What happens when the drug pipeline for common mental health concerns — such as depression, anxiety and bipolar disorder — starts to dry up?
“Most psychiatric drugs in use today originated in serendipitous discoveries made many decades ago,” according to a recent article on Science News by Laura Sanders. And it’s true — we can trace back today’s most popular psychiatric drugs to discoveries made over 30 — and in some cases, 40! — years ago.
Because of the heady cost of drug development — costing hundreds of millions of dollars to bring a new drug to market — most pharmaceutical companies have been playing it safe these past few decades. They’ve been working on developing “me too” drugs — subtle molecular changes to existing compounds.
Which means the pipeline is darned near empty of truly new drugs likely to come out in the next 5 to 10 years for the most common types of mental illness.
This provides the drug company with two things. The first is a new medicine they can patent and sell at a significant markup over the old, generic drug it’s based off of. The second is the illusion of progress, of releasing something that is “new and better” than the old thing — but which additional research almost always demonstrates is simply as good — not better — than the old thing (and usually with a different — not better — side effect profile).
So the “new” SSRIs of the 1990s did away with tricyclics’ side effects, but brought on a whole host of their own, new side effects (chief among these, sexual dysfunction… as though nobody cared much about the quality of their sex lives).
The one thing these “me too” drugs don’t provide is any additional, substantial relief to patients.
So it should come as no surprise that most pharmaceutical companies’ psychiatric drug pipelines are… how shall we say?… empty.
Not a single drug designed to treat a psychiatric illness in a novel way has reached patients in more than 30 years, argues psychiatrist Christian Fibiger of the University of British Columbia in Kelowna, who described the problem in a 2012 Schizophrenia Bulletin editorial. “For me, the data are in,” says Fibiger, who has developed drugs at several major pharmaceutical companies.
“We’ve got to change. This isn’t working.”
The biggest problem, from mine and other researchers’ perspective, is the simple lack of understanding of the organ we’re trying to impact with these drugs — the brain.
Perhaps the largest impediment to the development of new psychiatric drugs is the brain itself. A complex web of interconnected systems constantly altered by the environment, the brain is difficult to study.
Even though it’s nestled right in our heads, the brain is hard to reach. A blood pressure cuff can be slapped on for an instant and objective measure of what’s happening with the heart. A needle biopsy can physically pull out suspected breast cancer cells for further tests. But when it comes to the brain, there is no easy way to identify and measure the thing that isn’t working.
As neuroscientist Steven Hyman of the Broad Institute of MIT and Harvard says in the article, “You can’t just open up the hood, take out a chunk and see what’s happening.”
Thomas Insel, director of the National Institute of Mental Health, believes there is hope by pursuing a new path in research — understanding the very basics of the brain’s functioning. Combined with Obama’s announcement of the Brain Activity Map project to be undertaken by the U.S. later this year, there is hope that we can greatly increase our understanding of the body’s most vital organ.
The situation is grim, but not hopeless, says Insel. At a time when major pharmaceutical companies are abandoning psychiatric drug development, Insel says he is doubling down, investing federal grant money in places where investors fear to tread.
“There are a whole series of pretty amazing developments that I think are worth investing in,” he says.
That’s the good news… But it’s going to take years — and more likely, decades — before we will see the benefit of such research efforts.
But it Hasn’t Stopped Drug Sales…
But that hasn’t stopped the sales of all of these me-too psychiatric drugs:
Which only goes to show you that pharmaceutical company marketing works better than perhaps some would give it credit for.
Read the full Science News article (lengthy, but gives many examples and further details about this issue): No New Meds
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Last reviewed: By John M. Grohol, Psy.D. on 27 Feb 2013
Published on PsychCentral.com. All rights reserved.
Grohol, J. (2013). New Anxiety, Bipolar and Depression Drugs in the Pipeline?. Psych Central. Retrieved on January 26, 2015, from http://psychcentral.com/blog/archives/2013/02/28/new-anxiety-bipolar-and-depression-drugs-in-the-pipeline/