Episode 10: A Decade of Unravelling Mood Disorder Mysteries: The CAN-BIND Research Journey
Dr. Fabiano Gomes: Welcome everyone, to another exciting episode of The CAN-BIND Podcast. I’m your host for today, Dr. Fabiano Gomez, and today we have a truly special guest joining us. Please join me in welcoming Dr. Susan Rotzinger, the esteemed program manager of CAN-BIND. Dr. Rotzinger is not only an assistant professor in the Department of Psychiatry at the University of Toronto, but she has also been a driving force behind CAN-BIND since its very inception. For those of you who may not be familiar with CAN-BIND, it’s a national program of research and learning that is dedicated to improving depression care for all Canadians.
With a bold mission to deliver fast and effective care to individuals living with depression, CAN-BIND has been at the forefront of innovative research methods and collaborative efforts over the past ten years. Today, we’ll dive deep into the fascinating world of CAN-BIND with Dr. Rotzinger herself. Dr. Rotzinger, Susan, our dear Susan, thank you so much for joining us today. We’re thrilled to have you here. Can you tell us a bit more about yourself and what things you were doing before you joined CAN-BIND?
Dr. Susan Rotzinger: Sure. Thanks very much, Dr. Gomes, for having me here and giving me the opportunity to speak about CAN-BIND. Yeah, before I joined CAN-BIND, I’ve always been involved in neuroscience research.
I did a PhD in neuroscience and psychiatry at the University of Alberta with Dr. Glen Baker, and he was a fantastic mentor. So I really learned a lot about basic lab science and psychiatry as well. And then I did a postdoc in Toronto, at the University of Toronto with Dr. Franco Vacarino doing, again, basic lab science. But at that time, you know, he was speaking with Dr. Sidney Kennedy a lot about the idea of a biomarker discovery network. And along with- CANMAT, the Canadian Network for Mood and Anxiety Treatments, they had really been thinking that they wanted to develop this biomarker network so I had the good fortune of being in the right place at the right time, around 2009 when I started working with Dr. Kennedy.
Dr. Fabiano Gomes: That’s great. So you’re a hardcore neuroscientist, Susan. That’s amazing. And can you tell us a bit about how CAN-BIND came to be? What was CAN-BIND? How did the idea come out?
Dr. Susan Rotzinger: Yeah, so it was a good time for a number of things that came together. So I mentioned CANMAT. They are a national network focusing on developing guidelines and providing education for healthcare providers and the public. But they were also thinking at the same time about a biomarker network and in the field, it was recognized that we really needed biomarkers to help guide treatment selection. There are a lot of good treatments that work for people, but it’s hard to know which treatment is right for which individual person.
So the thought was to develop this biomarker network. And at the same time, a great funding opportunity came along through the Ontario Brain Institute and they were looking to bring together groups of researchers, community partners and industry partners to form these integrated discovery programs to help accelerate discovery, innovation, economic growth, and really ultimately help patient care. So we applied for this, and that was in 2011. We got a little bit of funding at the start and then in 2013, we were fully funded for the first five years of CAN-BIND.
Dr. Fabiano Gomes: So Susan, and how is the CAN-BIND group organized?
Dr. Susan Rotzinger: Mmhm. So we have quite a large executive team where we have one representative from each of the institutions that’s involved with CAN-BIND. And we also have a leader for each platform. So we have different data platforms. We have the Clinical Research Platform, Neuroimaging, EEG, Molecular, Knowledge Translation, and now we have a new Digital Health platform as well. So each of those platforms has a lead and different personnel who work within that data platform.
Dr. Fabiano Gomes: That’s great. And I’m interested in the knowledge translation platform too, because that’s when you usually get the translation. And so how does that knowledge translation platform work?
Dr. Susan Rotzinger: Yeah. So we’ve been very fortunate to have Dr. Sagar Parikh with CAN-BIND since the beginning and he’s also working with CANMAT since the beginning. And he really has an expertise and a passion for knowledge translation. So he brought to CAN-BIND different methods of sharing this knowledge through… could be conferences. We’ve organized several international conferences. We have continuing medical education events, we have public education events with community partners. We also have knowledge products such as podcasts, videos, newsletters, pieces on our website about research findings in plain language. And I think one of the highlights of the knowledge translation platform was the CHOICE-D Guide. And this was a guide created by and for people with lived experience to translate the professional CANMAT treatment guidelines into a more understandable lay version that people can use and discuss their treatment options with their health care provider.
Dr. Fabiano Gomes: That’s amazing. All these products, they’re all available on the CAN-BIND website.
Dr. Susan Rotzinger: Yes, yes. That’s right. So I definitely encourage people to go and take a look at that.
Dr. Fabiano Gomes: That’s great. And one important issue when we are thinking about those collaborations and partnerships is usually funding, right?
Dr. Susan Rotzinger: Yes.
Dr. Fabiano Gomes: And it seems like there was an opportunity for some funding, right?
Dr. Susan Rotzinger: Yes. That’s the biggest part of any research endeavour, is trying to raise the research funds. So it really was the Ontario Brain Institute or OBI that helped to launch us. And we also had to have funding partners for that opportunity. It was a grant that required matched funds be brought to the table. So we’ve had industry partnerships and each of the investigators who are involved in CAN-BIND also brings some of their own research funds, some funding from their institutions. So it’s been really a collaborative effort.
Dr. Fabiano Gomes: So it seems like you have different sorts of funding, right? Do you remember on the top of your head the funders of CAN-BIND?
Dr. Susan Rotzinger: Yeah, definitely. So we’ve been supported quite generously by Canadian Institutes of Health Research, so CIHR, a number of different grants over the years to different investigators as part of our team, and Brain Canada, Ontario Mental Health Fund, and the Ontario Research Fund for Research Excellence also funded us.
Dr. Fabiano Gomes: Quite broad, really interesting to have like public funding right, together with the institutions themselves and the researchers, and also industry. By industry, you mean like pharmaceutical companies? Any controversies about like bringing money from drug companies?
Dr. Susan Rotzinger: Yeah, there is the perception and we have to be very careful that they are completely unrestricted funds and this is completely investigator driven research, that it’s not influenced by the pharmaceutical company at all. But really, like I mentioned, it was part of our funding requirement that we brought this extra funding in and also the scope and the expense of our research. We couldn’t do it without the additional funding sources.
Dr. Fabiano Gomes: That’s interesting. Those unrestricted grants.They give the money and you can actually use the money as the program needs and in the interest of the program itself.
Dr. Susan Rotzinger: That’s correct. Yeah.
Dr. Fabiano Gomes: That’s great. That’s great. So, Susan, and how was your initial involvement with the program? I mean, dealing with all those big shot researchers in the mood disorders field, how did you start working with them?
Dr. Susan Rotzinger: They’re a great collaborative group of people, and it was a lot of fun. Everyone had the same vision and the same goal, and they really bought into the idea. It was truly Dr. Kennedy he was the driving force behind it, but we all had the same idea and vision, and it was you know weekly conference calls, lots of meetings, lots of discussions.
Dr. Fabiano Gomes: And how were the first programs and the first projects? What were you doing first?
Dr. Susan Rotzinger: So the first step was to develop a standardized data collection platform. So to really get all of the neuroimaging protocols standardized across the country, all of the clinical protocols, and to decide you know which data would we collect, which scales were we most interested in. So we had a lot of discussions about that. And then our first major study was what we called CAN-BIND 1, and that was a 16-week treatment trial.
Dr. Fabiano Gomes: So it started with kind of one project that had a unique portfolio of different biomarkers. They treated patients with a specific treatment, trying to understand what would be the predictors of like response and non response. Right? That’s quite innovative, right, at least if we think about like, ten years ago. So this is still really interesting. Do you have your own opinion about what makes CAN-BIND truly unique?
Dr. Susan Rotzinger: Yeah, I think one thing is definitely the network, the friendships, the trust that the researchers have for each other, and that has been critical to making it through some of the more difficult moments and long trials and other things. It’s the friendship and the trust that the group of researchers have. And I think on a research perspective, it is the breadth and depth of measures that we’re collecting. It is quite unusual to be able to collect all of these different types of biomarker data in one study.
Dr. Fabiano Gomes: That really, truly inspiring. And apart from this pivotal study with the treatment, there have been a lot of other even trials right within CAN-BIND, and I’m familiar that the group is also working about summarizing the findings. But there are other findings that you would like to highlight for the past ten years of CAN-BIND?
Dr. Susan Rotzinger: Yeah, I think one thing that we’d like to highlight is that we, as part of being funded by the Ontario Brain Institute, we make our data available to other researchers so that can be accessed once we have cleaned the data, analyzed the data ourselves, we do make it available for others to apply for and work with. And I think that’s quite important. And the other thing is, our knowledge translation program is very unique, and we’ve been providing healthcare provider information and public information to try to help people understand their own treatment options, what is depression, and what might be the best treatment option for an individual.
Dr. Fabiano Gomes: That’s great. And it’s really inspiring to hear about the impact right. Because what you’re talking is about how we can translate findings that usually are presented at conferences, published on manuscripts. Sometimes we do have one talk or another, but how can we translate that into change in practice? And eventually, I mean of course, with the goal of improving patient care. So that’s really inspiring. And if we think about it as an organization, Susan, how has CAN-BIND evolved over the past decade? What have been some of the biggest challenges you faced along the way? Because you started with that funding to maybe fund some projects, and it seems like it’s evolved and changed quite a bit.
Dr. Susan Rotzinger: Yeah, it has evolved. We started from no network whatsoever and no funding, and we were proposing this idea to funding agencies, and really people doubted the feasibility. They questioned whether we could do it. So I feel like that’s been our major accomplishment. We’ve not only done it, but now we’ve got data, over 1000 participants in our database and we’re moving into you know the next ten years. So I feel like we’ve evolved from trying to prove that we could do it to now really trying to test some of the biomarkers that we found in the first phase of funding and we’re really at a point now where we can do that.
Dr. Fabiano Gomes: It’s probably only possible with these collaborations. Right? And I’m sure that’s quite a complicated topic sometimes to navigate. Can you tell us a bit more about how you navigate the collaborations? Kind of having a way of everybody that it’s on board, it’s kind of satisfied with whatever results they have?
Dr. Susan Rotzinger: Sure. Yeah. So one of the difficulties of the collaborations is sort of the administrative aspect, the contract, the agreements. Those are the things that can slow things down or make it more difficult to move along as quickly as we’d like to but we must, you know, have all of the proper documents in place. But on a scientific perspective, I think we’ve got a good group with healthy debates, so we can talk about different ideas and bounce things back and forth. We meet very regularly, at least twice a month, all of the executive team gets together and we talk about any of the research issues. So there haven’t been any major conflicts, thank goodness. Along the way, we’ve been able to just work it out.
Dr. Fabiano Gomes: That’s great. So no problems dealing with all these high profile, high achiever researchers. It’s been okay for you then, Susan?
Dr. Susan Rotzinger: Yes. Yeah.
Dr. Fabiano Gomes: And it probably caused a lot of your personality. You have a nice temperament. It seems like someone that can navigate these issues quite well. It’s really interesting, actually. And I would like to emphasize the power of collaboration. And it seems like that’s what CAN-BIND is there for. Another interesting part of CAN-BIND is that it’s not only a network of the researchers, but there’s also a lot of patients, families. All the stakeholders are involved. And even if we think about policy making with the OBI and all the funding from the government…
Dr. Susan Rotzinger: Oh, definitely, yes. It’s been.. it’s wonderful to have the Community Advisory Committee, and we meet with them six times a year. We have researchers join the conversation so we can really hear what their concerns are and we can also bring ideas to our Community Advisory Committee to ask them, what do they think? We have two Community Advisory Committee members sitting on our executive for CAN-BIND, so they’re at every executive meeting, so we can consult with them, ask what they think.
You know when one of these conflicts does arise, when we’re debating different sides of an issue, we always turn to the Community Advisory Committee as well to say, what do you think? We used to be able to have a friends and family day in person prior to the pandemic, which was a wonderful opportunity to present the research findings to our community. And we hope to bring those back again now that we’re back to in-person events. We also used to have annual workshops where we would bring together all the stakeholders, the industry partners, the community partners, the researchers. And those were two day conferences which were, again, a great opportunity to share ideas and talk with our stakeholders.
Dr. Fabiano Gomes: That really unique and we can say that now it’s becoming a tendency, right? To all big groups and all big studies. They do bring people with lived experience, their families, to try to have some input, to get some input, and sometimes they become true collaborators. And it seems like at CAN-BIND that’s what happens, right. And it’s likely an integral part for this successful recipe that it’s CAN-BIND. Can you tell us a bit more, Susan, about the rewarding aspects of your role here at CAN-BIND? Because I can see that you’re quite excited and speak about it with a lot of enthusiasm, too. What are your personal rewards from working with CAN-BIND?
Dr. Susan Rotzinger: For me, it’s such a wonderful opportunity to be able to be part of this network and working with the scientists and the investigators and the community partners. It’s such a dedicated group and we’ve really seen such an evolution, like we were talking about earlier, about from the early days of thinking about this was a good idea until now. We’ve actually found biomarkers and we’re testing them. And I’m really fortunate to be able to work with the group of people that I do work with.
Dr. Fabiano Gomes: And it’s great. And it seems like you are able to continue to work on your career as a neuroscientist, right, but also with this administrative role, this really important role of getting things done. So it seems like it’s kind of your lab here. The CAN-BIND group, right? And do you have any advice, Susan, for people like researchers, maybe clinicians that are looking to pursue this career in depression research and care? Do we have any tips for them?
Dr. Susan Rotzinger: I think to reach out to the researchers, to the organizations. We’re always happy to speak with people and collaborate, and we have some amazing, even international collaborations that we’re working on now. And we’re growing, we’re in a new phase. So I’d say people should not be afraid to reach out and make a connection with us.
Dr. Fabiano Gomes: And Susan, I mean we talked about a bit of the opportunities and the advice you gave for like young researchers and the CAN-BIND community. Opportunities, maybe for people that are living with depression and they’re interested in participating in studies. Do you have open studies at this time?
Dr. Susan Rotzinger: Yes, we do have some studies that we’re recruiting for currently, and people can find out more information about them from our website.
Dr. Fabiano Gomes: That’s great. And CAN-BIND has a really good website and also a newsletter, right? So people can sign up to kind of get the information they need about the network, and also know the clinicians and the researchers that are working. I think there are great opportunities too. So can you give us a sneak peek of what’s coming for the next decade or maybe for the next few years of CAN-BIND?
Dr. Susan Rotzinger: Sure, yes. It’s very exciting. As I mentioned, our new director of CAN-BIND, the leader, Dr. Benicio Frey, and he has brought in a lot of new ideas. And we have a new funding opportunity right now through Brain Canada that we’ve been awarded. So we’re really moving away from the smaller projects toward a larger platform. This master clinical trial platform idea where we can enrol more participants and share the data more widely with other groups and collect biomarker data from different projects that are ongoing. So it’s really trying to expand this database of biomarker information and participants and being able to link participants. If people are interested in participating in research, we can link them with studies that are appropriate for them.
Dr. Fabiano Gomes: That can truly be like a game changer right in the field of depression research, especially with biomarkers having such an impressive network of really brilliant and high profile researchers. That’s amazing.
So Dr. Rotzinger, thank you so much for joining us today and providing us with such invaluable insights into the incredible work that CAN-BIND has done in the past few decades. It was really like an absolute pleasure having you here today.
Dr. Susan Rotzinger: Thank you very much. It was my pleasure.
Dr. Fabiano Gomes: And to all our listeners out there, thank you for tuning in to this episode of the CAN-BIND podcast. Stay curious and stay engaged. Thank you.