Dr. Petros Levounis is President of the American Psychiatric Association and a leader in addiction research. He joins host Thea Gallagher, PsyD, to talk about the latest in addiction medicine, the state of the opioid crisis, the growing problem of technology addiction, and the promise and risks of psychedelic medicine. He also shares his hopes for the future of psychiatry, including better integration of diagnoses, treatments, and outcomes for people with mental health disorders.
00:00 Introduction to NYU Langone Insights on Psychiatry
00:16 Dr. Levounis's role and priorities as APA president
00:46 The State of Addiction Medicine
02:12 Neurobiology of Addiction
03:37 Interplay Between Mental Health and Addiction
06:03 Potential and Challenges of Psychedelic Medicine
08:37 Cannabis and Tech Addictions
10:11 Addressing the Opioid Crisis: Strategies and Solutions
15:28 Addressing Technological Addictions
28:55 The Future of Psychiatry: Goals and Aspirations
35:47 Conclusion and Final Thoughts
Visit our website for more insights on psychiatry.
Podcast producer: Jon Earle
Dr. Petros Levounis is President of the American Psychiatric Association and a leader in addiction research. He joins host Thea Gallagher, PsyD, to talk about the latest in addiction medicine, the state of the opioid crisis, the growing problem of technology addiction, and the promise and risks of psychedelic medicine. He also shares his hopes for the future of psychiatry, including better integration of diagnoses, treatments, and outcomes for people with mental health disorders.
00:00 Introduction to NYU Langone Insights on Psychiatry
00:16 Dr. Levounis's role and priorities as APA president
00:46 The State of Addiction Medicine
02:12 Neurobiology of Addiction
03:37 Interplay Between Mental Health and Addiction
06:03 Potential and Challenges of Psychedelic Medicine
08:37 Cannabis and Tech Addictions
10:11 Addressing the Opioid Crisis: Strategies and Solutions
15:28 Addressing Technological Addictions
28:55 The Future of Psychiatry: Goals and Aspirations
35:47 Conclusion and Final Thoughts
Visit our website for more insights on psychiatry.
Podcast producer: Jon Earle
NOTE: Transcripts of our episodes are made available as soon as possible and may contain errors. Please check the corresponding audio before quoting in print.
DR. THEA GALLAGHER:
Welcome to NYU Langone Insights on Psychiatry, a clinician's guide to the latest psychiatric research. I'm Dr. Thea Gallagher. Each episode, I interview a leading psychiatric researcher about how their work is shaping clinical practice. Today it's my pleasure to welcome Dr. Petros Levounis. Dr. Levounis is president of the American Psychiatric Association and a leader in the fields of addiction research and LGBTQ+ mental health. In our conversation, we talk about his priorities as APA president, the state of the opioid crisis, tech addiction, and the future of psychiatric care.
Hi, Dr. Levounis, and thank you for being here on the Insights on Psychiatry podcast.
DR. PETROS LEVOUNIS:
Thanks so much for having me here.
DR. THEA GALLAGHER:
And we're just going to dive right into it because you've done a lot of work with addiction medicine, and I want to just get a sense of where do we stand in the field of addiction medicine?
DR. PETROS LEVOUNIS:
Pretty good, I would say. We're in a situation where, on one hand, science has done tremendous things for us. We have safe and effective medications to treat our patients. We're delving more and more into the basic science of the addictive process. So on that front, addiction psychiatry, addiction medicine is skyrocketing. What we're not doing so well is translating all these research and all these findings and implementing these findings and all the tools that we have into everyday practice, and that is where we're at right now.
DR. THEA GALLAGHER:
What is the stuck point? Why do you think that's happening?
DR. PETROS LEVOUNIS:
Some of it has to do with some really outdated notions that once a person's addicted, they're addicted for the rest of their lives and there's nothing that can be done about it. Things of that sort that have totally been put aside and we're far more hopeful about addiction as a treatable medical illness. So that still lingers both in the medical profession as well as the general public.
DR. THEA GALLAGHER:
And are there any recent advances in the neurobiology of addiction that you find particularly exciting and hope to see impact treatment in the long run?
DR. PETROS LEVOUNIS:
Yeah, we've been talking a lot about the pleasure reward pathways of the brain, and we're talking a lot about dopamine and about these sets, the fun part of using any substances or behavioral addiction for that matter. But these days we are very much focusing on the dark side of addiction, this chronic sense of discomfort, the irritability, angst, the restlessness that people feel with their chronic addiction and the desperate attempt that they do to counteract that by using more drugs.
So there's that part of the science that focuses on what is often called hyperkatifeia, a Greek word meaning super depressed or super uncomfortable or chronically feeling a sense of malaise. And that is very much connected to our memories, very much connected to our emotions and to traumatic experiences, which is something that is becoming more and more the focus of attention in research.
DR. THEA GALLAGHER:
Yeah. The question is, it sounds like you're talking about how maybe depression, anxiety, malaise has an impact on addiction. Is that your understanding about the common root, or is there also that people maybe with an unremarkable mental health history can get involved with an addiction and then that then further impacts their mental health?
DR. PETROS LEVOUNIS:
I'm so glad you asked this question. It's all three, sometimes depression, anxiety, trauma, all kinds of mental disorders can very well lead to addiction and classic self-medication. Other times it's the other way around where let's say chronic use of alcohol can very well result in depressive disorders and anxiety disorders, and sometimes it's a third variable. It's a third possibility where the addiction and the other mental condition have developed separately and they're truly co-occurring and they're showing up at the same person.
The bottom line here is that whether depression leads to addiction, addiction leads to depression, or there are two processes that they are developing simultaneously and in parallel with one another, the treatment seems to be very, very similar. We treat both the addiction and the other mental illness, and we don't spend that much time trying to figure out which one came first.
DR. THEA GALLAGHER:
So we're less concerned with what came first. But it sounds like it's important to understand how they impact each other in a non-reductive way. And is that part of the treatment too, to understand the relationship?
DR. PETROS LEVOUNIS:
I would say that if the patient is particularly concerned about the connection between the two, absolutely. This is part of the psychotherapeutic process. We can very well discuss these matters with a patient. But at the end of the day, the mental illness needs its own treatment. Medications if needed, psychotherapy if needed. Addiction needs its own treatment, we have incredibly safe and effective medications for, let's say, opioid use disorder, the tobacco use disorder. We do have some medications for alcohol use disorder, and these need to be used across the board, whether the patient also works on other problems that they may have with their lives or not.
DR. THEA GALLAGHER:
And I think everyone's really excited about the potential psychedelic treatments and their impact on mental health, specifically depression, alcohol use disorder. What are your thoughts about psychedelic medicine?
DR. PETROS LEVOUNIS:
I'm very enthusiastic as well, and I think that the data are very promising. I think it's absolutely wonderful work that is being done both in the United States and Europe. And I have every reason to be quite optimistic about psychedelics. However, we haven't crossed all our T’s, we haven't dotted all our I’s. We haven't figured out the long-term potential addictive potential or other consequences of these psychedelics. We haven't elucidated the entire situation with drug interactions, pregnancy, kidney function, liver function, on and on and on. So we're not there yet. And the idea of having mom and pop shops pushing psychedelics in our neighborhoods is certainly not a good idea.
DR. THEA GALLAGHER:
And it seems like the pace with which psychedelic medicine and research is happening, and again, moving to being something that a prescriber or a clinician could prescribe, it seems that there's going to be a longer delay. And it kind of, I know for some of my patients, they're connecting with people who are maybe doing it kind of on their own. Not that they're finding it on the street, but they're finding maybe alternative methods or providers who are excited about the research and maybe using it. What are your thoughts there?
DR. PETROS LEVOUNIS:
I think that we need to slow down this train. I think that we should leave it to the researchers and for the full, very well-established process of having a medication approved for a particular indication, the way that we're doing now take its course. And I think it's irresponsible to bypass this whole FDA process and try to push this agent, which has tremendous potential. I have to keep on emphasizing this part and the data are very optimistic, but we need to let the process take its course. We have been burned before. We have been burned before with all kinds of agents that seemed great, and then they end up not being as originally advertised. So let's slow down a bit here.
DR. THEA GALLAGHER:
Yeah. It seems like a lot of the research that's even coming out about cannabis is less than promising with regard to its ability to help depression, anxiety, et cetera. What are your thoughts there?
DR. PETROS LEVOUNIS:
Absolutely. I would say that cannabis is probably going in the opposite direction of the psychedelics. The more the data are put in, the more concerned we become. Become concerned about the connection between cannabis and psychosis. A major Danish study came out a few months ago that is quite alarming about that connection. We're very concerned about anxiety, panic disorder with cannabis. And let's not forget that the number one reason why people do use cannabis is to medicate a cannabis withdrawal syndrome.
So from a patient's perspective, it is very difficult to see that something that is so effective in relieving anxiety can possibly be bad for you. From an addiction psychiatrist perspective, this is absolutely nothing new. We've been having patients come to our offices for the longest time, "Doc, I'm anxious. I take my Xanax, I'm not anxious anymore. Why on earth don't you prescribe it for me? You must be a very mean person not to give me the one thing that I know will certainly relieve my anxiety." This is something that is bread and butter in addiction psychiatry. So we have been used to that kind of idea.
DR. THEA GALLAGHER:
So in talking about some of the long-term implications in addiction medicine, we're at least a decade into the opioid crisis and the number of annual deaths remain near all time highs. In your opinion, what's needed and what do we need to do to drive those numbers down and save lives?
DR. PETROS LEVOUNIS:
Yeah, very, very recently, I would say over the past 12 months, we've been having a glimpse of hope. Some of the mortality has slowed down in the United States, and from May of 2022 to May of 2023, we've seen a 0.8% decrease in mortality across the nation. So this is not true across the board. There are several states in the west, in the south that still are recording increases in mortality to opioids. But it seems that the huge increase that we experienced during the height of the pandemic has plateaued and may be actually showing a small decrease right now.
We haven't fully understood what drove this improvement, but we cannot help thinking that the efforts that we've made with the two major medications, naloxone and buprenorphine played a major role here. Naloxone for reversal of an overdose for acute severe opioid intoxication and buprenorphine for the long-term treatment of opioid use disorder. In combination, these two tried and through interventions in opioid use disorder that we've known bad for the longest time, but we finally have been somewhat able to implement and give to our patients, have made a difference.
DR. THEA GALLAGHER:
And so is your goal that more people will know how to utilize these medications and how to help people, or is it kind of a population health rollout that you hope for?
DR. PETROS LEVOUNIS:
It is. It is. And the major message there is that they're simple medications. One of the words that irks me the most is the word complex. That addiction is so complex that people give up. It's not that complex. You see somebody who's overdosing on the street, if you happen to have with you the intranasal spray, actually two of them are what's needed these days because of fentanyl and the fentanyl mono analogs that are so powerful. So you need to carry with you two intranasal sprays and you just squirt it up the person's nose and you save a life. You don't need that extensive training about it. You just read the instructions on the pamphlet and you can just save a life.
In a somewhat similar fashion, buprenorphine. Primary care physicians, OBGYNs, pediatricians, internists, anybody can just prescribe buprenorphine to a patient. It comes in very simple doses. It's a sublingual medication. Now we also have once a month preparation, which is subcutaneous. It's just a very straightforward, simple, safe treatment that has, I don't know, in my mind, very little complexity, especially when I compare it with other treatments in medicine that they're far, far more complex than prescribing buprenorphine to someone.
DR. THEA GALLAGHER:
And do you think that maybe that is what keeps addiction stigmatized? That it's so complex and we'll never understand and like you said, can't be fixed, don't touch it. Do you think that leads to some of those complications?
DR. PETROS LEVOUNIS:
Yes. I think so. I think that a lot of physicians fully recognize how central addiction is to the wellbeing of their patients, but somehow they feel that it's something that's outside their scope of practice. Things like poverty and the war come to mind, things that people appreciate as major factors in people's health and illness, but just they're outside the doctor's office. They're too big, they're too complex, they're just too much. And that's what we're trying to educate people about. That addiction is not that complex. It's pretty straightforward. You assess, diagnose, you treat. Boom, done.
DR. THEA GALLAGHER:
Yeah. And it seems like that's a change and maybe how it was looked at in the past and like you said, making the treatment more accessible to both providers and patients. Are there other priorities you have in educating clinicians about addiction? Things that you wish more clinicians would be aware of?
DR. PETROS LEVOUNIS:
Yes, certainly. We look at vaping. We had a whole campaign about the detrimental effects of vaping. We're right now in the midst of a campaign about alcohol as it coincides with the holidays, which is a particularly risky time for our patients who use alcohol. But also coming up, we have a campaign on technological addictions. I would say that alcohol, opioids, tobacco, vaping are things that at least they're somewhat in the horizon of most mental health providers and physicians in general. But technological addictions, things like being addicted to internet gaming, cyber sex, social media are things that are emerging right now. There are quite a lot of data to support the idea that these are medical conditions, but the majority of people don't appreciate the massage.
DR. THEA GALLAGHER:
I know that I've heard clinicians say, "If you throw the word addiction kind of haphazardly on everything, it almost waters it down." But it sounds like you're saying there are real ways to measure technological addiction, obviously alcohol use disorder. But with technological addiction, what actually constitutes it as a full addiction?
DR. PETROS LEVOUNIS:
Yes, and I share the concern about not medicalizing everything that happens in our everyday lives. I am fully in support of that and let's be very cautious about what we call a medical illness and what we don't. For example, I mentioned social media. The vast majority of people engage with social media one way or another. Only a very small number of people, maybe 3%, maybe 5% at the most will actually cross the line into a frank medical condition, of an addictive disorder. And crossing the line is probably something that I'm being asked about more than anything else. What makes something pathological versus a part of normal every day of prey?
And the good news there is that we do have some pretty good criteria. The criteria are similar across the board. We borrow very heavily from substance use disorders, and we do feel that the brain processes that dictate addiction with substances are very, very similar to the addictive processes that are responsible for the technological addictions. So we do use those tried and true criteria that we have for substance use disorders. We modify them, of course, some for the technological addictions. And we have found that this is a pretty good way to go for establishing a diagnosis of a technological addiction.
DR. THEA GALLAGHER:
And I don't know if you've heard about the recent lawsuit, I think it's across states suing these social media companies saying that they are using certain kinds of reinforcers, behavioral reinforcers on social media to get children and teens addicted, which in some ways is a great business model for them. But what are some of your thoughts about companies being a part of the addiction process and problem?
DR. PETROS LEVOUNIS:
Well, I cannot go into the legalities of these cases. Of course, I'm not a lawyer, but I can say that we have seen this movie before in some different versions with the tobacco industry. It’s a very well-known fact that the tobacco industries hired chemists with the explicit task of finding the perfect combination of chemicals in cigarettes to maximize the addictiveness of their products. So this idea of using psychologists and psychological expertise to maximize the addictiveness of any kind of internet game is not something that is novel to us.
DR. THEA GALLAGHER:
And knowing that, do you think there are policy ideas that should be used to limit the availability or addictiveness of certain technologies to certain age groups?
DR. PETROS LEVOUNIS:
Given that the majority of youth engage in social media and also engage in internet gaming and of course massively texting and all kinds of other technologies, I'm not so sure that any kind of age limit would be easily enforceable. On the other hand, having frank conversations in families with children about the risks of some of these technologies and how it can get to the extreme is quite helpful.
Let me just make another point here. Both patients and families sometimes are very quick to embrace a technological addiction while something very, very different may be happening. What I'm saying here is parents see the kid playing video games all day. Meanwhile, the kid also may be hearing some voices and may start having some delusional thinking. And it's easier for both the patient and the families to embrace a technological addiction as an explanation of what is happening with the kid rather than something that is much more aligned with the psychotic disorders.
So my recommendation there to both parents and patients is that if you think that you may be crossing the line towards a medical condition, absolutely get some professional help because there may be something else that may be happening here, something that we have very safe and effective treatments for. And it would be a huge shame to misdiagnose something that we could very well address and treat.
DR. THEA GALLAGHER:
And for providers, say who are even new to this term of technological addiction, what should they be looking for or assessing? Again, where is that line between, we all use social media and technology many hours of the day. What are some of the criteria? Is it functioning? Is it mood? What should providers be looking for to kind of assess technological addiction?
DR. PETROS LEVOUNIS:
All right, three major spheres that they need to look at. The first one is a physiological aspect of addiction, meaning tolerance. Like people using more and more of the technology in order to achieve the same effect. Withdrawal, if they abruptly stop playing the video game or engaging in the social media that they get dysphoric, have tantrums in children, that they get some kind of a withdrawal syndrome from it. So that would be like a physiological component of the assessment.
The second sphere would be an internal preoccupation, that the person constantly lives with this idea that they spend tremendous amounts of time engaging with a particular technology and may be using the technology as self-medication against the depression or anxiety in their head. There's very little space for anything else but that particular technology that they may be addicted to.
And the third sphere is the external consequences. If you see the kids' grades going south. If a person, if it's an adult, starts missing days at work, being late at work, not fulfilling the responsibilities, their interpersonal relations are suffering that kind of have legal issues or medical consequences, insomnia being of course a major one with technological addictions. So these will be the external consequences of the behavior.
So physiological dependence, internal preoccupation, external consequences, the three major spheres of evaluation. I want to add to that my favorite criterion, which is continued use despite knowledge of adverse consequences, continued use despite knowledge of adverse consequences. "Doc, I know it's bad for me, I really know so, but I cannot help myself." That is quite a strong telltale that there may be a problem here.
DR. THEA GALLAGHER:
And for something like technological addiction, we can't use something like naloxone. So would you recommend more behaviorally focused treatments for this type of addiction?
DR. PETROS LEVOUNIS:
Yes, we do have both cognitive behavioral therapy and motivational interviewing have been studied for several technological addictions and have been effective. But also, let's not forget a good evaluation for co-caring psychiatric disorders for comorbid psychiatric disorders. A lot of our patients with technological addictions also have depression and anxiety. ADHD—attention deficit hyperactivity disorder—is quite common among people who play internet games excessively. So a good evaluation for other psychiatric disorders that may very well need treatment independent of the technological addiction is in order here.
DR. THEA GALLAGHER:
And maybe again, a medication like an SRI or something else that could treat maybe the core of the problem like depression or anxiety. And I've seen that work with many of my patients as well. I do want to go back for one second when we were talking about opiate addiction, and I remember you said something on the SiriusXM show that was really powerful and I think it might be good and important for listeners to know. But you were talking about how people with opiate use disorder might not need cognitive behavioral therapy initially. And I would love for you to share that data with our listeners. I think it is powerful and maybe not what a lot of clinicians automatically believe.
DR. PETROS LEVOUNIS:
There are some addictions for which we only have behavioral treatments, psychotherapies counseling, powerful psychosocial treatments, but no medications. Of course, the stimulants like cocaine and crystal methamphetamine come to mind. There are other disorders for which we know that the combination of medication with psychosocial supports, mutual help involvement. Things like alcohol use disorder are one of the most effective ways to go about treatment.
And then there's opioid use disorder and tobacco use disorder where medication is a must. There are data from Yale University, David Fiellin's group and other groups that have shown that adding expert cognitive behavioral therapy to simply prescribing buprenorphine to patients does not really add all that much to the success of the treatment. Of course, I offer it for my patients. I think that I am a psychiatrist and of course I love talking to people. And the counseling psychotherapy is so much part of who I am as a physician, so I do offer that to my patients. But the data really show that the primary, really the major game changer in the treatment of a patient with opioid use disorder is medication. So you can do all the psychotherapy and the counseling in the world you want, but unless you have buprenorphine on board, the chance that your patient's going to do well does not look very good.
DR. THEA GALLAGHER:
And it sounds like even as an adjunctive, it didn't make much of a difference. And so I guess from a mechanistic perspective, what does that make you wonder?
DR. PETROS LEVOUNIS:
That it's a very biologically driven illness. Of course these days we don't make that much of a distinction between the mind and the body. We very much appreciate how integral they are to one another, how very well-connected they are to one another. But when it comes to opioid use disorder, maybe one way to think about it that could be helpful to providers, to clinicians is that it's a very biologically driven illness that does need its medication for the person to succeed.
DR. THEA GALLAGHER:
Well, it sounds like this goes along with your theme of making addiction less complex. And I think most providers would love something more simple than more complex. So as much as it might be surprising, it sounds like it could be a really helpful tool or helpful data point and understanding for clinicians as well.
DR. PETROS LEVOUNIS:
Yes.
DR. THEA GALLAGHER:
And just to switch gears a little bit, you're now almost halfway through your term as APA president. Can you tell us a little bit about your mission as APA president and what your plans are going forward?
DR. PETROS LEVOUNIS:
Yes. We are on the cusp of a sea change in mental health in the United States, very much tied to the pandemic. We are switching from us psychiatrists trying to alert the world of the importance of mental health to switching to the other side where the world is yelling at us, "We know that mental health is so important, help us. Do something about it. Provide services, education, support." All kinds of things that we'd love to do, but we don't have enough people to deliver these treatments and support and education and counseling that we would like.
So we are faced with a major workforce issue, which is even more severe for child adolescent psychiatry. So we have devised new ways of delivering this care. We very much support the collaborative model of mental health services delivery where we partner with our physicians in other specialties, OBGYN, pediatrics, family medicine, internal medicine, as well as our partners in mental health professions outside of medicine, psychologists and social workers, counselors, and clergy as well. So it is a very elaborate and quite effective model of partnership between psychiatry and other parts of medicine as well as other parts of mental health.
DR. THEA GALLAGHER:
And so is your hope that more psychiatrists and psychiatry and social workers, counselors, psychologists, are integrated in schools, hospitals, workplaces? Because I think that's what you're saying people are asking for too. They think the stigma around mental health is lifting. Everyone wants to talk about it, they want it, but we can't keep up. So it sounds like, is the goal to have psychiatry more integrated in our world and in again, the workplace, schools, et cetera?
DR. PETROS LEVOUNIS:
Yes. It's twofold actually. One is to increase the number of psychiatrists that we have. And we have been quite successful and pushing for more residency slots for our medical students who in my world here at Rutgers New Jersey Medical School, when I first came here 10 years ago, who had only a handful of medical students every year wanting to do psychiatry. In 2023 we had dozens of medical students wanting to go into psychiatry. And we do not have enough slots to actually accommodate them. So we are working very much with the government, both the local and federal government, to increase the number of residency slots for our medical students, resident drugs in psychiatry and child psychiatry, but primarily psychiatry so that we can respond to that need.
And the second part is this collaborative model that the American Psychiatric Association has put together that involves all kinds of people in partnership with us to address the mental health needs of our fellow citizens.
DR. THEA GALLAGHER:
And if someone's listening and they are maybe even thinking about going into psychiatry, what is exciting about being part of the field right now and being part of what's happening in psychiatry?
DR. PETROS LEVOUNIS:
I have a very simple recommendation for that. Come to our annual meeting. Every May, tens of thousands of psychiatrists come together. This year it's going to be in New York City the first week in May. I have no problem advertising our meeting in May because if you're thinking about psychiatrist as a career, if you're an undergraduate or if you're a medical student and you're thinking that maybe this is for me, come to our meeting, it's actually free for medical students and get the vibe, see the amazing programming of course that we're going to have, but also check out the vibe of the specialty. "Is this what I would like to be part of professionally for the rest of my career, for the rest of my productive years?" So it's an identity issue. If you really like to be a psychiatrist, if you think that the mind and the medical aspects of mental illness are part of what you would like to assess, diagnose, and treat, by all means. I think that this may be for you.
DR. THEA GALLAGHER:
And you talked a lot about the goals you have in the APA and in addiction medicine. Just for our final question, any kind of pipe dream or something that you hope for the future to see in the next 10 years in psychiatry?
DR. PETROS LEVOUNIS:
Well, I would like to see an integration of diagnosis, treatments and outcomes. We've done incredible strides in diagnosis. Everybody knows about the DSM-5, the DSM-5-PR more specifically, that came out last year. And I don't think there's anyone in the world of medicine or mental health more specifically who doesn't know about the DSM. So we've done a great job with diagnosis. We've done an amazing job with treatment and recommendations. We have all these guidelines, how to treat different disorders, and we are now working very hard with our registry into checking out the outcomes, the outcomes from our patients, how well they're doing, and how they're progressing towards their treatments. So there may very well be in the near future a way to combine diagnosis, treatments, and outcomes so that we can advance our research and be even more confident about our diagnostic acumen as well as our treatment recommendations.
DR. THEA GALLAGHER:
Yeah, so answering the call of this mental health crisis with this combination of efforts that will hopefully change outcomes and integrate mental health into our everyday lives.
DR. PETROS LEVOUNIS:
Absolutely.
DR. THEA GALLAGHER:
All right, well thank you so much, Petros. We really appreciate it. And thank you for being on the podcast.
DR. PETROS LEVOUNIS:
Thank you very much. It was great talking with you.
DR. THEA GALLAGHER:
Thanks so much again for that conversation, Dr. Levounis. If you enjoyed this episode, be sure to rate and subscribe to NYU Langone Insights on Psychiatry on your podcast app. Your support helps us bring you to the frontiers of psychiatry. Thank you. For the Department of Psychiatry at NYU Langone. I'm Dr. Thea Gallagher. See you next time.