Dr. Martin Tarzian '23 on psychiatry residency in Cleveland, OH

Dr. Martin Tarzian, a UMHS 2023 graduate, discusses his upcoming 2024 residency in psychiatry at MetroHealth in Cleveland, Ohio. He said he initially wanted to be a surgeon but found his passion for psychiatry during a rotation in Danbury, Connecticut. He was inspired by the way patients with mental health issues communicated and spoke passionately about their experiences. Dr. Tarzian emphasizes that psychiatry is more than just prescribing medication; it involves a holistic approach to mental health, including therapy and listening to patients. He also discusses the non-falsifiable nature of psychiatry, which requires detective work to understand and treat patients. Dr. Tarzian shares his hopes for his residency, including being part of the psychoanalytic renaissance in medicine and getting involved in research on new psychiatric drugs. He also offers advice to prospective psychiatry students, emphasizing the importance of a diverse portfolio, education, and networking. Finally, he discusses the stigma surrounding mental health and the need for it to be taken more seriously.

UMHS spoke to Dr. Tarzian earlier this spring when he had just returned from teaching for two semesters at UMHS in St. Kitts before starting his residency this summer.

Dr. Martin Tarzian. Photo: Courtesy of Dr. Tarzian.

UMHS Endeavour: Dr. Tarzian. I want to welcome you today and could you just tell us a little bit about your upcoming residency in psychiatry and where you'll be working?

Dr. Martin Tarzian: Sure, Scott. Thank you for having me here. I matched into psychiatry at a MetroHealth in Cleveland, Ohio, which is an affiliate hospital with Case Western.

Dr. Martin Tarzian teaching at UMHS in St. Kitts in spring 2024. Photo: UMHS.

What made you want to go into psychiatry as a specialty?

So, when I started medical school, I thought I was going to be a surgeon. Then I did a surgery rotation and I realized that I did not want to be a surgeon. And I was a little bit lost in my rotations, because I wasn't sure what I wanted to do with my career. Eventually I ended up in Danbury, Connecticut where I was doing my psychiatry, what's it called? Core? Psychiatry core. And I was enjoying it, but then one particular day we had a patient who was a little bit psychotic and another patient who was a little bit manic and they asked me if I would have my lunch on the inpatient unit with them.

I bought my lunch from the cafeteria and, as a young medical student, I didn't know any better. I sat on the inpatient unit with the manic guy and the psychotic guy. And we had a conversation, and I won't go into the topics that we covered in that conversation, but the way they spoke and the way they communicated and the passion with which they spoke really sparked something in me and I knew that I wanted to work with people like this for the rest of my life. I found them very interesting and fascinating.

So, you answered my next question, what made you want to go into psychiatry? Was it this specific, meeting these two people, or had you always had an interest in the field of psychiatry?

I've been told by my trainers and professors in the past that I'm psychologically minded and I didn't really know what that meant. I just took it as a compliment. The University of Toronto, which is where I did my undergrad, I did a major in psychology and I stepped away from it, because I wanted to do something more hands-on in medicine or I thought I did when I was a student. But I came back home as soon as I did my psychiatry rotation. I knew inside that this is what I want to do with my career. So, I went back to it.

The non-falsifiable nature of psychiatry

For current and prospective students who are unfamiliar with the specialty of psychiatry, could you just briefly explain what psychiatry is versus some of the preconceived notions about it in the general public?

I'll start with what the preconceived notions. I think everybody has an idea of what a psychiatrist is in their head. There’s this assumption that psychiatrists are almost pill pushers. Or you come to me, you list out the things that are bothering you and I listen for the buzzwords and then I give you your antidepressant or your anxiolytic. Psychiatry is so much more than that. It's this holistic approach to mental health. There's a lot of therapy, CBT, listening. And I think what ultimately makes psychiatry different from every other field of medicine and what really drew me to it is the non-falsifiable nature of psychiatry, which basically means that there aren't a lot of labs and tests that I can order to officially diagnose you with a condition.

If you have anemia, I can order a blood test, see that you have anemia and give you treatment. But with psychiatry it felt like a lot more detective work. I had to get through ego defense mechanisms, pathological lying, people not ready to come to terms with what's wrong with them, to get to the juxtapose of what their issue is, to formally treat them. And I think that's a really under looked part of psychiatry. And, in my opinion, that's the best part of psychiatry is the actual detective work you do when you're interviewing a patient. There's no field, not just in medicine, but anything really where you're almost playing psychological chess with the person in front of you to help them in the end. So, I found that to be the best part of psychiatry. And you don't really realize how much you do that until you do a couple of rotations in the inpatient units or even outpatient.

Dr. Martin Tarzian at UMHS graduation on June 7, 2024. Photo: Andres Bolourian, UMHS.

What do you hope to accomplish during your residency?

So, there's a lot of things that I'm looking at and trying to do inside and outside of residency. During my time, I'm definitely trying to be the best psychiatrist I can be. I'm hoping to be part of the psychoanalytic renaissance in medicine. I think that the Freudians, the Carl Jungs, the Alfred Adlers of old have lost their kind of space in modern psychiatry. And I truly believe in my heart that there is room in our interviews to incorporate what they taught and what they brought to our field into eliciting the kind of answers that we're looking for. So, I hope to get training to that. I know Cleveland has a really good institute of psychoanalysis that I'm hoping to be a part of.

I do a lot of research on new cutting-edge psychiatric drugs. So, I hope to get involved in some drug trials, particularly for a medication called lumateperone, which I think might be the future of treating certain parts of schizophrenia. On the side, I'm investing my money a lot more than I used to. I'm looking into different projects to build my wealth as I progress through residency and help me pay off my loans. And then obviously staying in shape. I'm trying to go to the gym every day. So, a lot of different avenues I'm focusing on as I go into residency.

Wow! Whenever you were looking at med schools, what made you choose UMHS over other med schools out there?

I'll be honest with you, when I was applying for medical schools, I had a good GPA. I'm Canadian. I had a good GPA at the University of Toronto. It was around a 3.7, but I had a really bad first year, where I almost flunked. So, altogether I couldn't break past a 3.75. So, I didn't get any interviews in Canada and I got one interview at a DO school in the United States. So, I was talking to my advisor and she told me that my best option would be to go to the Caribbean. And then she told me that there's a Big Six, like St. George, AUA, Ross, but there's this one new school that has really small classroom sizes and they really focus on student/professor interaction. And the professors don't even do research on the island, because they want to focus on education. And that was all important to me.

So, that was UMHS. So, I decided to take my chances and I went to UMHS and what she said was true. Every professor that I've had at UMHS, I have some kind of relationship with them even now. So much so that I actually went back, actually got back a few days ago to teach a couple semesters at UMHS in the interim, while I wait to begin my residency.

And at UMHS over the years we've really seen psychiatry going from being a lesser-known specialty to one of the most sought after and competitive. And I think it's especially with the mental health crisis during and after the pandemic and psychiatry becoming much less stigmatized. What would you say to people out there considering choosing psychiatry as a specialty with these things in mind?

So, I think the secret is out of the bag that psychiatry probably has the best lifestyle in medicine. And I think most young physicians are realizing that and also realizing that lifestyle is more important than making the highest salary. My advice to prospects who would like to be psychiatrists is that psychiatry is a little bit different. Every field of medicine is saying that they're holistic and they want the high score, or they want different things. Obviously, the highest scores are great, but psychiatry really wants that diverse portfolio. When you apply to research, there's journals where you could publish research on whatever fields you're interested in psychiatry. I know when I was in my third year, I published some papers on new psychotropic medications as well as a history of psychoanalysis. So, pick some fields that are psychiatry-related and publish some papers on it.

Dr. Martin Tarzian works while teaching at UMHS in St. Kitts in spring 2024. Photo: UMHS.

During my interviews, the fact that I was a teacher before medical school and a professor at UMHS really bolstered my application. As IMGs, we have the ability to write Step 3 right after we graduate. So, if you find yourself with that golden opportunity, do write Step Three. I got a couple interviews just because I wrote step three. Actually, the place I matched, I emailed them after I wrote Step 3 telling them I wrote Step 3 and then they granted me an interview and that's how I matched there. So, Step 3's super important. And then networking. Make sure you do your psychiatry rotations at every hospital UMHS offers. I think we had Danbury, Larkin, Oklahoma. We got a new one in Georgia and I think we have one in Wisconsin. So, rotate all those hospitals, get letters of recommendation from all those hospitals and I think you'll be okay.

That's great advice. And is there anything else that you'd like to say to our current or prospective students out there?

I was just at UMHS and we don't have a psychiatry club. So, basic science students, somebody step up and make a psychiatry club.

Dr. Martin Tarzian takes a break at UMHS in St. Kitts. Photo: UMHS.

Native of Toronto area

Where did you grow up? Wasn’t it somewhere near Toronto?

I was born in Mississauga in Canada. My parents were refugees from Iraq. So, born in Mississauga, grew up in a place called Scarborough, and then eventually moved to Markham, which is where I live now.

Did you want to be a doctor when you were a kid?

No. I didn't care for medicine. I wanted to be a basketball player, a professional. In my first year of college, I tore both my knees and then after that, picking medicine was a reluctant decision. My parents were just like, "Just go be a doctor." And I said, "Whatever, I'll go be a doctor." And then I got 4.0s for my second year on. Again, it couldn't make up for that first year where I didn't care. But, my love for medicine wasn't something—I think being around it all the time is what made me end up loving it, because I do love it. But my initial decision to do it was, "Whatever. I'll just do this, since everyone keeps telling me to do it."

You did your undergrad at the University of Toronto. What was your major?

I double majored in biology and psychology.

So, you had a good academic background for school. And I've heard a lot of good things about you from our academic affairs department, namely Patrick McCormick and Jonathan Timen. Did you find the academic affairs department at UMHS really helpful when it came time to apply for the Match?

Patrick McCormick is great. Jonathan Timen is great, too. Patrick would email me back within the day, no matter how. Even when I was spiraling and I was being ridiculous and I was asking things that were like, honestly didn't warrant an answer, he'd still answer me. He'd still show me that kind of warmth that I needed in that moment. Patrick did an excellent job. I'm a big fan of Patrick's. And I actually got to meet him face to face. He came to the island when I was there with Brandy and we chatted and they're actually even nicer in person, believe it or not. I really like both of them. They're good people.

Dr. Martin Tarzian while teaching in spring 2024 at UMHS in St. Kitts. Photo: UMHS.

Let's switch gears and focus on the field of psychiatry. Now, I've read that psychiatry is one of those medical specialties that doesn't follow a set algorithm when treating a patient. That you really have to think deeply and holistically about each of your patients. And if two patients have the same disorder, you likely wouldn't be using the same two treatment plans. And I know a little earlier we talked about how there aren't a lot of tests for a lot of psychiatric conditions. So, what are your thoughts on this?

So, my first rotation as a medical student was an IM. And the algorithms that they follow were great and it's a great way to do medicine. But that's not the way my brain works. My brain is that holistic, everybody's unique approach. And that was a big draw to me for psychiatry as well. You're right. The same two patients might not necessarily get the same two treatments. And the reason for that is everybody knows what the brain is, everybody knows what the body is. But, where's the mind in all that? Renee Descartes thought the mind was in the pineal gland. Some people think the mind is here or there, but nobody really knows what the mind is. So, we're almost like treating someone in a dark room in a way. And we're kind of throwing whatever we think can stick against the wall. I know people who their symptoms are almost the exact same, but one of them responded to Sitalopram and the other person responded to Wellbutrin. It’s such a unique, cutting-edge field.

Absolutely. And we talked a little bit about the stigma. And I think that's something that's so pervasive. I know just in American society within my own family and people that are not from the US, that are from other cultures, there just seems to be a stigma in every culture about mental health, which is so sad, and I think that's starting to change. But, how do you think are ways that we can overcome that stigma about mental health?

Well, the thing with COVID is it left a lot of us alone with our own thoughts. Our everyday distractions weren't there. And I think a lot of people realized, "Oh, my God! I'm sad," or, "I'm anxious." And then COVID would exasperate those feelings. So, it took a pandemic to bring about that renaissance or revolution in the field. There's no magic thing that's going to happen that overnight people are going to realize mental health is important or should be taken seriously. It's stepping stones. I once was interviewing at a hospital in Miami, back when I was applying for residency, and the senior resident asked us, "What's the point of a psychiatrist? If a family doctor can prescribe all your psychotropic medications, IM can prescribe it. Heck, any doctor. Your neurologist could prescribe it. What is the point of having a psychiatrist, if there are people that can do a psychiatrist’s job for them?" And it's kind of almost like a disrespectful question.

Really?

And I was taken back. And he's a psychiatrist, so I couldn't get why he was saying it. Then he said, "It's the idea that psychiatrists represent the idea that there are doctors out there that would specialize in treating your mental health, makes mental health real.” Now, I wouldn't take it to that extreme. I think psychiatrists are who you see when the family doctors and the IMs can't figure out how to treat somebody psychiatrically. But the point that he was making never even occurred to me, that just the fact that I exist that other psychiatrists exist, it makes mental health more real and be taken more seriously. So, yeah.

Absolutely. Many Americans don’t want to take an antidepressant, because their spouse or their family will say, "Oh, well, if you take that, that means you're crazy." Whether it’s Lexapro or Zoloft or Prozac or anything like that, there's a stigma in taking those drugs. As opposed to if one has a heart condition, a cardiologist gives them a heart drug and people don't think anything of it. What people don't realize is that the brain is part of the body and they just think only a neurologist deals with the brain. But, there's so much more to it than that. Would you agree with that analogy?

I agree to an extent. The thing with antidepressants is I'm not the kind of guy who is quick to just prescribe that. And antidepressants do have side effects. Weight gain, erectile dysfunction, just upset stomach, constipation, things like that. I am definitely a guy who subscribes to a holistic approach to mental health. Yes, our medications are a part of that, but I think there's a spiritual aspect to mental health that's often overlooked. I think regular exercise, taking care of yourself, sleep, hygiene are all things to be considered along with the psychotropic medication aspect of it. And similarly, to, I guess, a cardiologist who would say, "Yeah. I can give you this metoprolol," or whatever, "but if you're not going for walks every day, you're not eating healthy, you're fighting a losing battle." So, a similar regard to that in terms of mental health.

And I think probably from what you're describing, there's a lot of self-care involved that you need to talk about with patients and some CBT. But, yeah. Definitely there's a lot of things that people can do other than just taking a lot of meds, for sure.

Are there any new treatments or groundbreaking research and psychiatry that especially interests you right now?

Yes. I believe that there's first generation and second-generation antipsychotics. I believe that we are living at a time where there's a third generation of antipsychotics that are reaching the market. These are the medications that I actually did my research on, Mepron, Latuda, Caplyta. These are medications where rather than antagonizing dopamine receptors, what they do is they're partial agonists on the dopamine receptor, which basically means the parts of the brain where ... So, historically people thought schizophrenia was too much dopamine. What we've come to realize is that the negative aspects of schizophrenia, so when people are not talking and keeping to themselves, that's actually from too little dopamine in certain parts of the brain. And then the psychosis, the hallucinations, delusions, that's from too much dopamine. So, what a partial dopamine agonist would do is it would normalize the dopamine activity in every part of the brain, rather than antagonizing it everywhere.

So, the partial dopamine agonism is a huge direction it's going to. And it's leading to less extrapyramidal side effects. So historically, the first generation of antipsychotics, because they antagonize dopamine so much, people were left with akathisia, they couldn't sit still, their necks would kind of lock up like this. They'd get tardive dyskinesia, which is the smacking of the lips. And the second generation of antipsychotics, what they did is they really affected histamine and muscarinic receptors, which will lead to a lot of weight gain, restlessness. And then young people, particularly young women, wouldn't want to take their antipsychotics, because they'd be afraid of the weight gain.

But this new generation, it does partial dopamine agonism, and it's very, very little effects on the histamine and muscarinic receptors, which is a great draw in for people, because they're not going to be worried about the side effects. The tests show that the only real side effect that this new generation causes, from the different studies that I've looked at, is there's still a little bit of akathisia, which is the inability to sit still, but it's huge steps in the right direction. And once we can get an affordable generic version of these medications, I think they're going to take over the market in five to 10 years. Yeah.

We talked a little bit earlier about some of the psychotropic drugs. And you hear a lot about the ketamine being used. What do you know about ketamine being used to treat depression?

So, ketamine—some studies have shown that it's a great last resort option. I don't subscribe to the idea of giving my patients ketamine to treat it. When I did my training, there was more than one occasion where I had somebody in the inpatient unit who would get violent with us, because they wanted their ketamine treatment and we weren't offering it to them in that setting. So, they would get aggressive and to me that says they're addicted. And I'm not going to prescribe a medication that I believe you're going to need to live. I think there's other options to explore before we get to ketamine. I think TMS, what's the word? The EPS, the head shock therapy, things like that are better options. Do we try every antidepressant we could before we went to ketamine? I think [it] has a very, very, very niche place in psychiatry. And I don't have enough training in it to know. But, from what I've seen, I don't think that's something that I would do.

It's interesting that you say that, because I see things even on online like, "Oh, ketamine therapy. Do it online." And I think this cannot be good. This can't even be legit. I think it's very worrisome that this is out there, because I know there's a lot of recreational use of that particular drug, or there used to be. And there is a high potential for abuse, so I'm glad that you're very cautious about using that. I wasn't aware that they still did the shock therapy. I thought that was something from the past.

Oh, no. They do. Shock therapy, I've actually done it myself. When I was doing my training in Danbury, the attending would let me do it. So, it's not what you think. It's not somebody tied to a chair trying to get away. No. Everybody who's doing it is asking to have it done. Basically, the only indication for it right now is if your depression has gotten so bad that you're not eating, you're not talking, you're not responding to people speaking to you, and you're just almost catatonic. Well, we can give you shock therapy. And what I've seen is it works. It works and it works well. I remember we had a woman who had schizoaffective disorder, depression type, and she wasn't speaking. And she shut down and she hadn't eaten for a couple of days. So, we brought her down and we gave her the shock therapy. And the next day she's like, "Hi, how are you? Good to see you guys." It was like night and day. I couldn't believe that it was that effective. So, yeah.

Wow! And when does your residency start?

So, officially July 1st is my first orientation day. I'll be heading there to Cleveland on the 20th. I’ve just got to find somewhere to live first.

All right. So, we've covered a lot of material. Is there anything else that you would like to say that we haven't covered, either to current or prospective students or—I'm also working a lot on the alumni. We're going to be launching a new alumni site soon, and I'm the alumni liaison. Is there anything you want to say to alumni out there? Or anything that we haven't covered that you'd like to touch on?

I don't think we could touch on it now, but I think the alumni network is a great idea. I would love to be able to discuss potential fellowships and states to live in and practice in with graduates who are doing it right now, kind of similarly to what I'm doing for the medical students right now. If there was someone who's four years ahead of me to tell me what to do, that'd be great.

Is there anything else that you want to say that we haven't covered?

No, I think this has been great. Thank you for having me.

(Top photo) UMHS 2023 graduate Dr. Martin Tarzian starts his psychiatry residency at MetroHealth in Cleveland, OH on July 1, 2024. Photo: Courtesy of Dr. Tarzian.

Contact Dr. Martin Tarzian via email at martintarzian@gmail.com