To promote recovery and treatment of people with serious mental illnesses, the health care community must foster innovation in treatment and resources. We are making great strides with interventions such as Coordinated Specialty Care for early intervention in psychosis. Medications are a critical part of treatment and recovery for many persons, especially those with Serious Mental illnesses and we need to make sure we’re introducing new medications, as a critically important tool for pursuing recovery. Although numerous new medications are in various phases of testing, the next big breakthrough might involve using an existing medication in a new way.
It’s been a while since there have been major breakthroughs in pharmacological treatments. It was during the late 1980s and early 1990s that selective serotonin reuptake inhibitors used to treat depression and anxiety hit the market, with second generation antipsychotics, a host of new antipsychotic medications following behind
So how do we help people who don’t seem to benefit from currently available medications? Clinically, it makes sense to focus on developing drugs that work through different mechanisms. . However, from a business standpoint, it is less risky and more efficient to develop drugs that work in a ways similar to existing drugs. For these reasons, many drugs approved in the past decade have been similar to older drugs.
On the other hand, not all drug development is limited to new versions using the same mechanisms. Innovations in the works include a fast-acting nasal spray treatment for social anxiety and a substance that promotes the growth of new nerve cells in the brain as a treatment for depression. It is possible that one of these new drugs will be approved and change the lives of many. Then again, it is also possible that the next big innovation might come from drug repositioning—using a drug approved for other uses.
New Uses for Old Drugs
The National Institute of Mental Health is researching the use of ketamine, an anesthetic introduced in 1962, to treat depression. Not only would this represent a new use for an old drug, it would target different receptors in the brain than medications that are currently used to treat depression. This new development could help people who do not respond to currently available antidepressants. NIMH is also exploring potential benefit of taking non-steroidal anti-inflammatory durgs such as ibuprofen and naproxen to boost the effectiveness of medications for depression and for schizophrenia. Further research is needed to verify the effects and determine the situations in which NSAIDs might be helpful.
Another promising trend in behavioral science medication development has been to look at delivery systems that will help people take helpful medications regularly. One example of this is long acting injectable antipsychotic medications that only need to be taken once every four, 6 or even 12 weeks.
Unlike ketamine and NSAIDs, which have current clinical uses, psilocybin—the active ingredient in psychedelic mushrooms—is classified solely as a drug of misuse. Psilocybin has shown promise as a rapid antidepressant. Full-scale research, including investigating the potential for misuse, should tell us more.
It would be wonderful if a substance that we already know something about proves to be an effective treatment for behavioral health conditions. However, it is also important for the pharmaceutical industry to pursue new drugs that safely and effectively treat behavioral health conditions, just as urgently as they seek new treatments for physical conditions. Pharmacological approaches are often an important component of the treatment needed to support people in recovery, and we must ensure that people with behavioral health conditions have access to the best treatments possible.