Despite decades of research and billions of dollars invested, not a single mechanistically novel drug has reached the psychiatric market in more than 30 years. At the same time, the demand for psychiatric drugs has skyrocketed, according to Medco Health Solutions, a pharmacy benefit manager. Today, one in five Americans is currently on one psychiatric drug and mental disorders such as depression, schizophrenia, and bipolar disorder are increasingly recognized by healthcare systems worldwide. But the really disturbing part is that people who need help in the form of new, innovative drugs are not getting it.
This issue is the focus of this month’s Cerebrum feature: “Psychiatric Drug Development: Diagnosing a Crisis” by Dana Alliance and Dana Foundation Board member Steven M. Hyman, M.D., to find out the history of psychiatric drug development, the reasons for its retreat, and the changes necessary to meet the growing demand.
Few are better equipped than Hyman to tackle the topic. The director of the Stanley Center for Psychiatric Research at the Broad Institute and a Broad Institute core member, he is also Harvard University Distinguished Service Professor of Stem Cell and Regenerative Biology. Hyman was one of the key architects of the Broad Institute, when it was launched in 2004 as a bold experiment in biomedicine and became a permanent institution in 2009. He joined the Broad after a decade of service as provost of Harvard University, where he served as Harvard’s chief academic officer, and also had a special focus on the development of collaborative scientific initiatives that span multiple disciplines and cross-institutional boundaries. What’s more, from 1996 to 2001, he was on the frontlines of neuroscience funding as director of the National Institute of Mental Health from 1996 to 2001, where a large part of his role was emphasizing investment in emerging genetic technologies.
“During the past three years the global pharmaceutical industry has significantly decreased its investment in new treatments for depression, bipolar disorder, schizophrenia, and other psychiatric disorders,” says Hyman’s opening paragraph. “Some large companies, such as GlaxoSmithKline, have closed their psychiatric laboratories entirely. Others, such as Pfizer, have markedly decreased the size of their research programs. Yet others, such as AstraZeneca, have brought their internal research to a close and are experimenting with external collaborations on a smaller scale.”
Hyman is not alone in sounding the alarm that the field is in crisis. Drug development for complex psychiatric illnesses is misguided, he argues, stuck churning out slight variations on therapeutic themes. Faulty assumptions, animal models that don’t look anything like human diseases, hazy diagnoses and a lack of knowledge about how the brain works have all thwarted the search for better drugs.
But despite the dark cloud, Hyman finds some silver lining, mostly due to “the emergence of remarkable new tools and technologies to identify the genetic risk factors” and “the efforts of large international consortia that have formed to recruit and to study patients.”
– Bill Glovin