Featured Research Fellow: Mirjana Domakonda, MD

Featured Research Fellow: Mirjana Domakonda, MD

Mirjana Domakonda, MD, is an NIMH T32 postdoctoral research fellow under the mentorship of Rachel Marsh, PhD. Dr. Domakonda is investigating the evaluation, treatment, and neurobiological underpinnings of eating disorders. She is also interested in understanding the impact of the Internet, online connectedness, and social media on psychiatric practice, and has presented numerous workshops to assist physicians in harnessing the power of social media and technology to enhance their personal and professional lives.

Dr. Domakonda trained in psychiatry at the University of Massachusetts—Worcester, where she served as a PGY4 psychosomatic chief resident. During her training, she received several national awards, including the Association of Academic Psychiatrists (AAP) Fellowship Award and the American College of Psychiatrists Laughlin Fellowship, served as chair of the AAP Trainee Caucus, and authored several publications in the area of disordered eating. After graduating from psychiatry residency training, she joined the NYPH Child and Adolescent Psychiatry Training Program. She was the recipient of the Dr. Suzanne Munson Memorial Award and used this experience to explore her research interests in eating disorders. She was later awarded an AACAP Lilly Pilot Research Award to further pursue her interest in developing novel treatments for bulimia nervosa.

We sat down recently with Dr. Domakonda to discuss her work, her aspirations, and her clinical and research training thus far at the Columbia University Medical Center, New York State Psychiatric Institute, and NewYork-Presbyterian Hospital.

Q: Could you tell us what got you interested in the field of child and adolescent psychiatry? 

Throughout middle school and high school, I broke my ankle three times. After numerous surgeries, whereas most young adults would vow never to set foot in another hospital, I decided I wanted to be an orthopedic surgeon to help clumsy people like myself. However, after almost fainting my first few times in the OR (operating room), I realized I wasn’t destined to be a surgeon. During my psychiatry rotation, I spent a month in a pediatric emergency room evaluating kids with psychiatric concerts. One night, I met an overweight young woman who’d come to the ER because she was thinking about ending her life. Although her chief complaint was depression, we talked mostly about her weight, which had crept up over the last several years, starting with the loss of her mother in childhood and, more recently, when her brother left for college. Throughout the interview, we both realized her weight—a topic rarely discussed, but one she was constantly reminded of—played a major role in her depression. As a result of that interaction and my experience in the ER, I decided I wanted to learn more about child and adolescent psychiatry and the impact weight-related disorders have on the developing adolescent brain and psyche. During medical school, I worked on a project evaluating the psychological impact of BMI (body-mass index) screenings in Pennsylvania’s public schools, and that solidified my desire to pursue a career as a clinical researcher.

Q: Did you think the BMI screenings were a good idea?

I understand the desire to screen children and gather information, but the information I gathered from parents suggested the screens were upsetting for their children and didn’t provide any new information. Most parents already knew their teens were overweight, but they struggled with how to help. Unfortunately, the screens didn’t provide parents with any follow-ups or suggestions—at least that’s the impression parents had. To them, the system was intrusive and unnecessary. Another issue was that parents would receive the results, and think, “Yeah, I know,” and wouldn’t share the information with their child because they knew it would be upsetting. Treating weight-related issues goes far beyond a number, and the screenings were a tiny snapshot of a much broader issue.

Q: What led you to the Child and Adolescent Psychiatry Fellowship Program and the Columbia University Medical Center (CUMC)?  

It was actually a fortunate series of events. During my third year of general psychiatry residency at U. Mass, I received an ASCP (American Society of Clinical Psychopharmacology) fellowship to attend a research workshop. Dr. Moira Rynn happened to be one of the session speakers, and I was inspired by her research career, especially in a field dominated by men. I approached her after the talk and told her about my interests in disordered eating and that I had written a few papers but hadn’t worked on my own independent study. She ended up introducing me to Dr. Rachel Marsh, who heads the Cognitive Development and Neuroimaging Laboratory at the New York State Psychiatric Institute (NYSPI) here at the medical center. I ended up spending a month in Dr. Marsh’s lab, which is where I really started to look at the intersection between eating disorders and attentional dysfunction. That experience, along with attending the T32 seminars during my elective, set me on a specific path. I ultimately decided I wanted to be at Columbia for my child fellowship, so I could continue to work with Dr. Marsh and eventually apply for the T32 program to pursue my research interests.

Q: You currently have a pilot grant—what are you studying?

I was awarded a pilot grant through the American Academy of Child and Adolescent Psychiatry. The grant provides money to child-adolescent junior faculty psychiatrists to collect pilot data so they can apply for larger grants in the future. I’m interested in how the brain works, and I’m specifically looking at the relationship between attentional dysfunction and bulimia nervosa. I’m using a computer task to test whether adolescent girls with bulimia pay more attention to high-calorie or high-fat food, and how that contributes to their overeating episodes. The specific term is “attention bias,” and it’s been studied in anxiety, but less commonly in eating disorders. All the girls in my study also participated in Dr. Marsh’s longitudinal study, so I’ll fortunately be able to compare their results with their baseline brain scans to see if any attentional problems could have been detected early on in their development. I’m still gathering data, but I hope to publish some of the results this year.

Q: When I hear “residency,” I think extensive clinical training. You did a lot of clinical work, but it seems like you always had your eye on the research side. What is the expectation of residents, and were you not the norm?

Child psychiatry training is focused on the clinical experience, and the goal of the fellowship is that we become the best clinicians regardless of where our career leads. The fellowship at NYPH is great in that respect. Because there are so many training sites, we had the opportunity to see many different children across a wide range of disorders. As residents, we learned how to manage some of the toughest cases with the help and support of world-renowned faculty. That said, we were also encouraged to follow our passions and find our niche. Mine happened to be research, but other fellows pursued school-based mental health, autism, or trauma-related work, to name a few. In that sense, I wouldn’t say I’m different from other fellows, because I think clinical work and research are equally important and rewarding, and I plan to continue to treat children and adolescents in the future. Although I’m pursuing research, I’m a clinician first. My inspiration to pursue research stems from the hope that my work will translate into new and novel treatments for kids.

Q: Is there anything about the T32 fellowship here that has surprised you?

I wanted to do a T32 fellowship here because of the resources and faculty at Columbia. I was looking forward to continuing my work with Dr. Marsh and gathering as much knowledge as I could in a supportive and stimulating learning environment. There is, however, a huge and immediate shift from full-time clinical work to full-time research. One is no longer responsible for patients, but one has a whole host of new obligations, from mastering statistics to applying for grants. The learning curve is steep. Whereas I spent much of my fellowship doing clinical work and wishing I had more time for research, I’m now suddenly immersed in reading papers and wishing I could see patients! But in all seriousness, it’s a privilege to have dedicated research time and access to the some of the most esteemed researchers in the world, and I’m excited for the next few years.

Q: Do you have any advice for future fellows?

First, you need to be motivated. If you’re passionate about something– whether its childhood anxiety or healthcare reform–seek out opportunities to learn more about that passion. Get involved with others in the field, attend lectures, write, read, apply for travel awards—be proactive! Also, look outside your hometown. Many of the opportunities I have had arose from people outside of my institution, and they have since become collaborators and friends. That leads to the next piece of advice: Find a mentor. Or rather, think about a clinician or researcher you admire or one you would seek out for your toughest cases. That’s your mentor. It took me a long time to realize that mentors are all around, and that someone doesn’t need to designate herself as a “mentor” for them to be yours. Most of my mentors probably don’t even realize they serve that role, but they’ve all been immensely helpful in guiding me in my career decisions and talking me through tough choices. Finally, take care of yourself and your relationships. Fellowship is exciting, but intense, and you won’t survive if you give up your hobbies, neglect your health, or ignore your loved ones. I recommend planning in hobbies, gym classes, and time with family as if they are important meetings (because they are!) and blocking that time into your schedule. This will ensure your happiness and future success in all arenas.

Q: What do you envision for the future—both in terms of your own work as a psychiatrist and in terms of treatment for those suffering from eating disorders such as bulimia nervosa? 

After my T32 fellowship, I plan to apply for a K Award, which is a career research award, during which time I’ll be able to learn more extensively about how underlying brain mechanisms lead to the development of bulimia nervosa and other disordered eating patterns. I also hope to develop an expertise in neuroimaging techniques, such as functional magnetic resonance imaging, that I can use to study these neural networks. In the future, I want to become a principal investigator with my own research lab, which will allow me to broaden my research and translate my findings into clinically relevant treatments for those suffering from eating disorders and weight-related issues.