{"id":22799,"date":"2026-07-27T15:46:13","date_gmt":"2026-07-27T11:46:13","guid":{"rendered":"https:\/\/medscriptum.org\/?p=22799"},"modified":"2026-07-27T16:12:01","modified_gmt":"2026-07-27T12:12:01","slug":"luck-favors-the-prepared-irakli-mania","status":"publish","type":"post","link":"https:\/\/medscriptum.org\/en\/luck-favors-the-prepared-irakli-mania\/","title":{"rendered":"&#8220;Luck favors the prepared,&#8221; \u2013 Irakli Mania"},"content":{"rendered":"<p id=\"p-rc_9f6d8e57980860ee-95\" data-path-to-node=\"5\"><span data-path-to-node=\"5,0\">Growing up in the noisy courtyards of Zugdidi, Irakli Mania realized from an early age that his life could not be contained within a small town<\/span><span data-path-to-node=\"5,2\">. In the 1990s, marked by civil war, constant unrest, and poverty, students studied not from books but from photocopies under the flickering light of candles, and walked to university on foot<\/span><span data-path-to-node=\"5,4\">. At that time, he firmly decided that, no matter the circumstances, he would become the best doctor possible<\/span><span data-path-to-node=\"5,6\">. At that time, such a dream was out of reach in Georgia, so he would have to continue his education in the United States<\/span><span data-path-to-node=\"5,8\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-96\" data-path-to-node=\"6\"><span data-path-to-node=\"6,0\">From the hallways of Davit Tvildiani Medical School to research at Emory University, and from there to the prestigious Drexel residency in Philadelphia, the road was neither short nor easy<\/span><span data-path-to-node=\"6,2\">. At every stage, alongside medicine, he was learning resilience<\/span><span data-path-to-node=\"6,4\">. He had to overcome many obstacles, bridge cultural gaps, and adapt to strict standards<\/span><span data-path-to-node=\"6,6\">. His commitment to his goal and his readiness to meet every opportunity fully prepared ultimately led to his success<\/span><span data-path-to-node=\"6,8\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-97\" data-path-to-node=\"7\"><span data-path-to-node=\"7,0\">Today, he is not only a highly accomplished psychiatrist and scientist but also the president of the Pennsylvania Psychiatric Society<\/span><span data-path-to-node=\"7,2\">. For Irakli Mania, leadership is not about loud words, but about daily, relentless work<\/span><span data-path-to-node=\"7,4\">. You are a good doctor, he says, when you listen to the last patient who comes to you late at night with the same attention as you give the first patient of the morning<\/span><span data-path-to-node=\"7,6\">. When dreams from years ago have become your everyday reality, and you now guide others along the same path through your example<\/span><span data-path-to-node=\"7,8\">.<\/span><\/p>\n<p data-path-to-node=\"7\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-22796\" src=\"https:\/\/medscriptum.org\/wp-content\/uploads\/2026\/07\/irakli-mania-2--174x300.png\" alt=\"\u10d8\u10e0\u10d0\u10d9\u10da\u10d8 \u10db\u10d0\u10dc\u10d8\u10d0\" width=\"1114\" height=\"1921\" srcset=\"https:\/\/medscriptum.org\/wp-content\/uploads\/2026\/07\/irakli-mania-2--174x300.png 174w, https:\/\/medscriptum.org\/wp-content\/uploads\/2026\/07\/irakli-mania-2--244x420.png 244w, https:\/\/medscriptum.org\/wp-content\/uploads\/2026\/07\/irakli-mania-2--150x259.png 150w, https:\/\/medscriptum.org\/wp-content\/uploads\/2026\/07\/irakli-mania-2--300x517.png 300w, https:\/\/medscriptum.org\/wp-content\/uploads\/2026\/07\/irakli-mania-2-.png 308w\" sizes=\"auto, (max-width: 1114px) 100vw, 1114px\" \/><\/p>\n<p data-path-to-node=\"8\"><b data-path-to-node=\"8\" data-index-in-node=\"0\">What was the journey from Tbilisi to Philadelphia like? Which step was the turning point?<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-99\" data-path-to-node=\"10\"><span data-path-to-node=\"10,0\"> I came to America 25 years ago<\/span><span data-path-to-node=\"10,2\">. I&#8217;ve spent almost half of my life here<\/span><span data-path-to-node=\"10,4\">. The road was quite difficult, but at the same time, incredibly interesting<\/span><span data-path-to-node=\"10,6\">. I was born in Zugdidi, in the shadow of the Abkhazian war, poverty, and a very harsh social climate<\/span><span data-path-to-node=\"10,8\">. In such an environment, it was hard to even think about studying and personal growth, yet studying was what I loved most<\/span><span data-path-to-node=\"10,10\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-100\" data-path-to-node=\"11\"><span data-path-to-node=\"11,0\">It was clear to me that in those conditions, I would not be able to achieve my goals<\/span><span data-path-to-node=\"11,2\">. While still in school, I firmly decided that I wanted to become a doctor and that I had to continue my education in the United States<\/span><span data-path-to-node=\"11,4\">. I worked very hard, and perhaps I was talented enough, because during my university years, I passed the medical licensing exams required to study further in America<\/span><span data-path-to-node=\"11,6\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-101\" data-path-to-node=\"12\"><span data-path-to-node=\"12,0\">Right after graduating from university, I came to the U.S<\/span><span data-path-to-node=\"12,2\">. A well-known physician, Emory University professor, and a great friend of Georgia, Ken Walker, was the person who at that time helped talented Georgian students and doctors<\/span><span data-path-to-node=\"12,4\">. It was he who brought me to Atlanta<\/span><span data-path-to-node=\"12,6\">.<\/span><\/p>\n<p data-path-to-node=\"13\"><b data-path-to-node=\"13\" data-index-in-node=\"0\">Did that become the turning point?<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-103\" data-path-to-node=\"15\"><span data-path-to-node=\"15,0\"> I can&#8217;t say that a single moment had decisive importance<\/span><span data-path-to-node=\"15,2\">. I had to overcome many difficulties<\/span><span data-path-to-node=\"15,4\">. The work ethic and expectations here are very different<\/span><span data-path-to-node=\"15,6\">. I spent four years at Emory University engaged in psychiatric research<\/span><span data-path-to-node=\"15,8\">. Getting into Drexel&#8217;s residency program was a significant success, as I had succeeded in a highly competitive selection process<\/span><span data-path-to-node=\"15,10\">. There, I was appointed chief resident, and because of my high academic performance, right after completing residency, I received offers to study further at Yale, Harvard, and other universities<\/span><span data-path-to-node=\"15,12\">. My career path was set for a rapid climb, but the government at the time did not allow me to pursue it<\/span><span data-path-to-node=\"15,14\">. I was disappointed, but now, looking back, perhaps it was for the best<\/span><span data-path-to-node=\"15,16\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-104\" data-path-to-node=\"16\"><span data-path-to-node=\"16,0\">That path has led me to Keystone Health, where I have worked since 2008, and which has become my second family<\/span><span data-path-to-node=\"16,2\">. On this path, I have faced many challenges, but I overcame them thanks to the support of this team<\/span><span data-path-to-node=\"16,4\">. I&#8217;ve stayed here so long because I genuinely love these extraordinary people, and they value me as well<\/span><span data-path-to-node=\"16,6\">. We have achieved a lot together<\/span><span data-path-to-node=\"16,8\">. In 15 years, we have built a very modern and well-organized clinic in this small town<\/span><span data-path-to-node=\"16,10\">. Our center is one of the largest, and I don&#8217;t think there&#8217;s anything quite like it in a similar geographic location anywhere else in the United States<\/span><span data-path-to-node=\"16,12\">. I am very proud of that!<\/span><\/p>\n<p data-path-to-node=\"17\"><b data-path-to-node=\"17\" data-index-in-node=\"0\">What was the biggest surprise in the American clinical system?<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-106\" data-path-to-node=\"19\"><span data-path-to-node=\"19,0\"> I arrived in 2000 from Georgia, which was in a difficult state at the time<\/span><span data-path-to-node=\"19,2\">. I remember that we used to boil disposable gloves and reuse them<\/span><span data-path-to-node=\"19,4\">. Here, the hospital looked like a hospital<\/span><span data-path-to-node=\"19,6\">. The equipment, computers, and interiors were all new and well-maintained<\/span><span data-path-to-node=\"19,8\">. There is no need even to discuss hygiene or the availability of medications<\/span><span data-path-to-node=\"19,10\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-107\" data-path-to-node=\"20\"><span data-path-to-node=\"20,0\">Doctors, residents, fellows, nurses, and social workers all worked together as one united team caring for the patient<\/span><span data-path-to-node=\"20,2\">. Here, the physicians are held in the highest regard and trusted<\/span><span data-path-to-node=\"20,4\">. You feel it everywhere, whether in the clinic or even out on the street<\/span><span data-path-to-node=\"20,6\">. If they know you&#8217;re a doctor, they will address you as &#8220;Doctor Mania,&#8221; and in that address, you can sense deep respect for the profession<\/span><span data-path-to-node=\"20,8\">. Here, learning never ends<\/span><span data-path-to-node=\"20,10\">. Alongside students, practicing doctors and professors are always in search of something new<\/span><span data-path-to-node=\"20,12\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-108\" data-path-to-node=\"21\"><span data-path-to-node=\"21,0\">At first, I thought I would stay in America for 3-4 years and then return to Georgia to serve my homeland<\/span><span data-path-to-node=\"21,2\">. At that time, we all felt like that<\/span><span data-path-to-node=\"21,4\">. However, you soon realize that this is insufficient time, and upon seeing others advance in their careers and gain experience, you also aspire to grow professionally and reach your full potential<\/span><span data-path-to-node=\"21,6\">. That&#8217;s how I stayed<\/span><span data-path-to-node=\"21,8\">. Here, you are constantly developing, and if you work hard and give your all, nothing is out of reach<\/span><span data-path-to-node=\"21,10\">. If you had asked me 15 years ago whether I wanted to become president of the Pennsylvania Psychiatric Society, I would have laughed and said it was utopian<\/span><span data-path-to-node=\"21,12\">. And yet, based on my own example, I can say that in this country, anything is achievable<\/span><span data-path-to-node=\"21,14\">. The most important thing is still a well-functioning system<\/span><span data-path-to-node=\"21,16\">. In medicine, that&#8217;s decisive; one person alone can achieve nothing<\/span><span data-path-to-node=\"21,18\">. The system must be effective<\/span><span data-path-to-node=\"21,20\">.<\/span><\/p>\n<p data-path-to-node=\"22\"><b data-path-to-node=\"22\" data-index-in-node=\"0\">Dr. Irakli, how did a doctor born in Georgia become president of the Pennsylvania Psychiatric Society?<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-110\" data-path-to-node=\"24\"><span data-path-to-node=\"24,0\"> From childhood, I naturally assumed the role of a leader<\/span><span data-path-to-node=\"24,2\">. Perhaps it&#8217;s genetic, a family trait<\/span><span data-path-to-node=\"24,4\">. My father was a factory director, my mother managed a pharmacy, and my grandmother was a school principal<\/span><span data-path-to-node=\"24,6\">. What helps me greatly is that I am very goal-oriented<\/span><span data-path-to-node=\"24,8\">. I always have a clear direction<\/span><span data-path-to-node=\"24,10\">. I am constantly learning, developing, preparing, working, and whenever an opportunity arises, I am ready to seize it<\/span><span data-path-to-node=\"24,12\">. In reality, fortune favors the prepared<\/span><span data-path-to-node=\"24,14\">. Emotional intelligence and the ability to adapt quickly are also essential<\/span><span data-path-to-node=\"24,16\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-111\" data-path-to-node=\"25\"><span data-path-to-node=\"25,0\">I also enjoy meeting new and interesting people<\/span><span data-path-to-node=\"25,2\">. A leader must be able to accept failure, stand back up after a fall, and listen to criticism<\/span><span data-path-to-node=\"25,4\">. I sometimes joke that if you want to be loved by everyone, don&#8217;t become a leader, become an ice cream seller!<\/span><span data-path-to-node=\"25,6\"> The ability to make quick decisions and take responsibility is probably the most important<\/span><span data-path-to-node=\"25,8\">. I always try to lead others by my example, and that helps me a great deal<\/span><span data-path-to-node=\"25,10\">.<\/span><\/p>\n<p data-path-to-node=\"26\"><b data-path-to-node=\"26\" data-index-in-node=\"0\">Why has psychiatry become such a prestigious field?<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-113\" data-path-to-node=\"28\"><span data-path-to-node=\"28,0\"> Psychiatry is a fascinating specialty<\/span><span data-path-to-node=\"28,2\">. The stigma is gradually decreasing, and the level of stress is lower<\/span><span data-path-to-node=\"28,4\">. That&#8217;s why today, many talented people are entering the field, more than 10-20 years ago<\/span><span data-path-to-node=\"28,6\">. I&#8217;m pleased that this year, a record number of eight Georgian students came to my clinic for observerships, and they want to pursue psychiatry<\/span><span data-path-to-node=\"28,8\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-114\" data-path-to-node=\"29\"><span data-path-to-node=\"29,0\">In the United States, there is a vast demand for psychiatrists and mental health specialists, and a person should be where society needs them most<\/span><span data-path-to-node=\"29,2\">. Have you ever wondered why trauma surgery is so well developed in Germany?<\/span><span data-path-to-node=\"29,4\"> The explanation is simple: they went through two world wars and countless injuries<\/span><span data-path-to-node=\"29,6\">. In today&#8217;s world, psychiatry is experiencing similar popularity, and the field will continue to grow<\/span><span data-path-to-node=\"29,8\">. The need for psychiatrists will increase even further<\/span><span data-path-to-node=\"29,10\">. So, those who choose this path will undoubtedly be successful<\/span><span data-path-to-node=\"29,12\">.<\/span><\/p>\n<p data-path-to-node=\"30\"><b data-path-to-node=\"30\" data-index-in-node=\"0\">You&#8217;ve made such a compelling case for psychiatry that even I&#8217;m tempted to consider it&#8230;<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-116\" data-path-to-node=\"32\"><span data-path-to-node=\"32,0\"> They joke here that psychiatry is the new dermatology<\/span><span data-path-to-node=\"32,2\">. There&#8217;s always demand for dermatologists because they have a relatively more straightforward work schedule and a better work-life balance<\/span><span data-path-to-node=\"32,4\">. Now, getting into psychiatry has also become harder, with considerable competition<\/span><span data-path-to-node=\"32,6\">.<\/span><\/p>\n<p data-path-to-node=\"33\"><b data-path-to-node=\"33\" data-index-in-node=\"0\">Has isolation become the most significant challenge for psychiatry? Has technological progress increased the number of diagnoses?<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-118\" data-path-to-node=\"35\"><span data-path-to-node=\"35,0\"> About three or four years ago, the U.S. Surgeon General officially declared an epidemic of isolation and introduced a six-point plan to address it<\/span><span data-path-to-node=\"35,2\">. COVID made this problem even more visible<\/span><span data-path-to-node=\"35,4\">. Civilization is advancing, yet people have become more withdrawn, as if we no longer need one another<\/span><span data-path-to-node=\"35,6\">. Social media replaces personal interactions and fosters isolation, which in turn increases individualism<\/span><span data-path-to-node=\"35,8\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-119\" data-path-to-node=\"36\"><span data-path-to-node=\"36,0\">In our childhood, we could only read about or hear information in a newspaper or on the radio; now, we learn it instantly from social media<\/span><span data-path-to-node=\"36,2\">. There&#8217;s a constant flood of information: every disaster, tsunami, earthquake, flood, war, or other tragedy is reported to us in detail<\/span><span data-path-to-node=\"36,4\">. Our brains can&#8217;t handle that level of ongoing stress<\/span><span data-path-to-node=\"36,6\">. Life has become much more complex<\/span><span data-path-to-node=\"36,8\">. We were taught that life in the city was more difficult, with higher stress and greater prevalence of psychiatric disorders than in rural areas<\/span><span data-path-to-node=\"36,10\">. But now, everywhere feels like a city<\/span><span data-path-to-node=\"36,12\">. That&#8217;s why psychiatric disorders have increased<\/span><span data-path-to-node=\"36,14\">. This is a challenge of modern life<\/span><span data-path-to-node=\"36,16\">.<\/span><\/p>\n<p data-path-to-node=\"37\"><b data-path-to-node=\"37\" data-index-in-node=\"0\">Now that there&#8217;s less stigma surrounding psychiatric illnesses and better access to care, does that also contribute to the growing number of diagnoses?<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-121\" data-path-to-node=\"39\"><span data-path-to-node=\"39,0\"> Trust in psychiatrists has grown<\/span><span data-path-to-node=\"39,2\">. People are now convinced that if they come to a doctor, we will help them<\/span><span data-path-to-node=\"39,4\">. In the past, they suffered in silence at home; now they see professionals more often<\/span><span data-path-to-node=\"39,6\">. As a result, the proportion of depression and anxiety disorder cases has risen in the statistics, though it&#8217;s hard to say that the actual diseases themselves are more common today<\/span><span data-path-to-node=\"39,8\">.<\/span><\/p>\n<p data-path-to-node=\"40\"><b data-path-to-node=\"40\" data-index-in-node=\"0\">What is the greatest challenge in psychiatry?<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-123\" data-path-to-node=\"42\"><span data-path-to-node=\"42,0\"> Without a doubt, it&#8217;s substance abuse<\/span><span data-path-to-node=\"42,2\">. Both in the United States, in Georgia, and worldwide<\/span><span data-path-to-node=\"42,4\">. In America, everyone is talking about the opioid epidemic<\/span><span data-path-to-node=\"42,6\">. (The use of opioid narcotic drugs is a serious national problem and is closely linked to the pharmaceutical company Purdue Pharma<\/span><span data-path-to-node=\"42,8\">. As a result of their marketing campaign, the opioid OxyContin, previously prescribed only for severe cancer-related pain, became accessible to a much broader population<\/span><span data-path-to-node=\"42,10\">. It began to be prescribed for back pain, headaches, and other minor causes of pain, treating pain itself as an illness<\/span><span data-path-to-node=\"42,12\">. This led to an increase in opioid dependence, which in turn drove up demand for street drugs<\/span><span data-path-to-node=\"42,14\">. Purdue Pharma was blamed for triggering the opioid epidemic and was fined billions of dollars, funds that are now used annually to fight addiction.)<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-124\" data-path-to-node=\"43\"><span data-path-to-node=\"43,0\">The situation is dire<\/span><span data-path-to-node=\"43,2\">. In the United States, more people have died from overdoses than in all the wars America has fought in the last two centuries combined, more than have ever died in car accidents<\/span><span data-path-to-node=\"43,4\">. Every year, over 100,000 people lose their lives to drugs<\/span><span data-path-to-node=\"43,6\">. To counter these statistics, we must rely on substitution therapies and preventive programs<\/span><span data-path-to-node=\"43,8\">.<\/span><\/p>\n<p data-path-to-node=\"44\"><b data-path-to-node=\"44\" data-index-in-node=\"0\">In Georgia, the approach toward drug users is becoming stricter&#8230;<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-126\" data-path-to-node=\"46\"><span data-path-to-node=\"46,0\"> From what I hear, I don&#8217;t like it, though I&#8217;m not deeply involved in the matter<\/span><span data-path-to-node=\"46,2\">. Here, fentanyl is the biggest problem<\/span><span data-path-to-node=\"46,4\">. The government is trying to prevent its entry into the country, but this fight has not been very successful, since fentanyl is much more potent and cheaper than heroin<\/span><span data-path-to-node=\"46,6\">. As a result, the government has shifted much of the burden of addressing this issue onto psychiatrists and other addiction specialists<\/span><span data-path-to-node=\"46,8\">. Part of the funds that were previously allocated to law enforcement are now spent on treatment and prevention<\/span><span data-path-to-node=\"46,10\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-127\" data-path-to-node=\"47\"><span data-path-to-node=\"47,0\">In addition to public awareness campaigns and the over-the-counter availability of the medication Narcan (naloxone), so-called &#8220;safe injection sites&#8221; have also been created in exceptional cases<\/span><span data-path-to-node=\"47,2\">. Drug users can go there without fear, bring their drugs, and be provided with a clean needle or, if needed, foil or a smoking pipe<\/span><span data-path-to-node=\"47,4\">. After using the drug, they remain on-site for some time under observation, and if they feel okay, they go home<\/span><span data-path-to-node=\"47,6\">. It&#8217;s a controversial issue; it may seem like drug use is being enabled, but when a person&#8217;s life is hanging in the balance, you have to save the life<\/span><span data-path-to-node=\"47,8\">.<\/span><\/p>\n<p data-path-to-node=\"48\"><b data-path-to-node=\"48\" data-index-in-node=\"0\">Currently, Georgia&#8217;s approach resembles what it was during Nixon&#8217;s time. The &#8220;war on drugs&#8221; (the anti-drug campaign of the 1970s imposed very harsh penalties for the use of any narcotic substances). How has the U.S. approach to drug addiction changed? Has time shown that strict punishment alone doesn&#8217;t work?<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-129\" data-path-to-node=\"50\"><span data-path-to-node=\"50,0\"> In the U.S., the approach toward drug users changed about 10-20 years ago, and the discussion is still ongoing<\/span><span data-path-to-node=\"50,2\">. In my view, drug addiction should not be punished<\/span><span data-path-to-node=\"50,4\">. The &#8220;war on drugs&#8221; is a lost battle<\/span><span data-path-to-node=\"50,6\">. The drug trade has a much larger budget than what the U.S. government allocates to fighting it<\/span><span data-path-to-node=\"50,8\">. You cannot eliminate this problem; it&#8217;s impossible<\/span><span data-path-to-node=\"50,10\">. That doesn&#8217;t mean you should encourage or condone drug use, but drug users must be saved<\/span><span data-path-to-node=\"50,12\">.<\/span><\/p>\n<p data-path-to-node=\"51\"><b data-path-to-node=\"51\" data-index-in-node=\"0\">What role do psychiatrists play in shaping public opinion?<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-131\" data-path-to-node=\"53\"><span data-path-to-node=\"53,0\"> A major one, which is made possible by the structure of organized psychiatry in the United States<\/span><span data-path-to-node=\"53,2\">. We strive to help both the public and lawmakers make informed, fair decisions<\/span><span data-path-to-node=\"53,4\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-132\" data-path-to-node=\"54\"><span data-path-to-node=\"54,0\">To continue with the topic of drugs, for example, a hot topic currently is the legalization of Marijuana in the state of Pennsylvania<\/span><span data-path-to-node=\"54,2\">. There are pros and cons, and I have a hard time making a concrete statement, but what I can say is that the professional stance of the Psychiatric Association is that marijuana use should not be medicalized<\/span><span data-path-to-node=\"54,4\">. In some states, however, voters and, under their pressure, legislators are pushing for medical legalization<\/span><span data-path-to-node=\"54,6\">. In Pennsylvania, for instance, if a person has anxiety, they can obtain a certificate allowing them to use marijuana<\/span><span data-path-to-node=\"54,8\">. Medical societies, psychiatric or neurological associations, explain why this should not be permitted<\/span><span data-path-to-node=\"54,10\">. No professional medical organization to my knowledge supports medical use of marijuana<\/span><span data-path-to-node=\"54,12\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-133\" data-path-to-node=\"55\"><span data-path-to-node=\"55,0\">Under the U.S. Controlled Substances classification, there are five categories<\/span><span data-path-to-node=\"55,2\">. Paradoxically, marijuana belongs to the first category, defined as having no accepted medical use and a high potential for dependence; it is placed at the top of the pyramid alongside heroin<\/span><span data-path-to-node=\"55,4\">. Cocaine, on the other hand, is in the second category, meaning it still has some specific medical applications<\/span><span data-path-to-node=\"55,6\">. The third category includes substances that are used for medical purposes but still carry significant risks<\/span><span data-path-to-node=\"55,8\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-134\" data-path-to-node=\"56\"><span data-path-to-node=\"56,0\">This is why organized psychiatry is essential<\/span><span data-path-to-node=\"56,2\">. There must be a two-way relationship between lawmakers and organized psychiatric and other professional associations to ensure accurate information is communicated<\/span><span data-path-to-node=\"56,4\">. This is how mistakes can be avoided<\/span><span data-path-to-node=\"56,6\">. Sometimes they come to us for input; other times, we take the initiative to oppose specific legislative proposals<\/span><span data-path-to-node=\"56,8\">.<\/span><\/p>\n<p data-path-to-node=\"57\"><b data-path-to-node=\"57\" data-index-in-node=\"0\">Many people believe that only those with weak willpower become addicted. What role does dopamine play in the development of addiction?<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-136\" data-path-to-node=\"59\"><span data-path-to-node=\"59,0\"> Even in the United States, there is no unanimous agreement that addiction is a disease of the brain rather than simply a behavioral problem or a matter of weak willpower<\/span><span data-path-to-node=\"59,2\">. Strengthening this understanding will take a great deal of time, work, and effort<\/span><span data-path-to-node=\"59,4\">. As for dopamine, I&#8217;ll try to explain this complex topic in simple terms<\/span><span data-path-to-node=\"59,6\">. In the brain&#8217;s limbic system, there is an area called the nucleus accumbens, our pleasure center<\/span><span data-path-to-node=\"59,8\">. Everything that brings us pleasure connects to this nucleus<\/span><span data-path-to-node=\"59,10\">. Usually, pleasurable stimuli might be sex, food, drugs, alcohol, tobacco, or other things<\/span><span data-path-to-node=\"59,12\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-137\" data-path-to-node=\"60\"><span data-path-to-node=\"60,0\">Dr. Nora Volkow, the head of the U.S. National Institute on Drug Abuse, has a hypothesis that people with addiction do not have enough dopamine receptors in this nucleus<\/span><span data-path-to-node=\"60,2\">. As a result, they cannot derive sufficient pleasure from human interactions, and the drug becomes their primary source of joy<\/span><span data-path-to-node=\"60,4\">. Addiction forms through a combination of psychological and physiological processes: the body physically requires the substance, and the number of receptors decreases over time<\/span><span data-path-to-node=\"60,6\">. According to Volkow&#8217;s hypothesis, such individuals need an excess amount of stimulation to feel pleasure; perhaps this is how addiction begins<\/span><span data-path-to-node=\"60,8\">. There is another theory: a person may not initially have this receptor deficit, but for some reason, they start using a substance, and then gradually become physically dependent<\/span><span data-path-to-node=\"60,10\">. These substances, including nicotine, are not easily given up<\/span><span data-path-to-node=\"60,12\">. What happens next?<\/span><span data-path-to-node=\"60,14\"> When you consume these substances, dopamine surges, and you feel pleasure<\/span><span data-path-to-node=\"60,16\">. This is physiological when neurotransmitters are in excess, the receptors downregulate and become depleted<\/span><span data-path-to-node=\"60,18\">. It can take years for them to return to their original state<\/span><span data-path-to-node=\"60,20\">. The situation then resembles the first scenario, a closed loop<\/span><span data-path-to-node=\"60,22\">.<\/span><\/p>\n<p data-path-to-node=\"61\"><b data-path-to-node=\"61\" data-index-in-node=\"0\">Childhood trauma and severe psychological stress, such as PTSD, increase the risk of addiction. If we link dopamine receptor depletion to addiction, is this connected to childhood psychological trauma?<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-139\" data-path-to-node=\"63\"><span data-path-to-node=\"63,0\"> Addiction often develops in people who have experienced repeated trauma<\/span><span data-path-to-node=\"63,2\">. For example, veterans returning from war frequently have post-traumatic stress disorder (PTSD) and later develop alcohol dependence<\/span><span data-path-to-node=\"63,4\">. Most of the people with substance use disorders I encountered were in Veterans Affairs<\/span><span data-path-to-node=\"63,6\">. However, I&#8217;m not aware of studies indicating whether the problem stems directly from the trauma itself or whether it&#8217;s the stress-induced context that leads to substance use, which then affects dopamine function<\/span><span data-path-to-node=\"63,8\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-140\" data-path-to-node=\"64\"><span data-path-to-node=\"64,0\">These individuals need help<\/span><span data-path-to-node=\"64,2\">. If a patient cannot find relief, they may start &#8220;self-medicating&#8221; with drugs or alcohol<\/span><span data-path-to-node=\"64,4\">. Over time, dopamine receptors become depleted, the brain becomes impaired, and addiction develops<\/span><span data-path-to-node=\"64,6\">.<\/span><\/p>\n<p data-path-to-node=\"65\"><b data-path-to-node=\"65\" data-index-in-node=\"0\">Speaking of addiction, in the context of the obesity epidemic, should we also talk about food addiction? Does it arise for the same reasons?<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-142\" data-path-to-node=\"67\"><span data-path-to-node=\"67,0\"> In the United States, the obesity epidemic operates through the exact mechanisms as any other form of addiction, for example, dependence on ultra-processed foods that are very salty or sugary<\/span><span data-path-to-node=\"67,2\">. There&#8217;s also an interesting observation: GLP-1 agonists, such as Ozempic, which we use for obesity and diabetes, have produced unexpected results<\/span><span data-path-to-node=\"67,4\">. We prescribe the drug for weight loss, and suddenly the patient stops drinking alcohol<\/span><span data-path-to-node=\"67,6\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-143\" data-path-to-node=\"68\"><span data-path-to-node=\"68,0\">Nowadays, serious research is underway into whether this class of medications could also help with substance use disorders<\/span><span data-path-to-node=\"68,2\">. While there&#8217;s no conclusive evidence yet, if a patient is overweight and we are also addressing substance dependence, we often choose to prescribe this group of drugs<\/span><span data-path-to-node=\"68,4\">.<\/span><\/p>\n<p data-path-to-node=\"69\"><b data-path-to-node=\"69\" data-index-in-node=\"0\">In Georgia, people often go to psychologists for treatment of mental health issues and think that psychiatrists are only for prescribing medication. How does the American system work?<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-145\" data-path-to-node=\"71\"><span data-path-to-node=\"71,0\"> In Georgia, people sometimes don&#8217;t even go to psychiatrists for medication; they go to neurologists instead<\/span><span data-path-to-node=\"71,2\">. Yes, both of us treat the brain, but neurology focuses more on structural disorders like Parkinson&#8217;s disease, migraines, and others, whereas psychiatry deals more with the mind, mood, and personality<\/span><span data-path-to-node=\"71,4\">. There is still a stigma that if you go to a psychiatrist, it means you&#8217;re &#8220;crazy&#8221; or &#8220;insane.&#8221;<\/span><span data-path-to-node=\"71,6\"> This mindset must change; psychiatric patients should be going to psychiatrists<\/span><span data-path-to-node=\"71,8\">. Going to a neurologist to treat &#8220;neurosis&#8221; is wrong, wrong, wrong!<\/span><span data-path-to-node=\"71,10\"> These slogans should be everywhere<\/span><span data-path-to-node=\"71,12\">. Here, that&#8217;s not the case<\/span><span data-path-to-node=\"71,14\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-146\" data-path-to-node=\"72\"><span data-path-to-node=\"72,0\">Psychology and psychiatry are often confused, both here and in Georgia<\/span><span data-path-to-node=\"72,2\">. Psychiatry is a medical specialty<\/span><span data-path-to-node=\"72,4\">. A psychiatrist is a doctor who has completed a full medical education, with about 10 years of training<\/span><span data-path-to-node=\"72,6\">. A psychologist is not a doctor<\/span><span data-path-to-node=\"72,8\">. They can treat patients using psychotherapeutic methods, but cannot prescribe medication<\/span><span data-path-to-node=\"72,10\">. If a person has the means to see a psychiatrist, they should go to one<\/span><span data-path-to-node=\"72,12\">. The psychiatrist will develop a treatment plan, which may include prescribing medication, referring to a psychotherapist, or both<\/span><span data-path-to-node=\"72,14\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-147\" data-path-to-node=\"73\"><span data-path-to-node=\"73,0\">It&#8217;s unfortunate that in Georgia, psychiatrists don&#8217;t or can&#8217;t monitor their patients regularly<\/span><span data-path-to-node=\"73,2\">. These are chronic conditions; they evolve over time, and constant monitoring is essential<\/span><span data-path-to-node=\"73,4\">.<\/span><\/p>\n<p data-path-to-node=\"74\"><b data-path-to-node=\"74\" data-index-in-node=\"0\">I&#8217;d also like to ask about a relatively new field: interventional psychiatry. How effective is transcranial magnetic stimulation in cases of treatment-resistant depression?<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-149\" data-path-to-node=\"76\"><span data-path-to-node=\"76,0\"> Transcranial magnetic stimulation (TMS) is my favorite treatment method<\/span><span data-path-to-node=\"76,2\">. I&#8217;ve been performing TMS for a very long time and am considered an expert in this field<\/span><span data-path-to-node=\"76,4\">. I&#8217;m a member of the Clinical TMS Society and personally know many other experts<\/span><span data-path-to-node=\"76,6\">. In the U.S., this method is widespread<\/span><span data-path-to-node=\"76,8\">. The rest of the world is still catching up, but the procedure is gradually gaining ground in Europe as well<\/span><span data-path-to-node=\"76,10\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-150\" data-path-to-node=\"77\"><span data-path-to-node=\"77,0\">At this stage, we can&#8217;t use transcranial magnetic stimulation to treat everything<\/span><span data-path-to-node=\"77,2\">. I believe that as the technology improves, it will be applied to a broader spectrum of disorders<\/span><span data-path-to-node=\"77,4\">. Every psychiatric illness &#8220;lives&#8221; in the brain, and this tool allows us to reach any part of the brain non-invasively and influence it<\/span><span data-path-to-node=\"77,6\">. The more treatment options we have in psychiatry, the better results we&#8217;ll achieve<\/span><span data-path-to-node=\"77,8\">. Until recently, medication and psychotherapy were the only treatment methods, but that list is growing<\/span><span data-path-to-node=\"77,10\">.<\/span><\/p>\n<p data-path-to-node=\"78\"><b data-path-to-node=\"78\" data-index-in-node=\"0\">Why hasn&#8217;t TMS become the gold standard?<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-152\" data-path-to-node=\"80\"><span data-path-to-node=\"80,0\"> One of the main reasons is cost<\/span><span data-path-to-node=\"80,2\">. A complete course costs an average of $15,000, which is very expensive for psychiatric treatment<\/span><span data-path-to-node=\"80,4\">. Insurance does cover the treatment, but usually only in cases of treatment-resistant depression<\/span><span data-path-to-node=\"80,6\">. This is why there is a false perception that the method is used only for resistant depression<\/span><span data-path-to-node=\"80,8\">. In some cases, it could be the first-line treatment for depression<\/span><span data-path-to-node=\"80,10\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-153\" data-path-to-node=\"81\"><span data-path-to-node=\"81,0\">One of the advantages of this treatment is its specificity<\/span><span data-path-to-node=\"81,2\">. Any psychiatric medication has side effects, but TMS targets only a specific area of the brain and has no systemic side effects<\/span><span data-path-to-node=\"81,4\">. This method is also used for anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, and even tobacco and substance addiction<\/span><span data-path-to-node=\"81,6\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-154\" data-path-to-node=\"82\"><span data-path-to-node=\"82,0\">Comparing magnetic stimulation to medication treatment, I recall an important example<\/span><span data-path-to-node=\"82,2\">. From 2006 to 2010, the well-known STAR*D study (Sequenced Treatment Alternatives to Relieve Depression) was conducted<\/span><span data-path-to-node=\"82,4\">. Thousands of patients were given antidepressants in a step-by-step sequence according to an algorithm<\/span><span data-path-to-node=\"82,6\">. One of the key findings was that each subsequent medication was less effective than the previous one<\/span><span data-path-to-node=\"82,8\">. After four complete courses of antidepressants failed, the likelihood of solving the problem with further medications became very low, approaching zero<\/span><span data-path-to-node=\"82,10\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-155\" data-path-to-node=\"83\"><span data-path-to-node=\"83,0\">Today, before we can start magnetic stimulation for a patient, they must have tried at least four medications for insurance to cover it<\/span><span data-path-to-node=\"83,2\">. After treatment, among such seemingly hopeless patients, 60% experience significant symptom reduction, and 40% achieve complete remission, with all symptoms disappearing<\/span><span data-path-to-node=\"83,4\">. Considering all this, I believe this method will become the gold standard in the future<\/span><span data-path-to-node=\"83,6\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-156\" data-path-to-node=\"84\"><span data-path-to-node=\"84,0\">Of course, there are other types of neuromodulation, but at present, TMS is the best<\/span><span data-path-to-node=\"84,2\">. Important to note that TMS can be a first-line therapy; comparatively, ketamine therapy will never be first-line<\/span><span data-path-to-node=\"84,4\">. It should be used only when other treatment options have been exhausted<\/span><span data-path-to-node=\"84,6\">.<\/span><\/p>\n<p data-path-to-node=\"85\"><b data-path-to-node=\"85\" data-index-in-node=\"0\">For many, including students and doctors, psychiatry is associated with a cohort of severely ill patients, individuals who are challenging to communicate with, and the psychological stress that comes from working with them. How accurate is this stereotypical view of psychiatry, and how do you personally cope with it?<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-158\" data-path-to-node=\"87\"><span data-path-to-node=\"87,0\"> I have never regretted my choice for even a minute<\/span><span data-path-to-node=\"87,2\">. You need to know yourself; if you cannot accept people as they are, you should not become a psychiatrist<\/span><span data-path-to-node=\"87,4\">. Among my patients, there are murderers, drug addicts, robbers, but that doesn&#8217;t bother me<\/span><span data-path-to-node=\"87,6\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-159\" data-path-to-node=\"88\"><span data-path-to-node=\"88,0\">Today, we are effective<\/span><span data-path-to-node=\"88,2\">. In my practice, many patients feel very well, and you wouldn&#8217;t even notice they have a problem<\/span><span data-path-to-node=\"88,4\">. They live, they work, and some hold very high positions<\/span><span data-path-to-node=\"88,6\">. This gives me motivation, knowing I am doing meaningful work<\/span><span data-path-to-node=\"88,8\">. Having grateful patients is a huge encouragement<\/span><span data-path-to-node=\"88,10\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-160\" data-path-to-node=\"89\"><span data-path-to-node=\"89,0\">Because I have been working for many years, I now have two main types of patients: the first are long-term patients whom I see periodically and know very well<\/span><span data-path-to-node=\"89,2\">. If they have a problem, I can quickly help them, allowing them to continue living their regular lives<\/span><span data-path-to-node=\"89,4\">. The second group consists of people who have already seen every possible doctor and have finally come to me<\/span><span data-path-to-node=\"89,6\">. Working with them is much more difficult, but I can still help a great many of them, and that too is a huge motivator<\/span><span data-path-to-node=\"89,8\">. When others couldn&#8217;t help and you can, their gratitude is multiplied<\/span><span data-path-to-node=\"89,10\">. Of course, you can&#8217;t help everyone, but you can ease their condition<\/span><span data-path-to-node=\"89,12\">.<\/span><\/p>\n<p data-path-to-node=\"90\"><b data-path-to-node=\"90\" data-index-in-node=\"0\">As we wrap up, please tell us about the Psychiatric Association and organized psychiatry.<\/b><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-162\" data-path-to-node=\"92\"><span data-path-to-node=\"92,0\"> The American Psychiatric Association is a powerful and historic organization, founded 185 years ago<\/span><span data-path-to-node=\"92,2\">. I can&#8217;t even compare it to European associations<\/span><span data-path-to-node=\"92,4\">. Think of it as the World Psychiatric Association, with 40,000 members, each paying $1,500-$2,000 in annual dues<\/span><span data-path-to-node=\"92,6\">. We have lobbyists and committees that monitor legislation<\/span><span data-path-to-node=\"92,8\">. This is normal, lawmakers don&#8217;t understand psychiatry, so lobbyists work with congressmen while we provide them with expert advice<\/span><span data-path-to-node=\"92,10\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-163\" data-path-to-node=\"93\"><span data-path-to-node=\"93,0\">In addition, attending meetings and conferences arranged by APA allows us to discuss new developments, which is particularly beneficial for young professionals<\/span><span data-path-to-node=\"93,2\">. Here, they meet new colleagues, exchange ideas, get valuable advice, join interesting research projects, and gain many other opportunities<\/span><span data-path-to-node=\"93,4\">. We host engaging lectures, and updates reach all members in a timely manner<\/span><span data-path-to-node=\"93,6\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-164\" data-path-to-node=\"94\"><span data-path-to-node=\"94,0\">We have specialized programs\u2014if you&#8217;re interested in addiction psychiatry, or someone else is focused on child psychiatry, there are dedicated groups where members share information<\/span><span data-path-to-node=\"94,2\">. We support psychiatrists, people with mental health problems, and their families in every way possible<\/span><span data-path-to-node=\"94,4\">. This is organized psychiatry, and it is essential for every country<\/span><span data-path-to-node=\"94,6\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-165\" data-path-to-node=\"95\"><span data-path-to-node=\"95,0\">From the small streets of Zugdidi to a prestigious clinic in Pennsylvania, Irakli Mania&#8217;s journey has been not only a professional one but also a profoundly personal voyage<\/span><span data-path-to-node=\"95,2\">. He is convinced that the most significant changes begin when a person is not afraid of their own goals<\/span><span data-path-to-node=\"95,4\">.<\/span><\/p>\n<p id=\"p-rc_9f6d8e57980860ee-166\" data-path-to-node=\"96\"><span data-path-to-node=\"96,0\">&#8220;Treatment is not just about medications and procedures,&#8221; says Irakli<\/span><span data-path-to-node=\"96,2\">. &#8220;You must always empathize with the person and tell them: we are in this together<\/span><span data-path-to-node=\"96,4\">. When those words are sincere, that&#8217;s when true healing begins.&#8221;<\/span><\/p>\n<p data-path-to-node=\"96\"><strong>Author: Levan Alavidze; Photo: Kikala Studio<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Growing up in the noisy courtyards of Zugdidi, Irakli Mania realized from an early age that his life could not be contained within a small town. In the 1990s, marked by civil war, constant unrest, and poverty, students studied not from books but from photocopies under the flickering light of candles, and walked to university [&hellip;]<\/p>\n","protected":false},"author":9,"featured_media":22798,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1594],"tags":[6514],"class_list":["post-22799","post","type-post","status-publish","format-standard","has-post-thumbnail","category-news","tag-irakli-mania"],"acf":[],"_links":{"self":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts\/22799","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/comments?post=22799"}],"version-history":[{"count":2,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts\/22799\/revisions"}],"predecessor-version":[{"id":22802,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts\/22799\/revisions\/22802"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/media\/22798"}],"wp:attachment":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/media?parent=22799"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/categories?post=22799"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/tags?post=22799"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}