A short history of psychiatry in the West
The 1950s was a revolutionary era for the clinical introduction of new classes of psychiatric drugs. The discovery of many of these drugs could be seen as a happy accident. The first anti-psychotic, chlorpromazine, was originally synthesised in 1950 by the French pharmaceutical company Rhône-Poulenc, whilst developing antihistaminergic drugs.1 Two more fundamental contributions to the development of modern psychiatry came in the form of iproniazid and imipramine, a monoamine-oxidase inhibitor and tricyclic antidepressant, respectively, which were originally developed for use in tuberculosis. This kickstarted the era of psychiatry. Fast forward to 1987 where the first selective serotonin reuptake inhibitor, Prozac, was introduced to the market and was hailed as a wonder drug.2 With 40 million people taking Prozac worldwide, profits of the miracle drug peaked at £2 billion per year, globally.3 The popularity of Prozac started a psychiatric revolution which gave rise to a decade of blockbuster psychiatric drugs. The 1990s- what a wonderful time to be a psychiatrist.
The end of the Prozac era
Despite this seemingly exponential increase in psychiatric drug development, the pipeline is now drying up. In 2010, pharma giants AstraZeneca and GlaxoSmithKline cut all funding to psychiatric drug research and development, leaving psychopharmacology in crisis.
Why is big pharma abandoning psychiatry?
After years of big pharma vying to produce the next block buster psychiatric drug, it seems that it is no longer economically viable to continue investing in psychiatric research and development. According to the World Health Organisation, one in every four people will suffer from a mental disorder at some point during their lifetime, with 450 million people currently suffering.4 Despite this, in the past decade, the amount of psychiatric drugs being developed by large pharma companies has decreased by 70%. Within the last 10 years, only one anti-depressant, agomelatine, has been licensed for use.5 Despite high prevalence and an unmet clinical need, why is big pharma leaving psychiatry?
With patents of blockbuster psychiatric drugs from the 1990s expiring, it has been difficult to make profit from new drug development. Psychiatric drugs are arduous to develop, with little promise that after 15 years of research that the new drug will show efficacy. President of the University of Ottawa’s Institute of Mental Health Research, Dr. Zul Merali states that ‘the costs have been going up and up and the number of drugs actually approved for clinical use are not increasing in parallel, so it is a high-risk investment for the pharmaceutical industry.’6
Another factor in the decision for big pharma to pull out of psychiatry could be the controversy surrounding the suicidal tendencies and adverse drug reactions linked to many psychiatric drugs, such as the antidepressant Seroxat. However, Andrew Witty, the Chief Executive for GlaxoSmithKline, the company that makes Seroxat, denies that risk of litigation was an influencing factor in their decision.7
So what is the future for mental health?
While research and development into psychiatry has significantly stalled, it has not stopped all together. New, fast-acting drugs are showing promise for use in psychiatry, such as ketamine. Despite its reputation as an illegal party drug, ketamine shows much promise as an antidepressant, alongside its current use as an anaesthetic. Whilst most antidepressants target the serotoninergic and dopaminergic systems, ketamine acts on the glutaminergic system, targeting NMDA receptors. Despite this exciting research in to ketamine as a novel new antidepressant, it is not yet understood if its effects are a direct result of glutamate transmission or due to ketamine’s opioid properties. Additionally, there is also concern that the opioid effects of ketamine may potentially cause addiction.8
The pace of current neuroscientific research is also a hopeful avenue for psychiatry. As the precise aetiology underlying mental disorders still remains a mystery, neuroscience research may give clues to disruptions underpinning mental disorders.5
Watch out big pharma – we’re not giving up on psychiatry just yet.
- Haddad, et al. 2016. Chlorpromazine, the first antipsychotic medication: history, controversy and legacy. British Association for Pschopharmacology. Available from: https://www.bap.org.uk/articles/chlorpromazine-the-first-antipsychotic/
- Lopez-Munoz, F. and Alamo, C. (2009). Monoaminergic Neurotransmission: The History of the Discovery of Antidepressants from 1950s Until Today. Current Pharmaceutical Design, 15(14), pp.1563-1586.
- Meyers, M. (2011). Happy accidents: Serendipity in Modern Medical Breakthroughs. W W Norton.
- World Health Organisation. 2001. Mental disorders affect one in four people.
- O’Hara, M. and Duncan, P. (2016). Why ‘big pharma’ stopped searching for the next Prozac. The Guardian. [online] Available at: https://www.theguardian.com/society/2016/jan/27/prozac-next-psychiatric-wonder-drug-research-medicine-mental-illness [Accessed 1 Jul. 2017].
- CTV News (2012). Big pharma pulling back from mental health drug research: studies. [online] Available at: http://www.ctvnews.ca/health/health-headlines/big-pharma-pulling-back-from-mental-health-drug-research-studies-1.1015154 [Accessed 1 Jul. 2017].
- Moseley, S. (2011). Research into brain disorders under threat as drug firms pull out. The Guardian. [online] Available at: https://www.theguardian.com/science/2011/jun/13/research-brain-disorders-under-threat [Accessed 2 Jul. 2017].
- Sanacora, G., Zarate, C., Krystal, J. and Manji, H. (2008). Targeting the glutamatergic system to develop novel, improved therapeutics for mood disorders. Nature Reviews Drug Discovery, 7(5), pp.426-437.