FACULTY SPOTLIGHT
The Recipe to Achieving Almost the Impossible with Dr. Peter Giacobbe
By Sonja Elsaid
“N
ever give up!" This is Dr. Peter Giacobbe's recipe for achieving almost the impossible. We interviewed Dr. Peter Giacobbe, an Associate Professor at the Institute of Medical Science (IMS) and Department of Psychiatry at the University of Toronto, and the Associate Scientist at Sunnybrook Research Institute, to learn about his motivation for researching and treating patients with treatment-resistant depression. Dr. Giacobbe is one of the very few psychiatrists in the world with expertise in delivering Electroconvulsive Therapy (ECT), Deep-brain Stimulation (DBS), MRI-guided Focused Ultrasound Treatment, and repetitive Transcranial Magnetic Stimulation (rTMS). As an Interventional Psychiatrist, he provides the entire care continuum to his patients, including psychotherapy, various pharmacological treatments, and more invasive device-based regimens. Some patients do not get better, even after being repeatedly treated for their symptoms of depression. For many mental health workers, treatment-resistant depression is one of the most challenging psychiatric conditions to remedy. Only a few are up to the challenge of coming face-to-face with the almost impossible. When asked about his motivation to accept the challenge of treating persistent 30 | IMS MAGAZINE FALL 2021 GI & GUT MICROBIOME
depression, Dr. Giacobbe responded: "I was always interested in the world around me and 'how people work.' To answer this question, I pursued a Bachelor's in Science (BSc) degree in Neuroscience at the University of Toronto—a topic that helped me understand brain development, human personality, and behavior. That curiosity led me to the next level—the decision to become a psychiatrist. So, I went to medical school at the Western University in London and subsequently entered the psychiatric residency program at U of T. During the clinical rotations, I worked with patients who were very depressed. They repeatedly failed to respond to pharmacological treatments, but then they, all of a sudden, significantly improved with the ECT. I was fascinated! How could a non-esthetically pleasing procedure, such as ECT, performed at the basement of a hospital, produce such great results?" Thus, Dr. Giacobbe began exploring the biological paradigm that explains the physiological causes of depression. "We know that the brain is an electrochemical organ. Pharmacological treatments are only half of the equation. The electrical properties of the brain could also be changed by delivering electricity or magnetic pulses. We now know, that the brain is very responsive to externally delivered energy, which explains why
patients with depression who show little respond to other treatments can respond to the ECT or rTMS." Nevertheless, Dr. Giacobbe's desire to help patients went beyond learning to use all the available tools in his treatment kit. He wanted to improve the quantity and quality of life of his patients and destigmatize depression. By demonstrating that psychiatric illnesses are products of the brain, Dr. Giacobbe hoped that psychiatric disorders, like depression, would get the same level of acceptability as Parkinson's disease and epilepsy." Device-based treatments have the unique capability to destigmatize these illnesses. They [psychiatric disorders] are not illnesses of willpower or personality; they are illnesses of the brain. If we can alter the brain functioning of psychiatric patients therapeutically, then we can make people see that psychiatric illnesses are similar to neurological disorders." Dr. Giacobbe also pointed out how obtaining his Master's degree at the IMS was crucial for his career. "I did not only want to use all the treatments available, but also play a role in finding new ones. In my quest for discovery, I needed to learn how to pursue a hypothesis and choose the best methodology to test the questions I am passionate about." Graphic design by Michie (Xingyu) Wu
