GUEST: Dr. Charles Zorumski is the Samuel B. Guze Professor and Head of Psychiatry, and Professor of Neuroscience at Washington University School of Medicine (WUSM) in St. Louis. He also serves as Psychiatrist-in-Chief at Barnes-Jewish Hospital and Director of the Taylor Family Institute for Innovative Psychiatric Research.
In this engaging conversation, Dr. Mark Gold interviews Dr. Zorumski about Washington University’s (WashU) transformative impact on psychiatry. The discussion covers the institution’s foundational work in diagnosis, brain imaging, and treatment innovation.
Starting in the 1950s, WashU’s Department of Psychiatry—led by Eli Robbins, Sam Guze, and John Feiner—developed the first reliable diagnostic criteria, forming the basis for the DSM-III. This shift from subjective impressions to reproducible, criteria-based diagnoses enabled rigorous research and clinical trials, reshaping psychiatric practice.
WashU also pioneered brain imaging, progressing from early PET scans to advanced fMRI and precision functional mapping. These tools have helped link psychiatric symptoms to specific brain circuits, reinforcing the integration of neurobiology into psychiatry. A strong culture of mentorship has supported this interdisciplinary approach.
In treatment, WashU remains a leader in electroconvulsive therapy (ECT) for treatment-resistant conditions and has been at the forefront of testing rapid-acting antidepressants like ketamine and nitrous oxide. The institution has also advanced neuromodulation techniques such as vagal nerve stimulation and transcranial magnetic stimulation (TMS).
Dr. Zorumski highlights the translational success of neurosteroid research, particularly allopregnanolone, which led to FDA-approved treatments for postpartum depression and epilepsy. The conversation concludes with emerging research on psychedelics like psilocybin, where precision brain imaging is helping to uncover therapeutic mechanisms.
Key Insights
🏥 Medical Model Transformation: WashU revolutionized psychiatry by replacing psychodynamic impressions with a medically grounded, criteria-based diagnostic system. This enabled reproducible research and clinical trials, culminating in the DSM-III and reshaping global psychiatry.
🧩 Diagnosis as Prognosis: Sam Guze emphasized that diagnosis should predict illness course and guide treatment—an idea rooted in traditional medicine but novel in psychiatry. Longitudinal validation made psychiatric diagnoses more meaningful and clinically useful.
🧪 Imaging Bridges Biology and Diagnosis: WashU’s evolution from PET to fMRI and precision mapping has helped identify brain circuits underlying psychiatric symptoms. The challenge now is refining these tools for individual-level clinical use, akin to precision medicine in genetics.
⚡ Rapid-Acting Treatments Need Biomarkers: Traditional antidepressants take weeks to work. Rapid-acting agents like ketamine and nitrous oxide offer relief within hours but require new biomarkers and algorithms to guide personalized treatment.
💡 Neurosteroids from Bench to Bedside: Collaborative research at WashU led to the development of brexanolone and other neurosteroid-based treatments. This success story exemplifies how interdisciplinary science can yield transformative therapies.
🤝 Mentorship Fuels Innovation: WashU’s scientific culture, encouraged integration of neuroscience into psychiatry. This mentorship model continues to drive innovation in understanding and treating mental illness.
🍄 Psychedelics and Precision Imaging: Psilocybin studies at WashU use personalized connectome mapping to reveal how psychedelics alter brain connectivity. These insights may lead to individualized psychedelic therapies and deeper understanding of their mechanisms.
