Opinion: STAT+: It’s time to rethink everything about our approach to psychiatric drug development
Can biology explain how people with the same psychiatric disorder respond differently to the same treatment?
In many ways, psychiatry is still flying blind. People experiencing mental health conditions are prescribed various drugs until one (or a combination) finally works — a painful process that can take years. As a psychiatrist and neuroscientist, I became increasingly impatient and frustrated with this ineffective way of treating patients. This guided the core question behind my research: Can biology explain how people with the same psychiatric disorder respond differently to the same treatment?
Since I first began exploring this question more than a decade ago, mental illness has become a global epidemic. Despite significant efforts, progress in psychiatric drug development has remained disappointingly slow. There have been a few notable approvals in recent years, and a renewal of interest by Big Pharma, following a retreat from psychiatric research in the mid to late 2000s. But the landscape remains predominantly marked by failures and a dry drug development pipeline. Approved drugs follow the same pattern of prescribing via guesswork, with most patients not responding to a given drug. This cycle of trial-and-error drug development producing trial-and-error treatment arises from a simple source: We have not systematized a process for learning from our failures and successes.
For example, take depression: While the rise of selective serotonin reuptake inhibitors (SSRIs) in the 1980s and 1990s seemed to provide a solution, seminal studies in the 2000s exposed fundamental limitations of our treatment options. Antidepressants are widely prescribed, but their efficacy relative to placebo is modest.
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