A clarion call for a decade of disorder

This week’s Nature has an excellent editorial calling for a greater focus on the science of mental illness and summarising the challenges facing psychology and neuroscience in tackling these complex conditions.

It’s generally a very well-informed piece, but it does make one widely repeated blunder in the last sentence of this paragraph:

Frustratingly, the effectiveness of medications has stalled. Nobody understands the links between the symptoms of schizophrenia and the crude physiological pathologies that have so far been documented: a decrease in white brain matter, for example, and altered function of the neurotransmitter dopamine. The medications, which are often aimed at the dopamine systems associated with delusions, have advanced over the decades not in their efficacy but in a reduction of their debilitating side effects.

The idea that newer antipsychotic drugs have less side-effects is a myth, albeit one that was widely promoted by drug companies in the early days of the newer ‘atypical antipsychotics’.

The early antipsychotics were notorious for causing a syndrome of Parkinson’s disease-like abnormal movements owing to their long-term effect on the dopamine system.

The popular newer generation drugs do indeed produce fewer of these problems, although the difference is much smaller than was originally thought. But in addition, they tend to cause metabolic syndrome – weight gain, diabetes, heart problems – something which wasn’t such an issue with the older drugs.

In other words, the side-effects aren’t less, they’re just different. While the old drugs were more likely to produce movement problems, the newer are more likely to make you fat and give you diabetes.

Although antipsychotics were one of the most important medical advances of the 20th century, as the Nature editorial notes, there has been no improvement in the ability of these drugs to actually treat psychosis in the last few decades.

One of the main problems is that the most effective antipsychotics seems to have the highest levels of side-effects and a huge advance would simply be the production of a drug that was of equal effectiveness but less damaging to patients’ health.

Apart from this minor error, the Nature piece is an excellent brief summary of where psychiatric research is at, and where it needs to go to better tackle these episodes of mental turmoil, and comes highly recommended.

Link to Nature piece ‘A decade for psychiatric disorders’.

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