In many ways, psychiatry is still flying blind. People experiencing mental health conditions are prescribed various drugs until one (or a combination) finally works — a painful process that can take years. As a psychiatrist and neuroscientist, I became increasingly impatient and frustrated with this ineffective way of treating patients. This guided the core question behind my research: Can biology explain how people with the same psychiatric disorder respond differently to the same treatment?
Since I first began exploring this question more than a decade ago, mental illness has become a global epidemic. Despite significant efforts, progress in psychiatric drug development has remained disappointingly slow. There have been a few notable approvals in recent years, and a renewal of interest by Big Pharma, following a retreat from psychiatric research in the mid to late 2000s. But the landscape remains predominantly marked by failures and a dry drug development pipeline. Approved drugs follow the same pattern of prescribing via guesswork, with most patients not responding to a given drug. This cycle of trial-and-error drug development producing trial-and-error treatment arises from a simple source: We have not systematized a process for learning from our failures and successes.
For example, take depression: While the rise of selective serotonin reuptake inhibitors (SSRIs) in the 1980s and 1990s seemed to provide a solution, seminal studies in the 2000s exposed fundamental limitations of our treatment options. Antidepressants are widely prescribed, but their efficacy relative to placebo is modest.