Frederic Quitkin

Abstract

Psychiatrist who was a leader in psychopharmacology. Born on March 28, 1937, in New York, NY, USA, he died of pancreatic cancer in New York, USA, on Oct 9, 2005, aged 68 years. Patrick McGrath began working with Frederic Quitkin when he signed up for a residency elective with him in 1976 at the New York State Psychiatric Institute's Depression Evaluation Service, NY, USA. “It was a real eye-opening experience”, said McGrath, now a senior psychiatrist in the service, where Quitkin worked for decades. “He was one of the people who brought modern psychopharmacology to our then mainly psychoanalytically oriented institute. It was the beginning of a change here at Columbia and elsewhere.” Quitkin's research focused on assessing rational treatments for depression, anxiety, substance misuse, and schizophrenia. Quitkin went to college at Princeton University, Princeton, NJ, USA, and then graduated from medical school at the State University of New York at Downstate in Brooklyn. He became the founding director of the depression evaluation service and was a professor of clinical psychiatry at the Columbia University College of Physicians and Surgeons, New York. Some of Quitkin's earliest work confirmed UK studies done in the 1960s that showed that monoamine-oxidase inhibitors were more effective than tricyclic antidepressants in treating atypical depression, said Donald Klein, director of the department of therapeutics, of which the service was one division. Next, Quitkin turned his attention to antidepressant study methods. Psychopharmacology researchers had known for some time that when antidepressants were tested against placebo, about 60% tend to improve on the drug, while 30% tend to improve on placebo, said long-time colleague Jonathan Stewart. “The reason we say the drug is an active agent is that there's an incremental response for some people. If we knew who was who, that would be very helpful. If we knew who got better with placebo, it would help management of treatment of depression.” “Fred grabbed the ball”, Klein told The Lancet. “He looked for patterns of response that you didn't see on placebo, for example delayed but significant responses.” Quitkin's latest efforts were based on the idea of dual therapy. Traditionally, Stewart said, doctors would try one antidepressant, then another if that failed. “90% seemed to be getting better by the third trial”, Stewart told The Lancet. “But we were losing people, they weren't sticking around. So he said, ‘why not give them all the trials at once?’ No one had ever thought of that. We came up with a two-treatment study. We're getting a lot more people better much more quickly.” Quitkin also investigated social and cognitive deficits in patients with schizophrenia. His finding of subtle neurological impairments in people with schizophrenia was “dramatically ahead of its time”, according to McGrath, because it challenged received ideas at the time that the disorder was linked to defective parenting. “One of the important things about Fred's research was that he was very interested in seeing people get better”, McGrath said. “He wasn't interested in theory or laboratory studies, he was really only interested in treatment outcomes.” He also had a large private practice. “We all shook in our boots when he was going away and he would ask us to cover his practice”, said Stewart. “When he got sick we covered and I found out just how much his patients adored him, some for decades. They had the worst problems you can imagine, and he would systematically work through and solve them.” Quitkin “would push you very hard to justify your beliefs”, McGrath said. “He had no patience with uncritical thinking.” He didn't suffer fools gladly, and was neither diplomatic nor patient. “Consequently a lot of people experienced him as brusque, but once you got past that and he thought you were a serious thinker, and didn't just accept things, then he would take you seriously and he would be your companion”, McGrath said, “and he was great to work with”. “The field has lost somebody who really looked at things differently in a constructive and instructive way”, Stewart said. Quitkin's favourite bit of advice on how to succeed in psychiatry was: you should dress British but think Yiddish. “Fred never really mastered the dressing British part, but he certainly mastered the thinking Yiddish”, McGrath said. He was an avid tennis player, and was known for showing up to sessions at research meetings in tennis clothes. “Friends described him as one of the most vital people they'd ever met”, McGrath said. “He had amazing drive, energy, and single-mindedness, a bias for action.” He is survived by a son, Matthew, and two daughters, Megan and Rachel.