Thomas Insel, the director of the National Institute of Mental Health (NIMH), has been writing some very interesting blog posts over the past month (this one, and this one).

The theme is that there are very few drug treatment innovations coming for mental disorders. He said that this is due to changes in focus and funding at the big drug makers. He also adds that there are very few new “targets” (areas of the brain for drugs to influence) for drug researchers to explore.

When I read this I couldn’t help but think back to something Dr. Morgan Sammons (Aliant University) describes as the “paradoxes” of drug treatment for psychiatric disorders.

The first paradox is that the drugs are not “curative”. They reduce symptoms while someone is taking them, but the symptoms often return after the person stops. Second, most of the reasons the drugs actually work for mental disorders are not understood. Third, and perhaps most importantly, is that the newer drugs are not any more effective than the older ones. They are less toxic, but their effectiveness is essentially the same.

Putting this together, if history repeats itself, we would expect new drugs to have about the same effectiveness as those we have now (and maybe be a bit safer).

I think this offers an opportunity to people studying and practicing psychotherapy. With the landscape of medications likely staying constant for awhile, this is a great time for innovation, as well as communication about how effective psychotherapy can be, when practiced well.

I’m also hopeful that more work on how psychotherapy changes brain processes will emerge during this time. Either way, just because there are few drugs on the way does not mean that the innovation won’t emerge somewhere else, and I think psychotherapy is the right thing at the right time.