1 Boring Old Man

New psychiatric drugs low priority for pharmaceutical firms
^{Huge unmet need for better drugs for people with depression}
CBC News
Oct 14, 2012

The pharmaceutical industry has largely abandoned drug development for mental illnesses even though depression is a leading cause of disability, experts say. Authors of papers published in this week’s issue of the journal Science Translational Medicine argue that drug discovery for treating psychiatric disorders such as autism, schizophrenia, bipolar disorder and depression are at a near standstill. "Antipsychotics and antidepressants have been some of the most profitable agents for companies over the last two decades," said Dr. Thomas Insel, director of the U.S. National Institute of Mental Health and one of the authors. "But that doesn’t mean they’re effective. What it means is that they sell and they can be marketed."

In the last five decades, more than 20 antipsychotics and 30 antidepressants have been marketed with over $25 billion in sales in the U.S. in 2011 alone, Insel said. The drugs are descended from serendipitous discoveries such as the mood stabilizing effects of lithium in 1949, said Steven Hyman of Harvard University in Cambridge, Mass., and the author of the second paper. "The central problem is clear: Neither vast unmet medical need, nor large and growing markets, nor concerted sales campaigns that attempt to recast ‘me-too drugs’ as innovative can illuminate a path across very difficult scientific terrain," Hyman wrote. "Advances continue to be made in modes of cognitive psychotherapy and device-based psychiatric treatments; but despite the growing market opportunities, major pharmaceutical companies recently announced substantial cutbacks or complete discontinuation of efforts to discover new drugs for psychiatric disorders"…

^{The exit of the pharmaceutical industry from psychiatry, even in the face of substantial markets, underscores the difficulty of brain research but, more importantly, draws attention to the limitations of translational paradigms of the past several decades. It is time to eschew models and tools that have progressively shown themselves to be unsuccessful. It is time to look beyond pathophysiological hypotheses derived from small, disconnected islands of data that we had the good fortune to acquire.}

^{There has been a steady retreat by the private sector away from developing medications for mental disorders. This retreat comes just as research is identifying new molecular targets, new clinical targets, and new uses of current treatments that may serve as the basis for the next generation of treatments for mental disorders.}

It doesn’t take a rocket scientist to get a bit meta about all of this. First, the real problem is that the deep pockets pharmaceutical companies are abandoning psychopharmacology. There goes the research money. There goes the stream of drugs to talk about, to compare, to study and restudy, to pour into the Clinical Trials industry, to write reviews about, to offer to patients as something new, etc. So to the next meta question, "Why are the pharmaceutical companies jumping ship?" The drugs are lousy, loaded with side effects, low efficacy. They rode the wave of excitement and the popularization by psychiatric pundits, but that ship is sinking. So, get out now before it heads for Davy Jones Locker. Turning these dogs into blockbusters in the salad days was hard enough. In today’s grumbling climate, it would be impossible. Move on to something safer where the drugs are more effective and there’s not so much bad blood. Call me when there’s a real breakthrough. "But what about the pressing need, the substantial market, the promise of the future?" That pressing need was there in the Middle Ages too. Call me when there’s a real breakthrough.You can only make a silk purse out of a sow’s ear for so long before there’s a consumer revolt and you have to start giving back your profits. The psychopharmacology bubble has burst as surely as the housing market.