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Hans de Vries

Psychiatry - how to break out of stagnation?

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Hi.

 

How do we move past the stagnation of psychiatry? It is not moving forward very much.

In treating depression/anxiety/OCD we are stuck with SSRI/SNRI since late 1980s and they are marginally more effective than tricyclic antidepressants which were discovered in 1950s almost by accidens. Newest drugs for schizophrenia are no more effective in treating it than drugs introduced in 1950s. For many things (negative and cognitive symptoms of schizophrenia, autism etc) we have no effective methods of treatment at all. 

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I think it is not a fair characterization of the state of affairs. Especially in the area of anxiety there are quite a few advances, but they are less chemical in nature. Molecular sciences especially have helped to unravel the pathways involved in certain forms of anxiety and PTSD which have shown that there is a complex interaction between stress and immune pathways. That has a number ramifications. One is that chemical treatments of whatever sort are likely only be effective in certain subgroups of patients. This can be addressed by our improved knowledge of potential biomarkers that help us to distinguish patients with similar symptoms, but with different molecular pathologies. Second, monitoring of these pathways are a way forward to improve cognitive behavioural therapies, which have shown to be effective in many cases. Third, this knowledge has assisted in the development of chemical therapies targeting these pathways. For example it was found that similar pathways are involved in both, post partum depression and PTSD. which suggest that medication in trial for the former, could be adapted to the later.

As specifically for the question, a big challenge is of course understanding the mechanisms of disease and not rely entirely on phenotypic diagnostics to categorize them. Psychiatry has for a while now getting input from other research areas, often driven by new technological advances. The areas of neuropsychology and molecular psychology (at least from my experience) have seen massive growth. However, it will take time for these findings and research directions to make an impact.

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