Alan Rosenbaum is a pioneer psychiatrist who has been on the forefront of psychotropic drug research for over 50 years.
By Alice Burdick Schweiger
Before it was in vogue for psychiatrists to prescribe brain-based medications for their patients, Alan Rosenbaum, M.D., was researching and incorporating psychotropic drugs for his patients in need. That was more than 50 years ago. Today, Rosenbaum, who practices in Farmington Hills, is considered an expert and pioneer in the field.
In addition to serving as a clinical professor of behavioral science at Wayne State University and an adjunct clinical professor of psychiatry at the University of Michigan, he is a distinguished life fellow of the American Psychiatric Association.
For his years of dedication and commitment to treating mental illness, Rosenbaum was honored on Nov. 15 by the Michigan Psychoanalytic Foundation at an event at the Henry Ford Museum of American Innovation in Dearborn.
“We were so pleased to honor Dr. Rosenbaum,” says psychiatrist Sally Rosenberg, D.O., co-president of the foundation and president of the Michigan Psychoanalytic Institute. “He has had a major impact on the mental health community in the Detroit area.
“Dr. Rosenbaum’s expert combination of the science and the art of medicine has helped many patients with widely varying problems. His careful communications with referring practitioners have facilitated the integration of psychopharmacology and psychotherapy.”
Rosenbaum, born and raised in Detroit, went to medical school at U-M, where he simultaneously took classes at the Graduate School of Pharmacology. In 1965, he received both his medical degree and a master’s of science degree in pharmacology. He did a psychiatry residency at the Mayo Clinic in Rochester, Minn., where he remained on staff for 9.5 years.
Very early on, Rosenbaum incorporated his knowledge of brain-influencing drugs into his psychiatric practice.
“My first patient as a psychiatric resident was admitted after her husband died, and she developed a psychotic mania as a result of the stress,” he explains. “When she came on to our unit, I was told to talk her out of the psychosis. It didn’t work. I read about medications for mania and found research being done using lithium for bipolar disorder.
“For my next manic patient, I called the corner drugstore and asked if they had any lithium. They said yes — it was used as a salt substitute for blood pressure — and agreed to make up some capsules for me. I gave them to my patient, and they worked in about a week.”
At Mayo Clinic, while studying some of the new antidepressants, Rosenbaum measured stress hormones in patients with severe anxious depression and found that if their cortisone and adrenalin were too high, antidepressants made them worse.
In 1981, Rosenbaum, along with his wife, Maxine, and two daughters, moved back to Michigan. He pursued his career in psychopharmacology and continued doing drug evaluations.
Rosenbaum says psychiatric illnesses that may be severe enough to require medications include depression, bipolar disorder, ADHD, obsessive-compulsive disorder, panic disorders, severe anxiety, eating disorders and schizophrenia.
However, drugs are not prescribed without careful consideration, a thorough medical history and close monitoring.
“Depression and bipolar disorder cause a higher incidence of high blood pressure, strokes, diabetes and dementia,” he says. “Some of our newer anti-psychotic medications can cause a metabolic syndrome, increasing one’s risk of heart disease, stroke and Type 2 diabetes.
Patients have to be monitored regarding their cholesterol, sugar, thyroid and kidney function. Most drugs work about 50 percent of the time on the first try and, if the patient works with you, about 85 percent will get better.”
Drugs work by targeting neurotransmitters in the brain that stimulate or inhibit their release, he notes. “Initially, we thought the main transmitters were serotonin, norepinephrine and dopamine. But we began to see that stress hormones played a major part in depression, and research has now found that the main transmitter in the brain is glutamate, a protein that is a stimulating hormone and one of the main causes of anxiety.”
There was a time when many traditional psychoanalysts believed drugs undermined successful treatment. “Nowadays, more analysts are prescribing medications and the two approaches are recognized as needing each other,” Rosenbaum says. “When you put them together, the success rate goes up.”
In his practice, Rosenbaum has seen an increase in depression. “I think it has to do with the amount of stress people have,” he says. “The hours people work seem longer. Both spouses are working, and they don’t have enough time for themselves or with their children. We’ve also found that inflammation from any disease, or even surgery, can trigger depressions.”
Diet and exercise, he adds, “have been proven to be extremely important for our mental health, with exercise shown to even delay the onset of Alzheimer’s disease.”
As for the future of psychiatric drug treatment, Rosenbaum hopes scientists will find something similar to what has evolved for cancer treatment: medications that block genes that allow cancer to grow.
“My hope is we can find a medication that can block the gene or genes that allow the biological part of the psychiatric illness,” he says.