Sajoy Varghese, MD, FAPA, FASAM
Candidate for Regional Director
Region VI - Illinois, Indiana, Iowa, Michigan, Minnesota, Wisconsin
Sajoy Varghese, MD, FAPA, FASAM. Integrating findings from clinical populations, such as those obtained using peripheral markers with basic science discoveries for rapid diagnostic and therapeutic utilization has been particularly challenging in psychiatry. This is due in part to the relative paucity of trained psychiatrists with the requisite skills, knowledge, and experience to conduct meaningful clinical research.
Over the next two years, I plan to undertake an intensive training period to apply for an independent clinical researcher. I started my focused research on addiction psychiatry/medicine entitled “Stress and Drug Addiction: A focus on Corticotrophin Factors” from 2010 during PGY4 at Northwestern University, Chicago. Illinois. In that animal stress model project, I studied animal behaviors pre- and post-morphine exposure. I continued that project during my Addiction Psychiatry Fellowship at University of Illinois at Chicago during 2011-12 with the focus of prodynorphin expression in pre- and post-morphine exposed mice brain.
From 2011 to 2015, I have been studying the impact of Mindfulness Meditation Interventions (MBI) to prevent relapse among human subjects with substance use disorders (SUDs). The key finding of that study concluded that MBI provides patients with tools to target symptoms such as poor affect regulation, poor impulse control, and rumination. Evidence supports that using MBI in addition to the usual treatment can prevent SUDs relapse.
Since graduating medical school, I have dedicated myself to clinical psychiatric research. For this reason, I chose to perform my residency at Northwestern Feinberg School of Medicine and focused on bench science research and focused case studies on the field of Psychiatry and Addiction Medicine. Following residency, I accepted a position at the University of Illinois as an Addiction Psychiatry Fellow. Subsequently, I worked as a staff psychiatrist at Captain James A. Lovell, Federal Health Care center, then transferred to Jesse Brown VA Medical Center, subsequently transferred to Northern California VA Health Care System, and recently transferred to VISN 23, Clinical Resource Hub in between 2012 to 2024.
During this time, I moved my research work forward by presenting posters at national, international scientific meetings, and published papers based on these presentations.
Candidate Questionnaire Responses
1. What have been your greatest contributions to ASAM or to the field of addiction medicine over the last 10 years?
My interest in research peaked after watching a documentary on 鈥楽tress, Portrait of a killer鈥� by Dr. Robert Sapolsky. I began my research career in addiction psychiatry on 鈥淪tress and Drug Addiction: A focus on Corticotrophin Releasing Factor (CRF)鈥� in 2010 as a fourth-year psychiatry resident at the Northwestern University, Chicago. In a mice model, I studied stress and behaviors pre- and post-morphine exposure. I continued this work during my addiction psychiatry fellowship at University of Illinois at Chicago during 2011-12. In the mice model research, I also focused on Early Life Stress (ELS). ELS activate CRF which influences substance use disorders (SUDs).
As hypothesized, over-expression of CRF gene in the forebrain may play an important role in increasing the vulnerability to SUDs by modulating prodynorphin protein expression in the mice brain. Subsequently, I have been studying the impact of Mindfulness Based Interventions (MBI) to prevent relapse in humans with stress-related disorders and SUDs. The key finding of the study was that MBI provides patients with tools to target symptoms such as poor affect regulation, poor impulse control, and rumination. Evidence supports that using MBI in addition to the usual treatment can prevent SUDs relapse. I published these two important scientific works as a first author.
- Varghese SP, Ortiz MJ, Csernansky JG, Herrold A, Koola MM, Eiger RI, Dong H. Early Life Stress as Risk Factor for Substance Use Disorders: Clinical and Neurobiological Substrates. Indian J Psychol Med. 2015 Jan-Mar; 37(1):36-41. PMID: 25722510; PMCID: PMC4341308.
- Varghese SP, Koola M, Devens M, Eiger RI. Opioid Use Remits Depression Remains. Curr Psychiatr. 2014 Aug; 13(18):45-50. PMID: 25505852; PMCID: PMC4260355.
In 2013, I received a scholarship to attend one-week course on the Genetics of Addiction at the Jackson Laboratory in Bar Harbor. This amplified my curiosity in substance use disorder epigenetics. In 2014 I started working in Dr. David Gavin鈥檚 lab at Jesse Brown VA Medical Center. I adapted to the lab work quickly and generated some interesting data. At Dr. Gavin鈥檚 lab, I studied the epigenetic mechanism of poly ADP ribose polymerase (PARP) in binge alcohol drinking mice model. A review article published with JBVAMC researchers on 鈥淓thanol-induced perturbations in neuronal/astrocyte development and fetal alcohol syndrome disorders.鈥� I developed an interest in this area because of my work at the VA with Posttraumatic Stress Disorder (PTSD) and Alcohol Use Disorder (AUD). Increased binge alcohol intake is reported among US veterans suffering from PTSD. It is important to understand the molecular mechanism behind this pathology. I co-authored two clinical case reports and a basic science review article in between 2014-2017.
- Koola M, Varghese SP, Fawcett JA. High-Dose Prazosin for the Treatment of Post-Traumatic Stress Disorder. Ther Adv Psychopharmacol. 2014 Feb; 4(1):43-7. PMID: 24490030; PMCID: PMC3896131.
- Vaishnav M, Patel V, Varghese SP, McCagh J, Koola M. Fludrocortisone in Posttraumatic Stress Disorder: Effective for Symptoms and Prazosin-Induced Hypotension. Prim Care Companion CNS Disord. 2014;16(6). PMID: 25834757; PMCID: PMC4374816.
- Gavin DP, Grayson DR, Varghese SP, Guizzetti M. Chromatin Switches During Neural Cell Differentiation and Their Dysregulation by Prenatal Alcohol Exposure. Genes (Basel). 2017 May 11; 8(5). PMID: 28492482; PMCID: PMC5448011.
In 2018, I received Young Investigation Award, Research Colloquium (Alcohol, Pain, and Drug Abuse) for this work which were sponsored by American Psychiatric Association, Society of Biological Psychiatry, and National Institute on Drug Abuse. In 2019 I developed the hypothesis that focuses on over-activation of CRF receptors in the brain increases the expression of aquaporin-4 (AQP4), , a water channel protein expressed in astrocytes, especially in the foot processes adjacent to the blood-brain barrier (BBB). Increased stimulation of AQP4 leads to dysregulation of the BBB. I published this hypothesis in an article as mentioned below.
- Varghese SP, Kumari P, Yovankin, TG, Wijegunarantne H, Garlapati V, Koola M. Loperamide Addiction: Atypical Opioid Use Disorder Treated with Buprenorphine/Naloxone. Primary Care Companion. June 2019. PMID: 31274259.
In between 2019 to 2022, I collaborated with a group researcher nationally and internationally on the topic of MBI to manage stress-related disorders. I co-authored these works.
- Varghese SP, Florentin OD, Koola MM. Role of Spirituality in the Management of Stress-Related Disorders and Substance Use Disorders. Chronic Stress. Jan 2021. PMID: 33506156; PMCID: PMC7812390.
- Kundal D, Raj R, Garg R, Sidhu BS, Koola MM, Zachariah AR, Paul SD, Florentin OD, Varghese SP. The therapeutic efficacy of Rhemercise: A Novel Mindfulness Technique in patients With Opioid Use Disorder. Primary Care Companion for CNS Disorders. Feb 2022. PMID: 35144326.
- Biedlingmaier A, Yovankin T, Koola MM, Yanuck, M, Varghese SP. An Overview of Mindfulness-Oriented Addiction Recovery. The Journal of Nervous and Mental Disease. Oct 2022. PMID: 36179375.
Based on the over-activation of CRF receptors in the brain increases the expression of AQP4, I formulated a novel hypothesis on correlating kynurenine pathway and heart rate variability. A novel method to assess blood-brain barrier dysfunction in PTSD with and without AUD. In 2022 I received full Hines/FHCC VA IRB approval for this study protocol based on the above-mentioned hypothesis. In the meantime, I co-authored a letter to the editor and an important review article.
- Biedlingmaier A, Koola MM, Shad MU, John S, Reddy GG, Varghese SP. A Rare Case Report of Serotonin Syndrome with Buprenorphine and Other Serotonergic Medications. Journal of Clinical Psychopharmacology. March 2023. PMID: 37235514.
- Donlon J, Kumari P, Varghese SP, Bai M, Florentin OD, Frost ED, Banks J, Vadlapatla N, Abulseoud OA, Shad MU, Olivia K, Rahman S, Stone TW, Koola, MM. Integrative Pharmacology in the Treatment of Substance Use Disorders. Journal of Dual Diagnosis, 2024. PMID: 38117676.
2. How would your election to the 探花合集 Board of Directors benefit ASAM and the field of addiction medicine?
I will promote meaningful clinical research to help patients to fight SUD and co-occurring disorders.