking at how stress impacts the biological workings of breast cancer in mice. And then I came to Mount Sinai, to kind of continue this motif of stress and depression with this current lab, working at the SEAC lab with Helen Mayberg and Ki Sueng Choi in depression and white matter pathophysiology.

I think the biggest challenge was managing research on top of medical school itself. There's a lot of juggling that you have to do, for lack of a better term, with coursework, clinicals and kind of being a productive member of a research team. So, finding out how to manage that on my own expectations and then also how to manage others' expectations both in clinic and also in research was really important. So, I think good communication was really crucial as well as setting reasonable expectations not only for others in research but also for myself and what I would be able to do week to week, month to month, and per year. So, playing a long game, having some perspective, you're here for school, not as a researcher but at the same time kind of being able to approach what interests you and really go after it.

Murphy:  So, after studying those circus performers, I'm guessing the stress of medical school pales in comparison.

Gomberg: Yeah, it's, it was actually a really interesting project, where it's called … it's a topic called medical clowning, where they take circus performers, integrate them into medical teams. And it's very well researched in a very niche community, like a very tight knit community. So it was really interesting taking this kind of macroscopic approach for, oh, here's how humor and laughter and music can kind of impact stress on a higher tier clinical level. And then taking that into the minutia of data and brain scans and cross comparison studies and all this kind of nitty gritty. So, it's been really interesting to kind of approach it from, approach such a wide-ranging topic from both lenses.

Murphy: What advice would you offer to medical student researchers after conducting this project?

Gomberg: I would say pick and choose your mentors carefully. I have been very lucky to, especially with this project, have some of the most incredible, patient, welcoming mentors that I've ever had in my entire career. I really have to name Dr. Ki Sueng Choi, who has been meeting with me every week since the first year to really kind of like dig through this project, make sure that I'm staying on track, giving new ideas, teaching me along the way. The rest of the team led by Dr. Helen Mayberg, who is a true role model in how you can approach very nitty gritty data-driven research and then always have the eye on the prize of how is this going to be relevant clinically. So I would say definitely pick your research based on who is going to be a good role model and mentor in your research and in your career.

Murphy: What makes for a good mentor in research?

Gomberg: Patience, dedicating the time. I think that they, number one, if they show an interest in you as a person, I think is really helpful. I remember, you know, the first meeting I had with my current mentors, a lot of it seems more like a friendly conversation than an interview or anything. They just want to get to know you. And those have been the best mentorships over my medical school career is what stems from a personal relationship turns into a professional relationship.

So, finding people who are … have the patience and the time, and the willingness to get to know you as a person and grow with you and kind of let you do your own thing is a very core tenant.

Murphy: What do you see as the next steps in this work?

Gomberg: I would love to see some application, but I think, immediate next steps is publication. I would love to get this work out there, peer reviewed, get the community's takes on it. And then I think beyond that is what other applications are there. Can we look into if patients … if we can predict if patients will relapse on treatment? Can we predict if a very specific drug is better—SNRI versus SSRI? And most exciting to me is kind of why is this happening? Why are the … why are we seeing this in both functional connectivity and white matter tracks? So, kind of getting at how can we take this and move it to the bedside and actually help patients with this? And also, what does this mean for depression, depression treatments, how we understand how this disease works and why it does what it does in the brain, I think are all very exciting next steps in this research.

Murphy: You mentioned you've been involved in neurological research for a number of years. How will this particular project shape your career path? Is neurology your preferred specialty?

Gomberg: Yes, I think so. I've yet to do all my third-year rotations yet, but it is certainly the one that is most exciting to me right now. I think this research has really hit a nerve with my own interests. It's kind of inspired me in a different way than other research has. I know going into medical school, I basically swore off bench and mouse research that I had been doing for many years up to that point. Just kind of calling it quits on that. And I am … I think that was a good idea.

I really enjoy the clinical research, the more tailored approaches towards patients and how that can lead to changes at the bedside and lead to changes in prescription and how we view these tools that doctors have. So, I think next steps in my career is kind of seeing what else I can do with this type of research—with imaging, with how neuroimaging might play into neurology diseases and neurology. What is the crossover between this kind of arbitrary split of psychiatry and neurology when it's all one big organ system?

Murphy: You have a bright future ahead, certainly.  What else would you like our listeners to know about your journey in medicine?

Gomberg: I think I want them to know that it's a long road to get here and it's a long road ahead. So … but I am personally very much enjoying it while I am in it. I took three years off to do research before getting into medical school. And of course, residency seems like forever in the future, to the end of it. So, I've … there is a way to like really enjoy your time while you are going through the process and not just looking for that light at the end of the tunnel.

Murphy: Our last question is probably the most fun. Let's say you win the $10,000 grand prize. What would you do with the money?

Gomberg: I think I'd have to take my lab out to dinner or something like that. This wasn't really just—research is not a solo project. So definitely something to like give back to all the people that helped me along the way with this project. I think I invest back in my education. There's, you know, take my wife out to a real nice dinner, trip or vacation. I don't know. It's just been so exciting to get this far already. I think I'll cross that bridge if I am lucky enough to get to it.

Murphy: Well, Jack, thank you for joining us. Don't miss Jack and the other finalists compete on February 6 in the AMA Research Challenge finals. This has been Making the Rounds. I'm AMA Senior News Writer Brendan Murphy. Jack, thank you so much for sharing your research with our listeners.

Gomberg: Thank you so much for having me on.

Unger: Don’t forget to tune in to the AMA Research Challenge finals on February 6. Get the details at ama-assn.org/finals. Subscribe to Making the Rounds today.


Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

FEATURED STORIES