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Clinical Fellowship Program at NIMH

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>> MARK NICIU: I first learned about the Clinical Fellowship in 2010 when I was invited to the NIMH for the Outstanding Resident Training Program as a third-year adult psychiatry resident at Yale. At that time, I met Dr. Joyce Chung, the Clinical Fellowship Training Director, and my eventual research mentor, Dr. Carlos Zarate, whose work I was already aware of due to my burgeoning interest in ketamine as an experimental treatment for major depression. On this visit, we discussed the possibility of coming to the NIMH for fellowship after residency, and, in the following year, I was torn between remaining at Yale or joining the NIMH Experimental Therapeutics and Pathophysiology Branch. After much deliberation, I decided on the latter, which has been the best academic decision of my life.

The clinical research resources at the NIMH are unparalleled in the United States and maybe even in the World. There are three research-dedicated inpatient units, including the 12-bed Mood and Anxiety Disorders unit where I have worked for the past six years, and a dedicated outpatient psychiatric research clinic. Both have amazing clinical, nursing and other ancillary staff dedicated not only to the NIMH's research mission but also to providing the best psychiatric treatment possible. I have had the opportunity to work with some of the largest depression datasets in the world to answer critical research questions on the antidepressant response to ketamine and other experimental therapies in treatment-resistant depression. I have received exceptional supervision from Carlos, Joyce, the Office of the Clinical Director and the Office of the Scientific Director. I've also had access to world-class colleagues in neuroimaging and statistics for didactic instruction and consultation.

Finally, I had the opportunity to write and initiate a new clinical research protocol on potential alcohol-sensitive biomarkers of ketamine's antidepressant response. This study was approved in 2014 and was the basis for my 2016 K99R00 NIH "Pathway to Independence" award. There have also been incredible opportunities for collaboration both within the NIMH and across other NIH Institutes and Centers. My branch's collaborations with the NIMH Magnetic Resonance Spectroscopy core facility has been instrumental for the high-resolution detection of glutamate in the prefrontal cortex of depressed patients both prior to and during alcohol and ketamine infusions in the scanner.

I have also fostered and sustained numerous collaborations with the National Institute on Alcohol Abuse and Alcoholism. The NIAAA Section on Human Psychopharmacology instructed me in the technical aspects of pharmacokinetically-defined alcohol infusions. Finally, my collaborations with the NIAAA Laboratory of Human Neurogenetics allowed me to follow my basic and translational interests in pluripotent stem cell models of major depression to study the molecular and cellular effects of ketamine, its bioactive metabolites and potentially other compounds in the future. This collaboration was critical in my receipt of a 2-year NARSAD/Brain and Behavior Research Foundation Young Investigator Award in 2016.

Finally, and where the rubber really hits the road for any training program, I felt very confident to enter the academic job market in 2017. After a competitive recruitment, I was offered a tenure-track Assistant Professor possition with a generous start-up package to start my independent clinical/translational neuroscience research career at The University of Iowa Carver College College of Medicine and Iowa Neuroscience Institute.

As I hope is clear, this would not have been possible without the excellent training and clinical support from the NIMH Clinical Fellowship.