I think that comorbidity studies really have been long overdue in this field. We now know that individuals with mood disorders, which is really where I’m working primarily, most individuals will present at the time of consultation or sometime in their life with some comorbidity, whether it be a psychiatric or medical comorbidity. And now our challenge is okay, how do we treat the patient who has a mood disorder and some comorbidity?

And I think clinicians would like, as we all would like, an evidence base, a scientific evidence base, that’s more reflective of the patients they actually see. So in psychiatry there’s been an emerging I think consensus that we need more studies, so-called ecologically valid, or real world, studies conducted in patients who are representative of real world patients, patients who have comorbidity from a psychiatric perspective, or comorbidity from a medical perspective.

Now I think it will be impossible to study every comorbidity. The list would be endless. But I think that there are some guiding principles that would emerge from any endeavor that attempts to look at how to manage comorbidity from a psychiatric medical perspective.

So as I see it, we often talk about this gap, the efficacy-effectiveness gap, efficacy, the performance of a drug in idealistic situations, usually in a university-based setting. And effectiveness is how well does an intervention a drug or psychosocial intervention really work in the real world? And real world patients are comorbid with many conditions. So I think our challenge and what we’re going to take on in the next decade is bringing more representative patients in so we can develop data which informs decisions, but I think benefits the real world patient.