Dr. Friedman, writing in The New York Times recently, suggested that recent research will lead to a very different manner of treatment of depression “within a few years.” The headline attached to his opinion piece is even more deceiving — “personalized” depression drugs are “on the horizon.” If by “horizon,” you mean within the next decade or two, sure. And if by personalized, you mean “we know what might not work for you,” then all of this is accurate.
Of course, this isn’t what most people would think if they read a headline like that. They might think, “Wow, they’re going to make a personalized depression drug just for me!” No, they’re not.
What Dr. Friedman writes about is a simple mouse trial, conducted last October (not sure why this is “news” worthy of the New York Times 8 months later), that is hardly something natural:
[The researchers] inserted into a mouse a defective variant of the human gene for brain-derived neurotrophic factor, a protein that is increased in the brain with S.S.R.I. treatment and is critical to the health of neurons. Then he subjected these “humanized” mice to stress and found that they did not respond to Prozac with decreased anxiety.
So some curious research inserted into a mouse a variant of a human gene, to create something like what we think may be going on with some people with depression. Notice all the “think’s” and “maybe’s” and “something like’s” I used. Why?
Because there isn’t a neurochemical test for any of this in humans. Hundreds of mouse trials are conducted each year, but only a handful lead to relevant findings in humans. There’s currently no laboratory result a doctor can look at and say, “Oh, you have this genetic variant, maybe you should get XYZ drug.” This is all very cutting-edge stuff, important research that will hopefully lead to some interesting treatments (or rule-out some treatments) for people some day. But we’re a long way from that day.
And when I say, “long way,” I mean closer to decades than “within a few years.” We’ve been hearing “within a few years” for this biochemical marker or this neurological test for depression or bipolar disorder or schizophrenia for, well, decades now. I first heard of such promising results back in the 1980’s. Here it is 20+ years later, and still no such tests exist.
The reason for this is because mental health concerns, such as depression, have proved to be far more complex and challenging than the original simplistic models of brain chemistry suggested. It’s not that one neurochemical is “out of balance” (without a test, how would you know what “balance” even looks like?). It’s complex, and while research like this is helpful to add another data point to our knowledge, it is still just that — one data point.
I dislike these kinds of articles that give people who grapple with depression false hope that a “personalized drug” cure is just around the corner or just over the horizon. It isn’t. And shame on writers like Dr. Friedman for suggesting otherwise.